Percutaneous drainage of pulmonary abscesses in infants. Report of a case

Pulmonary abscesses are uncommon in infants and usually resolve under intra venous antimicrobial therapy. Surgery is needed in some cases. Percutaneous drainage under ultrasound guidance avoids the intra- and postoperative com plications of open surgery. A 13-month-old girl with an unremarkable medica l past was admitted for a 15-day history of fever to 40 degrees C despite c efuroxime therapy, sweats, chills, a dry cough, tachypnea, and subcostal re cession without cyanosis. The heart rate was 180 bpm, blood pressure was 12 0/70 mmHg, and SaO(2) was 90% while breathing room air. The breath sounds w ere asymmetric. A chest radiograph showed pneumonia of the upper right lobe . The white blood cell count was 30 300/mm(3), the serum fibrinogen level w as 8.9 g/L, and the serum C-reactive protein level was 240 mg/L. Amoxicilli n with clavulanic acid was given intravenously in combination with spiramyc in for eight days. The clinical manifestations persisted and chest radiogra phs showed a cavity in the right upper lobe and fluid in the right pleural cavity. The treatment was changed to a combination of cefotaxime, fosfomyci n, and metronidazole. Fiberoptic bronchoscopy disclosed complete stenosis o f the Fight apicoposterior segmental bronchus. A computed tomography scan o f the chest demonstrated an air-fluid level in a cavitated image occupying the entire right upper lobe. Percutaneous drainage of the cavity under ultr asound guidance recovered 85 mi of green-yellowish fluid. Cultures were neg ative. Clinical, laboratory test, and radiographic findings improved substa ntially after the change in antimicrobial therapy. Six months later the pat ient was doing well and had a normal chest radiograph. Most pulmonary absce sses resolve under intravenous antimicrobial therapy. In the few cases that fail to respond to this approach, percutaneous drainage avoids the complic ations associated with thoracotomy.