Lung necrosectomy in pediatric patients with necrotizing pneumonia

Abstract

Necrotizing pneumonia is a complication of bacterial pneumonia, resulting in consolidation of lung parenchyma with necrosis, solitary or multiloculated radiolucent foci. When the clinical course worsen in spite of proper antibiotic treatment, patients might need lung tissue resection: segmentectomy, lobectomy or bilobectomy. We have performed a conservative surgical approach in pediatric patients with necrotizing pneumonia, lung necrosectomy: resection of unviable necrotic tissue, in order to preserve more healthy and potentially recoverable lung parenchyma.

We present the results of our experience with lung necrosectomy.

Methods: Retrospective review of children with necrotizing pneumonia. The diagnosis was based on physical examination, laboratory data and contrast CT. Lung necrosectomy technique: resection of necrotic tissue with careful debridement; air leaks were sutured and/or tissue imbrication.

Results: From January 2006 to December 2018, 425 pediatric patients were admitted with the diagnosis of complicated pneumonia. Forty two (9.9%), 17 (40.47%) boys and 25 (59.52%) girls were treated surgically. All the patients presented productive cough, fever and dyspnea; chest x-rays showed consolidated areas with intraparenchymal cavities and hypoperfusion on the contrasted CT. Surgical treatment included: Lung necrosectomy 24 (57%); lobectomy 3 (7.14%); wedge resection 13 (30.95%); lobectomy + lung necrosectomy 1 (2.38%), and wedge resection + lung necrosectomy 1 (2.38%).

Conclusions: Lung necrosectomy is a conservative, effective surgical treatment, which solves lung necrotizing infection avoiding resection of healthy lung parenchyma.