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Association between pneumomediastinum and renal anomalies
387
ABSTRACTS
dren’s Hospital Medical Center, Boston, were reviewed. The younger infants had moderate to severe airway obstruction; all were less than seven months of age. Four were admitted with severe dyspnea, cyanosis, inspiratory and expiratory stridor and sternal retractions. Decreased or absent breath sounds with wheezing and rhonchi were common on the affected side. Chest radiographs reflected the severity of the airway obstruction. A mediastinal mass was seen on plain films of only three of the seven infants. In one child, bronchial obstruction caused such severe hyperinflation that this was mistaken for pneumothorax. In another, there was complete opacification of the left hemithorax caused by retention of the fluid within the alveoli normally seen in the fetus. A mediastinal mass was seen in the plain films of three children who had few respiratory symptoms. Barium swallow was found to be a helpful diagnostic maneuver. In five children in whom this was performed it was abnormal. The esophagus was deviated backward and usually to the right and, in some, the cyst was outlined between the esophagus and the lower trachea. Bronchoscopy and bronchography were done in two cases. In one, the result was misleading and in the other, airway obstruction developed, requiring immediate thoracotomy. Two patients were not operated on and died. Although the need for operation was recognized in eight of these ten patients, the precise diagnosis was not made in any. The differential diagnosis included cystic hygroma of the mediastinum, lobar emphysema, bronchial stenosis, hamartoma of the lung, pneumonia and spontaneous pneumothorax. The cysts were found deep to the mediastinal pleura at the level of the carina, necessitating retraction of the lung root anteriorly. Communication between the bronchogenic cyst and the tracheobronchial tree was not seen in any of these patients.Bruce
M. Henderson
NEURENTERIC
CYST
Edwin S. Wilson,
107:641-646
OF THE MEDIASTINUM.
Jr. Amer.
(November),
J. Roentgen. 1969.
Two cases of posterior mediastinal masses in children are presented. Each child, five months and 18 months, respectively, was admitted for evaluation and treatment of
an unrelated respiratory illness. Each had a definite posterior mediastinal mass and vertebral anomalies noted on plain chest films. Neurogenic tumors and intrathoracic meningocoele must be considered in the differential diagnosis but their association with the spine is usually destructive and not with anomalous vertebrae.--Wil/inni L. Schey ASSOCIATION TINUM
BETWEEN
AND RENAL
PNEUMOMEDIAS-
ANOMALIES.
Liberman, J. M. Abraham France. Arch. Dis. Child.
and
M. M. N. E.
44x471-475,
1969. Three cases of a fatal syndrome of pneumomediastinum, hypoplastic lungs and polycystic renal disease are described, together with a review of 1742 perinatal deaths over a 12-year period. Emphasis is laid on the association between severe extravasation of air outside of the alveoli, pulmonary hypoplasia, and renal abnormalities. In 20 cases of pneumomediastinum in a series of 920 necropsies on liveborn infants dying within the first week of life, nine infants had maldeveloped kidneys together with lungs which weighed less than half their normal weight: all 20 had pulmonary interstitial emphysema and 16 had pneumothorax. Only eight of these cases had been subjected to resuscitation. Nearly one half of the cases of pneumomediastinum coming to necropsy and nearly a third (16 out of 51) of cases of interstitial emphysema which were not resuscitated had associated hypoplastic lungs and renal anomalies. The three patients reported and a further two in the series reviewed did not show the typical Potter facies. The authors thus emphasize that although bilateral renal agenesis is probably always associated with hypoplastic lungs and Potter facies, and pulmonary hypoplasia is also frequent in infants with polycystic disease of the kidneys, the lack of the typical facial features in an infant presenting with acute respiratory distress due to pneumomediastinum should not lead the clinician into excluding an associated renal abnormality, since the presence of one normal kidney is adequate to avoid the development of Potter facies.J. Lister TRANSPLEURAL
BRONCHOTOMY
IN
THE
ABSTRACTS
dren’s Hospital Medical Center, Boston, were reviewed. The younger infants had moderate to severe airway obstruction; all were less than seven months of age. Four were admitted with severe dyspnea, cyanosis, inspiratory and expiratory stridor and sternal retractions. Decreased or absent breath sounds with wheezing and rhonchi were common on the affected side. Chest radiographs reflected the severity of the airway obstruction. A mediastinal mass was seen on plain films of only three of the seven infants. In one child, bronchial obstruction caused such severe hyperinflation that this was mistaken for pneumothorax. In another, there was complete opacification of the left hemithorax caused by retention of the fluid within the alveoli normally seen in the fetus. A mediastinal mass was seen in the plain films of three children who had few respiratory symptoms. Barium swallow was found to be a helpful diagnostic maneuver. In five children in whom this was performed it was abnormal. The esophagus was deviated backward and usually to the right and, in some, the cyst was outlined between the esophagus and the lower trachea. Bronchoscopy and bronchography were done in two cases. In one, the result was misleading and in the other, airway obstruction developed, requiring immediate thoracotomy. Two patients were not operated on and died. Although the need for operation was recognized in eight of these ten patients, the precise diagnosis was not made in any. The differential diagnosis included cystic hygroma of the mediastinum, lobar emphysema, bronchial stenosis, hamartoma of the lung, pneumonia and spontaneous pneumothorax. The cysts were found deep to the mediastinal pleura at the level of the carina, necessitating retraction of the lung root anteriorly. Communication between the bronchogenic cyst and the tracheobronchial tree was not seen in any of these patients.Bruce
M. Henderson
NEURENTERIC
CYST
Edwin S. Wilson,
107:641-646
OF THE MEDIASTINUM.
Jr. Amer.
(November),
J. Roentgen. 1969.
Two cases of posterior mediastinal masses in children are presented. Each child, five months and 18 months, respectively, was admitted for evaluation and treatment of
an unrelated respiratory illness. Each had a definite posterior mediastinal mass and vertebral anomalies noted on plain chest films. Neurogenic tumors and intrathoracic meningocoele must be considered in the differential diagnosis but their association with the spine is usually destructive and not with anomalous vertebrae.--Wil/inni L. Schey ASSOCIATION TINUM
BETWEEN
AND RENAL
PNEUMOMEDIAS-
ANOMALIES.
Liberman, J. M. Abraham France. Arch. Dis. Child.
and
M. M. N. E.
44x471-475,
1969. Three cases of a fatal syndrome of pneumomediastinum, hypoplastic lungs and polycystic renal disease are described, together with a review of 1742 perinatal deaths over a 12-year period. Emphasis is laid on the association between severe extravasation of air outside of the alveoli, pulmonary hypoplasia, and renal abnormalities. In 20 cases of pneumomediastinum in a series of 920 necropsies on liveborn infants dying within the first week of life, nine infants had maldeveloped kidneys together with lungs which weighed less than half their normal weight: all 20 had pulmonary interstitial emphysema and 16 had pneumothorax. Only eight of these cases had been subjected to resuscitation. Nearly one half of the cases of pneumomediastinum coming to necropsy and nearly a third (16 out of 51) of cases of interstitial emphysema which were not resuscitated had associated hypoplastic lungs and renal anomalies. The three patients reported and a further two in the series reviewed did not show the typical Potter facies. The authors thus emphasize that although bilateral renal agenesis is probably always associated with hypoplastic lungs and Potter facies, and pulmonary hypoplasia is also frequent in infants with polycystic disease of the kidneys, the lack of the typical facial features in an infant presenting with acute respiratory distress due to pneumomediastinum should not lead the clinician into excluding an associated renal abnormality, since the presence of one normal kidney is adequate to avoid the development of Potter facies.J. Lister TRANSPLEURAL
BRONCHOTOMY
IN
THE