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Empyema – chest drain — RACP Paediatrics MCQ

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ModerateRespiratoryEmpyema – chest drainRACP Paediatrics

The ultrasound shows a large loculated effusion with multiple septations (complex parapneumonic effusion). The child has ongoing fever and respiratory compromise. What is the most appropriate management?

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Correct answer: A — Chest drain with underwater seal

A large symptomatic complex parapneumonic effusion/empyema requires chest drain insertion for drainage. Intrapleural fibrinolytic therapy (urokinase or alteplase) can be instilled via the drain to break down septations and improve drainage. If fibrinolytics fail, VATS may be considered.

Reference: RCH Melbourne – 2023 – Pleural Effusion CPG; RACP Paediatric Curriculum – Respiratory