Tension pyopneumothorax in a child: a case report

Abstract

Pneumonia is an infection of the lung parenchyma that may result in pleural thickening, effusion, or an empyema. When there is air or gas in association with purulent exudate in the pleural cavity, a pyopneumothorax exists. The progression to pyopneumothorax under tension is extremely rare. We present a case of tension pyopneumothorax in a child.

Introduction

The presentation of pneumonia is highly variable. The severity of the disease depends on such factors as patient age, time to presentation, antibiotic administration, and co-morbid conditions.

Empyema occurs when there are purulent exudates within the pleural space, which may or may not be associated with air or gas. Tension pyopneumothorax occurs when an empyema causes a pneumothorax, displacing the mediastinal organs such as the heart, lungs, and trachea. The patient deteriorates as the systemic venous return falls with the shift of the mobile mediastinum and the functional lung is compromised due to compression. Although rare at any age, this is a life-threatening condition that requires immediate needle decompression, usually in the second intercostal space at the midclavicular line, followed by an accurate thoracostomy tube placement.

We present a case of tension pyopneumothorax in a child.