Diaphragmatic Pathology in Children: Not Always an Easy Diagnosis.

ABSTRACT: We present a rare case of a 10-year-old boy with a right diaphragmatic eventration (DE), an uncommon pathology in children. The case highlights the importance of making a correct differential diagnosis between an acquired diaphragmatic hernia and a DE, two uncommon diaphragmatic pathologies. Differential diagnosis of these two entities can usually be made based on radiological findings, by identifying the continuity or the lack of continuity of the diaphragm, but sometimes, especially when on the right side, like in our case, they can be very difficult to differentiate by imaging. Diaphragmatic eventration is an abnormal elevation of an intact diaphragm that maintains its continuity and its attachments to the costal wall. Diaphragmatic hernia occurs when abdominal organs move into the chest through a defect in the diaphragm. Diaphragmatic hernia is generally symptomatic and always a medical emergency and requires urgent surgery, whereas DE is generally asymptomatic, has a better prognosis, and can be treated conservatively.As the treatment, the surgical approach, and the prognosis of these two entities are very different, a correct differential diagnosis is very important.

Double cervical cyst derived from a single thyroglossal duct tract.

Thyroglossal duct cysts are one of the most common congenital cervical pathologic findings in children. This type of cyst can be located anywhere between the base of the tongue and the sternal manubrium. We report the case of a patient with a double thyroglossal cyst, one located in the hyoid region and the other in the thyroid gland. The 2 cysts were connected by a permeable tract, which confirms that an involution failure of the embryonic remains of the thyroglossal duct was responsible for the development of the cyst. Intrathyroid cysts of the thyroglossal duct, though uncommon, should be included in the differential diagnosis of thyroid cysts in children.

Tratamiento del pectus excavatum mediante toracoplastia percutánea videoasistida / Treatment of pectus excavatum with videoassisted percutaneous thoracoplasty

Fundamento. La deformación congénita más frecuentede la caja torácica es el pectus excavatum (PE): 95% de loscasos. PE es una malformación de los cartílagos costalesque comporta la respiración paradójica o invertida del pacientedesde la fase de la lactancia con hundimiento progresivodel esternón y deformación de toda la caja torácica.El tratamiento clásico del PE ha consistido entoracoplastia «a demanda» con resección subpericondralde todas las uniones costoesternales patológicas. La posibilidadde tratar esta afección mediante una técnica pocoinvasiva es una consideración que se debe evaluar.Objetivo. La finalidad de este trabajo es la presentaciónde nuestra experiencia en el tratamiento del PE mediantetoracoplastia percutánea videoasistida (TPV) segúnla técnica descrita por Nuss.Método. Desde el 14 de junio de 2001 a mayo de 2004hemos tratado 21 casos de PE grave mediante TPV. Todoslos casos correspondían a hombres de edades comprendidasentre 3 y 21 años (media edad: 10,4). Las exploracionescomplementarias requeridas son RX de tórax simple, pruebasde función respiratoria, ecocardiografía y TAC torácica conmedición de Indice de Haller (diámetro máximo LL / diámetromínimo del PE, considerando patológico un índice superior a3,2). El método quirúrgico se realiza bajo anestesia convencionale intubación orotraqueal. Con asistencia toracoscópicade 5 mm colocada en 7º espacio intercostal derecho seprocede a la reducción de la deformación y ferulización ortésicamediante una férula previamente configurada.Resultados. El tiempo medio ha sido de 65 minutos. Laspérdidas hemáticas son inapreciables (10-20 ml). Estanciamedia de 6.5 días. Como complicación se apreció un seroma en dos casos y granulomas en uno. La ortesis ha sido bientolerada en todos los casos, reintegrándose a su vida normala los 16 días de media. La férula ha sido ya retirada enseis pacientes por finalización del tratamiento. Todos loscasos se han reintegrado socialmente, y se ha conseguidouna adaptación rápida a la actividad física escolar. Seis pacientesque previamente presentaban cuadros bronconeumónicosde repetición no los han vuelto a sufrir. El resultadoestético es evidente desde la salida del quirófano, yaque únicamente se detectan tres pequeñas señales, quecon el tiempo se hacen imperceptibles. El beneficio económicose cifra en un 40% del procedimiento convencional.Conclusiones. Consideramos la TPV como un métodoatractivo del cual se pueden beneficiar todos los pacientesafectos de PE simétrico severo con independencia de suedad

Background. Pectus excavatum (PE) is the most commoncongenital malformation of the chest wall, accountingfor 95% of all cases. PE is a deformity of the cartilages ofthe chondrosternal joint that leads to inverted breathingand progressive chest deformity. Classic repair of PE is openthoracoplasty with subperichondral resection of the chondrosternaljoints. Alternative, less aggressive procedures,with minimally invasive techniques should be considered.Objective. The aim of this paper is to present our experiencein the treatment of PE with videoassisted percutaneousthoracoplasty (VPT), as previously described by Nuss.Patients and Methods. From June 2001 to May 2004,21 patients with severe PE were treated with VPT in our institution.All the patients were males, aged 3 to 21 years(mean 10.4 years). Chest XR, pulmonary function tests,echocardiography, and CT scan with measurement ofHaller index (LL diameter / AP diameter on the PE, andconsidering abnormal a ratio > 3.2) were the required diagnosticprocedures. Surgery was performed under generalanesthesia, with orotracheal intubation. The deformitywas corrected with the placement of previouslyconformed orthesis using videoassisted thoracoscopythrough the 7th intercostal space.Results. The mean duration of the intervention was 65minutes. Blood losses were minimal (10-20 ml), and themean length of hospitalization was 6.5 days (range 5 to 14days). Complications included seroma in 2 cases andwound granuloma in 1 case. The pectus bar was well toleratedin all patients, and normal activity was reached at amean of 16 days. The pectus bar was removed in 6 patientsonce the treatment was completed, and no recurrenceswere observed. Six patients that had history of recurrentbronchopulmonary infections prior to the correction are freeof symptoms. The good cosmetic outcome was apparent immediatelyafter surgery. Medical costs of this technique wereestimated to be 40% of the traditional techniques.Conclusions. The VPT is an effective minimally invasivesurgical technique that can be used in the treatment of allpatients with symmetric PE, regardless of age