Management of pioneumotorax in a pediatric patient at a national reference hospital

Abstract

Complicated pneumonia has an important relevance in children admitted to reference hospitals at the national level, with a presentation characterized by complex bronchopulmonary and pleural lesions. When it spreads to the pleurae and an empyema occurs, the clinical course and behavior of the entity are radically modified, thus constituting a challenge for its proper management, since there is no consensus on the classification criteria, which can lead to to delayed decision- making and timely intervention. The most frequent complications include: pneumothorax, necrotizing pneumonia, empyema and bronchopleural fistula. Necrotizing pneumonia may be suspected radiologically but is usually diagnosed by computed tomography. The use of conjugate vaccines against S. pneumoniae has modified its behavior with the appearance of serotypes related to a higher frequency of suppuration. It is difficult to calculate its real incidence, but several studies suggest that its frequency has been increasing. Its diagnosis has become easier and more frequent with the availability of imaging techniques. Necrotizing pneumonia usually coexists with empyema, which has also been increasing in incidence in different parts of the world, including Latin American countries. Lung abscesses, although they are less frequent complications in pediatric community-acquired pneumonia, have also increased their incidence. Treatment includes intravenous antibiotics, chest tube placement, intrapleural fibrinolytic, minimally invasive thoracotomy, video-assisted thoracoscopic surgery (VATS), and, rarely, open decortication.