Bradley et al listed criteria for a parapneumonic effusion or empyema in a pediatric patient with community-acquired pneumonia (CAP). The authors are from the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America.
Patient selection: pediatric patient with community-acquired pneumonia (CAP)
Criteria for parapneumonic effusion:
(1) collection of fluid in the pleural space
(2) associated with pneumonia
Criteria for parapneumonic empyema:
(1) collection of pus in the pleural space (based on gross appearance, positive bacterial culture and/or pleural white blood cell count > 50,000 per µL)
(2) associated with pneumonia
Reasons to suspect a significant parapneumonic fluid collection:
(1) prolonged fever
(2) pain (chest or abdominal)
(3) physical examination (dullness to percussion, diminished breath sounds, change in the quality of breath sounds and transmitted speech over the effusion)
(4) chest X-ray
(5) moderate to severe bacterial pneumonia
If a parapneumonic fluid collection is suspected but the chest X-ray is inconclusive then ultrasonography or a CT scan should be performed to quantify the fluid.
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