Pneumothorax & pneumopericardium

Pneumothorax, pneumopericardium pneumoperitoneum, subcut. emphysema

Pneumothorax, pneumopericardium pneumoperitoneum, subcut. emphysema

Pulmonary interstitial emphysemaPulmonary 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 levelUAC at T3- 4 level

UAC tip is at T11UAC tip is at T11

UVC tip is in portal veinUVC 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 obstructionIncomplete - check valve : Air

trappingComplete : Atelectasis

• S/S : Dyspnea, hyperpnea, cough,

+/- Hx of FB aspiration

F 11 mo , หายใจหอบหลังกิ�นถั่�วติ�ดคอมา1อาทิ�ติย�

F 11 mo , หายใจหอบหลังกิ�นถั่�วติ�ดคอมา1อาทิ�ติย�

IiInInspiration film

Expiration film , more air trapping in right lung

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

F 4mo, cough, หายใจหอบหลังสำ�าลักิเม�ดสำ�ม มา 1 wk

F 4mo, cough, หายใจหอบหลังสำ�าลักิเม�ดสำ�ม มา 1 wk

Post F.B.removalPost 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 = polygonalNormal 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.M 5 mo , vomiting for 5 d.