Use of an optical fiber scope to confirm endotracheal tube placement in pediatric patients.

OBJECTIVE: To determine the efficacy of a portable optical fiber scope to confirm endotracheal tube (ETT) placement. DESIGN: A prospective, nonrandomized, blinded study. SETTING: Pediatric intensive care unit in a children's hospital. PATIENTS: Thirty mechanically ventilated patients with an ETT in place. INTERVENTIONS: Patients entered into the study underwent ETT placement determination by chest roentgenogram (CXR) and by the optical fiber scope. MEASUREMENTS AND MAIN RESULTS: Thirty patients were entered into the study, for a total of 46 measurements (n = 46). ETT size ranged from 3.0 to 6.0 mm internal diameter. Distance from the ETT and the carina was determined by the scope and compared with the distance measured on the CXR. No statistical difference was found between the two methods. None of the patients experienced clinically significant side effects from the procedure. On three occasions, the presence of secretions in the ETT did not allow for the visualization of the carina by the scope. CONCLUSION: The use of a flexible optical fiber scope is an accurate, fast, and practical method to determine ETT placement in pediatric patients on mechanical ventilation.

Normal hip in children: correlation of US with anatomic and cryomicrotome sections.

Full and simultaneous exploitation of features designed to maximize signal-to-noise ratio with the new generation of ultrasound equipment enabled detailed sonographic depiction of the anatomy of the hip and its surroundings. Scanning in familiar planes provided images that are easier to interpret. In addition, correlation of these images with cryomicrotome sections and histochemical studies disclosed several new findings. The articular cartilage of infant hips-composed mostly of water-is anechoic. However, the hyaline cartilage-which contains many vascular channels, columns of cartilage cells, and mesenchymal stroma-appears as alternating hypoechoic or anechoic columns and echogenic columns. The fibrocartilage of the limbus, on the other hand, is echogenic, as are other fibrous tissues. As expected, the points of attachment of the distal aspect of the synovial membrane, the fibrous capsule, and the ligaments in relation to the epiphyseal growth plate, varied with age, as did the characteristics of the cartilaginous structures. Familiarization with the sonographic appearance of normal hip anatomy in subjects of all ages is a first step toward recognition of various pathologic entities of the hip.

Skull radiography in infants: potential hazards of the use of head clamps.

In six infants, aged 2 days to 3 months, the use of head clamps for immobilization during radiography resulted in depression of the cranial vault. In all of the infants the depression disappeared after removal or repositioning of the clamp. However, because of the possible unfavorable consequences, head clamps with spongy, larger surface areas should be used in infants.

Computed tomography in the assessment of pediatric abdominal trauma.

A retrospective review was conducted to determine the clinical reliability of computed tomography(ic) (CT) in the initial evaluation of pediatric blunt abdominal trauma. Sixty patients underwent CT with infusion over the two-year study period. Seventeen injuries were identified by CT scans in 12 patients. Injuries included splenic hematoma, hepatic injury, duodenal hematoma, traumatic pancreatitis, retroperitoneal hematoma, renal pelvis laceration, and perinephric hematoma. Three patients required abdominal exploration and CT findings were confirmed in these cases. Other diagnostic studies (nuclear imaging, ultrasonography, upper gastrointestinal tract studies) that were obtained in some patients also confirmed the CT findings. Patients who had normal CT scans had unremarkable hospital courses, and none required reevaluation for missed injury. Only two CT scans were inadequate due to motion artifact.

Unilateral absence of a pulmonary artery.

Congenital absence of a main pulmonary artery is a rare anomaly. Most patients without associated congenital cardiac abnormalities are asymptomatic, and the diagnosis is first suggested by the appearance of the involved lung on a routine chest roentgenogram. The ipsilateral lung will be smaller than normal, and the contralateral lung will be overinflated and may herniate across the midline. We describe eight children with unilateral pulmonary arterial atresia (seven on the right side, four of whom were without associated cardiac anomalies).

The thymic mass as a mediastinal dilemma.

Five patients with normal thymus glands whose radiographs were mimicking mediastinal masses are presented; one in an infant with a compressed right upper lobe bronchus and two in adolescents with normal large lobes of the thymus. There were also two patients with regrowth of the thymus, one after severe infection and one after irradiation for secondary malignancies. We discuss the use of various techniques utilised to confirm the diagnosis and avert surgical procedures.

Choledochal cyst with cholelithiasis: 15-yr follow-up.

A 15-yr-old boy, who had had surgery for a choledochal cyst in infancy, was worked up for recurrent right upper quandrant pair. Intravenous cholangiogram and ultrasound demonstrated a choledochal cyst with stones. Angiogram showed only a distorted branch of the gastro-duodenal artery. These findings were confirmed at surgery.

Empyema as a complication of retropharyngeal and neck abscesses in children.

Empyema developing from retropharyngeal abscess is a rare complication. Two infants with clinical symptomatology and inital chest radiographic findings of pleural fluid which suggested the possibility of retrophoryngeal abscess are described. A child with submandibular and cervical abscesses is also reported; pleural fluid and mediastinal abscess developed less than 24 hours after admission. Pathological processes in the neck can spread into the chest or conversely, either by direct continuity or by dissection through the fascial planes enveloping the cervical compartments. The middle or visceral space which is in direct continuity with the mediastinum is generally the area in which cervicothoracic disease inter-relates.

Caffey's disease: a case originating in the first metatarsal and review of a 12 year experience.

This paper describes an infant with Caffey's disease who presented with swelling of the first metatarsal shown as hyperostosis histologically. He then developed scapular sclerosis and new bone formation. The mandible became involved 26 days after onset. A review of a 12 year experience with Caffey's disease (33 patients) disclosed a definite decrease in the number and percentage of patients seen since 1968.