Abstract
Introduction: Empyema thoracis (ET) is an accumulation of pus in the pleural space. Considering the advantages of Video Assisted Thoracoscopic surgery (VATS), including reduced length of hospitalisation, lower postoperative morbidity and mortality, VATS is the treatment of choice for cases of stage 3 empyema. The objective of this study was to study the age-sex profile, clinical presentation, etiologic agents, management and the overall treatment outcome of empyema thoracis after early VATS in children.
 Methods: This was a retrospective observational study, conducted in the Department of Paediatrics, Rangadore Memorial Hospital, Bangalore, from November 2018 to March 2020. All children in the age group of 0 to 18 years diagnosed to have pyogenic empyema and presenting in stage 1 and 2 during the study period were included in the study. In the present study, 15 children were found to be having empyema (stage 1 and 2).
 Results: Majority of patients (66.6%) were seen in the age group of one to five years. Fever (100%), breathlessness (66.66%), and cough (80%) were the commonest presenting features. Bacteriological isolation was possible only in three cases (20%). Patients were treated with antibiotics and primary VATS in majority of cases (55.33%). Average duration of hospital stay in VATS group was 12.11 days.
 Conclusions: Empyema thoracis mainly affects younger children. Common presenting features are fever, difficulty in breathing and cough. Appropriate antibiotics and early VATS may be acceptable modality for management of pyogenic empyema thoracis in children.
Highlights
IntroductionConsidering the advantages of Video Assisted Thoracoscopic Surgery (VATS), including reduced length of hospitalisation, lower postoperative morbidity and mortality, VATS is the treatment of choice for cases of stage 3 empyema
Empyema thoracis (ET) is an accumulation of pus in the pleural space
There are a number of treatment modalities available for treatment of ET ranging from antibiotic treatment, intra-pleural fibrinolytic therapy (IFT) with radiologically placed pigtail catheters or a tube thoracostomy
Summary
Considering the advantages of Video Assisted Thoracoscopic Surgery (VATS), including reduced length of hospitalisation, lower postoperative morbidity and mortality, VATS is the treatment of choice for cases of stage 3 empyema. Empyema was described by Hippocrates in 600 B.C. as collection of pus in the pleural cavity and advocated open drainage as its treatment.[1] It is a common condition in childhood having significant morbidity and mortality.[2,3] The clinical manifestations of empyema are high grade fever with chills and rigors, cough, breathlessness, chest pain. There are a number of treatment modalities available for treatment of ET ranging from antibiotic treatment, intra-pleural fibrinolytic therapy (IFT) with radiologically placed pigtail catheters or a tube thoracostomy. These modalities are useful for patients in early stages of empyema. Surgical intervention can be performed using minimally invasive techniques including video-assisted thoracic surgery (VATS) or an open thoracotomy.[5]
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