Pneumatocele in Infants and Children

Abstract

Pneumatoceles were found in 2.4 per cent of 493 infants and children with pneumonia. In all cases, attempts were made to establish the etiology by means of blood cultures and of deep tracheal aspirations or pleural punctures, when indicated. A definite cause was established in 9 of 12 cases. Seven were due to infection: in two Hemophilus influenzae was involved; two others were due to Pseudomonas aeruginosa; and Staphylococcus aureus, Klebsiella pneumoniae, and Streptococcus pneumoniae were each isolated in one case. Two pneumatoceles were seen following kerosene ingestion. A coagulase negative staphylococcus isolated only on blood culture in one other child may have been related to the illness. Two patients experienced spontaneous pneumothorax and died of progressive respiratory failure due to enlargement of the pneumatocele, but all the other patients recovered without complication. Pneumatoceles in childhood can result from a variety of bacterologic infections as well as from kerosene ingestion.

Pneumatoceles in preterm infants—incidence and outcome in the post-surfactant era

“…17,18 A combination of these factors may lead to damaged epithelial lining of the lung causing a focal area of inflammation, which in some cases may lead to a checkvalve type airway obstruction, air-trapping, and pseudocyst formation. 17,19 Areas of lung most susceptible to such injury in an infant are the lower lobes and based on their anatomic location, the right middle and right lower lobes receive the brunt of this effect. The consistent finding of this lesion in the right lung in all studies heretofore lends credence to this pathophysiology.…”

“…12,13,22,23 Our findings were similar in that, all the surviving infants had complete resolution of pneumatoceles after a reduction in ventilator mean airway pressure or extubation. There have been reports of complications of pneumatoceles including, PTX and 19 Recently, there have been case reports of large or multiple pneumatoceles in infants needing interventions by surgical or percutaneous catheter-placed decompression or video-assisted thoracoscopic surgery and pig-tail catheter placement. [24][25][26][27] It is important to note that surgical intervention may have many inherent risks including the possibility of an undetected vascular malformation around the cyst and must be used only as the last resort.…”

Incomplete Treatment of Neonatal Pneumonia Causing Giant Pneumatocele in a 45-Day Infant

“…The differential diagnosis of a cystic pulmonary lesion includes congenital and acquired conditions such as pulmonary sequestration, bronchogenic cyst, congenital lobar emphysema, congenital cystic adenomatoid malformation, aspiration or bacterial pneumonia with cavitation and Wilson-Mikity syndrome [5]. They are generally observed on the fifth to sixth day of pneumonia, rarely on the initial chest radiograph [6] and they usually subside spontaneously and without sequelae after a few weeks alongside the pneumonic process [3,6,7]. Rarely, they may result in complications such as tension, infection, and rupture (pneumothorax) which may be life-threatening.…”

“…The incidence of the formation of pneumatocele ranges from 2% to 8% of all cases of pneumonia in children with incidence up to 85% in Staphylococcus aureus pneumonias [2,3]. Formation of pneumatocele also occurs with other agents, including Streptococcus pneumoniae, Haemophilus influenzae, Escherichia coli, group A streptococci, Serratia marcescens, Klebsiella pneumoniae, adenovirus, and tuberculosis alongside with Klebsiella pneumonia and Pseudomonas aeruginosa [5,6]. Two massive tension pneumatoceles were developed while on treatment for post-pneumonic empyema due to Enterobacter gergoviae pneumonia in a 3-month-old Nigerian male [1].…”

“…Two massive tension pneumatoceles were developed while on treatment for post-pneumonic empyema due to Enterobacter gergoviae pneumonia in a 3-month-old Nigerian male [1]. Some cases of post-infectious pneumatocele do not have a definite cause [6]. Non-infectious etiologies of pneumatoceles include the following: trauma, hydrocarbon ingestion, and positive pressure ventilation (especially among premature infants).…”