Clinical Indications for Discharge or Admission Most children with pulmonary edema will require hospitalization with supportive cardiopulmonary care and evaluation for underlying conditions PLEURITIS/PLEURAL EFFUSION CLINICAL PEARLS AND PITFALLS Pleuritis without significant effusion may be associated with systemic vasculitis Most pleural effusions in pediatrics are exudative Management of effusions involves treating associated chest pain, and thoracentesis for diagnostic and therapeutic purposes Current Evidence Pleuritis or pleurisy refers to inflammation of pleural membranes, resulting from primary pleural, adjacent pneumonic, or systemic disease This inflammation is usually associated with an increased volume of fluid in the pleural space Specific references to the evaluation and management of pleural effusions in various respiratory infections are made in Chapter 94 Infectious Disease Emergencies , and the surgical approach to pleural effusions is reviewed in Chapter 124 Thoracic Emergencies The pleural membrane is thin and double layered, separating the lung from the chest wall, diaphragm, and mediastinum The outer parietal pleura is adherent to the chest wall, and the inner visceral pleura completely covers the lungs except at the hila In healthy children, the two pleural layers are opposed, separated by only a thin physiologic layer of serous fluid This pleural fluid is constantly being turned over, entering from the parietal pleura and exiting via the lymphatics and vasculature of the visceral pleura Abnormal pleural fluid accumulation can result from changes in hydrostatic or oncotic pressures (such as seen with pulmonary edema) or diseases of the pleural surface that alter capillary permeability or affect lymphatic reabsorption The underlying pathophysiology will determine if an effusion will be transudative or exudative Transudates result from increased capillary hydrostatic pressure such as congestive heart failure or decreased oncotic pressure such as hypoproteinemic states Exudates result from diseases of the pleural surface that produce increased capillary permeability or lymphatic obstruction, such as pleural infection or tumor