Successful treatment of post-infectious pneumatocele via percutaneous drainage in a premature infant

Pneumatoceles are air-filled cysts within the lung parenchyma that can have a connection to the bronchial tree. These are often seen following severe lung infections mainly with Staphylococcus aureus (S. aureus). Currently there is no consensus on management of these lesions. We present the case of a premature 28 weeks gestational age male infant, born at an outside hospital, requiring intubation shortly after birth for respiratory distress, who during the first week of life developed a S. aureus pneumonia. He was treated with a three-week course of Nafcillin but on day of life (DOL) 13, chest radiographs (CXR) demonstrated the presence of a right upper lobe pneumatocele. Despite treatment of the pneumonia, the pneumatocele persisted. It steadily enlarged and progressed to an acute tension physiology presentation. Despite supportive care with maximal ventilatory support, the clinical condition deteriorated which led to a decision for surgical intervention. Because of the extremely high mortality risk associated with a formal lung resection in this premature infant, a percutaneous drain was placed at the bedside on DOL76. The drain remained in place until DOL106 when complete resolution of the pneumatocele prompted removal of the tube. During the prolonged course that the drain was in place, there were intermittent air leaks as well as pneumatocele expansion episodes that prompted intermittent suction. Based on our limited experience, single percutaneous chest tube drainage is a viable option for treatment of large post-infectious pneumatocele in preterm infants.