Pleuraempyem

ZUSAMMENFASSUNG

Das Pleuraempyem bei Kindern ist meist Folge einer Pneumonie. Aus einem anfänglich klaren Exsudat können sich ein fibropurulentes Stadium mit Fibrinpräzipitaten und Septierungen sowie im organisierten Stadium eine dicke fibröse Membran auf der Lunge entwickeln. Husten, Fieber und Dyspnoe prägen die klinische Symptomatik.

Die Therapie des Pleuraempyems ist abhängig vom Stadium und wird kontrovers diskutiert. Im Stadium I sollte das Empyem bei symptomatischen Kindern und/oder einem Erguss > 2 cm drainiert werden. In fortgeschrittenen Stadien werden über die Thoraxdrainage zusätzlich Fibrinolytika appliziert. Obwohl gegenwärtig keine Studien existieren, die eine Überlegenheit dieses Verfahrens gegenüber einer chirurgischen Therapie zeigen konnten, sind operative Strategien wie die videoassistierte thorakoskopische Chirurgie (VATS) oder die offene Dekortikation in den Hintergrund getreten. Sie kommen nur noch bei Versagen der Fibrinolysetherapie und damit selten zum Einsatz. Eine antibiotische Behandlung ist immer indiziert.

ABSTRACT

Pleural empyema in children is usually the result of a pneumonia. Starting as a clear exudate, a fibropurulent stage with fibrin precipitates can develop, ultimately reaching an organized stage with thick fibrous membranes covering the lungs. Clinical symptoms include cough, fever and dyspnea.

Treatment depends on the stage of empyema and is discussed controversially. In stage I, the empyema should be drained. In advanced stages, fibrinolytics are additionally applied via a chest tube. Although studies were unable to demonstrate the superiority of this protocol over surgical therapy, operative approaches such as video-assisted thoracoscopic surgery (VATS) and open decortication are rarely applied today and reserved for cases in which fibrinolysis have failed. An antibiotic treatment is always required.

Schlüsselwörter

Pleuraempyem - Thorakoskopie - VATS - Fibrinolyse

Keywords

Pleural empyema - video assisted thoracoscopic surgery - VATS - fibrinolysis

Publication History

Received: 20 November 2020

Accepted: 24 November 2020

Article published online:
17 June 2021

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