Open pleural decortication in a 12-day-old neonate with empyema thoracis

Biljana Medjo; Dragana  Vujović; Marina  Atanasković-Marković; Marija  Karličić; Tijana  Radović; Dimitrije Nikolić

doi:10.2298/VSP220205096M

Biljana Medjo University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Dragana Vujović University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Marina Atanasković-Marković University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Marija Karličić University Children’s Hospital, Belgrade, Serbia
Tijana Radović University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Dimitrije Nikolić University of Belgrade, Faculty of Medicine, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP220205096M

Keywords: diagnosis, infant, newborn, empyema, pleural, sepsis, thoracic surgical procedures, tomography, x-ray computed

Abstract

Introduction. Empyema thoracis, defined as the accumulation of pus in the pleural space, is rare in the neonatal population. Limited data are reported in the medical literature, and still, no treatment guidelines are available for this age. Case report. We present a term 12-day-old neonate (born healthy) who developed sepsis caused by methicillin-resistant Staphylococcus aureus (MRSA) and pneumonia associated with advanced-stage empyema. The child was admitted to our hospital with a few-hours history of difficulty breathing and lethargy. On admission, the child was cyanotic with desaturation and in severe respiratory distress; therefore, the child was intubated, and mechanical ventilation was started. Imaging tests were performed in an emergency, hence chest computed tomography (CT) scan was done without contrast. Suspected congenital pulmonary airway malformation with trapped air collections, significant mediastinal shift on CT scan, and deterioration of the patient’s condition indicated urgent surgery. Intraoperatively, the diagnosis of stage II empyema was established, and decortication of thickened parietal and visceral pleura was performed. Afterward, the baby showed quick and progressive clinical improvement. Conclusion. The diagnosis and management of empyema in neonates may be challenging, especially in the case of unremarkable history, fulminant progression of the disease, and incomplete imaging tests.

References

1. Winnie GB, Lossef SV. Purulent Pleurisy or Empyema. In: Kliegman R, Stanton B, St Geme JW, Schor NF, Behrman RE, Nelson WE. Textbook of Paediatrics. 19th ed. Philadelphia: Saunders Elsevier; 2011. p. 1507.

2. Mazumdar J, Sen S. Neonatal empyema thoracis. J Nepal Paediatr Soc 2014; 34(1): 65–7.

3. Zapata H, Wahba A. Severe necrotizing pneumonia complicated by empyema in a neonate. Respir Med Case Rep 2020; 31: 101248.

4. Diez JRV, Perez MLM, Malayan GV Cenabre MVL. Loculated empyema in a neonate successfully treated with chest tube thoracostomy and antibiotics. Respir Med Case Rep 2020; 31: 101274.

5. Sanghvi Y, Kewlani R, Walawalkar A, Kamat N, Birajdar N. Video-Assisted Thoracoscopic Surgery (VATS) in a 20-Day-Old Newborn With Empyema Thoracis. Indian Pediatr 2021; 58(3): 284‒5.

6. Islam S, Calkins CM, Goldin AB, Chen C, Downard CD, Huang EY, et al. APSA Outcomes and Clinical Trials Committee, 2011-2012. The diagnosis and management of empyema in children: a comprehensive review from the APSA Outcomes and Clinical Trials Committee. J Pediatr Surg 2012; 47(11): 2101‒10.

7. Newman B, Caplan J. Cystic lung lesions in newborns and young children: differential considerations and imaging. Semin Ultrasound CT MR 2014; 35(6): 571‒87.

8. American Thoracic Society. Management of non tuberculous empyema. Am Rev Respir Dis 1962; 85: 935‒6.

9. Singh AP, Shukla AK, Sharma P, Shukla J. Surgical management of stage III pediatric empyema thoracis. Lung India 2018; 35(3): 209‒14.

10. Kearney SE, Davies CW, Davies RJ, Gleeson FV. Computed tomography and ultrasound in parapneumonic effusions and empyema. Clin Radiol 2000; 55(7): 542‒7.

11. Donnelly LF, Klosterman LA. CT appearance of parapneumonic effusions in children: findings are not specific for empyema. AJR Am J Roentgenol 1997; 169(1): 179‒82.

12. Jaffe A, Calder AD, Owens CM, Stanojevic S, Sonnappa S. Role of routine computed tomography in paediatric pleural empyema. Thorax 2008; 63(10): 897‒902.

13. Koga H, Suzuki K, Nishimura K, Okazaki T, Lane GJ, Inada E, et al. Traction sutures allow endoscopic staples to be used safely during thoracoscopic pulmonary lobectomy in children weighing less than 15 kg. J Laparoendosc Adv Surg Tech A 2013; 23(1): 81‒3.

14. Rothenberg SS, Kuenzler KA, Middlesworth W, Kay S, Yoder S, Shipman K, et al. Thoracoscopic lobectomy in infants less than 10 kg with prenatally diagnosed cystic lung disease. J Laparoendosc Adv Surg Tech A 2011; 21(2): 181‒4.

15. Angurana SK, Kumar R, Singh M, Verma S, Samujh R, Singhi S. Pediatric empyema thoracis: What has changed over a decade? J Trop Pediatr 2019; 65(3): 231‒9.

16. Haggie S, Gunasekera H, Pandit C, Selvadurai H, Robinson P, Fitzgerald DA. Paediatric empyema: worsening disease severity and challenges identifying patients at increased risk of repeat intervention. Arch Dis Child 2020; 105(9): 886‒90.

17. Mandal KC, Mandal G, Halder P, Mitra D, Debnath B, Bhattacharya M. Empyema Thoracis in Children: A 5-Year Experience in a Tertiary Care Institute. J Indian Assoc Pediatr Surg 2019; 24(3): 197‒202.

18. Balfour-Lynn IM, Abrahamson E, Cohen G, Hartley J, King S, Parikh D, et al. Paediatric Pleural Diseases Subcommittee of the BTS Standards of Care Committee. BTS guidelines for the management of pleural infection in children. Thorax 2005; 60(Suppl 1): i1‒21.

19. Hendaus MA, Janahi IA. Parapneumonic Effusion in Children: An Up-to-Date Review. Clin Pediatr (Phila) 2016; 55(1): 10‒8.