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Article in Japanese

Video-assisted thoracoscopic surgery for refractory parapneumonic pleural effusion: A case report

Eiko KOIZUMI1), Yasuhiro IKAWA1), Akihiro YACHIE1)

The severity of parapneumonic pleural effusion(PPE) varies from uncomplicated PPE, which is treatable with antibiotics, to complicated PPE and empyema, which needs invasive treatment. This paper presents the case of a 13 year-old-boy with severe motor and intellectual disabilities following a car accident, who required video-assisted thoracoscopic surgery(VATS) for complicated PPE. He suffered from acute pneumonia that was treated with intravenous antibiotic infusions, but with no improvement in his symptoms. Thereafter, he was found to have pleural effusion with multiple loculations. Since an indwelling percutaneous pleural drainage tube did not result in successful effusion drainage, VATS was selected as second-line therapy. Abundant fibrinous septa, which had formed within the thoracic cavity, were removed under thoracoscopy. The lung expanded well postoperatively, and the patient was discharged without any sequelae or relapse. Fibrinolytic therapy tends to be selected for pediatric complicated PPE cases because of issues related to safety of the VATS procedure. However, due to improvements in the safety of VATS, this treatment could be first-line therapy even for pediatric complicated PPE patients.

1) Department of Pediatrics, Kanazawa University Hospital

Key words parapneumonic pleural effusion, video-assisted thoracoscopic surgery, multiple loculations
Received June 29, 2017
Accepted October 26, 2017

29 (4):351─356,2018