Diagnostic dilemmas, course, management and prognosis of traumatic lung cysts in children.

The patients were 8 and 9 years old respectively. Both were passengers in a vehicle and suffered multisystem injuries. Case no.1 suffered a fractured occipital bone, lung contusions and a small pneumothorax in addition to the traumatic lung cysts in the left lung. Case 2 sustained contused and lacerated liver and right lung cysts. CT examination showed cystic areas in the lung which were diagnostic in case 2. In case 1 a traumatic rupture of diaphragm could not be ruled out and the patient underwent an exploratory laparotomy to deal with the same. The lung cysts in both the patients were treated conservatively and both showed resolution in repeat CT scans done at 6 months.

Lung cysts following pulmonary artery operations: Diagnostic and therapeutic implications.

We describe the case of a child suffering from congenital cyanotic heart disease — double outlet right ventricle (DORV) with transposition of great vessels (TOGV). She underwent a left Blalock-Tausig (BT) shunt at one month of age followed by a Glen procedure with left pulmonary artery augmentation at six months. Following the second procedure she developed extensive cyst formation in the upper lobe of the left lung and pneumothorax. She was managed by intercostal drainage of the pneumothorax. The cysts were observed and on a CT scan X-rays taken at one month and six months no cysts were seen. This case illustrates the occurrence of pneumatoceles after pulmonary artery manipulation, their proclivity for causing pneumothoraces and involution on follow-up. Cysts noted in such a setting should be monitored carefully and followed up to resolution.

Congenital para esophageal hernia: A 10 year experience from Saudi Arabia.

Objective. To study the presentation and the outcome of treatment of congenital para esophageal hernias (CPEH) over a period of 10 years from a single tertiary care hospital in Saudi Arabia. Methods. The records of 9 patients presenting between 1997 and 2007, were retrospectively analyzed for demographics, presenting features, referral diagnoses, investigations, management including operative procedures, their outcome and follow-up. Results. Nine patients (3 males and 6 females) aged between 8 days to 34 months were seen. Respiratory distress (n=6), vomiting (n=5) and frequent respiratory tract infections (n=3) were the most common presentations. Cyanosis (n=2), cough and excessive crying were the other important symptoms. The referral diagnoses in these patients included congenital Bochdalek's hernias, lung abscess, bronchogenic cyst, pneumatocoele, bronchiolitis, and pneumonias which reflected a misinterpretation of their clinical findings and chest X-rays. Seven of these patients had other associated congenital anomalies. Three had cardiovascular abnormalities and 2 had lesions of the central nervous system. A pair of siblings had Marfan’s syndrome. All the patients had abnormal chest C-rays and an UGS (upper GI series) proved to be diagnostic in 8 patients. The CT scans done in 4 patients corroborated the findings of the UGS. A laparotomy was done on most patients (n=8) which comprised of reduction of the stomach, resection of the hernial sac, tightening of the hiatus and a gastropexy or a gastrostomy. One patient, who underwent thoracotomy died of surgical complications. Two others died of causes unrelated to the surgery. The remaining six operated patients have been followed up for a median of 3.5 years and are doing well. Conclusion. CPEH is uncommon in children, presents with respiratory tract symptoms and vomiting, and may be associated with Martan syndrome. It should be considered in the workup of a child with vomiting or frequent chest infections. Abnormal chest X-rays may indicate the diagnosis and a subsequent UGS, is confirmatory. The present study found laparotomy a good approach for repair of the wide hiatus. A gastropexy and a floppy fundoplication were added to prevent reherniation and post operative reflux though given the small numbers it is not possible to determine the place of either of these procedures. CPEH may be frequently associated with other congenital problems which may impact survival.

Air filled, inflammatory, lung pseudo-cyst: etio-pathogenesis and management.

Lung cysts in children are usually of congenital origin. Necrotising pneumonias, trauma, cystic fibrosis and kerosene poisoning may be the cause of acquired cysts in the lungs during childhood. We describe a child who presented with pneumothorax and was later discovered to have a cyst in his right lung. The cyst was resected and on histology found to be of inflammatory origin with no epithelial cell lining i.e. a pseudo-cyst. The immuno-histochemical staining of the inflammatory cells from the pseudo-cyst wall showed them to be predominantly histiocytes i.e:, CD68 antigen positive. The cells showed negative staining for S-100 (marker for Langerhans cells), cytokeratins (epithelial markers) and smooth muscle actins excluding the possibility of histiocytosisX, epithelial and congenital cysts respectively. This case illustrates the occurrence of acquired pulmonary pseudocysts unrelated to known etiologic agents which should be considered in the work-up for pneumothoraces.