Abstract
Pleural diseases, their management, and outcomes in pediatric setting differ from those of adults. Treatment options vary with the etiology of the pleural process. This article addresses new treatments for congenital hydrothorax and chylothorax, parapneumonic effusions, and spontaneous pneumothoraces in children. Invasive fetal surgical methods to drain pleural fluid in utero improve survival and reduce the chance of postnatal pulmonary hypoplasia. Video-assisted thoracoscopic surgery and intrapleural instillation of fibrinolytic agents produce similar outcomes for children with empyema and/or parapneumonic effusions. Spontaneous primary pneumothoraces in older children and young adults are increasingly treated with drainage methods that prevent or reduce hospitalizations. Newer treatments such as intrapleural combined tissue plasminogen activator and DNAase for empyema and intrapleural catheters attached to Heimlich valves for treatment of spontaneous pneumothoraces have been studied in adults but not yet in children and provide promise for better outcomes in the future.
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