In pediatrics, the majority of effusions are exudative Therefore, classification focuses largely on whether pleural fluid collections are infectious or noninfectious Goals of Treatment The goals of treatment for patients with pleural disease are focused on rapidly assessing and supporting respiratory function Supporting oxygenation and ventilation may be required passively or actively Drainage is indicated for therapeutic purposes in patients with respiratory compromise, and for diagnostic purposes, including identification of likely etiology, including microbiology in the case of infectious causes Clinical Considerations Clinical Recognition There exists a wide spectrum of conditions that lead to pleural inflammation ( Table 99.10 ) Infectious etiologies are most common and may include viruses (e.g., Coxsackie virus, Epstein–Barr virus, herpes zoster), mycoplasma, bacteria (e.g., S aureus, Streptococcus pneumoniae, H influenzae, group A streptococcus, Mycobacterium tuberculosis ), and fungi (e.g., histoplasmosis, coccidioidomycosis) Infections from pulmonary, subdiaphragmatic, or more distant sites may all eventually involve the pleura Neoplastic involvement may also be primary or metastatic When oncologic lesions obstruct the lymphatic drainage, accumulation of pleural fluid can occur Medications including hydralazine and procainamide can also cause pleural inflammation PE may cause pleural inflammation with or without effusion as a result of focal parenchymal necrosis Trauma, both accidental and following diagnostic and therapeutic procedures in the chest, can irritate the pleura and lead to secondary infection Pleuritis with or without effusion is seen in more than half of patients who have a systemic vasculitis such as SLE or sarcoidosis