Management of multiple tension pneumatoceles refractory to tube thoracostomy decompression

A 10-month-old boy had multiple tension pneumatoceles develop 4 weeks after pneumonia with para-pneumonic empyema caused by methicillin-resistant Staphylococcus aureus. The pneumatoceles failed to completely respond to tube thoracostomy drainage, and sudden onset of cardiopulmonary collapse occurred after induction of anesthesia. He was rescued by multiple percutaneous venous catheter decompressions, followed by lobectomy. Our experience showed that surgery remains the definitive treatment for pediatric patients with multiple tension pneumatoceles. However, extra caution should be taken in the preoperative management of these patients, even in the presence of tube thoracostomy.