An early thoracoscopic approach in necrotizing pneumonia in children: a report of three cases.
BACKGROUND
Cavitary necrosis remains a rare complication of bacterial pneumonia in children. Conservative medical treatment and radical surgical treatment with lung resection are the current therapeutic choices. Evaluation of thoracoscopy for this pathology has not yet been reported. We describe 3 cases.


METHODS
Between January 2001 and January 2002, 3 children (1, 2, and 3 years old) were admitted to our institution with necrotizing pneumonia. The diagnosis was based on injected computed tomography (CT) scan showing pulmonary condensation, intra-parenchymal bullae, and hypovascularization. In addition to an adapted antibiotic therapy, a thoracoscopic approach was decided on within 24 hours of diagnosis, with extensive decortication, ablation of superficial necrotic debris, irrigation, and drainage.


RESULTS
No conversion to open thoracotomy or lung resection was needed. Admission to the intensive care unit was unnecessary. On average, apyrexia was reached on postoperative day (POD) 2 and tube drainage was removed on POD 15. Mean follow-up at 16 months showed excellent lung re-expansion with no relapse.


CONCLUSIONS
On the condition that the decision is made quickly, thoracoscopy may be a valuable treatment option in childhood necrotizing pneumonia, as it hastens recovery and avoids lung resection. Injected CT scan allows an early diagnosis and we propose the first 24 hours after diagnosis as the optimal period for thoracoscopy because of the rapid natural course of lung gangrene.
Kalfa
Nicolas
N
Department of Visceral Pediatric Surgery, Lapeyronie-Arnaud de Villeneuve Hospital, 34295 Montpellier Cedex 5, France. nicolaskal@aol.com
Allal
Hossein
H
Lopez
Manuel
M
Counil
Fran Ois
FO
Forgues
Dominique
D
Guibal
Marie-Pierre
MP
Galifer
René-Benoît
RB
D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D009336:Necrosis; D018410:Pneumonia, Bacterial / Q000000981:diagnostic imaging / Q000601:surgery*; D013906:Thoracoscopy; D013908:Thoracotomy / Q000379:methods; D014057:Tomography, X-Ray Computed