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Principles of lung surgery
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Saleem Islam, James D. Geiger, Steven S. Rothenberg, M. Kunisaki Shaun
Lobar overexpansion can be found in neonates and infants. This may be acquired from mucous plugs or structural abnormalities obstructing a portion of the airway. Congenital lobar overexpansion is caused by absence of the bronchial cartilage in 35% of cases, leading to ball valve-type air trapping. Occasionally, extrinsic compression (e.g. congenital heart anomalies) can lead to distal air trapping and overexpansion. Bronchogenic cysts are also seen in association with this condition. A number of cases result from alveolar hyperplasia in a specific lobe of the lung leading to an emphysematous appearance. The symptoms arise from compression of other thoracic and mediastinal structures, which may occur acutely or chronically. Some infants do not require surgical intervention and remain stable without removing the lesion. Of those who need an operation, 50% will develop symptoms within a few days of birth, while the remaining present a few months later. Chest radiograph will show a hyperlucent area in the affected chest with a variable degree of compression of the mediastinal structures. The diaphragm is flattened on the affected side (Figure 16.1a and b). Involvement is usually restricted to the upper lobes (42% left upper, 21% right upper, 35% right middle), with less than 1% involving the lower lobes. Differential diagnosis includes pneumothorax, pulmonary airway malformation, pneumatocele, and atelectasis.
Paper 4
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
In contrast to this, lung contusions and pulmonary lacerations would usually be present at the time of the initial trauma imaging. Lung contusions are often seen in the form of consolidation which is frequently peripherally sited at an interface between the lung and a firmer structure, for example the ribs or mediastinum. Pulmonary lacerations cause a defect in the lung which can fill with blood or air, in which case it is called a pneumatocele.
Neonatal Pneumonia
Published in Lourdes R. Laraya-Cuasay, Walter T. Hughes, Interstitial Lung Diseases in Children, 2019
The course of neonatal pneumonia, regardless of etiology, is usually chronic, lasting days and weeks. Long-term sequelae of neonatal pneumonias are virtually unknown because it is impossible to separate the toxic effects of the therapy, particularly high concentrations of oxygen and high ventilating pressures from the inflammatory damage of the infection. Chemicals, oxygen, pressure from ventilators, and infectious agents can produce a severe chronic pneumonitis which results in fibrosis following pulmonary injury and leading to chronic lung disease. Bronchial dilations and gross bronchiectasis may occur, especially with staphylococcal pneumonia. Pneumatocele formation following staphylococcal pneumonia and other bacterial pneumonias are common but seldom produce respiratory compromise requiring intervention. It must be assumed that severe pneumonia, regardless of etiology, will lead to altered pulmonary function in later childhood and adulthood. Therefore it is important that infants recovering from pneumonia be carefully evaluated throughout infancy and childhood by frequent monitoring of pulmonary and cardiac function, using blood gases, respiratory rate, electrocardiograms, chest X-rays, and when feasible, pulmonary function testing using a respirometer. This monitoring should continue at least until these studies are normal for age.
Post-COVID-19 pneumonia pneumatoceles: a case report
Published in European Clinical Respiratory Journal, 2022
Wasim Jamal, Muhammad Sharif, Asma Sayeed, Saad Ur Rehman, Abdulqadir J. Nashwan
Approximately 4 weeks after his hospital discharge, he attended the emergency department with intermittent shortness of breath. He was apyrexial, clinically stable, and his oxygen saturations were over 94% on air. He had a chest X-ray which indicated a cavitating lesion on the right side (Figure 1(b)). His subsequent CT chest indicated findings consistent with bilateral pneumatoceles. There were two pneumatoceles on the right side and one on the left side (Figure 2 indicating the largest pneumatocele on the right side). Other CT chest findings included bilateral ground-glass changes. The pneumatocele also had an air-fluid level. His blood tests revealed unremarkable inflammatory markers. His WBCs were also normal. He was arranged to have a bronchoscopy. His bronchial washings did not grow any organism, and they were also negative for acid-fast bacilli. As the pneumatocele had an air-fluid level, there was a possibility of infection. However, as he was apyrexial, clinically well, had unremarkable inflammatory markers, and bronchial washings did not grow any organism, he was not commenced on any antibiotics. He was sent home and was arranged to have a follow-up with a repeat CXR. A three-week CXR’s follow-up revealed almost complete resolution of his pneumatocele (Figure 1(c)).
Progressive proptosis secondary to pneumosinus dilatans of the ethmoidal sinus in a pediatric patient
Published in Orbit, 2021
Rebeca Rosés Sáiz, Elsa Font Julià, Félix García Ortega, Cristina Piñero Cutillas
The term “pneumosinus dilatans” was first used by Benjamin in 19188,9 in his description of ballooning hyperpneumatization of the frontal sinus. The terms pneumosinus, pneumatocele, pneumocele, and air cysts are used interchangeably in literature to describe PD and similar conditions. Urken et al. put forward a classification system to specify these terms.10 They created the current standard nomenclature for hyperaeration of the paranasal sinuses by performing a review of the literature and comparing personal experience with normal sinus anatomy. In their work,10 they classified sinus hyperaeration into three distinct conditions based on an increasing degree of deviation from sinus anatomy: 1) hyper-sinus, a dilated sinus that does not extend beyond the normal anatomic verges of that sinus; 2) PD, a dilated sinus that extends beyond the normal anatomic boundaries; and 3) pneumocele, a dilated sinus that extends beyond the normal anatomic boundaries and causes erosion of the surrounding bony walls. Our case in effect can be classified as a 2-type condition.