Abstract A 45 day old female presented to the outpatient pulmonary hypertension clinic for routine follow-up upon discharge from the neonatal intensive care unit. She was born at 36 weeks gestation and had a perinatal course complicated by no prenatal care, precipitous delivery with chorioamnionitis, maternal substance abuse, HIE requiring cooling, pulmonary hypertension requiring VA ECMO, e. coli bacteremia, cholestasis, thrombocytopenia and a pneumatocele that was resolving at time of discharge. She was discharged from the NICU on 0.1 lpm NC support, as well as NG tube feeds via PO/gavage. Upon presentation to multidisciplinary PH clinic, she was well-appearing on baseline 0.1 lpm NC oxygen. Physical exam was grossly unremarkable with normal bilateral breath sounds. While in clinic, her NG tube was replaced. Following replacement, abdominal x-ray to confirm placement showed interval increase in the previously noted pneumatocele. Subsequently, a chest Xray demonstrated significant increase in size of large right pneumatocele with leftward midline shift. At that time, she was admitted to the inpatient pulmonary service for further workup of the pneumatocele. During her course of admission, her work of breathing was grossly normal. She did have an episode of tachypnea following a feed, due to which PO trials were stopped. Additionally, oxygen support was increased to 0.2 lpm NC. CT angiogram while admitted demonstrated multilobulated air filled cystic lesion with left ventricular outflow tract and superior vena cava compression. Due to concern for the aforementioned compression, surgical team performed a right video assisted thoracoscopy with pleural adhesiolysis and marsupialized the pneumatocele. The patient required placement of a chest tube. After a prolonged period of persistent enlargement of the pneumatocele, a second chest tube was placed. Eventually, the pneumatocele size stabilized, chest tubes were removed, and patient was weaned to her baseline oxygen requirement. Given the concern for tachypnea earlier in her course, she underwent a repeat swallow study which demonstrated no aspiration prior to discharge. On follow-up, repeat imaging showed that the pneumatocele was stable. She remained well without tachypnea, retractions, hypoxemia, or respiratory distress on follow-up. A pneumatocele is an acquired, air filled cystic lesion of the lung (most often due to infection or ventilator injury) and is more common in those born premature. Optimal management is primarily conservative, with intervention reserved for complications from mass effect or failure of resolution. This case highlights the potential for pneumatocele enlargement after apparent stabilization and underscores the importance of surveillance. This abstract is funded by: None
Ellington et al. (Fri,) studied this question.