Download - Case Report Tension Pneumatocele
Case ReportTension Pneumatocele
Feb. 4th, 2005
R1 Su, H.C.
MaleG3P3
C/S at 30 wksFeb. 19th, 2004
1640 gm7.6 kg
1st Admission: Ward
•High fever•Respiratory failure
•CT arranged
Sudden onset of severe tachypnea on Jan. 9th, 2005
Physical Examination
Jugular veins
Breath sounds
Heart sounds
2 Days Passed
Dyspnea
Progressive subcutaneous emphysema
Multiple Smaller Ones
Compressed pulmonary parenchymaCompressed pulmonary parenchyma
Recurrence !
It’s Tension Pneumatocele !
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 ?
About the Surgery
Left decubitus position
Posterolateral thoracotomy
Bullaes
LLL lobectomy
PneumatocelePneumatocele
NecrotizingPneumoniaNecrotizingPneumonia
Necrotizing Pneumonia
Invasive pneumonia + necrotic foci
Abscess
Bronchopulmonary fistula
Parapneumonic effusion
Rare in childhood
Synonyms: pulmonary gangrene
Surgery is often required
Thin-walled, gas-filled cysts
Sequela of pneumonia
1 week to 6 weeks
Check-valve
Antibiotic
Pneumatocele
Complications of Pneumatocele
Tension pneumatocele
Pneumothorax
Secondarily infected pneumatocele
Bullae?Pneumatocele ?
What Can We Do in Tension Pneumatocele ?
Outlines
Algorithm
Early Intervention
Operative Treatment
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
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
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
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
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
Thanks for your attention
Questions & AnswersQuestions & Answers