case report tension pneumatocele
DESCRIPTION
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 - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Case Report Tension Pneumatocele](https://reader035.vdocument.in/reader035/viewer/2022062304/568138d7550346895da09106/html5/thumbnails/1.jpg)
Case ReportTension Pneumatocele
Feb. 4th, 2005
R1 Su, H.C.
![Page 2: Case Report Tension Pneumatocele](https://reader035.vdocument.in/reader035/viewer/2022062304/568138d7550346895da09106/html5/thumbnails/2.jpg)
MaleG3P3
C/S at 30 wksFeb. 19th, 2004
1640 gm7.6 kg
![Page 3: Case Report Tension Pneumatocele](https://reader035.vdocument.in/reader035/viewer/2022062304/568138d7550346895da09106/html5/thumbnails/3.jpg)
1st Admission: Ward
•High fever•Respiratory failure
•CT arranged
![Page 4: Case Report Tension Pneumatocele](https://reader035.vdocument.in/reader035/viewer/2022062304/568138d7550346895da09106/html5/thumbnails/4.jpg)
Sudden onset of severe tachypnea on Jan. 9th, 2005
![Page 5: Case Report Tension Pneumatocele](https://reader035.vdocument.in/reader035/viewer/2022062304/568138d7550346895da09106/html5/thumbnails/5.jpg)
Physical Examination
Jugular veins
Breath sounds
Heart sounds
![Page 6: Case Report Tension Pneumatocele](https://reader035.vdocument.in/reader035/viewer/2022062304/568138d7550346895da09106/html5/thumbnails/6.jpg)
2 Days Passed
Dyspnea
Progressive subcutaneous emphysema
![Page 7: Case Report Tension Pneumatocele](https://reader035.vdocument.in/reader035/viewer/2022062304/568138d7550346895da09106/html5/thumbnails/7.jpg)
Multiple Smaller Ones
Compressed pulmonary parenchymaCompressed pulmonary parenchyma
![Page 8: Case Report Tension Pneumatocele](https://reader035.vdocument.in/reader035/viewer/2022062304/568138d7550346895da09106/html5/thumbnails/8.jpg)
Recurrence !
It’s Tension Pneumatocele !
![Page 9: Case Report Tension Pneumatocele](https://reader035.vdocument.in/reader035/viewer/2022062304/568138d7550346895da09106/html5/thumbnails/9.jpg)
NimbexNimbexNimbexNimbex
SCCSCCSCCSCC
IsofluraneIsofluraneIsofluraneIsoflurane
KetaminKetaminKetaminKetamin
Induction,Induction,keep spontaneous keep spontaneous
ventilation.ventilation.
Induction,Induction,keep spontaneous keep spontaneous
ventilation.ventilation.
Failed intubation x 2Failed intubation x 2Failed intubation x 2Failed intubation x 2
Catheters insertedCatheters insertedCatheters insertedCatheters inserted
Failed intubation x 1Failed intubation x 1Failed intubation x 1Failed intubation x 1
Laryngospasm,Laryngospasm,SpOSpO22 droped to 60%. droped to 60%.
Laryngospasm,Laryngospasm,SpOSpO22 droped to 60%. droped to 60%.
Paralyzed,Paralyzed,SpOSpO22 returned to 80%. returned to 80%.
Paralyzed,Paralyzed,SpOSpO22 returned to 80%. returned to 80%.
SpOSpO22 > 90%, > 90%,Surgery proceeded.Surgery proceeded.
SpOSpO22 > 90%, > 90%,Surgery proceeded.Surgery proceeded.
What Happened During Induction ?What Happened
During Induction ?
![Page 10: Case Report Tension Pneumatocele](https://reader035.vdocument.in/reader035/viewer/2022062304/568138d7550346895da09106/html5/thumbnails/10.jpg)
About the Surgery
Left decubitus position
Posterolateral thoracotomy
Bullaes
LLL lobectomy
![Page 11: Case Report Tension Pneumatocele](https://reader035.vdocument.in/reader035/viewer/2022062304/568138d7550346895da09106/html5/thumbnails/11.jpg)
PneumatocelePneumatocele
NecrotizingPneumoniaNecrotizingPneumonia
![Page 12: Case Report Tension Pneumatocele](https://reader035.vdocument.in/reader035/viewer/2022062304/568138d7550346895da09106/html5/thumbnails/12.jpg)
Necrotizing Pneumonia
Invasive pneumonia + necrotic foci
Abscess
Bronchopulmonary fistula
Parapneumonic effusion
Rare in childhood
Synonyms: pulmonary gangrene
Surgery is often required
![Page 13: Case Report Tension Pneumatocele](https://reader035.vdocument.in/reader035/viewer/2022062304/568138d7550346895da09106/html5/thumbnails/13.jpg)
Thin-walled, gas-filled cysts
Sequela of pneumonia
1 week to 6 weeks
Check-valve
Antibiotic
Pneumatocele
![Page 14: Case Report Tension Pneumatocele](https://reader035.vdocument.in/reader035/viewer/2022062304/568138d7550346895da09106/html5/thumbnails/14.jpg)
Complications of Pneumatocele
Tension pneumatocele
Pneumothorax
Secondarily infected pneumatocele
![Page 15: Case Report Tension Pneumatocele](https://reader035.vdocument.in/reader035/viewer/2022062304/568138d7550346895da09106/html5/thumbnails/15.jpg)
Bullae?Pneumatocele ?
![Page 16: Case Report Tension Pneumatocele](https://reader035.vdocument.in/reader035/viewer/2022062304/568138d7550346895da09106/html5/thumbnails/16.jpg)
What Can We Do in Tension Pneumatocele ?
![Page 17: Case Report Tension Pneumatocele](https://reader035.vdocument.in/reader035/viewer/2022062304/568138d7550346895da09106/html5/thumbnails/17.jpg)
Outlines
Algorithm
Early Intervention
Operative Treatment
![Page 18: Case Report Tension Pneumatocele](https://reader035.vdocument.in/reader035/viewer/2022062304/568138d7550346895da09106/html5/thumbnails/18.jpg)
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
Decompression of pneumatocele in a neonate by percutaneous catheter placement (Case Reports)
Kogutt et al. Pediatr Radiol 29: 488-489, 1999
![Page 19: Case Report Tension Pneumatocele](https://reader035.vdocument.in/reader035/viewer/2022062304/568138d7550346895da09106/html5/thumbnails/19.jpg)
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
![Page 20: Case Report Tension Pneumatocele](https://reader035.vdocument.in/reader035/viewer/2022062304/568138d7550346895da09106/html5/thumbnails/20.jpg)
Treatment of pneumothorax in newborns: Use of venous catheter versus chest tube
Arda 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
![Page 21: Case Report Tension Pneumatocele](https://reader035.vdocument.in/reader035/viewer/2022062304/568138d7550346895da09106/html5/thumbnails/21.jpg)
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
![Page 22: Case Report Tension Pneumatocele](https://reader035.vdocument.in/reader035/viewer/2022062304/568138d7550346895da09106/html5/thumbnails/22.jpg)
Necrotizing Pneumonia in Children. Hacimustafaoglu et al. Acta paediatr 93: 1172-1177, 2004Management of Complicated Pneumatocele. DiBardino et al. J Thorac Cardiovasc Surg 126: 859-861, 2003Decompression of Pneumatocele in a Neonate by Percutaneous Catheter Placement. Kogutt et al. Pediatr Radiol 29: 488-489, 1999Management of Tension Pneumatocele With High-Frequency Oscillatory Ventilation. Hsiu-Nien Shen et al. Chest 121: 284-286, 2002Treatment of Pneumothorax in Newborns: Use of Venous Catheter versus Chest Tube. Arda et al. Pediatr Int 44: 78-82, 2002
![Page 23: Case Report Tension Pneumatocele](https://reader035.vdocument.in/reader035/viewer/2022062304/568138d7550346895da09106/html5/thumbnails/23.jpg)
Thanks for your attention
Questions & AnswersQuestions & Answers