Spontaneous multiloculated multiseptated pneumomediastinum in a newborn baby: the spinnaker sail is rigged-CT features with pathologic correlation.

The CT appearance of a pathologically proven spontaneous multiloculated multiseptated pneumomediastinum in a newborn baby has not been reported in the English literature. Our baby was delivered vaginally at term and developed mild respiratory distress after birth. The antenatal history was unremarkable apart from borderline oligohydramnios. The multiple septa seen within the pneumomediastinum on CT on day 3 may simulate an underlying 'bubbly' lung lesion like congenital cystadenomatoid malformation or congenital lobar emphysema, but actually represent anatomically known fascia surrounding the thymus. Furthermore, in neonates, air in the mediastinum often loculates locally and tends not to dissect widely as in adults.

Pleuropulmonary blastoma with a large embolic cerebral infarct.

We report on a 3-year-old girl who developed a large embolic cerebral infarct 1 day after an uneventful thoracotomy to remove a large pleuropulmonary blastoma. The tumour had encased the heart and great vessels and ruptured into the left hemithorax. Pleuropulmonary blastoma is a rare, but unique, primary thoracic neoplasm in young children and, to our knowledge, the development of a secondary large embolic cerebral infarct is also uncommon and has not been reported in this tumour.

The value of early CT in complicated childhood pneumonia.

OBJECTIVE: To investigate the value of CT in complicated childhood pneumonia and its role in early intervention when chest radiography (CXR) is non-contributory. MATERIALS AND METHODS: Forty-two immunocompetent children, aged 1-11 years, admitted for community-acquired pneumonia from October 1997 to September 1999, had 42 contrast-enhanced CT scans and frontal chest radiographs on the same day, which were assessed independently. CT was performed when the patient remained unwell and the CXR images showed failure of resolution despite 7-10 days of antibiotics and/or drainage with urokinase therapy. RESULTS: Compared to CT, CXR revealed suboptimal accuracy rates of lobar involvement (84%), chest tube placement (73%), fluid loculation (42%), abscess formation (40%) and bronchopleural fistulae (33%). It could not assess parenchymal or pleural complications such as cavitary necrosis, early abscess formation, empyemas or pericardial effusions. On the basis of the CT findings and poor clinical progress, 16 patients underwent surgical intervention with the aid of video-assisted thorascopic surgery (VATS). The CT features correlated well with surgical findings. Ten cases required pleural decortication while six with destructive or necrotic lung lesions had surgical resection. Debridement was difficult when the pleura had become thick and fibrotic. Streptococcus pneumoniae was the offending organism in 81% of cases. The right side was affected in 67% of cases. CONCLUSIONS: In complicated childhood pneumonia, CT is far superior to CXR in revealing pleural and parenchymal complications, which may require early surgical intervention.