Published online November 4, 2008
PEDIATRICS Vol. 122 No. 6 December 2008, pp. e1231-e1235 (doi:10.1542/peds.2008-0171)

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Roberts, J. E. Articles by Quintos-Alagheband, M. L. Search for Related Content PubMed PubMed Citation Articles by Roberts, J. E. Articles by Quintos-Alagheband, M. L. Related Collections Infectious Disease & Immunity Social Bookmarking                         What's this?

ARTICLE

Association Between Parapneumonic Effusion and Pericardial Effusion in a Pediatric Cohort

Jon E. Roberts, MD^a, Brian J. Bezack, DO^a, David I. Winger, MD^b, Simcha Pollack, PhD^c, Rakesh A. Shah, MD^b, Mary Cataletto, MD^a, Douglas S. Katz, MD^b, Carlos Montoya-Iraheta, MD^a, Scott A. Schroeder, MD^d and Maria Lyn Quintos-Alagheband, MD^a

Department of ^a Pediatrics
^b Department of Radiology, Winthrop-University Hospital, Mineola, New York
^c Department of Computer Information Systems and Decision Sciences, St John's University, Queens, New York
^d Department of Pediatrics, Albany Medical Center, Albany, New York

OBJECTIVE. Associations between pleural and pericardial effusions have been described in malignancy and autoimmune disorders. Bacterial pneumonia is the most frequent cause of parapneumonic effusion; however, knowledge of the relationship between parapneumonic effusion and the presence of pericardial fluid in children is limited. We examined this relationship.

METHODS. We performed a retrospective chart review of pediatric patients who were admitted to our institution during a 6-year period with a diagnosis of either parapneumonic effusion or empyema and who had undergone an echocardiogram, a computed tomography scan of the thorax, or both. All demographic, clinical, radiographic, and laboratory data of these patients were collected, and statistical analysis was done with Student's t tests and ² analyses.

RESULTS. We reviewed the charts of 59 children with parapneumonic effusions. Forty-eight underwent 2-dimensional echocardiography, chest computed tomography scan, or both. Of these 48 patients, 54.2% (n = 26) were found to have a concomitant pericardial effusion. The majority of patients with pericardial effusions had left-sided pleural disease. Patients with pericardial effusions had more symptomatic days before hospitalization, lower pleural fluid albumin levels, elevated serum white blood cell counts, elevated pleural fluid white blood cell and absolute neutrophil counts, and an increased incidence of surgical intervention. One patient had evidence of hemodynamic compromise that required pericardiocentesis.

CONCLUSIONS. We found a high incidence of pericardial effusions in pediatric patients with parapneumonic effusions. Leukocytosis, higher pleural fluid leukocyte and neutrophil counts, and a propensity for surgical intervention suggest a prognostic relationship between pericardial effusions and more severe parapneumonic disease. The majority of these pericardial collections resolve with treatment of the underlying pleural disease.

---

Key Words: pneumonia • pleural effusion • parapneumonic effusion • empyema • pericardial effusion • pericardial thickening • echocardiography • chest CT • chest tube • fibrinolytic therapy • video-assisted thoracoscopic surgery • open thoracotomy

Abbreviations: PCE—pericardial effusion • CT—computed tomography • WBC—white blood cell • VATS—video-assisted thoracoscopic surgery

---

Accepted Aug 4, 2008.

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?