Ultrasound (US) is an ideal diagnostic tool for paediatric patients owning to its high spatial and temporal resolution, real-time imaging, and lack of ionizing radiation and bedside availability. In ...the current World Federation of Societies for Ultra-sound in Medicine and Biology (WFUMB) paper series so far (part I) the topic has been introduced and the technical require-ments explained. In the present paper the use of US in the lung in paediatric patients is analysed. Lung diseases including the interstitial syndrome, bacterial pneumonia and viral infections, CoViD findings, atelectasis, lung consolidation, bronchiolitis and congenital diseases of the respiratory system including congenital pulmonary airway malformation (CPAM) and sequester but also pneumothorax are discussed.
IntroductionEsophageal atresia(AE) is the most frequent congenital anomaly of the oesophagus. Although the survival rate of patients with AE has increased significantly in recent decades, ...postoperative morbidity is still high, anastomotic stenosis being the most common complication.ObjectiveEndoscopic management in a case with esophageal anastomotic stenosis following surgical intervention for AE.Case presentationWe present the case of a 9 year old girl, diagnosed on the first day of life with AE (distal esophageal-tracheal fistula – Vogt III B). The patient underwent a surgical procedure with the ligation of the fistula and end-to-end esophageal anastomosis, the immediate postoperative evolution being favourable. 4 months later,during a hospitalisation for aspiration pneumonia, the diagnosis of post-operative oesophageal stenosis is established, the patient being guided towards II nd Paediatrics Clinic Cluj-Napoca where one session of dilation of the oesophageal stenosis was performed(5 mm Savary dilator). The family didn’t comply with medical recommendations, further endoscopic treatment being cancelled. After another 9 months she is again hospitalised for an episode of aspiration pneumonia. The infant presented dysphagia for liquids and solids, being fed exclusively with formula milk. The underlying condition and the respiratory morbidities negatively influenced the nutritional status. Endoscopic dilatation of the post-operative esophageal stenosis was reinitiated. We performed 4 sessions of dilatation, 7–10 days apart, gradually increasing the diameter of the Savary dilators. Endoscopic passage at the level of stenosis was achieved and the infant tolerates now 2 soft meals/day.ConclusionsThe endoscopic management of anastomotic stenosis after AE surgery requires consistency and interdisciplinary collaboration.
Ultrasound (US) is an ideal diagnostic tool for paediatric patients owning to its high spatial and temporal resolution, real-time imaging, and lack of ionizing radiation and bedside availability. The ...lack of superficial adipose tissue and favorable acoustic windows in children makes US the first line of investigation for the evaluation of pleural and chest wall abnormali-ties. Lung parenchyma was previously thought to be inaccessible to ultrasound due to the presence of the air and bony thorax. The change in attitude and growing awareness of the diagnostic possibilities has led to lung ultrasound (LUS) being accepted as a valuable point of care method. In addition, the application of LUS has widened with improvements in technology such as higher resolution transducers, harmonic imaging and contrast-enhanced ultrasound. In the current World Federation of Societies for Ultrasound in Medicine and Biology (WFUMB) paper series the topic will be introduced, the technical requirements explained and the use of ultrasound in the lung and pleura in pediatric patients are discussed.
Ultrasound (US) is an ideal diagnostic tool for paediatric patients owning to its high spatial and temporal resolution, realtime imaging, and lack of ionizing radiation and bedside availability. The ...lack of superficial adipose tissue and favourable acoustic windows in children makes US the first line of investigation for evaluation of pleural and chest wall abnormalities.In the first part of the topic the technical requirements were explained and the use of ultrasound in the lung and pleura in paediatric patients were discussed. In the second part lung parenchymal diseases with their subpleural consolidations are reflected. In the third part, the use of ultrasound for chest wall, mediastinum, diaphragmatic diseases, trachea, interventions and artifacts in paediatric patients are summarized.
Button batteries (BB) remain a health hazard to children as ingestion might lead to life-threatening complications, especially if the battery is impacted in the esophagus. Worldwide initiatives have ...been set up in order to prevent and also timely diagnose and manage button battery (BB) ingestions. An European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) task force for BB ingestions has been founded which aimed to contribute to reducing the health risks related to this event. It is important to focus on the European setting, next to other worldwide initiatives, to develop and implement effective management strategies. As one of the first initiatives of the ESPGHAN task force, this ESPGHAN position paper has been written. The literature is summarized, and prevention strategies are discussed focusing on some controversial topics. An algorithm for the diagnosis and management of BB ingestions is presented and compared to previous guidelines (NASPGHAN, National Poison Center). In agreement with earlier guidelines, immediate localization of the BB is important and in case of esophageal impaction the BB should be removed instantly (preferably < 2 hours). Honey and sucralfate can be considered in ingestions ≤12 hours while waiting for endoscopic removal but should not delay it. In case of delayed diagnosis (first confirmation of the BB on x-ray >12 hours after ingestion or time point of removal >12 hours after ingestion) and esophageal impaction the guideline suggests to perform a CT scan in order to evaluate for vascular injury before removing the battery. In delayed diagnosis, even if the battery has passed the esophagus, endoscopy to screen for esophageal damage and a CT scan to rule out vascular injury should be considered even in asymptomatic children. In asymptomatic patients with early diagnosis (≤12 hours after ingestion) and position of the BB beyond the esophagus one can monitor with repeat x-ray (if not already evacuated in stool) in 7-14 days which is different from previous guidelines where repeat x-ray and removal is recommended after 2-4 days and is also based on age. Finally, prevention strategies are discussed in this paper.
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