RESUMO
La mayoría de los casos de quilopericardio en la infancia aparecen tras cirugía torácica, especialmente tras cirugía cardiaca, aunque de forma excepcional también se producen en niños sin estos antecedentes, como los 2 pacientes presentados en este artículo. El primero se trata de un niño de 9 años con un episodio de quilopericardio como primera manifestación de una linfangiomiomatosis, y el segundo de una niña de 15 meses con antecedentes de síndrome de Down y enteropatía autoinmune, catalogado como quilopericardio congénito primario. Además, se realiza una revisión bibliográfica de los casos publicados en los últimos 13 años y se analiza el manejo de esta rara entidad (AU)
Most cases of chylopericardium in childhood are secondary to thoracic surgery, especially after cardiac surgery. However, it can also be present in children without this history, as we show in this report. First, a nine year-old boy in whom chylopericardium was the first manifestation of a lymphangiomatosis, and the second one, a fifteen months old girl with a history of Down's syndrome and autoimmune enteropathy, which was classified as primary congenital chylopericardium. Also, a review of literature over the last 13 years is made, and management of this rare entity is discussed (AU)
Assuntos
Humanos , Masculino , Feminino , Lactente , Criança , Derrame Pericárdico/diagnóstico , Tamponamento Cardíaco/diagnóstico , Linfangioleiomiomatose/diagnóstico , Síndrome de Down/complicaçõesRESUMO
Most cases of chylopericardium in childhood are secondary to thoracic surgery, especially after cardiac surgery. However, it can also be present in children without this history, as we show in this report. First, a nine year-old boy in whom chylopericardium was the first manifestation of a lymphangiomatosis, and the second one, a fifteen months old girl with a history of Down's syndrome and autoimmune enteropathy, which was classified as primary congenital chylopericardium. Also, a review of literature over the last 13 years is made, and management of this rare entity is discussed.
Assuntos
Derrame Pericárdico , Criança , Quilo , Feminino , Humanos , Lactente , Masculino , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/terapiaRESUMO
OBJECTIVE: The purpose of our study was to determine the incidence, pathological features, clinical relevance and treatment of diaphragmatic paralysis (DP) after pediatric cardiac surgery. PATIENTS AND METHODS: Five hundred fifty-six children who had undergone cardiac surgery between 1990 and 1994 were retrospectively analyzed. Persistent raising of one or both hemidiaphragms on chest x-ray films lead to the diagnosis in all cases. RESULTS: Diaphragmatic paralysis was diagnosed in 13 patients (2.3%) ranging from 3 days to 13 years of age. Atrial septal defect closure (3 cases) and systemic-pulmonary shunt derivations (3 cases) were the type of operations most frequently involved. The other cases included, 2 arterial switch in transposition of the great vessels, 1 repair of total anomalous pulmonary venous drainage, 1 tetralogy of Fallot repair, 1 coarctation and aortic stenosis repair, 1 resection of subpulmonary stenosis of transposition of the great vessels and 1 pacemaker implantation. There was no significant association with the use of extracorporeal circulation. There were seven cases of right hemidiaphragmatic paralysis, but no bilateral paralysis was found. Ipsilateral thoracotomy section concordance was found in all patients and no relation with central venous line placement was found. Diagnosis was made by chest x-ray in all cases, and further confirmation was done using fluoroscopy in 6 patients and ultrasound studies in 2. Prolonged mechanical ventilation was needed in 3 patients, and one patient required diaphragmatic plication. No long term complications were found. CONCLUSIONS: Diaphragmatic paralysis is a rare complication of pediatric cardiac surgery which must be suspected when failed attempts of respiratory weaning, not attributable to cardiac or pulmonary problems, are present.
