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90th Annual Meeting Abstracts

High Incidence of Pneumatoceles After Thoracoscopic Treatment of Empyema in Children
*Carmelle Romain, MD, *Abigail E Martin, MD, *Christopher S Muratore, MD, Francois I Luks
Brown Medical School, Providence, RI

Objective:The use of video-assisted thorascopic surgery (VATS) in the treatment of empyema is now the standard of care where those resources are accessible. Long-term outcome is generally excellent, but the short-term clinical and radiographic course have not been well described. We examined the incidence of abnormal post-operative radiographic images, their clinical correlation and their natural history.
Design:Retrospective study.
Setting:Tertiary children’s hospital.
Patients:All infants and children who underwent VATS for the treatment of empyema in the last 8 years.
Interventions:VATS procedure for empyema.
Main Outcome Measures:We recorded the following parameters: Age, leukocytosis and temperature curves (at admission, 24 h preoperatively, postoperatively and at discharge), length of hospitalization (LOS) and interim radiographic imaging.
Results:Thirty-four VATS procedures were performed. Thoracoscopy was performed within 1-6 days of admission (median 2.5 days). Median postoperative LOS was 7.0 days. Within 24 h of their operation, 15/26 (58%) showed radiographic improvement (decreased size of the effusion and/or partial resolution of airspace disease). Within 1-3 weeks postoperatively, 35%of the patients showed radiographic evidence of pneumatocele formation. Half of these were qualified as large and/or complex (mediastinal shift, air-fluid level). One patient developed respiratory distress on postoperative day 6 from a ruptured pneumatocele. All others remained asymptomatic. They were followed by serial chest radiographs and subsequently showed radiographic resolution without surgical or medical re-intervention.
Conclusions:Following pneumonia-associated empyema and VATS, there is a high incidence of abnormal radiographic findings that persist, and even worsen, after discharge. Our data suggests that even for the large pneumatoceles, that develop in one-third of patients, long-term surveillance may suffice and that spontaneous resolution of these pulmonary abnormalities can be expected.


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