Lung abscess versus necrotizing pneumonia: implications for interventional therapy
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F A Hoffer1, D A Bloom, A A Colin
1Department of Radiology, Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Insights
Interventional therapy is effective for lung abscesses in children, aiding diagnosis and treatment. However, it can be harmful for post-infectious necrotizing pneumonia, highlighting distinct management approaches.
Area of Science:
- Pediatric Pulmonology
- Interventional Radiology
- Infectious Diseases
Background:
- Cavitating lung conditions like lung abscess and necrotizing pneumonia require distinct therapeutic strategies.
- Understanding the role of interventional therapy in these pediatric conditions is crucial for optimal patient outcomes.
Observation:
- A retrospective review of 14 children with lung abscess and 9 with necrotizing pneumonia was conducted.
- Interventional procedures included percutaneous aspiration, catheter drainage, and pleural drainage.
- Antibiotic therapy preceded all interventions.
Findings:
- Lung abscesses showed positive microbial identification and responded well to intervention, with rapid defervescence and no bronchopleural fistulas.
- Necrotizing pneumonia cases, often post-infectious, had limited microbial yield and were associated with complications like pneumatoceles and bronchopleural fistulas following intervention.
Implications:
- Aggressive interventional therapy is beneficial for diagnosing and treating pediatric lung abscesses.
- Interventional therapy may pose risks and is potentially harmful in cases of post-infectious necrotizing pneumonia.
Objective:
To assess and contrast the role of interventional therapy for two types of cavitating pneumonias: lung abscess and necrotizing pneumonia.
Materials And Methods:
We retrospectively reviewed the imaging, interventional therapy, and outcome of 14 children seen between February 1987 and January 1996 with lung abscess and 9 with necrotizing pneumonia. All children were treated with antibiotics prior to intervention. Pulmonary parenchymal fluid was percutaneously aspirated from ten lung abscesses and three necrotizing pneumonias. Percutaneous catheters drained five lung abscesses. Pleural drainage was performed for three lung abscesses and eight necrotizing pneumonias.
Results:
All 14 children with lung abscesses had positive Gram stains of the pulmonary fluid; 13 cultures were positive. All 14 defervesced within 48 h of intervention. None developed a bronchopleural fistula. All nine necrotizing pneumonias were presumed to be sequelae of prior pneumonia. Streptococcus pneumoniae was the only organism as documented by pleural fluid latex fixation in three patients, gram stain in two, and culture in only one. Seven of these children developed pneumatoceles, five developed bronchopleural fistulae, and three required long-term chest tubes for persistent pneumothoraces.
Conclusion:
Aggressive interventional therapy can be diagnostic and therapeutic in the infected lung abscess. Interventional therapy can be harmful in postinfectious necrotizing pneumonia.
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