Perinatology.  2018 Dec;29(4):175-179. 10.14734/PN.2018.29.4.175.

Aggravation and Relief after Surgical Resection of Post Infectious Pneumatocele in Very Low Birth Weight Infant

• Min DE
• Choi YS
• Kim SC

• KMID: 2430221
• DOI: http://doi.org/10.14734/PN.2018.29.4.175

Abstract

Pneumatocele (PC) is a thin-walled cyst of the lung that can occur at all ages and with various etiologies. However, there is no fully accepted consensus for the management of PC in a neonatal intensive care unit. Although the management of PC is generally expectant, it is difficult to decide how long conservative management should be maintained, especially under Korea's medical care environment and the parents' worry and anxiety. We report a male neonate, born at 27⁺⁵ weeks gestation, weighing 1,000 g, who had a post infectious PC caused by methicillin-resistant Staphylococcus aureus sepsis. We treated conservatively for about 100 days (roughly 14 weeks), but unfortunately after a few days of chest retraction, acute exacerbation occurred, video assisted thoracoscopic surgery (VATS) was deemed necessary and performed. The purpose of this publication is to describe the clinical course, aggravation and relief after VATS management with a review of the literature.

Keyword

Cysts/complications; Pneumonia; Staphylococcal/complications; Methicillin-resistant Staphylococcus aureus; Premature infant

MeSH Terms

Anxiety
Consensus
Humans
Infant, Newborn
Infant, Premature
Infant, Very Low Birth Weight*
Intensive Care, Neonatal
Lung
Male
Methicillin-Resistant Staphylococcus aureus
Pneumonia
Pregnancy
Publications
Sepsis
Thoracic Surgery, Video-Assisted
Thorax

Figure

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  Fig. 1 Chest X-ray on DOL 15. A cavitary lesion in LLLF, suggested PC was identified with SIMV care with FiO2 0.3. DOL, day of life; LLLF, left lower lung field; PC, pneumatocele; SIMV, synchronized intermittent mandatory ventilation.

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  Fig. 2 CT images on DOL 53. A single, large PC was identified and the size was larger than the previous examination. CT, computed tomography; DOL, day of life; PC, pneumatocele.

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  Fig. 3 Chest X-ray on DOL 133, following 11 days of VATS management, the PC was totally removed by wedge resection and the patient was discharged. DOL, day of life; VATS, video assisted thoracoscopic surgery; PC, pneumatocele.

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  Fig. 4 Ventilator support, NIV period and flow of pCO2 (from admission to discharge). CRP, C-reactive protein; VATS, video assisted thoracoscopic surgery; SIMV, synchronized intermittent mandatory ventilation; HFO, high-frequency oscillation; NIV, non-invasive positive ventilation; RA, room air.

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