Open pleural decortication in a 12-day-old neonate with empyema thoracis

Introduction. Empyema thoracis, defined as the accumulation of pus in the pleural space, is rare in neonatal population. There are limited data reported in the medical literature and there are still no treatment guidelines available for this age. Case report. We present a healthy term 12-day-old neonate with sepsis caused by methicillin-resistant Staphylococcus aureus (MRSA) and pneumonia associated with advanced stage empyema. The child was admitted to our hospital with a few-hours history of difficulty breathing and lethargy. At the admission, the child was cyanotic with desaturation, in severe respiratory distress, so it was intubated and started mechanical ventilation. Imaging tests were performed in emergency, therefore chest computed tomography (CT) scan was done without contrast. Suspected congenital pulmonary airway malformation (CPAM) with trapped air collections, significant mediastinal shift on CT scan and deterioration of the patient?s condition indicated urgent surgery. Intraoperatively, the diagnosis of stage 2 empyema was established, and decortication of thickened parietal and visceral pleura was performed. Afterwards the baby showed quick and progressive clinical improvement. Conclusion. The diagnosis and management of empyema in neonates may be a challenging one, especially in the case of unremarkably history, fulminant and rapid progression of the disease and incomplete imaging tests.