Nelson Textbook of Pediatrics 22nd Edition | Pleurisy: inflammation of pleura → pleuritic chest pain. Pleural effusion: transudate (hydrothorax, CHF, liver disease) vs exudate (pneumonia, malignancy, TB, collagen vascular disease). Empyema: pus in pleural space, complication of bacterial pneumonia (S. pneumoniae, S. aureus, GAS). Diagnosis: CXR, ultrasound, CT. Light's criteria for exudate. Management: treat underlying cause, thoracentesis, chest tube drainage, fibrinolytics (tPA/DNase), VATS for empyema.
🌐 paeds.online — Pakistan's Pediatric Platform| Type | Criteria | Management |
|---|---|---|
| Transudate | Protein <3.0 g/dL, LDH <200, pleural/serum protein <0.5, LDH ratio <0.6 | Treat underlying cause (CHF, cirrhosis, nephrotic syndrome), no drainage needed |
| Exudate | Protein >3.0, LDH >200, meets Light's criteria | Treat underlying cause, thoracentesis for diagnosis, drain if large or infected |
| Empyema (complicated parapneumonic) | Purulent fluid, pH <7.2, glucose <60, LDH >1000, positive Gram stain/culture | Chest tube drainage + fibrinolytics (tPA/DNase) or VATS, IV antibiotics |