Surgical Complications of Staphylococcal Pneumonia in Infancy and Childhood*   ALBERT MOWLEM, M.D., FREDERICK S. CROSS, M.D., F.C.C.P.  Diseases of the Chest  Volume 50, Issue 2, Pages 133-141 (August 1966) DOI: 10.1378/chest.50.2.133 Copyright © 1966 The American College of Chest Physicians Terms and Conditions

FIGURE 1 Typical changes found in staphylococcal pneumonia are seen in this photomicrograph of a section of lung obtained at necropsy. These include almost complete filling of the bronchus in the center of the field with pus and debris, necrosis and dissolution of the bronchial wall. The debris in the bronchus represents a possible ball valve mechanism permitting ingress of air, but not egress and may predispose to formation of pneumatoceles (specimen from patient 3 described in text). Diseases of the Chest 1966 50, 133-141DOI: (10.1378/chest.50.2.133) Copyright © 1966 The American College of Chest Physicians Terms and Conditions

FIGURE 2A This four-year-old patient was admitted comatose after asphyxiation in a fire one month prior to this x-ray film. Infiltrate and consolidation in right middle lobe is seen due to staphylococcal pmeumonia. (B) Twelve days later, a huge pneumatocele is seen in right lung compressing most of the lung and causing a shift of the mediastinum to the opposite side. Patient had increased respiratory distress at this time. Diseases of the Chest 1966 50, 133-141DOI: (10.1378/chest.50.2.133) Copyright © 1966 The American College of Chest Physicians Terms and Conditions

FIGURE 2C One week after intracystic catheter drainage of purulent material and air. There has been a decrease in the size of the cyst with partial return of the mediastinal structures to the midline position. (D) Film obtained approximately two and one-half months after drainage of large cyst showing almost complete resolution of the pneumonic process in the right lung, and disappearance of the pneumatocele. Slight pleural reaction is seen in right costophrenic angle. Diseases of the Chest 1966 50, 133-141DOI: (10.1378/chest.50.2.133) Copyright © 1966 The American College of Chest Physicians Terms and Conditions

FIGURE 3A Right middle lobe infiltrate due to staphylococcal pneumonia is seen in patient 1 described in text. Film obtained ten days after admission. (B) Approximately ten days later; there is considerable purulent effusion (empyema) in the right chest causing complete opacification of the right lung. During this interval the patient had three pleural needle aspirations with drainage each time of only a few ml. of pus; inadequate drainage. The patient died on the 20th hospital day following spontaneous evacuation of some of the empyema fluid through the chest wall. Diseases of the Chest 1966 50, 133-141DOI: (10.1378/chest.50.2.133) Copyright © 1966 The American College of Chest Physicians Terms and Conditions

FIGURE 4A (upper, opposite): There is infiltration in left lung of this one and one-half-year-old patient due to Staphylococcus pneumonia. Haziness is also noted because of the presence of empyema. Admission film. Five days later, tension pneumothorax developed with complete collapse of the left lung and shift of the mediastinum to the right. (B) (center) Next day—A catheter has been inserted in the left pleural cavity and connected to suction. Partial pneumothorax is still visible, but mediastinal structures are nearer the midline. A few air-containing cystic lesions may be seen in the collapsed left lung. (C) (lower) The tube is withdrawn and the left lung is completely expanded. The pneumotoceles are now well visualized. This process healed completely without residual damage. Diseases of the Chest 1966 50, 133-141DOI: (10.1378/chest.50.2.133) Copyright © 1966 The American College of Chest Physicians Terms and Conditions