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Pediatr Radiol 2021 May 12. Epub 2021 May 12.

Department of Radiology, Boston Children's Hospital, Harvard University, Boston, MA, USA.

In addition to radiography, ultrasound (US) has long proved to be a valuable imaging modality to evaluate the pediatric lung and pleural cavity. Its many inherent advantages, including real-time performance, high spatial resolution, lack of ionizing radiation and lack of need for sedation make it preferable over other imaging modalities such as CT. Since the introduction of ultrasound contrast agents (UCAs), contrast-enhanced ultrasound (CEUS) has become a valuable complementary US technique, with many well-established uses in adults and evolving uses in children. Read More

Pediatrics 2021 May;147(5)

Feinberg School of Medicine, Northwestern University, Chicago, Illinois;

Objectives: Validated prognostic tools for pediatric community-acquired pneumonia (CAP) do not exist. Thus, clinicians rely on "gestalt" in management decisions for children with CAP. We sought to determine the ability of clinician gestalt to predict severe outcomes. Read More

Radiol Case Rep 2021 May 24;16(5):1061-1064. Epub 2021 Feb 24.

Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia.

Empyema thoracis (ET) is defined as pus in the pleural space, either localized or involving the entire pleural cavity, due to diverse etiologies. In severe form, it may infiltrate the extrapulmonary region. Clinical guideline describes 3 stages of parapneumonic effusion before developing into an ET, namely the exudative stage, the fibrinopurulent stage, and the organizing/late stage. Read More

Crit Care 2021 02 18;25(1):72. Epub 2021 Feb 18.

Médecine Intensive Réanimation, Centre Hospitalier Départemental de Vendee, Les Oudairies, 85000, La Roche-Sur-Yon, France.

Background: The COVID-19 pandemic is responsible for many hospitalizations in intensive care units (ICU), with widespread use of invasive mechanical ventilation (IMV) which exposes patients to the risk of ventilator-associated pneumonia (VAP). The characteristics of VAP in COVID-19 patients remain unclear.

Methods: We retrospectively collected data on all patients hospitalized for COVID-19 during the first phase of the epidemic in one of the seven ICUs of the Pays-de-Loire region (North-West France) and who were on invasive mechanical ventilation for more than 48 h. Read More

Hosp Pediatr 2021 Mar 12;11(3):207-214. Epub 2021 Feb 12.

Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts;

Objectives: To assess the characteristics of children hospitalized with complicated pneumonia at US children's hospitals and compare these characteristics with those of children hospitalized with community-acquired pneumonia (CAP).

Methods: We identified children hospitalized with complicated pneumonia (parapneumonic effusion, empyema, necrotizing pneumonia, or lung abscess) or CAP across 34 hospitals between 2011 and 2019. We evaluated differences in patient characteristics, antibiotic selection, and outcomes between children with complicated pneumonia and CAP. Read More

Clin J Gastroenterol 2021 Apr 1;14(2):422-426. Epub 2021 Feb 1.

Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.

The patient was a 44-year-old man with a history of schizophrenia. He had a history of esophageal dysphagia and vomiting and presented with sudden strong epigastric pain. He was taken to a medical emergency center in a state of septic shock. Read More

Proc (Bayl Univ Med Cent) 2020 Oct 16;34(1):131-132. Epub 2020 Oct 16.

Department of Pulmonary and Critical Care Medicine, State University of New York Upstate Medical University, Syracuse, New York.

Image-guided cryoablation has low procedure-related morbidity and mortality rates, with the complications usually being self-limiting. The most common complications include pneumothorax, hemoptysis, pleural effusion, cough, phrenic nerve injury, and tumor implantation. Bronchopleural or bronchocutaneous fistula formation is a rare but severe complication of lung cancer ablation. Read More

Lung India 2021 Jan-Feb;38(1):80-83

Department of Pulmonary and Critical Care Medicine, Medeor JCS Institute of Pulmonary, Critical Care and Sleep Medicine, New Delhi, India.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is commonly recommended for the diagnosis of mediastinal lymphadenopathy with malignant and nonmalignant etiology. EBUS-TBNA has been preferred over mediastinoscopy because of several advantages such as comparable diagnostic accuracy, safety, cost-effectiveness, and less invasiveness. Hemorrhage, mediastinitis, pneumonia, mediastinal abscess, empyema, lung abscess, pericarditis, and pneumothorax have been reported as major complications of EBUS-TBNA. Read More

Oxf Med Case Reports 2020 Dec 28;2020(12):omaa111. Epub 2020 Dec 28.

Department of Child's Health, Faculty of Medicine Padjadjaran University/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.

Amebiasis is caused by the protozoan . Extraintestinal amebiasis manifestation includes liver abscess and other rare manifestations involving the lungs, heart and brain. Liver abscess is the most common extraintestinal manifestation. Read More

J Pediatr Rev 2020 Apr;8(2):65-78

Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.

Context: Although biological sex influences Acute Lower Respiratory Tract Infections (ALRIs) morbidity and mortality patterns in children living in sub-Saharan Africa, the exact mechanism about the effect is unknown.

Objective: We assessed the quality and strength of evidence on the association of sex with incidence, etiology, and outcomes of ALRI in African children.

Data Sources Study Selection And Data Extraction: We systematically searched electronic databases for publications from 1971-2016 in PubMed, African Journals Online, and Google scholar for ALRI literature in the African children. Read More

Lancet 2020 09;396(10253):786-798

Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial School of Medicine, Imperial College London, London, UK. Electronic address:

Complicated community-acquired pneumonia in a previously well child is a severe illness characterised by combinations of local complications (eg, parapneumonic effusion, empyema, necrotising pneumonia, and lung abscess) and systemic complications (eg, bacteraemia, metastatic infection, multiorgan failure, acute respiratory distress syndrome, disseminated intravascular coagulation, and, rarely, death). Complicated community-acquired pneumonia should be suspected in any child with pneumonia not responding to appropriate antibiotic treatment within 48-72 h. Common causative organisms are Streptococcus pneumoniae and Staphylococcus aureus. Read More

Cureus 2020 Jul 29;12(7):e9454. Epub 2020 Jul 29.

Infectious Diseases, Rutgers New Jersey Medical School/Trinitas Regional Medical Center, Newark, USA.

Empyema necessitans is a relatively rare clinical entity in which the empyema extends through the parietal pleura into the adjacent soft tissue and musculature of the chest wall. It usually occurs due to inadequate treatment of a primary lung infection. Aggregatibacter (formerly Actinobacillus) actinomycetemcomitans is a facultative anaerobic gram-negative coccobacillus that is part of the normal oral flora. Read More

Ann Pharmacother 2021 01 16;55(1):36-43. Epub 2020 Jun 16.

Johnson City Medical Center, Johnson City, TN, USA.

Background: The 2019 community-acquired pneumonia guidelines recommend using recent respiratory cultures and locally validated epidemiology plus risk factor assessment to determine empirical coverage of methicillin-resistant (MRSA) and .

Objective: To develop a methodology for evaluating local epidemiology and validating local risk factors for and MRSA.

Methods: This multicenter, retrospective cohort evaluated adult patients admitted for pneumonia. Read More

J R Coll Physicians Edinb 2020 Mar;50(1):42-45

Department of Medicine, JIPMER, Puducherry 605006, India, Email:

Subretinal abscesses due to endogenous staphylococcal blood stream infection is a rare occurrence. A young adult male presented with subretinal abscesses, necrotising pneumonia, pleural empyema, skin and soft tissue infection, muscle abscesses and deep vein thrombosis. Aspirate from one of the abscesses and blood culture revealed meticillin-susceptible Staphylococcus aureus. Read More

Kyobu Geka 2020 May;73(5):362-365

Department of Thoracic Surgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan.

A 71-year-old woman presented to our hospital with fever and dyspnea. Computed tomography showed shadows of bilateral pneumonia and anterior vertebral mass. She was admitted to our hospital for respiratory failure. Read More

RMD Open 2020 02;6(1)

Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.

Objective: Little is known about the prognosis of infections in patients with ankylosing spondylitis (AS) compared with patients without AS. The purpose of this study was to examine whether AS is associated with poorer outcomes in patients who are hospitalised with pneumonia.

Methods: In a population-based cohort study including patients with hospitalised pneumonia with and without AS, we compared 90-day rates of mortality, all-cause readmission (90 days post-discharge) and pulmonary complications including pulmonary embolism, empyema and pulmonary abscess. Read More

Am J Case Rep 2020 Apr 20;21:e922195. Epub 2020 Apr 20.

Fourth Department of Surgery, Saint Petersburg City Hospital #15, Saint Petersburg, Russian Federation.

BACKGROUND Pancreaticopleural fistula is a rare complication of chronic pancreatitis. Its formation is associated with local disruption of the pancreatic duct or pseudocyst communicating with the ductal system. Rarely, other intrathoracic complications may develop such as mediastinitis, pericarditis, hemothorax, and pleural empyema. Read More

PLoS One 2020 19;15(3):e0230252. Epub 2020 Mar 19.

Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany.

Introduction: In children with pneumonia, chest x-ray (CXR) is typically the first imaging modality used for diagnostic work-up. Repeated CXR or computed tomography (CT) are often necessary if complications such as abscesses or empyema arise, thus increasing radiation exposure. The aim of this retrospective study was to evaluate the potential of radiation-free chest magnetic resonance imaging (MRI) to detect complications at baseline and follow-up, compared to CXR with and without additional lung ultrasound (LUS). Read More

Rev Paul Pediatr 2020 9;38:e2018258. Epub 2020 Mar 9.

Centro Hospitalar de São João, Porto, Portugal.

Objective: To highlight the pathogenicity of Streptococcus anginosus, which is rare in pediatric patients, but can cause severe infections that are known to have a better outcome when treated early with interventional procedures and prolonged antibiotic therapy.

Case: description: The patient is a 6-year-old boy with global developmental delay, examined in the emergency room due to fever and respiratory distress. The physical examination and diagnostic workout revealed complicated pneumonia with empyema of the left hemithorax; he started antibiotic therapy and underwent thoracic drainage. Read More

Chest 2020 08 4;158(2):797-807. Epub 2020 Mar 4.

Department of Respiratory Medicine, Fujita Health University School of Medicine, Japan. Electronic address:

Background: Infectious complications after endobronchial ultrasound-guided transbronchial biopsy with a guide sheath (EBUS-GS-TBB) are serious in that they may delay or change scheduled subsequent therapy. The aim of this study was to identify risk factors for infection after EBUS-GS-TBB.

Research Question: What are the risk factors for infection after EBUS-GS-TBB?

Study Design And Methods: We retrospectively reviewed the medical records of 1,045 consecutive patients who had undergone EBUS-GS-TBB for peripheral lung lesions between January 2013 and December 2017 at Fujita Health University Hospital. Read More

Am J Med Sci 2020 01 5;359(1):54-56. Epub 2019 Nov 5.

Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Chengdu, China. Electronic address:

Intern Med 2020 Mar 22;59(5):611-618. Epub 2019 Nov 22.

Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Japan.

Objective In Japan, the aging demographic structure is becoming pronounced, and the full-blown graying of society appears not far off, which indicates an increasing population that will require healthcare contact. Klebsiella spp. are major pathogens in healthcare-associated infections, and their importance is increasing. Read More

Postgrad Med J 2019 Dec;95(1130):656-659

Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia

Sir William Osler's great work and achievements are extensively documented. Less well known is his prolonged battle with postinfluenza pneumonia, lung abscess and pleural infection that eventually led to his demise. At the age of 70, he was a victim of the global Spanish influenza epidemic, and subsequently developed pneumonia. Read More

Ann Transl Med 2019 Aug;7(15):357

Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Westchester Medical Center, Valhalla, NY, USA.

Postobstructive pneumonia can complicate lung cancer, particularly in more advanced stages of the disease, producing significant clinical decline and a poorer prognosis. It can lead to complications such as empyema, lung abscess and fistula formation. Postobstructive pneumonia can also be the first manifestation of an underlying malignancy. Read More

Clin Infect Dis 2020 04;70(9):1933-1940

Département des Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, Paris, France.

Background: Rarely, Legionnaires' disease (LD) can progress into a slowly or nonresolving form.

Methods: A nationwide retrospective study was conducted by the French National Reference Center for Legionella (2013-2017) including cases of slowly or nonresolving LD defined as persistent clinical symptoms, computed tomography (CT) scan abnormalities, and Legionella detection in lower respiratory tract specimens by culture and/or real-time (RT) polymerase chain reaction (PCR) >30 days after symptom onset.

Results: Twelve cases of community-acquired slowly or nonresolving LD were identified among 1686 cases of culture-positive LD. Read More

J Infect Public Health 2020 Jan 6;13(1):140-142. Epub 2019 Jun 6.

Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan.

Empyema necessitatis (EN) is a rare complication of empyema in which the pleural infection spreads outside the pleural space. Lower airway infections are common among children with cerebral palsy (CP). Although harmless to healthy individuals, Pseudomonas aeruginosa can cause invasive infections, including CP, in immunocompromised hosts. Read More

Am J Med Sci 2019 09 6;358(3):243. Epub 2019 Apr 6.

Pulmonary and Critical Care Medicine Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California.

BMJ Case Rep 2019 May 10;12(5). Epub 2019 May 10.

Pulmonology, Hospital de Egas Moniz, Lisboa, Portugal.

We report the case of a 66-year-old man with dental infection who presented to our emergency department complaining of a 3-month medical history of chest pain and productive cough, in association with malaise, fever, weight loss and anaemia. His chest radiograph showed a nearly total opacification of the right hemithorax and chest ultrasound findings were suggestive of empyema, subsequently confirmed by a chest CT. The patient started appropriate treatment. Read More

Health Technol Assess 2019 03;23(11):1-70

School of Population Health and Environmental Sciences, King's College London, London, UK.

Background: Unnecessary prescribing of antibiotics in primary care is contributing to the emergence of antimicrobial drug resistance.

Objectives: To develop and evaluate a multicomponent intervention for antimicrobial stewardship in primary care, and to evaluate the safety of reducing antibiotic prescribing for self-limiting respiratory infections (RTIs).

Interventions: A multicomponent intervention, developed as part of this study, including a webinar, monthly reports of general practice-specific data for antibiotic prescribing and decision support tools to inform appropriate antibiotic prescribing. Read More

Sisli Etfal Hastan Tip Bul 2019 19;53(1):54-57. Epub 2019 Mar 19.

Department of Chest Disease, Biruni University, İstanbul, Turkey.

Objectives: The aim of this study was to determine the causes of pleural effusion in patients who experienced end-stage renal failure and did not demonstrate any regression of effusion with dialysis treatment.

Methods: Patients with pleural effusion that did not regress though they attained dry weight with dialysis and those with 2 years of follow-up were included in the study. The mean age of the patients was 48. Read More