Pleural effusion in children

Pleural effusion in children may be dry (fibrinous) and pericardial and in most cases is a complication of inflammatory process in the lung. Serous pleurisy are tuberculosis, rheumatism. In children is more common purulent pleurisy, which is particularly relevant for pneumonia staphylococcic etiology, as well as at the break, lung abscess in the pleural cavity (pyopneumothorax). Pyothorax can be plasement with small amounts of exudate, evenly enveloping light, or total with a large number of pus.
An accumulation of pus in the pleural cavity, especially in combination with air, leads to a sharp deterioration of the General condition of the child: increasing shortness of breath, cyanosis, temperature. Compression of light and offset bodies mediastinum causes severe disorders of respiration and heart activity. On the affected side percutere (depending on the prevalence of air or liquid) is defined by the sound box or abrupt shortening of the sound. Auscultatory breath weakened or not heard. When Troubleshooting crucial results of x-ray and puncture of the pleural cavity.
Treatment. Along with the complex therapy of the main disease (pneumonia) when pleurisy crucial surgical methods of treatment: re puncture of the pleural cavity in the separated forms and Pedavena pietracci, and an introduction to the pleural cavity rubber drainage followed by active aspiration when pyopneumothorax and total pyothorax (see Suction drainage). Recently in the specialized thoracic departments when staphylococcal defeat pleura, especially in newborns and infants, are increasingly resorting to early radical operations.

Pleurisy in children is most often occur as a complication of pneumonia. Their etiology can be contagious or infectious-allergic. Among the causative agents of P. in children of early age often staphylococcal, rarely pneumo - and streptococcal infection in children of preschool and school age - tuberculosis, rheumatic or viral infection. In occurrence of P. in older children is of great importance allergic condition of the body.
The severity of purulent P. depends not only on the nature of the pathogen, its virulence, but also on the age of the child, its reactivity and previous diseases. In children of the first year of life P. often occurs simultaneously with pneumonia after year grows the number postpneumonic P.
The nature of the exudate in P. may be different depending on the type of pathogen and stage of the process. In children of the first year of life serous or fibrinous effusion often complicated by suppuration. Purulent pleurisy more often one-sided; serous on can be bilateral.
Clinic of pleurisy is determined by the character of the pathogen and the original state of the organism and the disease stage. Major symptoms are a violation of the General conditions, temperature rise, the emergence or increase of breathlessness. Symptoms P. may be very diverse, and recognition of the disease is sometimes great difficulties. Clinic purulent P. characterized the overall poor condition, severe shortness of breath, large temperature or constant high temperature; only in a weakened children of the first year of the temperature reaction may be low.
The younger the child is, the less pronounced physical data, characteristic P. Dullness of percussion sound not so much even with massive effusion; it is not always possible to identify the line Ellis - Damaso - Sokolova and the triangle of Grocka - St Petersburg. Auscultation of infants with small effusion pleural cavity may listens bronchial breath instead weakened. Noise pleural friction as in the initial stage of Peterhof and opposite the inflammatory process and organization of the effusion may listens only briefly. Physical data often change during the P. in connection with the accession of pneumothorax (see), which most often occurs when staphylococcal pleuropneumonia.
Due to a loose connection parietal pleura with breast fascia, weak development of fiber mediastinum and weak commit pleura in children of early age with pleurisy easier it is offset from the heart, large vessels and mediastinal in a healthy way, what causes the dysfunction of the respiratory and circulatory, threatening the life of the child. Thus on the patient side of the border heart percutere not defined, as they merge with stupidity, defined over the affected easy.
From the side of cardiovascular system are identified significant muted tones and shifting borders of the heart. In connection with the General intoxication and disturbances of hemodynamics in the lungs (right ventricular failure), increased liver, and often spleen. In the study of blood marked leukocytosis, especially when staphylococcal P., neutrophilia, with a shift to the left, accelerated ROHE.
Diagnosis of pleurisy helps the x-ray examination of the chest. In the initial stage small effusion pleural plaques difficult is defined as physical methods and radiographically.
With the release of the pleural cavity from pus at the high content of fibrin in the exudate can be formed of fusion of the pleura and adhesions can develop multi-pneumatic or pyopneumothorax; the resolution of air and pus is slow, and recovery is delayed.
The treatment of purulent pleurisy should be complex - to the appointment of a massive antibiotic therapy and destruction of cancer of the pleural cavity by aspiration or surgical intervention (thoracocentesis, thoracotomy, according to testimony drainage of the pleural cavity - see above Purulent pleurisy). Applies also stimulating therapy - blood transfusion, gamma globulin, vitamins, P. staphylococcic etiology - toxoid (see Staph infection). When antibiotics are taken into account views of the pathogen isolated from pleural exudate, and its sensitivity to a particular antibiotic. When staphylococcal P. penicillin treatment does not give sufficient effect due to the capacity of a microbe to allocate penitsillinazou, so you should assign a semisynthetic penicillins (oxacillin, methicillin) or other antibiotics (erythromycin, oleandomitin, oletetrin, neomycin). Antibiotics are used not only inside or intramuscularly, but be sure vnutriplevralno with a puncture, and in severe forms of the disease and intravenously.
Serous pleurisy, usually observed in children over 2-3 years, are often infectious-allergic Genesis. They can develop tuberculosis, rheumatism and other collagen diseases, as one of the manifestations of polyserositis. With modern methods of treatment of tuberculosis and rheumatism these types of P. in this time there are much rarer. The diagnosis is usually possible to put and without trial puncture. In the treatment of P. the main point is the struggle with the main disease. Antisense and antibacterial agents.