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Context <p>Although thoracic ultrasonography (USG) provides valuable information for managing empyema, many clinicians resort to thoracic computed tomography (CT) scans.</p> Objective <p>This systematic review was conducted to synthesize evidence on the efficacy, safety and cost of thoracic CT scan versus USG for managing childhood empyema.</p> Evidence Acquisition <p>We searched for diagnostic test accuracy studies and observational studies in PubMed, EMBASE, the Cochrane Library, Scopus, Web of Science, clinical trial registries and grey literature sources (ProQuest and OpenGrey), without any language restrictions. Two reviewers independently screened studies for inclusion. Studies in children (&lt; 18&#xa0;years) with confirmed empyema were included. The outcomes evaluated were findings impacting management missed by the other modality, adverse events, concordance, additional findings identified with either modality, and cost. Risk of bias was estimated using study design-specific tools. Certainty of evidence was evaluated using the GRADE approach.</p> Results <p>Only one retrospective study with 13 participants met the inclusion criteria. CT identified one additional case with loculations compared to USG, and one additional lung abscess, although it was not confirmed at surgery. Fibrin strands seen on USG in all 13 cases were not detected by CT. Both modalities detected pulmonary consolidation in 11 patients; although the sites of consolidation differed in some children. There was no comparative data on cost and adverse events. The GRADE evidence certainty was judged as very low.</p> Conclusion <p>The limited, very low certainty evidence suggested no advantage of CT scan over USG in the management of childhood empyema. Appropriately designed prospective studies can resolve this question.</p>

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Thoracic Computed Tomography Scan Versus Thoracic Ultrasonography for Management Decisions in Empyema Thoracis: A Systematic Review

  • 期刊论文

  • 发表日期：

    2026年7月9日

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  • Davinder Kaur,
  • Ketan Kumar,
  • Pravakar Mishra,
  • Mounika Reddy,
  • Narayan Santuka,
  • Anshula Tayal,
  • Pranita Pradhan,
  • Joseph L. Mathew

摘要

Context

Although thoracic ultrasonography (USG) provides valuable information for managing empyema, many clinicians resort to thoracic computed tomography (CT) scans.

Objective

This systematic review was conducted to synthesize evidence on the efficacy, safety and cost of thoracic CT scan versus USG for managing childhood empyema.

Evidence Acquisition

We searched for diagnostic test accuracy studies and observational studies in PubMed, EMBASE, the Cochrane Library, Scopus, Web of Science, clinical trial registries and grey literature sources (ProQuest and OpenGrey), without any language restrictions. Two reviewers independently screened studies for inclusion. Studies in children (< 18 years) with confirmed empyema were included. The outcomes evaluated were findings impacting management missed by the other modality, adverse events, concordance, additional findings identified with either modality, and cost. Risk of bias was estimated using study design-specific tools. Certainty of evidence was evaluated using the GRADE approach.

Results

Only one retrospective study with 13 participants met the inclusion criteria. CT identified one additional case with loculations compared to USG, and one additional lung abscess, although it was not confirmed at surgery. Fibrin strands seen on USG in all 13 cases were not detected by CT. Both modalities detected pulmonary consolidation in 11 patients; although the sites of consolidation differed in some children. There was no comparative data on cost and adverse events. The GRADE evidence certainty was judged as very low.

Conclusion

The limited, very low certainty evidence suggested no advantage of CT scan over USG in the management of childhood empyema. Appropriately designed prospective studies can resolve this question.