Percutaneous Drainage of Pediatric Pulmonary Abscesses: An Effective Therapy

• Published in: Journal of pediatric surgery 2024-09, Vol.59 (9), p.1725-1729
• Main Authors: Baker, Joe B., Balu, Abhinav R., Rajeswaran, Shankar, Patel, Sameer J., Goldstein, Seth D., Donaldson, James S.
• Format: Article
• Language: English
• Subjects: Adolescent; Antibiotic therapy; Bronchopleural fistula; Child; Child, Preschool; Drainage - methods; Female; Humans; Infant; Interventional radiology; Length of Stay - statistics & numerical data; Lung Abscess - surgery; Lung Abscess - therapy; Male; Percutaneous drainage; Pulmonary abscess; Retrospective Studies; Treatment Outcome
• ISSN: 0022-3468; 1531-5037; 1531-5037
• DOI: 10.1016/j.jpedsurg.2024.04.024

Pulmonary abscess is a complication of lung infection with localized necrosis and purulent cavity formation. Pulmonary abscesses are typically managed using antibiotic therapy with anatomic surgical resection reserved as a rescue. Percutaneous drainage is considered relatively contraindicated in some centers due to perceived risk of bronchopleural fistula. However, drain placement has been frequently employed at our institution. The purpose of this study was to review and describe our longitudinal experience. Medical records of children diagnosed with lung abscess and treated with percutaneous drainage from 2005 through 2023 were reviewed. Patient clinical parameters, follow-up imaging, and clinical outcomes were evaluated. Percutaneous drainage (n = 24) or aspiration alone (n = 4) under imaging guidance was performed by interventional radiologists for 28 children with lung abscesses. A single catheter (8–12 Fr) was deployed in the pulmonary abscess cavity and remained for a median of 6 days (IQR: 6–8 days). The median hospital stay was 10 days (IQR: 8.8–14.8 days). The technical success rate for percutaneous drainage or aspiration of primary pulmonary abscesses was 100% (26/26). Two children were later diagnosed with secondarily infected congenital pulmonary airway malformations that were both successfully drained and ultimately surgically resected. The abscess cavities resolved in all patients and catheters were removed upon clinical, radiographic, and laboratory improvement. Complications included the presence of two bronchopleural fistula, both of which were treated with immediate pleural drain placement. Percutaneous drainage of pulmonary abscesses is an effective therapeutic option in children and can be considered alongside antibiotics as part of the initial treatment for pulmonary abscesses. Bronchopleural fistula can occur, but at a lower frequency than previously reported. Level V.