Common causes and treatment options of pleural effusion in children

Aim and Objective: To determine the frequency of various causes of pleural effusion in children. To evaluate the treatment options in these cases. Patients and Methods: It is a case series study done at the medical ward of the Children's Hospital and Institute of Child Health, Lahore form Feb 2009 to Jan 2011. A total of 85 patients aged 6 months to 16 years with clinical diagnosis of pleural effusion were enrolled after fulfilling the inclusion criteria. Etiology was determined with the help of appropriate investigations. All patients were treated medically and surgical interventions done where indicated. The data obtained was analyzed. Results: A total of 85 children (age 2 months to 16 years) fulfilled criteria and were included for analysis. The commonest age group was 5-16 years (41.2%). The mean age was 4.5 years with male:female ratio of 1.5:1. Fever was the most common symptom present in all of the cases followed by cough (87%), respiratory distress (79%), pallor (62.4%), chest pain (58.8%), decreased appetite (55%) and vomiting (24.7%). Parapneumonic pleural effusions were found in 59 cases (69.4%) while18 (21.2%) were tuberculous. Malignancy and congestive cardiac failure was the etiology in 3 cases each (3.5%), while two patients (2.4%) had nephrotic syndrome. All patients were managed with antibiotics, where as chest tube drainage was required in 66 (77.6%) patients. Out of total 85 patients, 19 (22.4%) improved with antibiotics alone and 56 (65.8%) improved with tube thoracostomy and antibiotics. Open surgical intervention (i.e. decortication) was required in 10 patients (11.7%). Amongst the patients requiring chest intubation the duration of drainage was less than 10 days in 55 (64.3%) patients and only in 15.3% cases it was more than 10 days. Conclusion: In our study the commonest cause of pleural effusion in children was parapneumonic. It's early recognition and effective treatment is important to prevent further complications.