Pediatric Pleural Empyema

Etiology: Infected fluid collection in pleural space
Imaging CT:
— Nonspherical in shape
— Displaces lung
— May or may not be loculated
— Split pleura sign (sign of fluid in pleural space)
— Obtuse angles to chest wall
— Thickened pleura
— Eenhancing rim sign (sign of pleural inflammation due to empyema)
Imaging US:
— More complex appearing on US than on CT
— Loculated pleural fluid with multiple thick septations suggests but does not diagnose empyema
DDX: Pleural effusion, lung abscess
Complications:
Treatment: Thoracoscopy and chest tube
Clinical:

Radiology Cases of Pleural Empyema

CXR and CT of pleural empyema — CXR PA and lateral shows complete opacification of the left hemithorax causing tracheal and mediastinal shift to the right, which is seen on the axial CT with contrast of the chest to be due to a large pleural fluid collection with an enhancing pleura causing near complete left lung atelectasis.

CXR and CT of subpulmonic pleural effusion and empyema — CXR AP (above) shows a right lower lobe infiltrate and elevation of the right hemidiaphragm and lateralization of its apex. Coronal 2D reconstruction from CT with contrast of the chest (below) shows a loculated fluid collection between the inferior border of the right lung and the right hemidiaphragm.

CXR and CT of pediatric pleural empyema — CXR (above left) shows near complete opacification of the right hemithorax with no evidence of mediastinal shift. Coronal (above right) and axial (below) CT with contrast of the chest shows a large right pleural fluid collection that has multiple loculations within it which is causing complete collapse of the right lung.

CXR and CT of pleural empyema — CXR AP (above) shows consolidation in the right upper lobe and a large right pleural effusion. Axial CT with contrast of the chest (below) shows a large right pleural effusion with an enhancing rim causing atelectasis of the adjacent lung.

CXR and CT of bronchopleural fistula — CXR AP (above) shows diffuse bilateral airspace disease and a right sided pneumothorax that is almost completely drained by a right chest tube. Axial CT with contrast of the chest (below left) shows air and fluid and a chest tube in the right pleural space and an enhancing rim sign of the pleura. There is also a bronchopleural fistula from the superior segment of the right lower lobe to the necrotic lung and pleural space (below right).