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Role of lung decortication in symptomatic empyemas in children
R A Gustafson1, G F Murray, H E Warden
1Department of Surgery, West Virginia University School of Medicine, Morgantown.
Insights
Lung decortication effectively treated pediatric empyema when conservative methods failed. This surgical intervention freed trapped lungs, leading to significant clinical improvement in children with refractory empyema.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Infectious Diseases
Background:
- Empyema in children can be refractory to standard antibiotic and drainage treatments.
- Delayed or inadequate initial management may contribute to treatment failure.
Purpose of the Study:
- To evaluate the efficacy of lung decortication for pediatric empyema unresponsive to conservative therapy.
- To identify factors contributing to treatment failure in pediatric empyema.
Main Methods:
- Retrospective analysis of 10 children (2-16 years) undergoing lung decortication for symptomatic empyema.
- Review of initial chest computed tomographic scans and clinical data.
- Surgical removal of pleural peel and, in two cases, lobectomy for necrotic lung tissue.
Main Results:
- Lung decortication led to marked clinical improvement in all 10 patients.
- Temperature, white blood cell count, and appetite normalized post-surgery.
- Minimal postoperative morbidity was observed.
Conclusions:
- Lung decortication is a safe and effective treatment for refractory pediatric empyema.
- Inadequate or delayed initial management, particularly pleural drainage, may lead to treatment failure.
- Surgical intervention is crucial for trapped lungs in pediatric empyema.
Abstract:
Despite appropriate antibiotics and pleural drainage, the condition of some children with empyema fails to improve. In a 5-year period, 10 children ranging in age from 2 to 16 years underwent lung decortication for a refractory, symptomatic empyema, which had developed 3 to 5 weeks after an initial pneumonic infiltrate. Responsible organisms included beta-hemolytic streptococci, Haemophilus influenzae, or Streptococcus pneumoniae in 6 children. Negative cultures were found in 4 children. The initial computed tomographic scan of the chest in 4 of 8 patients showed more than 75% limitation of lung expansion by the contents of the empyema cavity. In 4 other patients, an extensive pleural peel was seen on initial computed tomographic scan of the chest. Several studies also showed cystic lesions in the collapsed lung. Multiple computed tomographic scans in 3 patients confirmed the lack of clinical and chest roentgenographic improvement with conservative therapy. At decortication in each, the visceral and parietal pleural peel was completely removed, freeing the trapped lung. Two patients also had a concomitant lobectomy for a necrotic right upper lobe (1 patient) and left lower lobe (1). Clinical improvement was marked, with return of temperature, white blood cell count, and appetite to normal. Postoperative morbidity was minimal. Analysis of these patients in whom traditional conservative therapy failed suggested that the initial management during the early exudative phase was often delayed and was not aggressive enough from the standpoint of pleural drainage.(ABSTRACT TRUNCATED AT 250 WORDS)