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Empyema – VATS — RACP Paediatrics MCQ

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HardRespiratoryEmpyema – VATSRACP Paediatrics

A child with empyema has had a chest drain inserted and has received 3 days of intrapleural urokinase. However, the effusion remains loculated with ongoing fever and the drain output has diminished. What is the most appropriate next step?

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Correct answer: A — VATS (video-assisted thoracoscopic surgery)

VATS (video-assisted thoracoscopic surgery) is indicated when chest drain with intrapleural fibrinolytics fails to adequately drain a complicated parapneumonic effusion/empyema. VATS allows direct visualisation, breakdown of loculations, and debridement under direct vision. It has comparable outcomes to prolonged fibrinolytic therapy with potentially shorter hospital stays.

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