Ultrasound-guided thoracoscopic debridement in children with fibrinothorax

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Abstract

BACKGROUND: With the spread of endoscopic procedures, thoracoscopy has become an ideal method for the surgical treatment of pleural complications. Ultrasound examination of the pleural cavity made it possible to differentiate the nature of the pleural contents and timely use of thoracoscopic sanitation of the pleural cavity.

AIM: This study aimed to conduct ultrasound monitoring of the complete restoration of the pleural cavity after video-assisted thoracoscopic debridement in children with fibrinothorax.

MATERIALS AND METHODS: The study was conducted in the children’s surgical department of the Republican Children’s Clinical Hospital of Health Ministry of the Chuvash Republic. From 2011 to 2019, 31 children aged 1 month to 18 years were diagnosed with community-acquired pneumonia complicated by fibrinothorax, and thoracoscopic debridement and drainage of the pleural cavity were performed. During hospitalization, before thoracoscopy, 1–3 ultrasound examinations of the pleural cavities and lungs were performed in all children, which made it possible to determine methods of management. After thoracoscopic debridement, ultrasound examination of the pleural cavities was performed 3–7 times during hospitalization and 1–2 times monthly for 3–6 months after discharge from the hospital until the pleural cavity was completely restored.

RESULTS: Ultrasound monitoring of the pleural cavities and lungs after thoracoscopic debridement at the outpatient stage showed that changes in the pleural cavity and lung parenchyma can last up to 6 months, while children’s health status was satisfactory.

CONCLUSIONS: Preoperative and postoperative ultrasound monitoring can adequately assess the overall state of the pleural cavities and lungs. Changes in the pleural cavity after thoracoscopic debridement under ultrasound guidance are observed later than by X-ray. In this regard, after discharge from the hospital, children with complicated purulent and destructive pneumonia who underwent thoracoscopic debridement need ultrasound monitoring of the pleural cavity until it is completely restored.

About the authors

Anatoly A. Pavlov

Republican Children’s Hospital; Ulyanov Chuvash State University

Author for correspondence.
Email: doctorpavlov@mail.ru
ORCID iD: 0000-0003-1709-646X

Cand. Sci. (Med.)

Russian Federation, 45, Moskovsky av., 428017, Chuvash Republic, Cheboksary; Cheboksary

Adelina I. Sergeeva

Republican Children’s Hospital; Ulyanov Chuvash State University

Email: sergeyeva@list.ru
ORCID iD: 0000-0003-2973-625X
SPIN-code: 3483-8417

Cand. Sci. (Med.), Associate Professor, Hematologist

Russian Federation, 45, Moskovsky av., 428017, Chuvash Republic, Cheboksary; Cheboksary

Zot I. Zolnikov

Republican Children’s Hospital; Ulyanov Chuvash State University

Email: zolnikovz1950@mail.ru
ORCID iD: 0000-0002-9331-8573
SPIN-code: 3471-5624

Cand. Sci. (Med.), surgeon

Russian Federation, 45, Moskovsky av., 428017, Chuvash Republic, Cheboksary; Cheboksary

Tatyana I. Dianova

Republican Children’s Hospital; Ulyanov Chuvash State University

Email: D.t.i_21@mail.ru
ORCID iD: 0000-0001-6622-9906
SPIN-code: 3643-9658

teaching assistant, doctor of ultrasound diagnostics

Russian Federation, 45, Moskovsky av., 428017, Chuvash Republic, Cheboksary; Cheboksary

Olga N. Ivanova

Ulyanov Chuvash State University

Email: lonleb@mail.ru
ORCID iD: 0000-0002-6059-9890
SPIN-code: 8999-1964

teaching assistant

Russian Federation, 45, Moskovsky av., 428017, Chuvash Republic, Cheboksary

Sergey N. Andreev

Republican Children’s Hospital

Email: doctorpavlov@mail.ru
ORCID iD: 0000-0002-0415-0343

doctor of ultrasound diagnostics

Russian Federation, 45, Moskovsky av., 428017, Chuvash Republic, Cheboksary

Irina G. Egorova

Republican Children’s Hospital

Email: doctorpavlov@mail.ru
ORCID iD: 0000-0003-2358-956X

doctor of ultrasound diagnostics

Russian Federation, 45, Moskovsky av., 428017, Chuvash Republic, Cheboksary

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Supplementary files

Supplementary Files
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1. JATS XML
2. Fig. 1. Removal of fibrin deposits from the pleural cavity. 1 — fibrin, 2 — infiltrated lung parenchyma

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3. Fig. 2. Echogram of the pleural cavity and lung parenchyma: 1 — pleural cavity; 2 — fibrin overlay on the pleura; 3 — lung parenchyma of reduced airiness

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4. Fig. 3. Echogram of the pleural cavity and lung parenchyma: 1 — pleural cavity; 2 — lung parenchyma with a small subpleural focus of the airless lung parenchyma; 3 — artifacts of the type “comet tails” (interstitial changes)

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