Parapneumonic effusion is fluid accumulation in the pleural space caused by pneumonia. It can be treated with antibiotics and drainage, but in severe cases, surgery may be needed. Complicated effusions can lead to thoracic empyema, which is diagnosed using a thoracentesis test. The condition can be fatal in about 10% of cases.
A parapneumonic effusion occurs when patients with pneumonia experience fluid accumulation in the pleural space. This is the space between the membrane that covers the lungs and the membrane that lines the chest cavity. Parapneumonic effusion can result from any type of pneumonia and affects about 40% of all patients with bacterial pneumonia. Most often, the condition can be treated successfully using antibiotics. In severe cases, a drainage tube is placed between two of the ribs in the pleural space.
Parapneumonic effusion is a special type of pleural effusion. The tissues that line the chest cavity and cover the lungs are known as the visceral pleura and parietal pleura. Normally, as the lungs expand and deflate during breathing, the pleurae slide past each other. They are aided by a small amount of lubricating pleural fluid between the two layers.
A pleural effusion develops when excess fluid leaks into the pleural space. This can result from lung injury and inflammation, which is seen in pneumonia. It can also arise as a result of increased pressure in blood vessels, which sometimes occurs in heart failure.
Parapneumonic effusions can be described as complicated or uncomplicated. Uncomplicated effusions are a result of the inflammation seen in pneumonia. The fluid in the pleural space consists mainly of white blood cells, and the effusion usually resolves with antibiotics.
Complicated effusions occur when bacteria enter the pleural space. The immune system can remove the bacteria fairly quickly, but a fluid collection that requires drainage may remain. Sometimes pus accumulates within the pleural space and this type of parapneumonic effusion is known as thoracic empyema.
Thoracic empyema is diagnosed using a test known as a thoracentesis. Fluid is withdrawn from the pleural space using a needle, and thick pus indicates that the patient has empyema. This is the most severe form of parapneumonic effusion. The risk of developing it is higher in children and the elderly and in patients whose pneumonia required hospitalization. Thoracic empyema is also more common in people with existing conditions such as diabetes, alcoholism and the lung disease known as bronchiectasis.
Most patients recover from parapneumonic effusion, but in about ten percent, the condition can be fatal. It is important to treat the condition as soon as possible with antibiotic medications and drainage of the pleural space. In some cases, a surgical procedure is needed to remove pus and scar tissue.
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