Necrotizing Pneumonia 9292010 4 yo Girl n n

Necrotizing Pneumonia 9_29_2010

4 yo Girl n n Otherwise healthy girl saw her primary physician in Oct. 2009 Fever, cough, fatigue Elevated WBC with left shift Normal O 2 sats

CXR 10/14/09 ØConsolidation RLL ØSmall effusion ØVery little V/Q mismatch as O 2 sats are 100%

4 yo Girl n n n Admitted for IV antibiotics Due to continued fevers a CT scan was obtained Ct scan 10/18/09 ØComplete opacification of right lung ØLarge right pleural effusion ØPockets of gas within consolidated lung ØConsistent with necrotizing pneumonia ØPatchy consolidation and atelectasis in LLL

CXR 10/19/09 4 yo Girl Ø Ø Ø Chest tube placed No organism recovered Sent home after 10 days in the hospital to complete 2 more weeks of IV therapy ØHeterogeneous consolidation of the right lung ØLarge right pleural effusion

4 yo Girl – one month later CXR 11/12/09 Ø Ø Lateral – positive spine sign. Overall CXR improved Patient doing well clinically

4 yo Girl – two months later CT scan 12/17/09 Ø Ø Ø Follow up CT scan Multi-locular cavities with parenchymal thickening and scarring No systemic blood supply – no concern for sequestration Consistent with resolving necrotizing pneumonia

4 yo Girl – 7 months later CXR 5/2010 ØSmall infiltrate RML ØOverall improved ØNo pneumatocele Consistent with natural progression of necrotizing pneumonia

4 yo Girl – 9 months later CXR 7/2010 ØIncreased markings RLL ØConsistent with natural progression

4 yo Girl – 9 months later ØResolving pneumonia ØParenchymal tissue present within cysts ØResidual scarring ØNo bronchiectasis n Child is doing well clinically and has no limitations.

Clinical Pearl n It can take up to 1 year for a necrotizing pneumonia to clear completely on CXR