title: An early thoracoscopic approach in necrotizing pneumonia in children: a report of three cases.
abstract: 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.
authors.affiliation: Department of Visceral Pediatric Surgery, Lapeyronie-Arnaud de Villeneuve Hospital, 34295 Montpellier Cedex 5, France. nicolaskal@aol.com
authors.forename: Nicolas
authors.initials: N
authors.lastname: Kalfa
authors.forename: Hossein
authors.initials: H
authors.lastname: Allal
authors.forename: Manuel
authors.initials: M
authors.lastname: Lopez
authors.forename: Fran Ois
authors.initials: FO
authors.lastname: Counil
authors.forename: Dominique
authors.initials: D
authors.lastname: Forgues
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Guibal
authors.forename: René-Benoît
authors.initials: RB
authors.lastname: Galifer
mesh_terms: 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