Abstract
Pulmonary abscesses are uncommon in infants and usually resolve under intravenous antimicrobial therapy. Surgery is needed in some cases. Percutaneous drainage under ultrasound guidance avoids the intra- and postoperative complications of open surgery. A 13-month-old girl with an unremarkable medical past was admitted for a 15-day history of fever to 40 degrees C despite cefuroxime therapy, sweats, chills, a dry cough, tachypnea, and subcostal recession without cyanosis. The heart rate was 180 bpm, blood pressure was 120/70 mmHg, and SaO(2) was 90% while breathing room air. The breath sounds were asymmetric. A chest radiograph showed pneumonia of the upper right lobe. The white blood cell count was 30 300/mm(3), the serum fibrinogen level was 8.9 g/L, and the serum C-reactive protein level was 240 mg/L. Amoxicillin with clavulanic acid was given intravenously in combination with spiramycin for eight days. The clinical manifestations persisted and chest radiographs showed a cavity in the right upper lobe and fluid in the right pleural cavity. The treatment was changed to a combination of cefotaxime, fosfomycin, and metronidazole. Fiberoptic bronchoscopy disclosed complete stenosis of the Fight apicoposterior segmental bronchus. A computed tomography scan of the chest demonstrated an air-fluid level in a cavitated image occupying the entire right upper lobe. Percutaneous drainage of the cavity under ultrasound guidance recovered 85 mi of green-yellowish fluid. Cultures were negative. Clinical, laboratory test, and radiographic findings improved substantially after the change in antimicrobial therapy. Six months later the patient was doing well and had a normal chest radiograph. Most pulmonary abscesses resolve under intravenous antimicrobial therapy. In the few cases that fail to respond to this approach, percutaneous drainage avoids the complications associated with thoracotomy.