Dignosis and Management of Parapneumonic Effusions in 97 Cases_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

HE Yufei ,  ZHAO Ziwen

Department of Respiratory Medicine, First Municipal People ’s Hospital, Guangzhou Medical College.Guangzhou, Guangdong, 510180, ChinaCorresponding Author: ZHAO Zi-wen, E-mail: zhaozw@ yeah. net;

Corresponding author：

ZHAO Ziwen, Email: zhaozw@yeah.net

Keywords：

Parapneumonic effusions; Diagnosis; Treatment

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To elucidate the clinical features and treatment of parapneumonic effusions ( PPE) . Methods Ninety-seven patients were analyzed retrospectively in Guangzhou First Municipal People’s Hospital fromJanuary 2004 to July 2008. The data of 54 patients with complicated parapneumonic effusion ( CPPE) and 9 cases with empyema were compared with 49 patients with tuberculosis pleural effusions. Results Of 97 cases, 34 patients with uncomplicated parapneumonic effusion ( UPPE) were treated with antibiotics only, whose hospitalization time was ( 14. 8 ±7. 6) days, and 27 cases were cured ( 79. 4% ) . Of 54 CPPE patients, 42 were treated with antibiotics and pleural space drainage with central venous catheter, whose hospitalization time was ( 21. 7 ±13. 0) days, and 32 were cured ( 76. 2% ) . Another
12 CPPE patients were treated with interapleural urokinase and drainage from the chest tube, whose hospitalization time was ( 22. 5 ±9. 3) days, and 8 were cured ( 66. 7% ) . Nine cases with empyema were rinsed the pleural with metronidazole solution, whose hospitalization time was ( 25. 7 ±17. 4) days, and 8 were cured( 89. 0% ) . Compared with the tuberculous pleurisy patients, most CPPE and empyema occurred in middle and old aged patients with an average age of ( 63. 3 ±19. 3) years. Polykaryocyte and lactate dehydrogenase increased significantly. Adenosine deaminase ( ADA) was lt; 45 U/L in most UPPE and empyema patients, but was gt; 45 U/L in 7 cases ( 11% ) . Conclusions UPPE is simple and preferably treated with antibiotics alone. While CPPE and empyema should be drainaged as early as possible, and the low-dose urokinase may be helpful. The level of ADA can not absolutely distinguish parapneumonic effusion from tuberculous pleural effusion.

Citation： HE Yufei,ZHAO Ziwen. Dignosis and Management of Parapneumonic Effusions in 97 Cases. Chinese Journal of Respiratory and Critical Care Medicine, 2009, 09(6): 547-550. doi: Copy

1.	Light RW, Giard WM, Jenkinson SG, et al. Parapneumonic effusions. Am J Med, 1980, 69: 507-512.
2.	Chapman SJ, Davies RJ. Recent advances in parapneumonic effusions and empyema, Curr Opin Pulm Med, 2004, 10: 299-304.
3.	Light RW. A new classification of parapneumonic effusions and empyema. Chest, 1995, 108: 299-301.
4.	Light RW, Rodriguez RM. Management of complicated parapneumonic effusions. Clin Chest Med, 1998, 19: 373-382.
5.	Light RW. Parapneumonic effusions and empyema. Proc AmThorac Soc, 2006, 3: 75-80.
6.	Sahn SA. Diagnosis and management of parapneumonic effusions and empyema. Clin Infect Dis, 2007, 45 : 1480 -1486 .
7.	孙耕耘. 肺炎旁胸腔积液和脓胸的临床治疗. 世界临床药物,2005, 26: 46-48, 54.
8.	朱元珏, 陈文彬, 主编. 呼吸病学. 北京: 人民卫生出版社, 2004, 1285.
9.	Bouros D, Schiza S, Tzankis N, et al. Intrapleural urokinase in the treatment of complicated parapneumonic pleural effusions and empyema. Eur Respir J, 1996, 9: 1656-1659.
10.	Moulton JS, Moore PT, Mencini RA. Treament of loculated pleural effusions with transcatheter intracavitary urokinase. AJR, 1989, 153 :941-945.
11.	Bouros D, Schiza S, Patsourakis G. et al. Intrapleural streptokinase versus urokinase in the treatment of complicated parapneumonic effusions: a prospective, double-blind study. Am J Respir Crit Care Med, 1997, 155: 291-295.
12.	Diacon AH, Theron J, Schuurmans MU, et al. Intrapleural streptokinase for empyema and complicated parapneumonic effusions. Am J Respir Crit Care Med, 2004, 170: 49-53.
13.	Tasci S, Burghard A, Sch　fer H, et al. Long-term outcome of intrapleural fibrinolytic therapy via small-bore catheter drainage in the management of complicated parapneumonic effusion and empyema-a case series. Med Klin ( Munich) , 2005, 100: 181-185.
14.	Ozol D, Oktem S, Erdinc E. Complicated parapneumonic effusion and empyema thoracis: microbiologic and therapeutic aspects.Respir Med, 2006, 100: 286-291.
15.	Tokuda Y, Matsushima D, Stein GH, et al. Intrapleural fibrinolytic agents for empyema and complicated parapneumonic effusions: a meta-analysis. Chest, 2006, 129: 783-790.
16.	Froudarakis ME, Kouliatsis G, Steiropoules P, et al. Recombinant tissue plasminogen activator in the treatment of pleural infections in adults. Respir Med, 2008, 102: 1694-1700.
17.	Moulton JS, Benkert RE, Weisiger KH, et al. Treatment of complicated pleural fluid collections with image-guided drainage and intracavitary urokinase. Chest, 1995, 108: 1252-1259.
18.	Bouros D, Schiza S, Tzanakis N, et al. Intrapleural urokinase versus normal saline in the treatment of complicated parapneumonic effusions and empyema. A randomized, double-blind study. Am J Respir Crit Care Med, 1999, 159: 37-42.
19.	Misthos P, Sepsas E, Konstantinou M, et al. Early use of intrapleural fibrinolytics in the management of postpneumonic empyema. A prospective study. Eur J Cardiothorac Surg, 2005, 28: 599-603.
20.	Schiza SE, Antonious KM, Economidou FN, et al. Pharmacotherapy in complicated parapneumonic pleural effusions and thoracic empyema. Pulm Pharmacol Ther, 2005, 18: 381-389.

1. Light RW, Giard WM, Jenkinson SG, et al. Parapneumonic effusions. Am J Med, 1980, 69: 507-512.
2. Chapman SJ, Davies RJ. Recent advances in parapneumonic effusions and empyema, Curr Opin Pulm Med, 2004, 10: 299-304.
3. Light RW. A new classification of parapneumonic effusions and empyema. Chest, 1995, 108: 299-301.
4. Light RW, Rodriguez RM. Management of complicated parapneumonic effusions. Clin Chest Med, 1998, 19: 373-382.
5. Light RW. Parapneumonic effusions and empyema. Proc AmThorac Soc, 2006, 3: 75-80.
6. Sahn SA. Diagnosis and management of parapneumonic effusions and empyema. Clin Infect Dis, 2007, 45 : 1480 -1486 .
7. 孙耕耘. 肺炎旁胸腔积液和脓胸的临床治疗. 世界临床药物,2005, 26: 46-48, 54.
8. 朱元珏, 陈文彬, 主编. 呼吸病学. 北京: 人民卫生出版社, 2004, 1285.
9. Bouros D, Schiza S, Tzankis N, et al. Intrapleural urokinase in the treatment of complicated parapneumonic pleural effusions and empyema. Eur Respir J, 1996, 9: 1656-1659.
10. Moulton JS, Moore PT, Mencini RA. Treament of loculated pleural effusions with transcatheter intracavitary urokinase. AJR, 1989, 153 :941-945.
11. Bouros D, Schiza S, Patsourakis G. et al. Intrapleural streptokinase versus urokinase in the treatment of complicated parapneumonic effusions: a prospective, double-blind study. Am J Respir Crit Care Med, 1997, 155: 291-295.
12. Diacon AH, Theron J, Schuurmans MU, et al. Intrapleural streptokinase for empyema and complicated parapneumonic effusions. Am J Respir Crit Care Med, 2004, 170: 49-53.
13. Tasci S, Burghard A, Sch　fer H, et al. Long-term outcome of intrapleural fibrinolytic therapy via small-bore catheter drainage in the management of complicated parapneumonic effusion and empyema-a case series. Med Klin ( Munich) , 2005, 100: 181-185.
14. Ozol D, Oktem S, Erdinc E. Complicated parapneumonic effusion and empyema thoracis: microbiologic and therapeutic aspects.Respir Med, 2006, 100: 286-291.
15. Tokuda Y, Matsushima D, Stein GH, et al. Intrapleural fibrinolytic agents for empyema and complicated parapneumonic effusions: a meta-analysis. Chest, 2006, 129: 783-790.
16. Froudarakis ME, Kouliatsis G, Steiropoules P, et al. Recombinant tissue plasminogen activator in the treatment of pleural infections in adults. Respir Med, 2008, 102: 1694-1700.
17. Moulton JS, Benkert RE, Weisiger KH, et al. Treatment of complicated pleural fluid collections with image-guided drainage and intracavitary urokinase. Chest, 1995, 108: 1252-1259.
18. Bouros D, Schiza S, Tzanakis N, et al. Intrapleural urokinase versus normal saline in the treatment of complicated parapneumonic effusions and empyema. A randomized, double-blind study. Am J Respir Crit Care Med, 1999, 159: 37-42.
19. Misthos P, Sepsas E, Konstantinou M, et al. Early use of intrapleural fibrinolytics in the management of postpneumonic empyema. A prospective study. Eur J Cardiothorac Surg, 2005, 28: 599-603.
20. Schiza SE, Antonious KM, Economidou FN, et al. Pharmacotherapy in complicated parapneumonic pleural effusions and thoracic empyema. Pulm Pharmacol Ther, 2005, 18: 381-389.

Next Article
Strategies to Develope an Essential Healthcare Package: Definition, Package and Criteria

Chinese Journal of Respiratory and Critical Care Medicine

Dignosis and Management of Parapneumonic Effusions in 97 Cases

Abstract Full text Figures/Tables Video References Cited by

Next Article

Format

Content