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    Go to the top of the page   ID: 20110329123519 Original case in english  More links about this topic on Pubmed (PubMed Reader)
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    Pneumomediastinum/pneumothorax - iatrogenic
    Kraig J. Pneumomediastinum/pneumothorax - iatrogenic. PedRad [serial online] vol 11, no. 3.
    URL: www.PedRad.info/?search=20110329123519


     
     Pediatric Radiology CasesImages to this case: There are X-Ray-images available for this case. [ X-Ray ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    Kraig J. Lage (University of Missouri Hospital and Clinics / Columbia / MO / United States)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    N/A  

     
     Pediatric Radiology CasesGender:

    Male  

     
     Pediatric Radiology CasesRegion-Organ:

    Thorax-Lung  

     
     Pediatric Radiology CasesMost likely etiology:

    physical  

     
     Pediatric Radiology CasesHistory:

    Newborn male (39 weeks gestation) who had a forceps assisted delivery secondary to nonreassuring fetal heart tones. At delivery, infant was cyanotic, had poor tone, and no cry. Infant was dried, warmed, suctioned, and stimulated without response. Bag/mask ventillation was administered with response of heart rate rising to greater than 100. Bag/mask ventillation was continued for one minute until spontaneous respirations. Infant continued to have increased work of breathing with flaring, retractions, and tachypnea. CPAP was continued with decreased work of breathing.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease :

    Alveolar rupture is caused by a pressure gradient between the alveolus and the surrounding interstitium. The pressure gradient is a product of either hyperinflation of the alveolus or a decrease in the surrounding interstitial pressure.

    The air forced into the interstitial tissues tracts centrally toward the peribronchial and perivascular tissue, and may continue into the mediastinum, neck and subcutaneous tissues.

    Because not all alveoli are ruptured, adjacent normal alveoli cause an equalisation of pressure between the affected and damaged alveoli with the result that the interalveolar walls remain intact and the lungs inflated.  

     
     Pediatric Radiology CasesRadiological findings:


    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Large lucency surrounds the superior mediastinum with lucency crossing midline. Subtle lucency is also seen inferior and lateral of the right lung base at the costophrenic angle and hemidiaphragm.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Large lucency surrounds the superior aspect of the anterior mediastinum with elevation of the thymic shadow.



     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    Total constellation (Consens)  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings:

    N/A  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other :

    Pneumomediastinum occurs in approximately 0.1% of neonates and carries a good prognosis, typically without complications or long term sequella.

    Factors predisposing to pneumomediastinum include pneumonia or meconium aspiration syndrome.

    Neonatal pneumomediastinum can be attributable to pulmonary infection, immature lungs and ventilatory support. However, a significant portion of cases of spontaneous pneumomediastinum occur without identifiable risk factors.  

     
     Pediatric Radiology CasesComments of the author about the case:

    Diagnosis of pneumomediastinum is confirmed by frontal CXR.

    Typical radiologic signs are:

    1. In infants, the “spinnaker sign” which is upwards and outwards displacement of thymic lobes raised above the heart by pneumomediastinal air that separates it from the underlying cardiac silhouette.

    2. "continuous diaphragm sign", visible as lucency interposed between the pericardium and the diaphragm.

    3. Linear bands of mediastinal air parallelling the left side of the heart and the descending aorta with the pleura seen as a thin line separated from the mediastinum by the air lucency. The air may extend superiorly along the great vessels into the neck.  

     
     Pediatric Radiology CasesFirst description / History:

    Neonate presenting with respiratory distress.  

     
     Pediatric Radiology CasesLiterature:

    1. Medline: Medline
    Doug Hacking, M.D., and Michael Stewart, M.D.
    Neonatal Pneumomediastinum
    N Engl J Med 2001 June 14; 344:1839

    2. Medline: Medline
    Annik Hauri-Hohl, Oskar Baenziger, and Bernhard Frey
    Pneumomediastinum in the neonatal and paediatric intensive care unit
    Eur J Pediatr. 2008 April; 167(4): 415–418

     

     
     Pediatric Radiology CasesKeywords:

    Pneumomediastinum, Pneumothorax, continuous diaphragm sign, spinnaker sign, child, childhood, pediatric radiology  

     
     Pediatric Radiology Cases Cite this article:

    Kraig J. Pneumomediastinum/pneumothorax - iatrogenic. PedRad [serial online] vol 11, no. 3.
    URL: www.PedRad.info/?search=20110329123519  

     
     Pediatric Radiology Cases Read similar articles: with corresponding keywords
    in the same field: Thorax-Lung
    or in the region: Thorax
    or in the tissue/organ: Lung
    or with the etiology: physical
     
     Pediatric Radiology CasesImages to this case: There are X-Ray-images available for this case. [ X-Ray ] View all modalities [ All ]   
     
    Pneumomediastinum/pneumothorax - iatrogenic
    Kraig J. Pneumomediastinum/pneumothorax - iatrogenic. PedRad [serial online] vol 11, no. 3.
    URL: www.PedRad.info/?search=20110329123519


     

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    Pneumomediastinum/pneumothorax - iatrogenic
    Other cases by these authors:

    Search Kraig J. Lage in Medline Kraig J. Lage (1)   

    Pneumomediastinum/pneumothorax - iatrogenic  
     
    Pneumomediastinum/pneumothorax - iatrogenic
    Kraig J. Pneumomediastinum/pneumothorax - iatrogenic. PedRad [serial online] vol 11, no. 3.
    URL: www.PedRad.info/?search=20110329123519


     

    Which diagnosis have other collegues guessed?


    • IRDS
      Votes: 1 (2 %)


    • Pneumothorax with pneumomediastinum
      Votes: 28 (80 %)


    • Pneumonia
      Votes: 1 (2 %)


    • Child abuse
      Votes: 1 (2 %)


    • Ebstein anomaly
      Votes: 4 (11 %)



        Total answers: 35

     
    Pneumomediastinum/pneumothorax - iatrogenic
    Kraig J. Pneumomediastinum/pneumothorax - iatrogenic. PedRad [serial online] vol 11, no. 3.
    URL: www.PedRad.info/?search=20110329123519


     

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    Pneumomediastinum/pneumothorax - iatrogenic
    Kraig J. Pneumomediastinum/pneumothorax - iatrogenic. PedRad [serial online] vol 11, no. 3.
    URL: www.PedRad.info/?search=20110329123519


     




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