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Objective:To investigate the clinical manifestations, diagnosis, treatment and prognosis of Kawasaki disease (KD) complicated with acute abdomen in children.Methods:Clinical manifestations, laboratory examinations, abdominal B-ultrasound scans, abdominal plain films, abdominal CT findings, coronary artery lesions and prognosis of 16 children with KD and acute abdomen admitted to Guangzhou Women and Children′s Medical Center, Guangzhou Medical University from August 1, 2015 to July 31, 2019 were retrospectively analyzed.The measurement data of age, leukocyte, hemoglobin, platelet and biochemical indexes are expressed by M (range). Results:A total of 16 cases were included, involving 7 males and 9 females aged 4 years and 8 months (7 months to 8 years). Among them, 9 cases of KD complicated with cholecystitis, 5 cases with intestinal obstruction, 2 cases with acute appendicitis, 2 cases with necrotizing enterocolitis, 2 cases with acute peritonitis and 1 case with acute pancreatitis.There were 3 cases complica-ted with 2 or more kinds of acute abdomen diseases.All 16 patients had symptoms of abdominal pain, 7 cases had vomiting, 4 cases had obvious abdominal distension and 1 case had bloody stool.Abdominal B-ultrasound was performed in all cases, and 8 cases showed enlargement of gallbladder and edema and thickening of gallbladder wall, 2 cases of appendicitis, 2 cases of intestinal obstruction and 1 case of pancreatic enlargement.Abdominal plain film examination was performed in 8 cases, suggesting necrotizing enterocolitis in 2 cases and intestinal obstruction in 2 cases.Abdominal CT examination was performed in 3 cases, including edema of gallbladder wall in 1 case, peritonitis in 1 case, intestinal obstruction in 2 cases and enlargement of pancreas in 1 case.All the 16 cases were treated with pulsed intravenous immunoglobulin (IVIG) at 2 g/kg and antiplatelet agents.Eight IVIG-resistant cases were treated with the second dose of IVIG at 2 g/kg, among whom, 4 children still had fever and intravenous Methylprednisone was given.Two cases underwent enterostomy and abdominal puncture drainage.All the 16 children were followed up until 6 months after discharge, and 4 cases (25%) were complicated with coronary artery aneurysm (CAA) during the acute stage or follow-up period.Conclusions:KD complicated with acute abdomen is more commonly manifested as cholecystitis and intestinal obstruction.Besides the classic symptoms of KD, abdominal pain and vomiting are the most common in KD with acute abdomen.Abdominal ultrasound, plain film and CT examinations are conductive to the early diagnosis of KD complicated with acute abdomen.In addition, the incidence of IVIG-resistance and CAA is relatively high in children with KD complicated with acute abdomen.
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Objective To investigate the characteristics of long-term changes in giant coronary artery aneurysm (GCAA) caused by Kawasaki disease (KD) and the technical approach of using selective coronary angiography (SCAG) in children.Methods A retrospective analysis was made in 52 patients with KD and GCAA in acute phase,including 38 males and 14 females with an average age of (4.1 ±2.5) years old ranging from 1 to 14 years old,from January 2008 to December 2018 at the Department of Cardiology,Guangzhou Women and Children's Medical Center.The selective coronary angiography (SCAG) was performed in the patients who were followed up for (10.6 ± 3.6) years (1-19 years).The changes in coronary artery lesions were analyzed and the technical approach of SCAG was discussed in children.Results Among 52 patients investigated by SCAG,the location of coronary artery lesion was found the left-anterior descending branch in 21 cases(40.4％),20 cases(38.5％) in the right coronary artery,8 cases (15.4％) in the left main trunk and 3 cases(5.7％) in cimumflex.The left coronary artery in 2 cases and the right coronary artery in 4 cases were completely occluded,and collateral vessel formation was found in 12 cases.There were 21 cases of right coronary artery stenosis,including 7 cases of the right coronary artery occlusion and bridge-like neovascularization,and 4 cases of the right coronary artery woven lesions (thrombotic occlusion and clustered neovascularization).There were 27 cases of the left coronary artery stenosis with different degrees,including 5 cases of the left coronary artery occlusion and bridge-like neovascularization,and 2 cases of the left coronary artery woven lesions (thrombotic occlusion and clustered neovascularization).All of 52 patients with GCAA were followed up for 1 to 19 years.GCAA still existed in 40 cases.Regression to small coronary artery aneurysm was found in 8 cases,and mild-dilation regression was observed only in 4 patients.The resting electrocardiogram showed pathological Q wave and the left ventricular enlargement in 6 cases,and normal in the remaining 46 patients.The children had no subjective symptoms and their activities were not restricted.Compared with SCAG,echocardiography detected 52 cases with proximal morphological changes in the coronary artery,but distal changes were found only in 3 cases.And 12 cases with coronary artery occlusion and neovascularization failed to be prompted by echocardiography.Conclusions GCAA induced by KD can persist for a long time,and has characteristics of coronary occlusion,stenosis,and collateral vessel formation.The conventional electrocardiogram and echocardiography are insensitive to the coronary artery morphology and dysfunction in KD sequelae.The SCAG is of great value in tracking this disease.For using SCAG in children,as long as the appropriate equipment and projection angle are selected,and the operation skills are mastered,satisfactory images and high success rate can be obtained.
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Objective@#To summarize the clinical characteristics of pediatric hypertrophic cardiomyopathy and analyze its etiology for providing guidance for early identification, diagnosis and prognosis.@*Methods@#Fifty-two cases of pediatric hypertrophic cardiomyopathy admitted to Guangzhou Women and Children′s Medical Center from January 2012 to June 2018 were retrospectively analyzed and summarized from the aspects of age, gender, family history, clinical features, auxiliary examination, etiology, drug efficacy and disease outcome.@*Results@#(1) There were 52 cases in this group including 36 males and 16 females.The ages of patients ranged from 15 days to 14 years (with mean age of 27.7 months, median 6.5 months). A total of 34 patients (65.4%) were followed up for 1-78 months (mean 30.6 months). Echocardiography showed 52 cases of left ventricular wall thickening (100%), 21 cases of double ventricular hypertrophy (40.4%), 18 cases of left ventricular outflow tract obstruction (34.6%), and 18 cases of hepatic enzyme elevation (34.6%). The etiology of 11 cases was clear (21.2%), including 7 cases of type Ⅱ glycogen accumulation, 3 cases of Noonan syndrome and 1 case of primary carnation deficiency.No routine heart transplantation was performed at the end of follow-up, and 12 patients (35.3%) died, 7 cases of whom died in infancy.@*Conclusions@#Children with hypertrophic cardiomyopathy have a relatively young age, so it is necessary to search for the etiology actively, carry out disease risk assessment, and conduct personalized management and treatment.
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Objective@#To investigate the characteristics of long-term changes in giant coronary artery aneurysm (GCAA) caused by Kawasaki disease (KD) and the technical approach of using selective coronary angiography (SCAG) in children.@*Methods@#A retrospective analysis was made in 52 patients with KD and GCAA in acute phase, including 38 males and 14 females with an average age of (4.1±2.5) years old ranging from 1 to 14 years old, from January 2008 to December 2018 at the Department of Cardiology, Guangzhou Women and Children′s Medical Center.The selective coronary angiography (SCAG) was performed in the patients who were followed up for (10.6±3.6) years (1-19 years). The changes in coronary artery lesions were analyzed and the technical approach of SCAG was discussed in children.@*Results@#Among 52 patients investigated by SCAG, the location of coronary artery lesion was found the left-anterior descending branch in 21 cases(40.4%), 20 cases(38.5%) in the right coronary artery, 8 cases(15.4%) in the left main trunk and 3 cases(5.7%) in circumflex.The left coronary artery in 2 cases and the right coronary artery in 4 cases were completely occluded, and collateral vessel formation was found in 12 cases.There were 21 cases of right coronary artery stenosis, including 7 cases of the right coronary artery occlusion and bridge-like neovascularization, and 4 cases of the right coronary artery woven lesions (thrombotic occlusion and clustered neovascularization). There were 27 cases of the left coronary artery stenosis with different degrees, including 5 cases of the left coronary artery occlusion and bridge-like neovascularization, and 2 cases of the left coronary artery woven lesions (thrombotic occlusion and clustered neovascularization). All of 52 patients with GCAA were followed up for 1 to 19 years.GCAA still existed in 40 cases.Regression to small coronary artery aneurysm was found in 8 cases, and mild-dilation regression was observed only in 4 patients.The resting electrocardiogram showed pathological Q wave and the left ventricular enlargement in 6 cases, and normal in the remaining 46 patients.The children had no subjective symptoms and their activities were not restricted.Compared with SCAG, echocardiography detected 52 cases with proximal morphological changes in the coronary artery, but distal changes were found only in 3 cases.And 12 cases with coronary artery occlusion and neovascularization failed to be prompted by echocardiography.@*Conclusions@#GCAA induced by KD can persist for a long time, and has characteristics of coronary occlusion, stenosis, and collateral vessel formation.The conventional electrocardiogram and echocardiography are insensitive to the coronary artery morphology and dysfunction in KD sequelae.The SCAG is of great value in tracking this disease.For using SCAG in children, as long as the approp-riate equipment and projection angle are selected, and the operation skills are mastered, satisfactory images and high success rate can be obtained.
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Objective To analyze the treatment and follow-up of congenital coronary artery fistula (CAF) with giant coronary artery aneurysm (GCAA) in children.Methods The clinical data were analyzed retrospectively in 13 patients who were diagnosed as congenital CAF with GCAA between July 2009 and December 2016 in Guangzhou Women and Children's Medical Center.There were 8 boys and 5 girls.The median age was 18 months,ranging from 40 days to 12 years old.The body weight ranged from 3.8 kg to 29.0 kg with a median of 8.8 kg.Fistulas originated from right coronary artery accounted in 8 patients,with 5 from left coronary artery.Fistulas drained into right atrium in 3 patients,right ventricular in 8 patients and left ventricular in 2 patients.Single fistula occurred in 12 patients and multiple fistulas in 1 patient.The diameter of coronary artery aneurysm ranged from 8 mm to 16 mm with a median of 9.2 mm.Results One patient had tachypnea and growth retardation without heart murmur.The other 12 patients were asymptomatic with heart murmurs occasionally found in routine physical examination.One patient underwent fistula ligation without cardiopulmonary bypass (CPB).The remaining 12 cases received fistula correction with beating heart CPB.Direct suture was used in 10 patients and autologous pericardial patch in other 2 patients.Two patients were associated with atrial septal defect (ASD) and underwent repair of ASD concurrently.The coronary artery aneurysm remained original shape without any intervention during the operation.The mean hospital delay was (11.0 ± 2.5) days.Two patients had decreased ejection fraction as low as 38％ within 3 days after the operation,but went up to over 50％ in follow-up 1 month later.Transient T wave change occurred in 7 patients,and another 2 patients showed a residual shunt with size of 1 to 2 millimeters through the fistula without further intervention after the surgical closure.All 13 patients had antiplatelet therapy with 12 taking Aspirin and one taking Dipyridamole.The dosage was 3-5 mg/(kg · d) with duration ranging from 3 days to 13 months with a median of 1 month.During the perioperative period and the follow-up period (3 months to 8 years),all patients were asymptomatically alive.Transthoracic echocardiography showed normal cardiac function.Compared with preoperative status,the diameter of dilated coronary arteries was not changed after the operation.There was no formation of thrombus in the coronary arteries.Electrocardiography showed no ST-T changes or arrhythmia or myocardial ischemia.Conclusions GCAA can be combined with congenital CAF in children,so it needs early operation.The evidence-based intervention of coronary artery aneurysm and usage of anticoagulant and antiplatelet therapy in pediatric patients was still lacking,which needs long-term follow-up.
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Objective Analyze the surgical and follow-up outcomes of congenital coronary artery fistula(CAF) in children and to discuss the treatment methods.Methods The clinical data were analyzed retrospectively in 22 patients who were diagnosed as congenital CAF and received surgical treatment between July 2008 and January 2017 in Guangzhou Women and Children's Medical Center.There were 14 boys and 8 girls.The median age was 17 months ranging from 14 days to 12 years old.The median weight was 8.8 kilograms ranging from 3.0 to 31.0 kilograms.Results Two patients had shortness of breath.Three had growth retardation with recurrent respiratory infection or tachypnea.The remaining 17 patients were asymptomatic.Twenty had heart murmurs.Fistulas originated from right coronary artery accounted for 11 patients,with 10 from left coronary artery,1 from both right and left coronary arteries.Fistulas drained into coronary sinus in 1 patient,right atrium in 6 patients,right ventricular in 13 patients and left ventricular in 2 patients.Single fistula occurred in 20 patients and multiple fistulas in 2 patients.The coronary arteries were obviously dilated in all patients with diameter from 4.0 to 12.0 millimeters.There were 8 cases with aneurysmal dilation of coronary arteries.Two patients underwent fistula ligation without cardiopulmonary bypass(CPB).The remaining 20 cases received fistula correction with beating heart CPB.Direct suture was used in 3 patients for closure of fistula inlet and 11 children for outlet.Both inlet and outlet were closed in 6 patients,and in 2 of them autologous pericardial patch was used for outlet.Other associated intra-cardiac anomalies in 7 children were corrected during the operation.The aneurysmal coronary arteries remained original shape without any intervention during the operation.The mean hospital delay was(12.3±3.2) days.Two patients appeared decreased heart function within 3 days after the operation,and recovered in return visit one month later.Another 2 patients showed a residual shunt with size of 1 to 2 millimeters through the fistula without further intervention after the surgical closure.During the perioperative period and the follow-up period(3 months to 8 years),all 22 patients were asymptomatically alive without regular anticoagulation management.Transthoracic echocardiography showed normal cardiac function.Compared with preoperative status,the diameter of dilated coronary arteries was reduced over 6 months follow up after the operation.There were no formation of thrombus in the coronary arteries.Electrocardiography showed no ST-T changes or arrhythmia or myocardial ischemia.Conclusion Clinical symptoms can be appeared in children with congenital CAF due to large shunt.Surgical correction is an effective method for the management of single CAF or CAF with coexisted intra-cardiac anomalies.The outcome was well.
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Objective To summarize the clinical characteristics,imaging characteristics,treatment and progno-sis of unilateral pulmonary vein atresia (UPVA)in children and to improve the clinician′ s understanding of this disease. Methods The clinical data of 4 cases of UPVA from January 2014 to December 2016 in Department of Cardiology,Guangzhou Women and Children′s Medical Center were retrospectively analyzed,and 50 cases from reviews of PubMed,OVID and Elsevier in the international medical literature database and 4 cases in Wanfang database for the domestic report were reviewed. The clinical characteristics,diagnosis,treatment and prognosis of total of 58 cases were analyzed. Results Four patients,with an average age of 1. 8 years (1. 5 - 2. 7 years),showing congenital UPVA in 3 patients and secondary UPVA in 1 patient. There was 1 case of left upper pulmonary vein atresia,2 cases of left pulmo-nary vein atresia and 1 case of right pulmonary vein atresia. Three cases showed recurrent hemoptysis and recurrent cough occurred in 1 case. Three cases were complicated with congenital heart disease. There was one case underwent bronchial artery embolization,1 case received pulmonary vein left atrium connection,and 2 cases received conservative treatment. All patients had been followed up for 1 - 3 years so far. The patient receiving pulmonary vein left atrium had been completely cured,and the patient receiving bronchial artery embolization showed no occurrence of hemoptysis but still showed recurrent cough hemoptysis. The patient with secondary UPVA had no obvious clinical symptoms,the other 1 case who rejected operation and received conservative treatment still had recurrent pulmonary infection,intermittent hemoptysis. The average age of 54 cases(40 cases with age ≤18 years old)from the literature reports was 13. 76 years (8 days - 43 years)in which 52 cases were diagnosed as congenital UPVA,while 2 cases were secondary UPVA. Twenty - seven cases were right pulmonary vein atresia,22 cases were left pulmonary vein atresia,and 5 cases were other types. There were 94. 4％(51 / 54 cases)of the patients having recurrent cough,pulmonary infection,92. 6％(50 /54 cases)of the patients with exertional dyspnea and polypnea,68. 5％(37 / 54 cases)of the patients with hemoptysis and hematemesis. There were 50. 0％(27 / 54 cases)of UPVA patients who were complicated with heart malformation. Different degrees of pulmonary hypertension were observed in 75. 9％(41 / 54 cases)of children,and 35. 2％(19 / 54 cases)of patients had pulmonary lymphatic dilatation. Pulmonary resection was performed in 25 cases,pulmonary vein left atrium connection was performed in 11 cases,bronchial artery embolization was performed in 7 cases,and conserva-tive treatment was performed in 11 cases. After operation,most of the patients had good prognosis without obvious clini-cal symptoms or mild symptoms. Conclusions In clinical practice,if unexplained hemoptysis,recurrent lower respira-tory tract infection,pulmonary consolidation,pulmonary dysplasia or pulmonary hypertension present,the possibility of UPVA should be considered. Early diagnosis and early bronchial artery embolization,reconstruction of the pulmonary vein and atrial connection and repair of the defect of heart,can improve the symptoms or cure the children and reduce the morta-lity significantly.
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Objective To analyze the clinical and anatomic characteristics of bridging bronchus (BB) malformation in children,and to explore its diagnostic strategy,treatment and risk factors.Methods A retrospective study was performed in 23 pediatric patients with BB who were admitted to Guangzhou Women and Children's Medical Center form May 2010 to October 2016.All their clinical features,imaging examination,treatment and prognosis were reviewed and analyzed.Results (1) Among the 23 patients with BB,15 were males and 8 were females.The age range of onset was 0 to 4 years old with a median age of 3.17 months.(2)The main clinical manifestations were cough (23/23 cases,100.0％),recurrent wheezing (20/23 cases,87.0％),cyanosis (8/23 cases,34.8％) and feeding diffficulty/slow body weight growth (6/23 cases,24.6％).(3) There were 17 cases of type Ⅰ and 4 cases of type Ⅱ according to Wells,and the other 2 cases were anterior BB.There were 2 cases with atypical anatomical morphology in type Ⅰ and type Ⅱ respectively.(4) Twenty-one cases were associated with bronchial stenosis in which the origin of left main bronchus complicated with BB stenosis was the most common(5 cases).Bronchoscopy revealed bronchomalacia in 5 of the 16 patients.Sixteen patients associated with cardiac or vascular anomalies,11 of whom were compound anomalies,and the most common type was sling left pulmonary artery (SLPA) (12 cases).(5) Nine of 12 patients with SLPA received surgical management,ages ranging from 1 month to 8 years old.The respiratory symptoms remitted gradually or disappeared from 4 to 17 months after surgical management.Two died and one has been lost to follow-up among the remaining 3 patients with SLPA.Conclusions BB is a rare tracheobronchial malformation that is often associated with stenosis or bronchomalacia,and cardiac or vascular anomalies.The severity of the disease mainly depends on whether there is airway stenosis or malacia and its extent.The definitive diagnosis of BB requires the combination of different imaging modalities.The combination with simple SLPA could get better curative effect.
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Objective To summarize the clinical features,treatment and prognosis of infantile hepatic hemangioendothelioma(IHHE) combined with congestive heart failure(CHF) in children.Methods A retrospective analysis was made with the clinical data from 4 children with IHHE combined with CHF in Department of Pediatric Cardiology,Affiliated Guangzhou Women and Children's Medical Center of Guangzhou Medical University from May 2013 to December 2015.Results Among 4 infants,there were 3 male and 1 female,mean aged of 109 days (21-219 days),the average weight of 4 350 g (2 750-6 500 g),and 1 case was admitted because of abdominal swelling and respiratory distress,1 case of abdominal swelling,jaundice,shortness of breath admission,1 case of fever and shortness of breath admission,and 1 case of cyanosis and shortness of breath admission.Two patients were associated with hemangioma and Kasabach-Merritt syndrome.Three cases had multiple liver hemangioma scattered in the left lobe and right lobe of the liver,and 1 case had solitary liver hemangioma scattered in the right lobe.Tumor size diameters were ranged from 2-10 mm.Four children had been used Prednisone [1-2 mg/(kg · d)] and Digoxin,Dopamine,Furosemide,Spironolactone.Two cases responsed well to the therapy and were followed up for 2 years or 1 year and 6 months respectively,whose heart size,heart function and pulmonary hypertension became normal.One case with Kasabach-Merritt syndrome responsed poorly to the therapy.Two cases experienced transcatheter hepatic arteriovenous fistula embolization by using coil occlusion of hepatic artery-venous fistula.The postoperative hepatic tumor volume was significantly decreased,and the heart function was improved.One patient was followed up for 1 year and 6 months,and the heart size,pulmonary hypertension and heart function returned to normal.One case was still under follow-up.One case with Kasabach-Merritt syndrome died from heart failure and severe infection before surgery.The mortality rate was 25％ (1/4 cases).Conclusions IHHE is a rare cause of CHF in children.If heart failure is found unexplained in children,abdominal ultrasound or CT examination should be done immediatey in order to confirm the presence or absence of IHHE.The mortality rate in IHHE associated with CHF is very high.Early identification,early intervention,especially Prednisone combined with transcatheter hepatic arteriovenous fistula embolization can significantly improve heart function,reduce the mortality and improve the prognosis of IHHE associated with CHF in children.
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<p><b>OBJECTIVE</b>To evaluate the prognosis and clinical features of patients with giant coronary artery aneurysm (GCAA) caused by Kawasaki disease (KD).</p><p><b>METHOD</b>KD complicated with GCAA was diagnosed in 55 patients between January 2003 and December 2012 in Guangzhou Women and Children's Medical Center.Of the 55 patients, 48 were studied(43 boys, 5 girls). According to the follow-up time, these patients were divided into four groups: ≤ 1 year follow-up group, > 1-3 years follow-up group, > 3-5 years follow-up group, and > 5-10 years follow-up group. These patients were investigated at the acute stage, and were followed up respectively at two weeks, one month, three months, six months, and one year after hospitalization and every 3 to 6 months after a year. All patients regularly accepted echocardiography and electrocardiographic examination, while some cases accepted CT coronary angiography (CTA) examination and coronary angiography (CAG) examination to confirm the condition of GCAA.</p><p><b>RESULT</b>(1) The age of 48 patients ranged from 2 months to 10 years. Twenty cases were less than 1 age (42%), 30 cases were under 3 years of age (62%) and follow-up time was (4.0 ± 3.1) years. Age at endpoint was 1.5 to 19 years, mean (6.8 ± 4.2) years respectively. (2) In ≤ 1 year follow-up group, the proportions of no significant changes, retraction, and stenosis were 48%, 48% and 4% respectively. In > 1-3 years follow-up group, the proportions of no significant changes, retraction, and stenosis were 39%, 39% and 22% respectively. In > 3-5 years follow-up group, the proportions of no significant changes, retraction, and stenosis were 30%, 35% and 35% respectively. In > 5-10 years follow-up group, the proportions of no significant changes, retraction, stenosis were 30%, 20% and 50% respectively. Compared with the ≤ 1 year group, a significant increase in the proportion of coronary artery stenosis occurred at the other three groups.Significant difference in the stenosis rate could be found between the ≤ 1 year group and the other three groups respectively (χ(2)=6.026, 11.121, 15.652; P=0.019, 0.002, 0.001). (3) The rate of retraction in bilateral GCAA group (20 cases) was lower than unilateral GCAA group (28 cases ); bilateral GCAA group had lower rate than the unilateral group(15% (3/20) vs. 36% (10/28)). There was no significant difference in coronary artery outcome between two groups (P > 0.05) . (4) There were six severe ischemic heart disease in 48 cases including 2 deaths. (5) CTA showed coronary artery wall thickening, mural thrombus and calcification, the CAG could display coronary artery occlusion and recanalization and collateral vessels formation.</p><p><b>CONCLUSION</b>KD complicated with GCAA may occur in infants under one year of age, especially infants under 6 months of age. A significant increase in the proportion of coronary artery stenosis occurred with the follow-up time extended. The proportion of bilateral GCAA patients who had ischemic heart disease and died was higher than the unilateral cases. The combined application of echocardiography, CTA and CAG may greatly help to discover coronary thrombosis, stenosis and occlusion.</p>
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Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Aneurisma Coronario , Angiografía Coronaria , Trombosis Coronaria , Ecocardiografía , Electrocardiografía , Estudios de Seguimiento , Síndrome Mucocutáneo Linfonodular , PronósticoRESUMEN
Objective To summarize the characteristics of ecthyma gangrenosum and explore its significance in early diagnosis of pseudomonas aeruginosa sepsis in children.Methods We retrospectively reviewed the medical records of 11 children with ecthyma gangrenosum who were hospitalized at Guangzhou women and children's medical center between May 2008 and Apr 2011.Results Eight cases were male and 7 were less than twelve months,the oldest was 2 years old,all of them were diagnosed as Pseudomonas aeruginosa spesis.Two patients had a single lesion,and the others had multiple lesions.Ecthyma gangrenosum located on the trunks in 7 cases,on anogenital areas in 5 cases,on extremities in 5 cases and on faces in 3.The lesions appeared on day 2 to day 10.On average,they developed on day 5.Seven patients developed ecthyma gangrenosum before admission,the course of the illness before admission was 6 days.Fever and multiple organ dysfunction occurred in all the patients and their cultures grew pseudomonas aeruginosa,blood cultures were positive in 8 cases,the others were isolated psudomonas aeruginosa from tissue of the lesion,discharge,ascites,pleural effusion,respectively.The time of ecthyma gangrenosum appeared was earlier than the time of the culture results reported.All of the patients were started empiric antibiotics therapy on admission,the initial antibiotic regimen was appropriate in 9 patients,8 needed surgical intervention,4 were treated with continuous blood purification.Ten patients survived and 2 died,the hospital stay was from 1 to 63 days,the average was 30.Conclusion Ecthyma gangrenosum is a known cutaneous manifestation of pseudomonas aeruginosa sepsis,which is helpful for early diagnosis and treatment,and then the outcome will be improved.