How do parapneumonic effusions and empyema occur in bacterial pneumonia?

Updated: Sep 30, 2020
  • Author: Justina Gamache, MD; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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Answer

Parapneumonic effusions are common complications of bacterial pneumonia. These pleural effusions occur adjacent to a bacterial pneumonia, resulting from migration of excess interstitial lung fluid across the visceral pleura. Small-volume parapneumonic effusions typically resolve with treatment of the bacterial pneumonia and thus do not require drainage. However, pleural effusions greater than 10mm on lateral decubitus radiographic view should undergo thoracentesis and pleural fluid analysis, Gram stain, and culture to further guide antibiotic selection. Parapneumonic effusions with radiographic evidence of loculated or thickened pleura suggestive of empyema, or pleural fluid pH less than 7.2 or a glucose value less than 60, typically require thoracostomy tube drainage and possible thorascopic debridement via thoracic surgery. Empiric antibiotics for bacterial pneumonias complicated by empyema should include anaerobic coverage, as anaerobic bacteria are often cultured from empyemas. [51]

Go to Parapneumonic Pleural Effusions and Empyema Thoracis  for complete information on this topic.


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