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Kucerova B, Kovacova AS, Polivka N, Cejnarová K, Doucha M, Coufal S, Hlava S, Wasserbauer M, Dotlacil V, Kyncl M, Snajdauf J, Koucky V, Pohunek P, Rygl M. CT findings predicting lung resection in children with complicated community-acquired pneumonia. Pediatr Surg Int 2022; 38:431-436. [PMID: 35092464 DOI: 10.1007/s00383-022-05071-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate computed tomography (CT) features which predict lung resection in children with complicated community-acquired pneumonia. METHODS A retrospective study of CT findings of patients with complicated pneumonia treated between January 2010 and December 2019. Fisher's exact test and ROC curves were used for statistical analysis. RESULTS The study cohort consisted of 84 patients who underwent chest CT for complicated pneumonia. Lung resection was performed in 36 patients, 3 patients were treated by lung decortication, 45 patients were cured conservatively. Seven CT features were found statistically significant among the patients who underwent lung resection. 80.5% of patients from the resection group had two or more of these features on the initial CT scan, 64% had three or more. According to ROC analysis, simultaneous occurrence of multiple cavities equal to or greater than 3 cm and lung abscess predicted a pulmonary resection. CONCLUSION The combination of CT features which clearly predict lung resection are the simultaneous occurrence of multiple cavities ≥ 3 cm and lung abscess. The most common triple combination of CT signs in the resected group of patients were multiple cavities ≥ 3 cm, consolidation of lung tissue and pleural effusion < 3 cm.
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Affiliation(s)
- Barbora Kucerova
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Motol University Hospital, Charles University, V Uvalu 84, Prague 5, Czech Republic.
| | - A S Kovacova
- Department of Radiology, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - N Polivka
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Motol University Hospital, Charles University, V Uvalu 84, Prague 5, Czech Republic
| | - K Cejnarová
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Motol University Hospital, Charles University, V Uvalu 84, Prague 5, Czech Republic
| | - M Doucha
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Motol University Hospital, Charles University, V Uvalu 84, Prague 5, Czech Republic
| | - S Coufal
- Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - S Hlava
- Department of Internal Medicine, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - M Wasserbauer
- Department of Internal Medicine, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - V Dotlacil
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Motol University Hospital, Charles University, V Uvalu 84, Prague 5, Czech Republic
| | - M Kyncl
- Department of Radiology, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - J Snajdauf
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Motol University Hospital, Charles University, V Uvalu 84, Prague 5, Czech Republic
| | - V Koucky
- Department of Pediatrics, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - P Pohunek
- Department of Pediatrics, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - M Rygl
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Motol University Hospital, Charles University, V Uvalu 84, Prague 5, Czech Republic
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Rose MA, Barker M, Liese J, Adams O, Ankermann T, Baumann U, Brinkmann F, Bruns R, Dahlheim M, Ewig S, Forster J, Hofmann G, Kemen C, Lück C, Nadal D, Nüßlein T, Regamey N, Riedler J, Schmidt S, Schwerk N, Seidenberg J, Tenenbaum T, Trapp S, van der Linden M. [Guidelines for the Management of Community Acquired Pneumonia in Children and Adolescents (Pediatric Community Acquired Pneumonia, pCAP) - Issued under the Responsibility of the German Society for Pediatric Infectious Diseases (DGPI) and the German Society for Pediatric Pulmonology (GPP)]. Pneumologie 2020; 74:515-544. [PMID: 32823360 DOI: 10.1055/a-1139-5132] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The present guideline aims to improve the evidence-based management of children and adolescents with pediatric community-acquired pneumonia (pCAP). Despite a prevalence of approx. 300 cases per 100 000 children per year in Central Europe, mortality is very low. Prevention includes infection control measures and comprehensive immunization. The diagnosis can and should be established clinically by history, physical examination and pulse oximetry, with fever and tachypnea as cardinal features. Additional signs or symptoms such as severely compromised general condition, poor feeding, dehydration, altered consciousness or seizures discriminate subjects with severe pCAP from those with non-severe pCAP. Within an age-dependent spectrum of infectious agents, bacterial etiology cannot be reliably differentiated from viral or mixed infections by currently available biomarkers. Most children and adolescents with non-severe pCAP and oxygen saturation > 92 % can be managed as outpatients without laboratory/microbiology workup or imaging. Anti-infective agents are not generally indicated and can be safely withheld especially in children of young age, with wheeze or other indices suggesting a viral origin. For calculated antibiotic therapy, aminopenicillins are the preferred drug class with comparable efficacy of oral (amoxicillin) and intravenous administration (ampicillin). Follow-up evaluation after 48 - 72 hours is mandatory for the assessment of clinical course, treatment success and potential complications such as parapneumonic pleural effusion or empyema, which may necessitate alternative or add-on therapy.
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Affiliation(s)
- M A Rose
- Fachbereich Medizin, Johann-Wolfgang-Goethe-Universität Frankfurt/Main und Zentrum für Kinder- und Jugendmedizin, Klinikum St. Georg Leipzig
| | - M Barker
- Klinik für Kinder- und Jugendmedizin, Helios Klinikum Emil von Behring, Berlin
| | - J Liese
- Kinderklinik und Poliklinik, Universitätsklinikum an der Julius-Maximilians-Universität Würzburg, Würzburg
| | - O Adams
- Institut für Virologie, Universitätsklinikum Düsseldorf
| | - T Ankermann
- Klinik für Kinder- und Jugendmedizin 1, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - U Baumann
- Pädiatrische Pneumologie, Allergologie und Neonatologie, Medizinische Hochschule Hannover
| | - F Brinkmann
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Ruhr-Universität Bochum
| | - R Bruns
- Zentrum für Kinder- und Jugendmedizin, Ernst-Moritz-Arndt-Universität Greifswald
| | - M Dahlheim
- Praxis für Kinderpneumologie und Allergologie, Mannheim
| | - S Ewig
- Kliniken für Pneumologie und Infektiologie, Thoraxzentrum Ruhrgebiet, Bochum/Herne
| | - J Forster
- Kinderabteilung St. Hedwig, St. Josefskrankenhaus , Freiburg und Merzhausen
| | | | - C Kemen
- Katholisches Kinderkrankenhaus Wilhelmstift, Hamburg
| | - C Lück
- Institut für Medizinische Mikrobiologie und Hygiene, Technische Universität Dresden
| | - D Nadal
- Kinderspital Zürich, Schweiz
| | - T Nüßlein
- Klinik für Kinder- und Jugendmedizin, Gemeinschaftsklinikum Mittelrhein, Koblenz
| | - N Regamey
- Pädiatrische Pneumologie, Kinderspital Luzern, Schweiz
| | - J Riedler
- Kinder- und Jugendmedizin, Kardinal Schwarzenberg'sches Krankenhaus, Schwarzach, Österreich
| | - S Schmidt
- Zentrum für Kinder- und Jugendmedizin, Ernst-Moritz-Arndt-Universität Greifswald
| | - N Schwerk
- Pädiatrische Pneumologie, Allergologie und Neonatologie, Medizinische Hochschule Hannover
| | - J Seidenberg
- Klinik für pädiatrische Pneumologie und Allergologie, Neonatologie, Intensivmedizin und Kinderkardiologie, Klinikum Oldenburg
| | - T Tenenbaum
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Mannheim
| | | | - M van der Linden
- Institut für Medizinische Mikrobiologie, Universitätsklinikum Aachen
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Masters IB, Isles AF, Grimwood K. Necrotizing pneumonia: an emerging problem in children? Pneumonia (Nathan) 2017; 9:11. [PMID: 28770121 PMCID: PMC5525269 DOI: 10.1186/s41479-017-0035-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 06/22/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND In children, necrotizing pneumonia (NP) is an uncommon, severe complication of pneumonia. It is characterized by destruction of the underlying lung parenchyma resulting in multiple small, thin-walled cavities and is often accompanied by empyema and bronchopleural fistulae. REVIEW NP in children was first reported in children in 1994, and since then there has been a gradual increase in cases, which is partially explained by greater physician awareness and use of contrast computed tomography (CT) scans, and by temporal changes in circulating respiratory pathogens and antibiotic prescribing. The most common pathogens detected in children with NP are pneumococci and Staphylococcus aureus. The underlying disease mechanisms are poorly understood, but likely relate to multiple host susceptibility and bacterial virulence factors, with viral-bacterial interactions also possibly having a role. Most cases are in previously healthy young children who, despite adequate antibiotic therapy for bacterial pneumonia, remain febrile and unwell. Many also have evidence of pleural effusion, empyema, or pyopneumothorax, which has undergone drainage or surgical intervention without clinical improvement. The diagnosis is generally made by chest imaging, with CT scans being the most sensitive, showing loss of normal pulmonary architecture, decreased parenchymal enhancement and multiple thin-walled cavities. Blood culture and culture and molecular testing of pleural fluid provide a microbiologic diagnosis in as many as 50% of cases. Prolonged antibiotics, draining pleural fluid and gas that causes mass effects, and maintaining ventilation, circulation, nutrition, fluid, and electrolyte balance are critical components of therapy. Despite its serious nature, death is uncommon, with good clinical, radiographic and functional recovery achieved in the 5-6 months following diagnosis. Increased knowledge of NP's pathogenesis will assist more rapid diagnosis and improve treatment and, ultimately, prevention. CONCLUSION It is important to consider that our understanding of NP is limited to individual case reports or small case series, and treatment data from randomized-controlled trials are lacking. Furthermore, case series are retrospective and usually confined to single centers. Consequently, these studies may not be representative of patients in other locations, especially when allowing for temporal changes in pathogen behaviour and differences in immunization schedules and antibiotic prescribing practices.
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Affiliation(s)
- I. Brent Masters
- Department of Respiratory and Sleep Medicine, Lady Cilento Children’s Hospital, South Brisbane, QLD Australia
| | - Alan F. Isles
- Department of Respiratory and Sleep Medicine, Lady Cilento Children’s Hospital, South Brisbane, QLD Australia
| | - Keith Grimwood
- School of Medicine and Menzies Health Institute Queensland, Gold Coast campus, Griffith University, Building G40, Southport Gold Coast, QLD Australia
- Departments of Infectious Diseases and Paediatrics, Gold Coast Health, Southport Gold Coast, QLD Australia
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Krenke K, Sanocki M, Urbankowska E, Kraj G, Krawiec M, Urbankowski T, Peradzyńska J, Kulus M. Necrotizing Pneumonia and Its Complications in Children. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 857:9-17. [PMID: 25468010 DOI: 10.1007/5584_2014_99] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Necrotizing pneumonia (NP) is an emerging complication of community acquired pneumonia (CAP) in children. This study aimed at the evaluation of etiology, clinical features, treatment, and prognosis of NP. The institutional database of children with CAP treated between April 2008 and July 2013 was searched to identify children with NP. Then, data on the NP characteristics were retrospectively reviewed and analyzed. We found that NP constituted 32/882 (3.7%) of all CAPs. The median age of children with NP was 4 (range 1-10) years. The causative pathogens were identified in 12/32 children (37.5%) with Streptococcus pneumoniae being the most common (6/32). All but one patient developed complications: parapneumonic effusion (PPE), pleural empyema or bronchopleural fistula (BPF), which required prompt local treatment. The median duration of hospital stay and antibiotic treatment was 26 (IQR 21-30) and 28 (IQR 22.5-32.5) days, respectively. Despite severe course of the disease no deaths occurred. A follow-up visit after 6 months revealed that none of the patients presented with any signs and symptoms which could be related to earlier pneumonia. Chest radiographs showed complete or almost complete resolution of pulmonary and pleural lesions in all patients. We conclude that necrotizing pneumonia is a relatively rare but severe form of CAP that is almost always complicated by PPE/empyema and/or BPF. It can be successfully treated with antibiotics and pleural drainage without major surgical intervention.
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Affiliation(s)
- Katarzyna Krenke
- Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warszawa, Poland
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Pande A, Nasir S, Rueda AM, Matejowsky R, Ramos J, Doshi S, Kulkarni P, Musher DM. The incidence of necrotizing changes in adults with pneumococcal pneumonia. Clin Infect Dis 2011; 54:10-6. [PMID: 22042878 DOI: 10.1093/cid/cir749] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Necrotizing pneumonia is generally considered a rare complication of pneumococcal infection in adults. We systematically studied the incidence of necrotizing changes in adult patients with pneumococcal pneumonia and examined the severity of infection, role of causative serotypes, and association with bacteremia. METHODS We used a database of all pneumococcal infections identified at our medical center between 2000 and 2010. Original readings of chest X-rays (CXR) and computerized tomography (CT) were noted. Images were then independently reevaluated by 2 radiologists. The severity of disease at admission was assessed using SMART-COP and Pneumonia Outcomes Research Team (PORT) scoring systems. RESULTS In 351 cases of pneumococcal pneumonia, necrosis was reported in no (0%) original CXR readings and in 6 of 136 (4.4%) CTs. With rereading, 8 of 351 (2.3%) CXR and 15 of 136 (11.0%) CT had necrotizing changes. Overall, these changes were identified in 23 of 351 (6.6%) patients. The incidence of bacteremia and the admitting SMART-COP and PORT scores were similar in patients with and without necrosis (P = 1.00, P = .32, and P = .54, respectively). Type 3 pneumococcus was more commonly isolated from patients with necrosis than from patients without necrosis (P = .05), but 10 other serotypes were also implicated in 16 cases for which the organism was available for typing. CONCLUSIONS Necrotizing changes in the lungs were seen in 6.6% of a large series of adults with pneumococcal pneumonia but were often overlooked on initial readings. Patients with necrosis were not more likely to have bacteremia or more severe disease. Type 3 pneumococcus was the most commonly identified serotype.
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Affiliation(s)
- Anupam Pande
- School of Public Health, University of Texas Health Science Center, Houston, Texas, USA
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7
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Abstract
BACKGROUND Severe necrotizing pneumococcal pneumonia may progress to the development of bronchopleural fistula (BPF). The purpose of this study was to describe the clinical courses and identify risk factors for the development of bronchopleural fistula in children with pneumococcal pneumonia. Histopathologic features of children receiving surgical resections of the lung because of BPF were analyzed to explore the pathogenesis of destructive lung disease caused by Streptococcus pneumoniae. METHODS A total of 112 cases of culture-proven pneumococcal pneumonia were identified between January 2001 and March 2010 at Chang Gung Children's Hospital. The medical charts of all cases of culture-proven pneumococcal pneumonia were reviewed. RESULTS Pneumococcal pneumonia in 18 children (18/112, 16.1%) was complicated by BPF. As compared with children without BPF, children with BPF had significantly lower white blood cell counts at admission (P = 0.03) and significantly longer durations of fever and hospitalization (P < 0.001). Multivariate analysis revealed that acute respiratory failure (odds ratio = 8.9; 95% confidence interval = 2.6-30.9; P = 0.001) and serotype 19A infection (odds ratio = 5.0; 95% confidence interval = 1.2-22.1; P = 0.03) were risk factors for the development of BPF. Histopathologic analyses were available for 12 children who underwent surgical resections of the lung. Coagulative necrosis with pulmonary infarction was found in 11 of the 12 cases. CONCLUSIONS Serotype 19A was strongly associated with BPF. Vaccines containing this serotype will be important for prevention.
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Sharp JK, Hereth J, Fasanello J. Bronchoscopic findings in a child with pandemic novel H1N1 influenza A and methicillin-resistant Staphylococcus aureus. Pediatr Pulmonol 2011; 46:92-5. [PMID: 21171187 DOI: 10.1002/ppul.21306] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 03/03/2010] [Accepted: 03/04/2010] [Indexed: 11/11/2022]
Abstract
The spectrum of disease with pandemic novel H1N1 influenza A (2009) virus ranges from non-febrile, mild upper respiratory tract infection to severe or fatal pneumonia. We report the bronchoscopic findings associated with a fatal case of H1N1 influenza A associated with co-infection with methicillin-resistant Staphylococcus aureus (MRSA) in a previously healthy child, which were more severe than those previously described as associated with seasonal influenza infection alone. The severity of the airway pathology seen on bronchoscopy in this patient may be due to a unique effect of the H1N1 influenza A virus or may be as a result of a destructive synergism between this virus and bacteria such as MRSA.
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Affiliation(s)
- Jack K Sharp
- Pediatric Pulmonology, State University of New York at Buffalo, Women and Children's Hospital of Buffalo, Buffalo, New York 14222, USA.
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Westphal FL, Lima LCD, Netto JCL, Tavares E, Andrade EDO, Silva MDSD. Tratamento cirúrgico de crianças com pneumonia necrosante. J Bras Pneumol 2010. [DOI: 10.1590/s1806-37132010000600008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Descrever os resultados do tratamento cirúrgico de crianças com pneumonia necrosante. MÉTODOS: Análise retrospectiva dos prontuários de 20 crianças diagnosticadas com pneumonia necrosante e submetidas ao tratamento cirúrgico nos serviços de cirurgia torácica de dois hospitais na cidade de Manaus (AM) entre março de 1997 e setembro de 2008. Dados referentes a idade, sexo, agente etiológico, motivos da indicação cirúrgica, tipo de ressecção cirúrgica realizada e complicações pós-operatórias foram compilados. RESULTADOS: Dos 20 pacientes analisados, 12 (60%) eram do sexo feminino. A média de idade dos pacientes foi de 30 meses. Os agentes etiológicos mais encontrados foram Staphylococcus aureus, em 5 pacientes (25%), e Klebsiella sp., em 2 (10%). Os motivos de indicação cirúrgica foram sepse, em 16 pacientes (80%), e fístula broncopleural, em 4 (20%). Os tipos de procedimentos cirúrgicos realizados foram lobectomia, em 12 pacientes (60%), segmentectomia, em 7 (35%), e bilobectomia, em 1 (5%). Além desses procedimentos, 8 pacientes (40%) foram submetidos à descorticação pulmonar. As complicações pós-operatórias foram as seguintes: fístula broncopleural, em 4 pacientes (20%); empiema, em 1 (5%); pneumatocele, em 1 (5%); e flebite em membro superior esquerdo, em 1 (5%). Quatro pacientes (20%) morreram. CONCLUSÕES: Pacientes com evidências de necrose pulmonar devem ser considerados para a ressecção cirúrgica, que está indicada em casos graves de sepse, fístula broncopleural de alto débito ou insuficiência respiratória aguda que não respondem ao tratamento clínico.
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Spalding SJ, Cambria M, Arkachaisri T. Distinguishing Wegener's granulomatosis from necrotizing community acquired pneumonia: A case report and comparison of radiographic findings. Pediatr Pulmonol 2009; 44:195-7. [PMID: 19148934 PMCID: PMC3705734 DOI: 10.1002/ppul.20959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Wegener's granulomatosis (WG) is a necrotizing granulomatous vasculitis, affecting medium to small vessels in the respiratory and renal vasculature. Patients with WG may present with clinical and radiographic features similar to community-acquired pneumonia (CAP), which may delay life-saving immunosuppressive therapy. We report a 14-year-old female originally diagnosed with recalcitrant, necrotizing CAP complicated by massive pulmonary cavitations eventually proven to be WG. We also compare the radiographic features of WG and necrotizing CAP.
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Affiliation(s)
- Steven J Spalding
- Department of Rheumatic and Immunologic Disease, Cleveland Clinic, Cleveland, Ohio, USA.
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Mohos E, Szabó E, Módi J, Beller J, Szabados G, Nagy A. [Surgical case of bronchopleural fistula caused by necrotizing pneumonia in a two year old child]. Magy Seb 2007; 60:518-22. [PMID: 17474307 DOI: 10.1556/maseb.60.2007.1.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The treatment possibilities of broncho-pleural fistula (BPF) caused by necrotizing pneumonia (NP) are discussed based on the experiences of a case and on the basis of the literature. In case of pleural fluid caused by NP the importance of thoracic drainage and--in selected cases--video assisted thoracoscopy (VATS) are emphasized. If BPF develops and the oxygen saturation in the blood can not be kept on acceptable level because of the large volume of the lost air through the fistula bronchoscopic occlusion of the bronchus leading to the BPF is recommended. In conservative therapy resistant cases thoracotomy can be indicated.
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Affiliation(s)
- Elemér Mohos
- Veszprém Megyei Csolnoki Ferenc Kórház Altalános Sebészeti Osztály
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Lungenresektion aufgrund nekrotisierender Pneumonie im Kindesalter. Monatsschr Kinderheilkd 2007. [DOI: 10.1007/s00112-005-1088-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Velhote CEP, Velhote MCP. O papel da cirurgia torácica vídeo-assistida - CTVA - no tratamento da pneumonite necrosante na criança. Rev Col Bras Cir 2006. [DOI: 10.1590/s0100-69912006000100004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Avaliar o papel da cirurgia torácica vídeo-assistida (CTVA) no tratamento das complicações pleurais da pneumonite necrosante (PN) na criança, em sua fase aguda. MÉTODO: Avaliação prospectiva de sete pacientes com idades entre quatro e sete anos, portadores de empiema pleural com PN, com diagnóstico confirmado por tomografia computadorizada de tórax (TC) e cirurgia. Realizou-se a descorticação pulmonar com esvaziamento do pleuris, desbridamento e ressecção do tecido pulmonar comprometido, e drenagem torácica, através de videotoracoscopia com três portais. Foram avaliados no pós-operatório a curva térmica, o leucograma, o tempo de drenagem torácica e a permanência hospitalar. RESULTADOS: Houve re-expansão pulmonar completa em todos os pacientes tratados pela CTVA, com rápida melhora do estado geral, queda de temperatura e da leucocitose na primeira semana pós-tratamento. O período de drenagem pós-CTVA variou de sete a 17 dias, e a permanência hospitalar póscirúrgica foi menor quando comparada com dados da literatura em que o tratamento utilizado foi a drenagem torácica com antibioticoterapia ou a cirurgia a céu aberto. CONCLUSÕES: A utilização da CTVA como coadjuvante no tratamento da PN acompanhada de complicações pleurais, tem papel importante na aceleração da recuperação clínica do paciente, proporcionando a reexpansão mais rápida do pulmão colapsado, com melhoria das condições respiratórias.
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Wong KS, Lin TY, Huang YC, Chang LY, Lai SH. Scoring system for empyema thoracis and help in management. Indian J Pediatr 2005; 72:1025-8. [PMID: 16388150 DOI: 10.1007/bf02724404] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the implications of a newly defined severity scoring of empyema in children for the prediction of surgical management and to compare the length of hospitalization as an outcome measure of patients treated using medical therapy, salvage video-assisted thoracoscopic surgery (VATS) vs early elective VATS. METHODS A retrospective chart review of parapneumonic empyema of patients below 18 years of age admitted to a tertiary children's hospital in northern Taiwan from April 1993 to December 2002 was performed. Patients were categorized into a medical group who received antibiotic therapy, needle aspirations with/without tube thoracostomy; a salvage VATS group when the patients required surgery for the relief of persistent fever > 38 degrees C, chest pains or dyspneic respirations despite initial medical therapy; an early VATS group when the patients received elective surgery early after admission. The demographic data, clinical features, laboratory findings, and duration of hospitalization were compared using a severity score of empyema (SSE). RESULTS Streptococcus pneumoniae was the most common infecting organism, followed by Staphylococcus aureus, Pseudomonas aeruginosa. No organisms were recovered in 39% of patients. A pleural pH < 7.1 increases the odds of requiring surgical intervention by 6 times among this cohort. Children who required decortication of empyema had a higher severity score (mean 4.8 vs 3.0, p < 0.005). The duration of hospitalization for patients having early VATS showed a shortening stay (mean 18 vs 28 days) as compared to salvage VATS. CONCLUSION A pleural pH < 7.1 and a newly designed clinical severity score of empyema 4 are two predictors of surgical intervention for fibrinopurulent empyema in the present study. Early elective VATS may be adopted not later than 7 days after failure of appropriate antibiotic therapy and adequate drainage of empyema to decrease the length of stay and minimize morbidity.
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Affiliation(s)
- K S Wong
- Department of Pediatrics, Chang Gung Children's Hospital, Taiwan.
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Brady KM, Harris ZL, Hammer GB, Berkowitz ID, Easley RB. Lung isolation in a child with unilateral necrotizing Clostridium perfringens pneumonia. Crit Care Med 2005; 33:2676-80. [PMID: 16276197 DOI: 10.1097/01.ccm.0000186776.40271.6a] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe lung isolation and the selective application of continuous positive airway pressure using an endobronchial blocker in a patient with sickle cell disease and unilateral necrotizing Clostridium perfringens pneumonia. DESIGN Case report. SETTING Pediatric intensive care unit. PATIENT A 12-yr-old male with sickle cell disease developed persistent necrotizing pneumonia of the left lung following exchange transfusion for acute chest syndrome and hyper-hemolytic syndrome. INTERVENTIONS An endobronchial blocker was placed into the left main stem bronchus for lung isolation and application of continuous positive airway pressure to the left lung for 48 hrs. MEASUREMENTS AND MAIN RESULTS After 14 days of persistent atelectasis of the left lung despite thorascopic decortication and multiple bronchoscopies, our patient had substantial lung aeration within 48 hrs of continuous positive airway pressure applied via the endobronchial blocker. Lung resection was avoided and the patient was successfully extubated 2 days after removal of the blocker. CONCLUSIONS This case report demonstrates a therapeutic application of prolonged lung isolation and differential ventilation in a patient with an airway too small for commercially available double-lumen endotracheal tubes. The apparent success of this intervention suggests the feasibility of selective ventilation in pediatric patients and highlights a novel application of the bronchial blocker.
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Affiliation(s)
- Ken M Brady
- Department of Anesthesiology/Critical Care Medicine and Pediatrics, Johns Hopkins Hospital, Baltimore, MD, USA
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Vera Estrada M, Cols Roig M, Badosa Pagès J, Ribó Cruz J, Pou Fernández J. Abscesos pulmonares múltiples por Staphylococcus aureus en un paciente portador de port-a-cath. An Pediatr (Barc) 2005; 63:176-8. [PMID: 16045881 DOI: 10.1157/13077464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Llombart Cantó M, Chiner Vives E, Pastor Esplá E, Andreu Rodríguez AL. [Necrotizing pneumonia complicated by empyema with slow resolution]. An Pediatr (Barc) 2005; 63:79-80. [PMID: 15989878 DOI: 10.1157/13076774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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18
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Koşucu P, Ahmetoğlu A, Cay A, Imamoğlu M, Ozdemir O, Dinç H, Sarihan H, Gümele HR. Computed tomography evaluation of cavitary necrosis in complicated childhood pneumonia. ACTA ACUST UNITED AC 2005; 48:318-23. [PMID: 15344980 DOI: 10.1111/j.0004-8461.2004.01314.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of the present study was to retrospectively investigate the chest radiograph (CR) and CT findings of childhood pneumonia complicated by cavitary necrosis, and to evaluate the role of CT in decision-making for surgical intervention. Chest CT was performed in 51 patients presenting with persistent or progressive pneumonia, respiratory distress and sepsis despite 7-10 days of appropriate antibiotic treatment and closed tube drainage. Chest radiograph and CT findings were retrospectively evaluated in 23 patients (45%) with cavitary necrosis. Chest radiographs showed consolidation in 19 of 23 patients, cavitation in five patients, parapneumonic effusions in 17 patients and air-fluid levels in the pleural space in one patient. The CT scans demonstrated consolidation and cavitary necrosis in all patients. There were parapneumonic effusions in all patients with concomitant loculated collections in six patients. Twenty-two of 23 patients had pleural thickening. In seven patients there were air-fluid levels in the pleural space. In five of these patients, CT scans demonstrated bronchopleural fistulae. On the basis of the CT and clinical findings, 11 patients underwent surgical intervention. Computed tomography is superior to CR for demonstrating cavitary necrosis complicating pneumonia, and other parenchymal and pleural complications. It also has a crucial decision-making role for surgery.
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Affiliation(s)
- P Koşucu
- Department of Radiology, Faculty of Medicine, Karadeniz Technical University, Farabi Hospital, Trabzon 61080, Turkey.
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Buckingham SC, King MD, Miller ML. Incidence and etiologies of complicated parapneumonic effusions in children, 1996 to 2001. Pediatr Infect Dis J 2003; 22:499-504. [PMID: 12799505 DOI: 10.1097/01.inf.0000069764.41163.8f] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The incidence and causative organisms associated with complicated parapneumonic effusions in children with community-acquired pneumonia are likely to have changed during the past several years. METHODS Data regarding clinical and laboratory features were abstracted retrospectively from medical records of 76 subjects with complicated parapneumonic effusions at a tertiary children's hospital from 1996 through 2001. Incidence rates per 10 000 hospital discharges and per 1000 patients with nonviral pneumonia were calculated. RESULTS Etiologic organisms were Streptococcus pneumoniae (31 subjects), Staphylococcus aureus (7), Streptococcus pyogenes (5), Abiotrophia sp. (1) and no culture-confirmed agent (32). The annual incidence of complicated parapneumonic effusions per 10 000 discharges progressively increased from 4.5 in 1996 to 25.0 in 1999 (P = 0.0001), then declined to 10.1 in 2001 (P = 0.03). Similarly the incidence per 1000 cases of nonviral pneumonia increased from 2.9 in 1996 to 11.0 in 1999 (P = 0.003) and then declined to 4.8 in 2001 (P = 0.053). Whereas S. pneumoniae was the leading confirmed etiology in each year, the proportion of cases caused by Staphylococcus aureus increased from 6% in 1996 to 2000 (all of which were methicillin-susceptible) to 30% in 2001 (all methicillin-resistant; P = 0.04). CONCLUSIONS The incidence of complicated parapneumonic effusions in children with community-acquired pneumonia increased from 1996 to 1999 and then declined concomitant with the introduction of the pneumococcal conjugate vaccine. Although cases caused by S. pneumoniae have decreased, community onset methicillin-resistant Staphylococcus aureus has emerged as a cause of pneumonia with complicated effusions in children.
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Affiliation(s)
- Steven C Buckingham
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
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Klig JE. Lower respiratory infections in children. Curr Opin Pediatr 2002; 14:116-20. [PMID: 11880746 DOI: 10.1097/00008480-200202000-00021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jean E Klig
- Yale University School of Medicine, New Haven, Connecticut, USA.
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