Abstract

Pleural effusions following bacterial pneumonias, pulmonary abcess and bronchiectasis are called parapneumonic effusions. Parapneumonic effusions are present in 20-60% of patients hospitalized for bacterial pneumonia. The effusion resolves with antibiotic therapy in most of the cases but empyema develops in 5-10% of them. Therefore, the effusion should be recognized early, proper antibiotic therapy must be instituted and drainage must follow if necessary. The most important decision in the management of pleural effusions is to drain the fluid and the timing of it. The clinical status of the patient, radiology and characteristics of the pleural fluid guide this decision. Intrapleural instillation of fibrinolytics may increase the amount of drainage when the pleural fluid can not be removed completely.