Decompression of Multiple Pneumatoceles in a Premature Infant by Percutaneous Catheter Placement

Therapeutic Lung Puncture for Diffuse Unilateral Pulmonary Interstitial Emphysema in Preterm Infants

“…Lung rupture could result from puncturing the overinflated and tensioned lung parenchyma. However, neither in the reported cases [1,3,8] nor in our patients was this complication noted. In addition, CT-guided percutaneous needle lung biopsy has been reported by several authors as being a safe procedure in infants and children [12].…”

“…Surgical resection of the affected lobe or lobes has been shown to be an effective treatment for localized pulmonary interstitial emphysema when nonsurgical measures fail [10]. Finally, lung puncture with the creation of an artificial pneumothorax has been reported as a successful method in a few case reports [1,3,5,8]. We report our experience with three premature infants suffering from severe diffuse, unilateral PIE, which did not respond to conventional treatment but dramatically improved following an ipsilateral pneumothorax.…”

“…Two additional infants with severe diffuse PIE managed by artificial pneumothorax have been reported [1,10]. Why a lung puncture at a single site should prove effective in widespread emphysema remains obscure.…”

Pneumatoceles in preterm infants—incidence and outcome in the post-surfactant era

“…There have been reports of complications of pneumatoceles including, PTX and 19 Recently, there have been case reports of large or multiple pneumatoceles in infants needing interventions by surgical or percutaneous catheter-placed decompression or video-assisted thoracoscopic surgery and pig-tail catheter placement. [24][25][26][27] It is important to note that surgical intervention may have many inherent risks including the possibility of an undetected vascular malformation around the cyst and must be used only as the last resort. 28 There has also been a report of successful treatment of a large pneumatocele by selective intubation of the contra-lateral lung and treatment with high-frequency ventilation in a strategy similar to that used for severe PIE.…”

Decreasing mean airway pressure as a management strategy for tension pneumatocoeles

“…A multidisciplinary (surgery/respiratory/ENT) discussion of treatment options debated pigtail catheter placement1 but considered this inappropriate given the multiple septations and likelihood of persistent air leak. Selective intubation of the left main bronchus2 or ballooning of the right main bronchus was considered technically challenging and inappropriate given the large left-sided pneumatocoele.…”