CRP4 FROM CRISIS TO CURE: MANAGING PNEUMATOCELE IN EXTREME PREMATURITY THROUGH CT-GUIDED PIGTAIL DRAINAGE – A CASE REPORT

Jia Cheng Ong1,2,4, Mohd Hafizuddin Husin2,3, Noraida Ramli1,2, Nor Rosidah Ibrahim1,2, Farohah Che Mat Zain1,2
1 Department of Pediatrics, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bahru, Kelantan, Malaysia
2Radiology Department, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bahru, Kelantan, Malaysia
3 Hospital Universiti Sains Malaysia (HUSM), Health Campus, Kubang Kerian, 16150 Kota Bahru, Kelantan, Malaysia
4 Faculty of Medicine, Universiti Sultan Zainal Abidin, Medical Campus, 20400 Kuala Terengganu, Malaysia

Introduction
Pneumatocele management in extremely low birth weight (ELBW) infants presents significant clinical challenges due to underlying prematurity and limited therapeutic options.

Case Presentation
We report a male infant born at 26 weeks gestation weighing 810 grams who developed severe pneumatocele secondary to necrotizing pneumonia. He initially presented with respiratory distress syndrome (RDS) requiring high-frequency oscillatory ventilation (HFOV) and surfactant therapy. At day 12, he contracted Pseudomonas aeruginosa bacteraemia, followed by infections with Stenotrophomonas maltophilia and ESBL Klebsiella pneumoniae. Despite appropriate antibiotic therapy and conservative management, serial imaging revealed progressive pneumatocele development, with a large right-sided lesion on CT at day 48. Due to persistent respiratory compromise, percutaneous drainage was performed at day 74 using a 6F pigtail catheter under CT guidance. The procedure was complicated by pneumothorax and subcutaneous emphysema but achieved complete pneumatocele resolution after 33 days of drainage. Following successful drainage, respiratory status improved significantly, allowing extubation to non-invasive ventilation at day 79 of life and discharge on room air at 5 months.

Conclusion
CT-guided percutaneous drainage represents a safe and effective treatment for large pneumatoceles in ELBW infants when conservative management fails, requiring multidisciplinary approach for optimal outcomes.