Pleural effusions. Management and treatment.

Diagnosis of pleural effusion is difficult in children. The etiologies are numerous; however, infectious agents are more frequent. Thoracocentesis proves to be the first-line diagnostic fool. Light's criteria are the best for distinguishing whether the effusion is a transudate or an exsudate. If the patient has an exsudative pleural effusion, other tests are indicated to determine the etiology and in some cases the treatment: macroscopic appearance, cytology and differential white cell count (level of glucose, lactate deshydrogenase, adenosine deaminase, pH, bacterial cultures). Others investigations -biopsy of pleura by thoracoscopy or video-assisted thoracoscopy, bronchofibroscopy, CT scan- are sometimes useful. Intrapleural instillation of urokinase appears to be useful and safe. Evaluation is necessary for video-assisted thoracoscopy used early. (C) 2000 Editions scientifiques et medicales Elsevier SAS.