ABSTRACT
OBJECTIVE: To determine the prevalence and clinical significance of adrenal hemorrhage in infants undergoing ECMO therapy. METHODS: Prospective US evaluation of the adrenal glands was performed in 50 consecutive infants undergoing ECMO. The infants were examined at least every other day while on bypass. Adrenal hemorrhage was diagnosed at US examination when a suprarenal mass or adrenal gland enlargement was identified. RESULTS: Adrenal hemorrhage was identified in two infants (4%); one infant with septicemia, and one with primary pulmonary hypertension. Both hemorrhages were unilateral; one was right-sided, and one left-sided. One hemorrhage occurred on the first day following the onset of ECMO and the other on the third day. The adrenal hemorrhage was not associated with an acute drop in hematocrit nor with adrenal insufficiency in either infant. CONCLUSION: Adrenal hemorrhage is uncommon in infants undergoing ECMO. When hemorrhage did occur in this series, it did not result in clinical complications.
Subject(s)
Adrenal Gland Diseases/etiology , Extracorporeal Membrane Oxygenation/adverse effects , Hemorrhage/etiology , Adrenal Gland Diseases/diagnostic imaging , Female , Hemorrhage/diagnostic imaging , Humans , Infant, Newborn , Male , Prospective Studies , UltrasonographyABSTRACT
One hundred eighty pediatric patients with suspected appendicitis were prospectively examined with graded compression ultrasonography (US) to assess the sensitivity, specificity, and accuracy of graded compression US in the diagnosis of appendicitis in children and to compare those results with results of clinical assessment in the diagnosis of this disorder. Patients were assigned to one of three groups prior to US based on the clinical level of confidence that appendicitis was present and on the planned management decision. Of 141 patients in the low- and intermediate-clinical risk categories, 20 (14%) had appendicitis: US had a sensitivity of 100%, specificity of 97%, and accuracy of 97% in these two groups. Of 39 patients in the high-clinical risk category, 32 (82%) had appendicitis: US had a sensitivity of 81%, specificity of 86%, and accuracy of 82%. Of 52 patients with surgically proved appendicitis, the initial management decision was to discharge to home or admit for observation and further testing in 18 (35%). Results at US were positive for appendicitis in all 18 patients in the latter two categories.
Subject(s)
Appendicitis/diagnostic imaging , Adolescent , Adult , Appendicitis/diagnosis , Appendicitis/pathology , Appendix/diagnostic imaging , Appendix/pathology , Child , Child, Preschool , Diagnosis, Differential , Diagnostic Techniques, Surgical , False Positive Reactions , Female , Follow-Up Studies , Humans , Male , Patient Care Planning , Probability , Prospective Studies , Risk Factors , Sensitivity and Specificity , UltrasonographyABSTRACT
Adrenal gland size was evaluated in six infants with congenital adrenal hyperplasia. All of the infants had a severe deficiency of the 21-hydroxylase enzyme resulting in the salt-losing form of congenital adrenal hyperplasia. The adrenal measurements were compared with those of 40 consecutive age-matched, asymptomatic infants. Mean adrenal length was 14.4 mm and width was 1.9 mm in asymptomatic infants, whereas in infants with congenital adrenal hyperplasia mean adrenal length was 23.7 mm and width was 5.3 mm. Although infants with congenital adrenal hyperplasia may have normal-sized adrenal glands, mean length measurements of 20 mm or greater and mean width measurements of 4 mm or greater suggest the diagnosis.
