Pediatric empyema thoracis: roles and outcomes of surgery in advanced disease

The role of the early video-assisted thoracoscopic surgery in children with pleural empyema

PURPOSE

Pleural empyema (PE) is a collection of purulent material in the pleural space. PE's management in children is a challenge and an inappropriate diagnostic-therapeutic work up can lead to serious short and long-term complications. The aim of this study is to define the correct timing to approach a pediatric PE by video-assisted thoracoscopic surgery (VATS).

METHODS

A retrospective observational study was conducted including pediatric patients who underwent video-assisted thoracoscopy for pleural empyema between May 2005 and September 2022.

RESULTS

62 patients were subjected to VATS for PE (32 in Group Early VATS, 30 in Group Late VATS). It emerged that the elapsed period between the onset of symptoms and surgery correlates in a statistically significant way with the post-operative stay in intensive care (z score 4.3 and p value < 0.0001) and the analysis between early VATS, late VATS and postoperative hospitalization showed a statistically significant reduction of the post-operative hospitalization in the early VATS groups (p value < 0.02).

CONCLUSIONS

VATS resulted to be safe and effective for the treatment of PE in children, and an early minimally invasive thoracoscopic intervention (early VATS) correlates with better outcomes, specifically in terms of intensive care hospitalization and overall hospitalization.

A rare case of multiloculated thoracic empyema in a neonate

Thoracic empyema, defined as the accumulation of pus in the pleural space, is a rare cause of respiratory distress in neonates. Its occurrence in neonate patients has been only described in few literatures, as opposed to cases in older children. Even though the diagnosis of thoracic empyema is confirmed by histopathological examination of pleural fluid, radiographic examinations have important roles in helping clinicians narrowing down the differential diagnoses. This case report describes a neonatal patient who exhibited symptoms of respiratory distress and imaging modalities revealed multiloculated thoracic empyema.