Lung resection in infants and children with pulmonary infections refractory to medical therapy☆
Section snippets
Materials and methods
The charts of all patients who underwent pulmonary surgery at C.S. Mott Children's Hospital between 1975 and 1999 were reviewed. Charts of patients who had undergone resection of lung parenchyma for infectious causes were separated and reviewed in detail. Patient demographics, prior medical history, presenting complaints, preoperative evaluation, treatment, operation, and postoperative course were reviewed and follow-up and long-term results assessed.
Results
Twenty-one patients were identified who underwent pulmonary resection for infection between 1975 and 1999. This patient population included 13 boys and 8 girls with a median age of 8 years (range, 2 to 20).
Discussion
Pneumonia is a common condition and is felt to occur when defenses against infection are overcome by offending organisms. The cornerstone of treatment remains appropriate antimicrobial therapy directed against the identified or presumed microbial pathogen. Pneumonia that is resistant to medical therapy or that progresses to lung abscess is rare and requires more aggressive treatment strategies. This study shows that pulmonary infections requiring parenchymal resection are rare, with 21 cases
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Cited by (34)
Right middle lobe syndrome in a 7-year-old child
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2018, Principles and Practice of Pediatric Infectious DiseasesSurgical Management of Complicated Necrotizing Pneumonia in Children
2017, Pediatrics and NeonatologyCitation Excerpt :Most reported cases of NP have been in adults and are usually associated with staphylococcal pneumonia.5,6 In pediatric patients, the most common pathogen is S. pneumoniae, followed by S. aureus and Klebsiella pneumoniae.5,6,8 Clinically, the severity of NP is substantially influenced by the degree of inflammation, area of necrosis, time course, and degree of sepsis.
Surgical management for complications of pediatric lung injury
2015, Seminars in Pediatric SurgeryCitation Excerpt :All of the reported mortality occurred in a single series of 8 patients (5 of 8 died) with poor prognostic indicators including secondary abscesses, comorbidity, and virulent pathogens. Surgical drainage of lung abscess by segmental resection or lobectomy has been described since the 17th century and is reserved for chronic, large, thick-walled abscesses or for the few patients who do not respond to intensive antibiotic therapy and percutaneous drainage.17 Other indications include chronic abscesses lasting greater than 3 months, bronchial stenosis, bronchiectasis, pulmonary necrosis, and persistent hemoptysis causing anemia.
Middle lobe syndrome in children today
2014, Paediatric Respiratory ReviewsCitation Excerpt :Surgical removal of the middle lobe or lingula is advocated for patients with failure of the lung to re-expand accompanied by persistent symptoms after prolonged (at least 6 months), aggressive medical therapy or who have frequent relapses of lobar atelectasis and established bronchiectasis. Surgery should be also considered in patients with persistent lung infection, clinically problematic bronchiectasis or abscesses, lung scarring and fibrosis [8,45]. The surgical procedure is usually more successful if the disease is limited to the middle lobe only [46].
Infections and Diseases of the Lungs, Pleura, and Mediastinum
2012, Pediatric Surgery, 2-Volume Set: Expert Consult - Online and Print
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Address reprint requests to Arnold G. Coran, MD, 1500 E Medical Center Dr, F3970 Mott Children's Hospital, Ann Arbor, MI 48109-0245.