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The Annals of Thoracic Surgery, Vol 49, 940-946, Copyright © 1990 by The Society of Thoracic Surgeons
RA Gustafson, GF Murray, HE Warden and RC Hill
Despite appropriate antibiotics and pleural drainage, the condition of some
children with empyema fails to improve. In a 5-year period, 10 children
ranging in age from 2 to 16 years underwent lung decortication for a
refractory, symptomatic empyema, which had developed 3 to 5 weeks after an
initial pneumonic infiltrate. Responsible organisms included beta-hemolytic
streptococci, Haemophilus influenzae, or Streptococcus pneumoniae in 6
children. Negative cultures were found in 4 children. The initial computed
tomographic scan of the chest in 4 of 8 patients showed more than 75%
limitation of lung expansion by the contents of the empyema cavity. In 4
other patients, an extensive pleural peel was seen on initial computed
tomographic scan of the chest. Several studies also showed cystic lesions
in the collapsed lung. Multiple computed tomographic scans in 3 patients
confirmed the lack of clinical and chest roentgenographic improvement with
conservative therapy. At decortication in each, the visceral and parietal
pleural peel was completely removed, freeing the trapped lung. Two patients
also had a concomitant lobectomy for a necrotic right upper lobe (1
patient) and left lower lobe (1). Clinical improvement was marked, with
return of temperature, white blood cell count, and appetite to normal.
Postoperative morbidity was minimal. Analysis of these patients in whom
traditional conservative therapy failed suggested that the initial
management during the early exudative phase was often delayed and was not
aggressive enough from the standpoint of pleural drainage.(ABSTRACT
TRUNCATED AT 250 WORDS)
ARTICLES
Role of lung decortication in symptomatic empyemas in children
Department of Surgery, West Virginia University School of Medicine, Morgantown.
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