Multiple tension pneumatocele due to necrotising pneumonia

Introduction: Pneumatoceles are thin-walled cystic lesions of lung parenchyma. They may be developed after inflammation or injury. They regress after treatment of underlying disease. Necrotising pneumonia is one of the reasons. In childhood, pneumonia may cause pneumatoceles. Tension pneumatocele may be developed with respiratory and cardiovasculary collapse. Case: Four-year-old boy under treatment of stafilococcus aureus pneumonia was consulted us. Large air-filled multiple cystic lesions were detected compressing the lung. After a small catheter insertion in one of the cystic lesions, the patient got worse. Other cystic lesions were getting larger radiologically, tension was developed and lesions compressed heart also. A second catheter was inserted in the upper lesion. Respiratory symptoms were improved, mediastinal shift regressed. Discussion: Percutaneous decompression may be recommended for single symptomatic pneumatoceles while resection is recommended for symptomatic ones. Because of higher mortality and morbidity rates with surgical management, we think that multiple attempts to percutaneous decompression can be successful and should be tried first.