Management of Parapneumonic Effusions

Despite the advent of potent antibiotics, bacterial pneumonia still results in morbidity and mortality in the American population. It is estimated that the annual incidence of bacterial pneumonia exceeds 1.2 million, with a mortality that exceeds 70,000 each year. Bacterial pneumonias have an associated pleural effusion (parapneumonic effusion) approximately 40% of the time. Most of these parapneumonic effusions resolve without operative intervention, but about 10% of these parapneumonic effusions require a tube thoracostomy for their resolution, and these are designated as complicated parapneumonic effusions. The morbidity and mortality of those patients with parapneumonic effusions, particularly when the effusions are complicated, are greater than those of patients without pleural effusions. The purpose of this article is to review the natural history and rational management of parapneumonic effusions in patients, with the goal of minimizing morbidity and mortality.

NATURAL HISTORY OF PARAPNEUMONIC EFFUSIONS  The evolution of a parapneumonic effusion can be divided