Management of Parapneumonic Effusions
Annotation for Point D
Pleural collections persisting for more than 24 hours after adequate tube thoracostomy, confirmed by ultrasonography, warrant prompt computed tomographic (CT) imaging for evaluation of the entire thoracic space.16,29 This is diagnostic level II evidence. Delay in diagnosis of an undrained simple fluid collection allows progression to a complex multilocular process and the final organization stage.46 As Sahn and Light28 stated in 1989, ‘‘the sun should never set on a parapneumonic effusion’’; early diagnosis and treatment of complicated pleural infection is essential for optimal outcomes. CT images are crucial for the next step in the management of pleural space infections that have not resolved with tube drainage. 4,16,29,46 This is a grade B recommendation.