CT in the evaluation of pleural versus pulmonary disease in children.

Post pneumonic empyema in children is the result of infection by Staphylococcus aureus in approximately 80% of cases. Approximately 93% of children with empyema respond well to treatment with appropriate antibiotics and drainage of the pleural space. We present seven children in whom such therapy failed to produce an adequate response. Computed tomography alone clearly excluded persistent pneumonia as a cause of symptoms while in all seven patients revealing an unexpectedly extensive empyema rind. This information, coupled with the lack of clinical improvement and the specific organism isolated, led to a change in clinical management. These children were infected by organisms other than Staphylococcus aureus and required surgical decortication of the fibrinous pleural rind to alleviate persistent symptoms.