Abstracts: Causes of pleural effusion in Children

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M. Mearadji
International Foundation for Pediatric Imaging Aid
Rotterdam, The Netherlands

The pleural fluid collection is a frequent finding in the pediatric age group.
The term ‘pleural effusion’ is non-specific and may indicate e.g. empyema, exudate, transudate or blood as so many different causes.
Pneumonia is the most common cause of pleural effusion in childhood, followed by congestive heart failure and renal failure. Iatrogenic pleural effusion may also occur. Less frequently neoplastic masses present themselves with pleural fluid.
Congenital chylothorax or collagen vascular disease can present with fluid collections in the pleural spaces.

The causes of a pleural effusion can be suspected clinically, but to evaluate the nature and causes of the effusion, imaging procedures are essential for adequate diagnosis as well as therapy.
The use of imaging modalities should be problem orientated depending on the condition of the child. The chestfilm in AP and lateral position is the first imaging procedure in cases where pleural effusion is suspected, also in evaluating therapeutic results.
Additional use of ultrasound is mostly useful to evaluate the nature and origin of pleural effusion as well as for localization and extension to indicate a suitable site for a puncture as a diagnostic or therapeutic procedure. In cases suspected to have neoplastic disease an ultrasound examination of the abdomen or neck as well as the mediastinum should be supplementary performed.
Evaluation by CT should be performed in complicated pulmonary infection, especially primary tuberculosis, neoplastic diseases as well as iatrogenic conditions and in some rare cases of pleural effusion of unknown etiology.
MRI of the chest is indicated in heart failure or surgical sequellae.
In this presentation, the value of systematic approach with different modalities will be demonstrated and a large number of patients with pleural effusion due to different etiology, infectious or non-infectious, will be shown.