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Case Reports
. 2015 Jul;30(4):299-302.
doi: 10.5001/omj.2015.59.

Two Cases of Pneumatoceles in Mechanically Ventilated Infants

Mohammed Al-Ghafri  1 , Said Al-Hanshi  1 , Suad Al-Ismaily  1
Affiliations
Case Reports

Two Cases of Pneumatoceles in Mechanically Ventilated Infants

Mohammed Al-Ghafri et al. Oman Med J. 2015 Jul.

Abstract

Pulmonary pneumatocele is a thin-walled, gas-filled space within the lung that usually occurs in association with bacterial pneumonia and is usually transient. The majority of pneumatoceles resolve spontaneously without active intervention, but in some cases they might lead to pneumothorax with subsequent hemodynamic instability. We report two cases presented to the pediatric intensive care unit at the Royal Hospital, Oman with pneumatoceles. The first was a 14-day-old baby who underwent surgical repair of total anomalous pulmonary venous connection (TAPVC) requiring extracorporeal membrane oxygenation (ECMO) support following surgery. He was initially on conventional mechanical ventilation. Seven days after the surgery, he started to develop bilateral pneumatoceles. The pneumatoceles were not regressing and they did not respond to three weeks of conservative management with high-frequency oscillation ventilation (HFOV). He failed four attempts of weaning from HFOV to conventional ventilation. Each time he was developing tachypnea and carbon dioxide retention. Percutaneous intercostal chest drain (ICD) insertion was needed to evacuate one large pneumatocele. Subsequently, he improved and we were able to wean and extubate him. The second case was a two-month-old male admitted with severe respiratory distress secondary to respiratory syncytial virus (RSV) pneumonitis. After intubation, he required a high conventional ventilation setting and within 24 hours he was on HFOV. Conservative management with HFOV was sufficient to treat the pneumatoceles and no further intervention was needed. Our cases demonstrate two different approaches in the management of pneumatoceles in mechanically ventilated children. Each approach was case dependent and could not be used interchangeably.

Keywords: Cardiopulmonary Bypass; Extracorporeal Membrane Oxygenation; High Frequency Oscillation Ventilation; Respiratory Syncytial Virus.

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Figures

Figure 1
Figure 1
Chest radiograph of a 14-day-old baby (case one)immediately following cardiac surgery showed no evidence of pneumatoceles.
Figure 2
Figure 2
Chest radiograph of a 14-day-old baby (case one) showing bilateral pneumatoceles.
Figure 3
Figure 3
Right sided pneumatocele was visible by chest radiograph (case two).
See this image and copyright information in PMC

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