PMID- 17039385
OWN - NLM
STAT- MEDLINE
DCOM- 20070227
LR  - 20181113
IS  - 0179-0358 (Print)
IS  - 0179-0358 (Linking)
VI  - 22
IP  - 12
DP  - 2006 Dec
TI  - Paediatric thoracic tumours presenting as empyema.
PG  - 1009-14
AB  - Ultrasonography (US) is considered to be adequate for the preoperative evaluation 
      of childhood empyema. This study was aimed to improve awareness that paediatric 
      intra-thoracic tumours can mimic childhood post-pneumonic empyema and highlights 
      the value of computed tomogram (CT) scan with intravenous (IV) contrast in 
      preoperative evaluation of childhood empyema. The data were analysed on eight 
      children (four boys and four girls) presented at the median age of 6.2 years 
      (1.8-15 years) for the management of empyema and later confirmed to have 
      intra-thoracic tumours. Intra-thoracic tumours in 8 (5.3%) children out of 150 
      cases of post-pneumonic empyema were managed during the study period. All eight 
      had clinical features, increased white cell count, raised inflammatory markers 
      and biochemical parameters suggestive of childhood empyema. Chest X-ray showed 
      localised opacity in 3/8 while in other five suggested significant pleural 
      collection with mediastinal shift. Additional investigations in referring 
      hospital were suggestive of empyema in four children; US in three, CT scan 
      without IV contrast in one. Referring hospital carried out non-diagnostic 
      thoracocentesis in four children with blood stained pleural tap in two. In four 
      children corroborative evidence suggestive of infection within pleural cavity and 
      acute respiratory distress led to an emergency mini-thoracotomy resulting in 
      significant intra-operative bleeding in two children. Histology on biopsy of the 
      infected material showed primitive neuroectodermal tumour (PNET) in one, 
      pleuropulmonary blastoma in one, metastatic malignant melanoma in one and 
      cytology of pleural fluid diagnosed lymphoma in one. Pre-operative CT scan with 
      IV contrast in four children correctly identified underlying intra-thoracic 
      tumour (two benign teratoma, two PNET). In two cases CT with IV contrast was 
      performed because chest X-ray suggested mediastinal loculated empyema while in 
      other two high clinical index of suspicion prompted preoperative evaluation with 
      CT scan with IV contrast. We advocate caution and increased awareness before 
      considering therapeutic options in childhood empyema and recommend preoperative 
      CT scan with IV contrast in some selected and unusual cases.
FAU - Sharif, Khalid
AU  - Sharif K
AD  - Birmingham Children's Hospital, Birmingham, West Midlands, B4 6NH, UK. 
      ksharif@hotmail.com
FAU - Alton, Helen
AU  - Alton H
FAU - Clarke, Jane
AU  - Clarke J
FAU - Desai, Maya
AU  - Desai M
FAU - Morland, Bruce
AU  - Morland B
FAU - Parikh, Dakshesh
AU  - Parikh D
LA  - eng
PT  - Journal Article
DEP - 20061013
PL  - Germany
TA  - Pediatr Surg Int
JT  - Pediatric surgery international
JID - 8609169
SB  - IM
MH  - Adolescent
MH  - Child
MH  - Child, Preschool
MH  - Empyema, Pleural/diagnostic imaging/*etiology
MH  - Female
MH  - Humans
MH  - Infant
MH  - Male
MH  - Punctures
MH  - Retrospective Studies
MH  - Teratoma/complications/diagnosis
MH  - Thoracic Neoplasms/*diagnostic imaging
MH  - Thoracotomy
MH  - Tomography, X-Ray Computed
EDAT- 2006/10/14 09:00
MHDA- 2007/02/28 09:00
CRDT- 2006/10/14 09:00
PHST- 2006/07/03 00:00 [accepted]
PHST- 2006/10/14 09:00 [pubmed]
PHST- 2007/02/28 09:00 [medline]
PHST- 2006/10/14 09:00 [entrez]
AID - 10.1007/s00383-006-1732-6 [doi]
PST - ppublish
SO  - Pediatr Surg Int. 2006 Dec;22(12):1009-14. doi: 10.1007/s00383-006-1732-6. Epub 
      2006 Oct 13.