Non-Surgical Management of a Large Pulmonary Abscess in a Pediatric Patient: A Case Report

Background: Lung abscess is a complication of pneumonia that represents a cavity filled with purulent content in the lung parenchyma, resulting from its destruction. Not infrequently, this condition is complicated by persistent air leak (PAL), which further complicates the course of the disease.

Case Description: We present a clinical case of a two-year-old child with a lung abscess with minimal pleural reaction. Targeted drainage of the cavity was performed, which achieved adequate sanitation. After drainage, bronchoscopic obstruction of the left lower lung lobe was performed due to PAL. The obturation was performed with a pre-molded bronchial blocker for a period of 30 days. Its placement and extraction were performed via rigid bronchoscopy. The air leak ceased during the intervention itself, which was verified by monitoring the underwater drainage system.

Conclusions: The combination of these two methods allows for complete lung healing without the need of resection surgery. Targeted drainage of the abscess cavity facilitates evacuation of the purulent collection, while bronchoscopic occlusion addresses the persistent air leak and allows for prolonged pleural lavage.