The conservative treatment of the tension lesions of staphylococcal pneumonia in infancy.

Characteristic lesions of staphylococcal pneumonia in infancy are the tension cyst of lung and tension pyopneumothorax. The radiological appearances are often alarming and, at first sight, seem to indicate the necessity for urgent aspiration or drainage. The two obvious dangers are those of immediate suffocation (the French refer to the tension cysts as bulles suffocantes) and of gross pleural thickening as a later complication. The dramatic radiological appearances, the fear that the infant will suffocate, or the expectation of late morbidity may result in unnecessary surgical intervention. The object of this paper is to describe how the size of the pneumatocele or pneumothorax may be controlled, and to show how tension within the lesion during the phase of active infection tends to keep the air space empty and to prevent the deposition of fibrin. To persevere with conservative treatment in a desperately ill baby whose radiographs show a large pneumatocele or pneumothorax is not easy. Confidence in the method is essential. A striking feature of most of the published series is the infrequency with which suffocation is, in fact, a cause of death. In a series of complications of staphylococcal pneumonia described by Sabiston, Hopkins, Cooke, and Bennett (1959), catheter drainage was used in 43% of patients with empyema of whom 23%. had associated pneumothorax, but they make the following comment: