What is Pleural Effusion in Children?

Pleural effusion is an abnormal increase in fluid between the two leaves of the membrane that surrounds the lung and is called pleura. Pleural effusion can occur as a result of involvement in a wide range of systemic diseases as well as different lung diseases. Pleural effusion is the most common manifestation when lung or extrapulmonary diseases affect the pleura.

 

Why does pleural effusion occur in children?

Normally, the fluid between the pleural leaves is approx. (0.1 ml / kg) and protein-poor (1 g / dl). This fluid is continuously filtered through the systemic microcirculation in the parietal pleura (the outer leaf of the pleura) and reaches the pleural cavity and is absorbed and removed by the lymphatic channels in the parietal pleura. The parietal lymphatics are involved in the control of the amount of fluid and protein as well as the negative pressure of the pleural cavity. Lymphatic ducts can increase their flow rate 20-fold in response to increased fluid volume. When fluid filtration exceeds the maximum lymphatic drainage capacity, fluid accumulates in the pleura, resulting in pleural effusion.

Are There Types of Pleural Effusion in Children?

First of all, pleural effusions can be classified into two main categories:

1- Uncomplicated pleural effusion: It contains fluid that does not carry a serious infection. If the amount of fluid is large enough, an uncomplicated pleural effusion may cause symptoms. If this fluid is not excessive and does not affect the lung and other anatomical structures, it may not cause clinical symptoms.

2- Complicated pleural effusion: Contains fluid that is infected or caused by infections. If left untreated, it may harden and form a compressive ring around the lung. This process, called the organization phase, can permanently impair breathing.

Pleural effusion can also be termed transudative and exudative.

Transudative: The pleural effusion fluid is similar in character to the fluid normally present in the pleural space. The fluid is clear or light yellowish in color. They rarely require fluid drainage unless they are very large. Congestive heart failure is an example of a condition that can cause transudative pleural effusion.

Exudative: The pleural effusion fluid contains a lot of protein, blood or signs of inflammation or infection. Depending on the severity of the inflammation and the amount of fluid, it may require drainage. The leading cause of exudative pleural effusion is lung infections, i.e. pneumonia. The type of pleural effusion can only be determined by a sample taken from the pleural effusion fluid.

What Causes Pleural Effusion in Children?

Many diseases can cause inflammation of the pleura. These diseases include viral infections, lung cancer, trauma, tuberculosis, systemic lupus erythematosus, congestive heart failure and pulmonary embolism. The most common causes of pleural effusion in children are pneumonia and tuberculosis.

What are the Questions to be Decided Clinically in the Presence of Pleural Effusion?

• Should thoracentesis be performed?
• Is pleural fluid transudate or exudate?
• What is the etiology of pleural fluid

What are the Clinical Symptoms of Pleural Effusion in Children?

Pleural effusion itself usually does not cause clinical symptoms when it is small in size. When it is of medium or large size, it causes clinical symptoms. However, the patient will have symptoms of the disease causing the pleural effusion. The most common infections that cause pleural effusion in children and the most common clinical symptoms of effusion are;

• Shortness of breath
• Chest pain. Especially when breathing deeply (pleurisy/ pleurisy, pleuritic pain)
• Fever
• Cough
• Feeding Feeding
• Fatigue
• Deterioration of general condition, especially in delayed cases.

How is Pleural Effusion Diagnosed in Children?

The diagnosis is made by history and physical examination, and confirmed by imaging, blood and pleural fluid examination.

In the history; there are the clinical complaints mentioned above, there is a history of recent lung infection, and the patient should be questioned about tuberculosis and it should be learned whether there is tuberculosis treatment in the environment. On the other hand, systemic diseases such as heart, liver and kidney disease should be questioned.

In the physical examination, systemic maueyene should be performed and attention should be paid for the presence of chronic diseases. Auscultation (listening with a stethoscope) lung sounds are not obtained on the affected side and there are listening findings of previous lung infection. Percussion (chest tapping) and other maneuvers may be used.

Imaging methods to evaluate pleural effusion are as follows; Chest X-ray (should be done standing up), Ultrasonography and if necessary, Chest Computed Tomography.

• Chest X-ray: The first step in defining the condition is usually a plain chest x-ray. Pleural effusion appears as a white area at the base of the lung on X-rays. If there is a possibility of pleural effusion, the person may be placed on their side and an additional X-ray taken. These X-rays, called decubitus X-rays, can show fluid moving freely in the chest.

  

  

  

  

  

   

• Ultrasound: A probe placed on the skin reflects high-energy sound waves from intra-chest structures, creating an image on a video screen. Ultrasound can determine if a free-flowing pleural effusion is present and guide fluid drainage.

  

  

   

• Computed tomography (CT scan): A CT scanner takes multiple X-rays quickly and a computer creates images of the inside of the chest. It gives more detailed information about pleural effusion and other lung abnormalities than a chest X-ray.

  

  

  

To determine the characteristic nature and severity of a pleural effusion identified by imaging tests, a sample of fluid is usually taken. In this procedure, called thoracentesis, the doctor inserts a needle and catheter into the pleural space between the ribs and draws out some fluid for testing. Large amounts of fluid may also be drained during this procedure to relieve symptoms such as shortness of breath.

Blood and other tests are also performed depending on the suspected cause.

How is pleural effusion treated in children?

The main purpose of pleural effusion treatment is to treat the cause of fluid accumulation. For example, antibiotics are used for lung infection (pneumonia) and diuretics are used for congestive heart failure.

In the treatment of effusion, treatment method is applied by considering some criteria. These are; The character of the fluid (Exudate? Transudate?), the amount of fluid (whether there is a clinical finding, especially respiratory distress), the stage of organization of the exudate, the leukulation pattern of the fluid and the presence of additional pathology are taken into consideration.

Large, infectious or inflammatory pleural effusions usually require drainage to prevent complications and relieve symptoms. Procedures used to treat pleural effusions include

Thoracentesis: Fluid is drained through a thick needle inserted through the chest wall. This also allows us to learn the properties of the fluid. It can drain large amounts of fluid and effectively treat many pleural effusions. In addition, the patient relaxes and improves clinically.

Tube thoracostomy (chest tube): A plastic tube is inserted into the pleural cavity through a small incision. The chest tube is connected to vacuum equipment and is usually kept in place for several days.

 

Pleurodesis (pleural fibrosis): An irritant (such as talc or doxycycline) is injected into the pleural cavity through a chest tube. The healing after the injury caused by the substance binds the pleural cavity and the chest wall tightly together. Pleurodesis can prevent recurrence of pleural effusion in many cases.

Pleural decortication (pleurectomy): Surgeons can remove dangerous inflammation and unhealthy tissue in the pleural cavity. This procedure, called decortication, can be performed through small incisions (thoracoscopy) or through a large opening (thoracotomy).

 

 

 

 

What are the complications of pleural effusion in children if left untreated?

Pleural effusion, especially exudate, can cause serious complications if left untreated. The main ones are

• Bronchopleural fistula (pyopneumothorax)
• Empyema necessitatis (spontaneous drainage of empyema from the chest wall)
• Inflammation of the ribs and vertebrae (osteomyelitis)
• Pericarditis (inflammation of the pericardium)
• Esophagopleural fistula
• Metastatic abscess formations (12% of brain abscesses are etiological factors)
• Fibrothorax
• Chronic empyema

*** The information provided here, the content of the website is intended to inform the visitor, especially families. No information should be considered as advice by visitors and should not lead to any decision or action. Families should definitely have their patient examined by a pediatric surgery specialist, consult with him/her and make a decision by consulting his/her knowledge one-on-one.