Empyema Thoracis in Children: A 5-Year Experience in a Tertiary Care Institute

Beyond diagnosis: a narrative review of the evolving therapeutic role of medical thoracoscopy in the management of pleural diseases

Background and Objective

Medical thoracoscopy (MT) is an endoscopic technique performed by interventional pulmonologists with a favorable safety profile and few contraindications, providing diagnostic and therapeutic intervention in a single sitting. This narrative review was designed to summarize the therapeutic role of MT based on the latest results from the available literature.

Methods

Pertinent literature published in English, relative to human studies, between 2010-2022 was searched in Medline/PubMed and Cochrane databases. Publications regarded as relevant were considered for inclusion in this review; additional references were added based on the authors' knowledge and judgment. The review considered population studies, meta-analyses, case series, and case reports.

Key Content and Findings

MT has mostly been described and is currently used globally in the diagnostic approach to exudative pleural effusion of undetermined origin. Carefully evaluating the literature, it is clear that there is initial evidence to support the use of MT in the therapeutic approach of malignant pleural effusion, pneumothorax, empyema, and less frequently hemothorax and foreign body retrieval.

Conclusions

MT is an effective procedure for treating the clinical entities presented in this document; it must be carried out in selected patients, managed in centers with high procedural expertise. Further evidence is needed to assess the optimal indications and appropriate patients' profiles for therapeutic MT. The endpoints of length of hospital stay, surgical referral, complications and mortality will have to be considered in future studies to validate it as a therapeutic intervention to be applied globally.

Haemophilus Influenzae Empyema in a Two-Month-Old Infant

Empyema can rarely complicate pneumonia in neonates; it has a high morbidity and mortality in this population. We report a two-month-old healthy term male neonate who presented with fever, mild shortness of breath and reduced feeding to a tertiary care hospital in Muscat, Oman, in 2021. Investigations revealed the presence of Haemophilus influenzae empyema. He was managed with video-assisted thoracoscopic surgery and prolonged course of antibiotics. A follow-up at the end of the antibiotic course revealed complete symptom resolution with a repeated chest x-ray showing significant right chest opacity improvement. A baseline immune work-up was done and was reported to be within normal ranges.

A rare case of multiloculated thoracic empyema in a neonate

Thoracic empyema, defined as the accumulation of pus in the pleural space, is a rare cause of respiratory distress in neonates. Its occurrence in neonate patients has been only described in few literatures, as opposed to cases in older children. Even though the diagnosis of thoracic empyema is confirmed by histopathological examination of pleural fluid, radiographic examinations have important roles in helping clinicians narrowing down the differential diagnoses. This case report describes a neonatal patient who exhibited symptoms of respiratory distress and imaging modalities revealed multiloculated thoracic empyema.