Abstract
Introduction: Empyema thoracis is an uncommon complication of childhood pneumonias but a common problem faced by a thoracic surgeon. Its management is still controversial, with a range of treatment options available and evolving gradually towards adoption of video-assisted thoracoscopic surgery (VATS) as the most commonly practiced one.
 Aim: The aim of this study was to review our experience in pediatric empyema thoracis.
 Methods: It was a retrospective review of the prospectively recorded data, spanning a period of 18 months in the Department of Cardio-Thoracic and Vascular Surgery in Manmohan Cardio-Thoracic Vascular and Transplant Center.
 Results: A total of 40 consecutive patients, 29 males and 11 females, aged 15 years or less were operated upon for a diagnosis of empyema thoracis made based on clinical, radiological and laboratory evidence. All of them were referred patients, mostly from pediatricians. VATS was undertaken in 36 of them, the remaining four treated by open approach. Deloculation sufficed in majority (26/40; 65%) of the patients which mostly (23/26; 90%) had either acute or subacute presentation. Decortication was required in 35% (14/40) of the patients. However, all of the patients but one had a successful outcome in terms of lung expansion, sterilization of the pleural cavity and absence of recurrence. There was no operative mortality.
 Conclusion: Surgical management of pediatric thoracic empyema is feasible and safe with favorable outcome. VATS is gradually becoming the more favored modality of operative management.
Highlights
It is an uncommon complication of childhood pneumonias but a common problem faced by a thoracic surgeon
One infant had presented as empyema necessitans which had been incised in an attempt to drain an assumed abscess of the chest wall
Empyema thoracis is a common problem in children
Summary
Empyema thoracis is an uncommon complication of childhood pneumonias but a common problem faced by a thoracic surgeon. Empyema thoracis is an accumulation of infected fluid in the pleural space. It is an uncommon complication of childhood pneumonias but a common problem faced by a thoracic surgeon. It still is associated with high morbidity worldwide.[1] Empyema develops in three stages; exudative, fibrinopurulent and organized stage.[2, 3] The incidence of childhood empyema shows an increasing trend over the last two decades. The rise in the incidence of empyema is partly because of rise in the incidence of multi-drug resistant pathogenic microorganisms.[4,5] Delay in early diagnosis, failure to institute appropriate antimicrobial therapy, multidrug resistant organisms, malnutrition, comorbidities, poor health seeking behavior and high treatment cost contribute to increased morbidity in children.
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