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Case Report Tension Pneumatocele

Case Report Tension Pneumatocele. Feb. 4 th , 2005 R1 Su, H.C. Male G3P3 C/S at 30 wks Feb. 19 th , 2004 1640 gm 7.6 kg. 1 st Admission: Ward. High fever Respiratory failure CT arranged. Sudden onset of severe tachypnea on Jan. 9 th , 2005. Physical Examination . Jugular veins

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Case Report Tension Pneumatocele

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  1. Case ReportTension Pneumatocele Feb. 4th, 2005 R1 Su, H.C.

  2. Male G3P3 C/S at 30 wks Feb. 19th, 2004 1640 gm 7.6 kg

  3. 1st Admission: Ward • High fever • Respiratory failure • CT arranged

  4. Sudden onset of severe tachypnea on Jan. 9th, 2005

  5. Physical Examination • Jugular veins • Breath sounds • Heart sounds

  6. 2 Days Passed • Dyspnea • Progressive subcutaneous emphysema

  7. Multiple Smaller Ones Compressed pulmonary parenchyma

  8. Recurrence ! It’s Tension Pneumatocele !

  9. Isoflurane SCC Nimbex Induction, keep spontaneous ventilation. Ketamin Failed intubation x 1 What Happened During Induction ? Laryngospasm, SpO2 droped to 60%. Paralyzed, SpO2 returned to 80%. Failed intubation x 2 SpO2 > 90%, Surgery proceeded. Catheters inserted

  10. About the Surgery • Left decubitus position • Posterolateral thoracotomy • Bullaes • LLL lobectomy

  11. Pneumatocele Necrotizing Pneumonia

  12. Necrotizing Pneumonia • Invasive pneumonia + necrotic foci • Abscess • Bronchopulmonary fistula • Parapneumonic effusion • Rare in childhood • Synonyms: pulmonary gangrene • Surgery is often required

  13. Pneumatocele • Thin-walled, gas-filled cysts • Sequela of pneumonia • 1 week to 6 weeks • Check-valve • Antibiotic

  14. Complications of Pneumatocele • Tension pneumatocele • Pneumothorax • Secondarily infected pneumatocele

  15. Bullae?Pneumatocele ?

  16. What Can We Do in Tension Pneumatocele ?

  17. Outlines • Algorithm • Early Intervention • Operative Treatment

  18. Decompression of pneumatocele in a neonate by percutaneous catheter placement (Case Reports)Kogutt et al. Pediatr Radiol 29: 488-489, 1999 • A 1m/o, markedly hypoxic, high risk for open surgery management • Under fluoroscopic guidance • Guidewire through an 18-gauge needle into the pneumatocele; dilatation of the tract followed. • 5-Fr pigtail catheter inserted with Pleur-Evac

  19. Management of Tension Pneumatocele With High-Frequency Oscillatory Ventilation (Case Reports)Hsiu-Nien Shen et al. Chest 121: 284-286, 2002 • 3 y/o girl with pneumonia, intubated with CMV • Massive air leak via chest tube + persistence of poor oxygenation • CMV may predispose her to enlarging pneumatocele and airleak • HFOV initiated • Condition improved

  20. Treatment of pneumothorax in newborns: Use of venous catheter versus chest tubeArda et al. Pediatr Int 44: 78-82, 2002 • 72 newborn patients divided into 2 groups • Chest tube versus 18-gauge catheter • Shorter duration of the procedure • Lower complication rate • A safe alternative, particularly useful for newborn

  21. What Do We Learn From This Case? • Tension Pneumatoceles, Multiple • Unsatisfactory Oxygenation • Blind Insertion of Multiple Catheters • Little Risk of Myocardium Stab • Life-saving Technique

  22. Necrotizing Pneumonia in Children. Hacimustafaoglu et al. Acta paediatr 93: 1172-1177, 2004 • Management of Complicated Pneumatocele. DiBardino et al. J Thorac Cardiovasc Surg 126: 859-861, 2003 • Decompression of Pneumatocele in a Neonate by Percutaneous Catheter Placement. Kogutt et al. Pediatr Radiol 29: 488-489, 1999 • Management of Tension Pneumatocele With High-Frequency Oscillatory Ventilation. Hsiu-Nien Shen et al. Chest 121: 284-286, 2002 • Treatment of Pneumothorax in Newborns: Use of Venous Catheter versus Chest Tube. Arda et al. Pediatr Int 44: 78-82, 2002

  23. Thanks for your attention Questions & Answers

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