Management of pediatric hemoptysis: review and a case of isolated unilateral pulmonary artery agenesis.

OBJECTIVES: Management of hemoptysis in the pediatric patient requires an otolaryngologist knowledgeable and skilled in the causes and management of this potentially life-threatening condition. This paper will discuss the management of pediatric hemoptysis by the otolaryngologist through an index case of massive hemoptysis seen in a child with isolated unilateral pulmonary artery agenesis (IUPAA). STUDY DESIGN: Literature review and index case. METHODS: Through a Medline search and the experience of the author (A.J.M.), we reviewed the causes and treatment options for hemoptysis in the pediatric patient. RESULTS: Management of hemoptysis by the otolaryngologist requires prompt diagnosis and patient stabilization. This allows the patient access to multiple treatment options which may include diagnostic or therapeutic bronchoscopy, angiography with embolization, and surgical intervention such as resection or revascularization. IUPAA is an unusual, and potentially life-threatening cause of hemoptysis in the pediatric patient. CONCLUSION: Hemoptysis in the pediatric patient requires prompt and thorough evaluation and treatment. An approach for the management of pediatric hemoptysis, including massive hemoptysis, is described.

Facial motion analysis with a video and computer system after treatment of acoustic neuroma.

OBJECTIVE: To objectively evaluate facial function with a computer and video system in a group of normal adults and a group of adults who have been treated for acoustic neuroma. STUDY DESIGN: A prospective descriptive study was performed in which the experimenter performing the objective facial motion analysis was blinded to the subjective rating of facial function. PATIENTS: The normal subjects comprised 18 women and 16 men. The subjects who had been treated for acoustic neuroma included 12 patients (seven women and five men) who underwent treatment for acoustic neuroma. METHODS: Light-reflective markers were placed at selected facial sites. A video and computer-assisted system was used to measure displacement that was unconfounded by head motion at these sites during two expressions. Proximal and remote displacement were measured for the x and y coordinates. Percentage of asymmetry relative to the total displacement was determined. RESULTS: Significant asymmetry in displacement for the y coordinate during the eyes-closed expression occurred in 100% of the subjects who had been treated for acoustic neuroma with apparent facial dysfunction and 0% of the subjects who had been treated for acoustic neuroma with no apparent facial dysfunction. Synkinesis was severe (>0.2 cm) in 17%, moderate (0.1-0.2 cm) in 25%, mild (>95th percentile for normal subjects but <0.1 cm) in 42%, and absent in 16% of the subjects who had been treated for acoustic neuroma. CONCLUSION: This method of objective assessment of facial function is useful in the evaluation of the asymmetry in facial motion and in the detection and quantification of synkinesis. The findings suggest that those subjective rating systems of facial function that compare the abnormal to the normal side may be confounded by compensatory motion on the presumed normal side.