VIDEO-ASSISTED THORACOSCOPIC SURGERY IN A 35-DAY-OLD INFANT WITH MULTILOCULATED THORACIC EMPYEMA: CASE REPORT

Abstract

The authors report a clinical case of a 35-day-old infant with multiloculated thoracic empyema who was successfully operated on by the surgical team. The infant was transferred from a regional medical facility with fever, low-productive cough, and dyspnea. The disease had started 7 days earlier, but despite 5 days of antibiotic treatment in the hospital of his place of residence, the child’s condition continued to deteriorate, so he was transferred to the pediatric intensive care unit of our institution. After admission, a CT scan revealed massive closed fl uid collections with subpleural localization in the right hemithorax and in the projection of the anterior mediastinum associated with subtotal atelectasis of the right lung, closed pleurisy without signs of lung tissue destruction, suspicion of intrathoracic cystic lymphangioma. The patient underwent video- assisted thoracoscopic surgery, during which several purulent localized collections were identifi ed, which were opened and drained with a volume of approximately 200 ml of viscous purulent fl uid. The postoperative period was diffi cult but favorable. 6 months later, CT and scintigraphy showed some insignifi cant residual lung changes and diff use perfusion changes, confi rming the slow regression of the septic infl ammatory process of the pleural cavity after resolution. The authors conclude that the presented case highlights the diffi culties of imaging diff erential diagnosis and suggests that VATS is an eff ective and safe treatment option for infants with pleural empyema, especially in multiloculated fi brinopurulent forms, allowing a favorable outcome with a short duration of thoracostomy with tube and comparatively short recovery and hospitalization periods.