487 A FULL TERM INFANT WITH REPAIRED CONGENITAL HEART DISEASE AND SOLITARY RADIOLUCENT PULMONARY LESION. (1st January 2005)

• Record Type: Journal Article
• Authors: Hsing, D. D.; Baruch-Oren, T.; Epstein, D.
• Is Part Of: Journal of investigative medicine. Volume 53:Number 1(2005)
• Page Start: S163
• Page End: S163
• Publication Date: 2005-01-01
• Subjects: Clinical medicine -- Periodicals; Medicine -- Research -- Periodicals; Medicine; Research -- United States; Clinical medicine; Medicine -- Research; Periodicals; 616.075
• DOI: 10.2310/6650.2005.00005.486
• Languages: English
• ISSNs: 1081-5589

Abstract

Abstract : Our patient was a full term acyanotic infant diagnosed with Tetralogy of Fallot shortly after birth. The patient underwent complete cardiac repair at one month of age. Her post-operative course was complicated by respiratory failure and cardiac arrest requiring open chest cardiac massage and institution of emergent extra-corporeal membranous oxygenation (ECMO) therapy on post-operative day 2 (ten minutes after elective extubation). She required ECMO therapy for seven days. Throughout this time, her chest remained open and broad-spectrum antibiotic and antifungal prophylactic therapy was administered. A post-decannulation chest x-ray demonstrated significant pulmonary edema, left pleural effusion, as well as a large radiolucent lesion projecting over the left lower lobe of the lung. Chest closure in this patient remained unfeasible due to generalized edema and respiratory difficulties with evidence of progressive pulmonary lesion enlargement on chest x-ray. An echocardiogram demonstrated good biventricular function. A chest CT showed large left lower hemithorax air collection with an air fluid level and associated compression of the lung parenchyma. The patient underwent subsequent left lower lobe lobectomy in view of the above findings. The left lower lobe pathology was consistent with pneumatocele formation surrounding an area of focal lung necrosis. The culture of the left lower lobe grew Stenotrophomonas maltophilia. A delayed primary chest closure was successful six days after lobectomy. However, the patient remained in critical condition and subsequently developed multi-organ system failure despite aggressive management. She eventually expired at 3-months of age due to sepsis.