Pneumothorax & pneumopericardium

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Presentation transcript:

Pneumothorax & pneumopericardium

Pneumothorax, pneumopericardium pneumoperitoneum, subcut. emphysema

Pulmonary interstitial emphysema

CATHETER AND TUBE POSITION 1. ENDOTRACHEAL TUBE : 1 cm below vocal cord & 2 cm above carina 2. NASOGASTRIC TUBE : In stomach 3. UVC : in IVC or RA proper 4. UAC : in thoracic aorta below level of DA ( T4 ) and above origin of celiac artery ( T11 )

UAC at T3- 4 level

UAC tip is at T11

UVC tip is in portal vein

RESPIRATORY DISTRESS IN NEWBORN SURGICAL CAUSES DIAPHRAGMATIC HERNIA Common on left side Multiple lucencies or cysts ( bowel loops ) in the chest Shifting of heart and mediastinum to the other side Decreased bowel gas or gasless abdomen

FOREIGN BODY ASPIRATION Common in children 1 - 3 years old Tracheal obstruction Bronchial obstruction Incomplete - check valve : Air trapping Complete : Atelectasis S/S : Dyspnea, hyperpnea, cough, +/- Hx of FB aspiration

F 11 mo , หายใจหอบหลังกินถั่วติดคอมา 1อาทิตย์

IiInInspiration film

Expiration film , more air trapping in right lung

Scope : peanut in Rt.main bronchus Post F.B. removal film

F 4mo, cough, หายใจหอบหลังสำลักเม็ดส้มมา 1 wk

Post F.B.removal

Alimentary Tract Disease in Children

ALIMENTARY TRACT OBSTRUCTION IN NEWBORN Normal abdominal bowel gas pattern : ‘Polygonal pattern’ Stomach : immediate after birth Small bowel : within 3 hours Colon : within 5 hours Rectum : within 6-8 hours Prone film to demonstrate air in rectum ( R/O obstruction ) Upright or left lateral decubitus film to demonstrate free air

Normal bowel pattern = polygonal

ESOPHAGEAL ATRESIA ( EA ) MC = proximal eso. atresia with distal TEF High incidence of associated anomalies : VACTERL ( V-vertebral, A-anorectal , C-cardiovascular , TE-tracheoesophageal ,R-renal , L-limb )

GASTRIC OUTLET OBSTRUCTION IDIOPATHIC HYPERTROPHIC PYLORIC STENOSIS S/S : Non-billous vomitting Onset ~ 1 month old Minimal upper abdominal distension +/-palpable mass ( olive ) at epigastrium

IDIOPATHIC HYPERTROPHIC PYLORIC STENOSIS ( IHPS ) X-RAY FINDINGS : Plain film : Gastric dilatation with large amount of air/fluid content , Decreased small bowel gas US : Elongation with thickening of muscle wall of pyloric canal UGI : Narrowing and elongation of pyloric canal ‘String sign’ Muscle indentation on lumen of stomach and duodenum ‘shoulder sign’

M 5 mo , vomiting for 5 d.