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Cervical thymic cysts in children
ABSTRACTS
981
increased to 40%, and in patients with burns of greater percentage, 40% had hypertension. Fluid resuscitation in hypertensive patients did not differ from that of normotensive patients. In this series of patients, the incidence of hypertension was 19.8%. Encephalopathy and seizures decreased over the last five years of the study indicating better monitoring of blood pressure and use of anti-hypertensive agents. Return of blood pressure to normal values in the convalescent phase indicated that hypertension in the burned patient was an acute phenomenon.--Jane F. Goldthorn HEAD A N D NECK
age or older and general anesthesia is almost never required if a rapid scanner is used. various disease states that can be diagnosed or illustrated such as osteogenic sarcoma arising in the chest wall, mediastinal tumors, neuroblastoma arising in the paraspinal region illustrating intra- and extraspinal extension. A foreign body is well-demonstrated in the trachea that did not show on plain x-ray. Metastatic tumors in the lung are well demonstrated that also did not show on plain films. It is concluded that chest CT is a feasible imaging modality for use in children and that it can provide valuable information not demonstrable with other techniques. David L. Collins
latrogenic Acute Nasal Obstruction in an Obligate Nose Breather. L. S. Ulin and G. L. Bartlett, Jr. J A M A
Diagnostic Ultrasound for Chest Diseases in Children. jr. O.
234(16):1657, (April), 1980.
Hailer. Pediatr Ann 9:(5)22-30, (May), 1980.
A case is reported of a 34-day-old girl who was brought into the emergency department with severe respiratory distress due to nasal congestion. The mother had taken the baby to another hospital for a runny nose 2 days previously and had been instructed to use a vaporizer and salt solution nose drops which she mistakenly made up with 1 tablespoon of salt per 8 oz of water. This hypertonic solution had been used every 4 hr for 2 days prior to admission. The baby required treatment with an endotracheal tube and Decadron and was extubated after 24 hr. The case emphasizes the dangers of nasal obstruction in infants who are obligate nose breathers and also the danger of giving verbal instructions for the home preparation of saline nose drops which should be mixed with a I/4 teaspoon of salt per 8-oz glass of water to yield a concentration of approximately 0.5% sodium chloride.--David L. Collins
In spite of the physical limitations imposed on ultrasonography by the aerated lung and surrounding bony thorax, both of which transmit sound poorly, the authors feel that diagnostic ultrasound is valuable in the diagnosis of chest disease in children. In order to avoid interference from the thorax there are certain ultrasonic windows in the suprasternal region, xiphoid, and subcostal margin, which are illustrated, which can be used, to examine the mediastinum and lungs. Several cases are illustrated including one that appeared to be pleural effusion on plain x-ray but on sonography turned out to be a solid tumor. Another example that was a pleural effusion was shown where the ultrasonogram showed an echo free accumulation in the pleural space. A pericardiac mass examined and found to be solid suggesting that it is a neoplasm rather than a pericardial cyst. Opacification in a child with esophageal perforation is demonstrated to be echo free suggesting the diagnosis of abscess rather than consolidation. It is thus felt that sonography generally compliments radiographic and radionuclide examinations of the chest and is particularly helpful in distinguishing solid from cystic lesions. David L. Collins
Cervical Thymic Cysts in Children. M. Reiner, A. R. Beck, and B. Rybak. A m J Surg 139:704-707, (May), 1980.
Two case reports of boys aged 5 and 9 yr with thymic cysts are presented. Normal thymic embryology is reviewed. Pathogenesis of thymic cysts is attributed to: (1) embryonic remnants of thymus, thymopharyngeal ducts, or branchial cysts; (2) degenerating Hassel's corpuscles; (3) neoplastic processes involving lymphoid or connective tissues; (4) sequestration of elements during thymic involution; or (5) lymph vessels, blood vessels, or connective tissues in various stages of thymic development. This lesion appears at its highest incidence in children. A series of 45 children was reviewed in which 73% were male and 27% were female, although there is no known reason for male predominance. Thymic cysts usually appear suddenly in the anterior cervical triangle and there is no predisposition to malignant degeneration. Differential diagnosis includes branchial cysts, dermoid cysts, cystic hygroma, parathyroid and thyroid cysts, and thyroglossal duct cysts. Complete surgical excision, as was done in these patients, is the treatment of choice.--Jane F. Gotdthorn THORAX Computed Tomography for Chest Examination in Children.
Asymmetric
Congenital
Deformity of the Ribs. M. M.
Ravitch. Ann Surg 191:534-538, (May), 1980. Four females and one male who had asymmetric chest deformities consisting of deeply sunken right ribs and variable degrees of sternal rotation are reported. There were minimal, but definite, left-sided deformities and no pulmonary or cardiovascular abnormalities appreciated. The surgical procedure is well-illustrated.--Jane F. Goldthorn Rare Posterior Mediastinal Tumors in Children. F. G u i l l e -
rain, M. Schmitt, P. Gautry, et al. Chir P6diatr 2 0 : 4 1 3 4 1 6 , (November/December), 1979. The authors report three cases in a series of 15 of rare posterior mediastinal tumors: a bronchogenic cyst, an esophageal cyst and a pheochromocytoma. They suggest angiography as a good preoperative diagnostic method in differentiating these from the more common neurogenic t u m o r s . ~ . Deevey Pulmonary Hypoplasia: Lung W e i g h t and Radial Alveolar Count as Criteria of Diagnosis. S. S. Zskenazi and M.
D. R. Kirks and M. Korobkin. Pediatr Ann 9:(5)31-43, (May), 1980.
Perlman. Arch Dis Child 54:614-618, (August), 1979.
The authors recommend the use of rapid scanners for chest examinations in children with less than a 5-see scan time. Sedation will usually not be needed for children 4 yr of
A postmortem study of the lungs of liveborn and stillborn infants has produced a working definition of pulmonary hypoplasia (PH). About 200 infants in whom PH was
981
increased to 40%, and in patients with burns of greater percentage, 40% had hypertension. Fluid resuscitation in hypertensive patients did not differ from that of normotensive patients. In this series of patients, the incidence of hypertension was 19.8%. Encephalopathy and seizures decreased over the last five years of the study indicating better monitoring of blood pressure and use of anti-hypertensive agents. Return of blood pressure to normal values in the convalescent phase indicated that hypertension in the burned patient was an acute phenomenon.--Jane F. Goldthorn HEAD A N D NECK
age or older and general anesthesia is almost never required if a rapid scanner is used. various disease states that can be diagnosed or illustrated such as osteogenic sarcoma arising in the chest wall, mediastinal tumors, neuroblastoma arising in the paraspinal region illustrating intra- and extraspinal extension. A foreign body is well-demonstrated in the trachea that did not show on plain x-ray. Metastatic tumors in the lung are well demonstrated that also did not show on plain films. It is concluded that chest CT is a feasible imaging modality for use in children and that it can provide valuable information not demonstrable with other techniques. David L. Collins
latrogenic Acute Nasal Obstruction in an Obligate Nose Breather. L. S. Ulin and G. L. Bartlett, Jr. J A M A
Diagnostic Ultrasound for Chest Diseases in Children. jr. O.
234(16):1657, (April), 1980.
Hailer. Pediatr Ann 9:(5)22-30, (May), 1980.
A case is reported of a 34-day-old girl who was brought into the emergency department with severe respiratory distress due to nasal congestion. The mother had taken the baby to another hospital for a runny nose 2 days previously and had been instructed to use a vaporizer and salt solution nose drops which she mistakenly made up with 1 tablespoon of salt per 8 oz of water. This hypertonic solution had been used every 4 hr for 2 days prior to admission. The baby required treatment with an endotracheal tube and Decadron and was extubated after 24 hr. The case emphasizes the dangers of nasal obstruction in infants who are obligate nose breathers and also the danger of giving verbal instructions for the home preparation of saline nose drops which should be mixed with a I/4 teaspoon of salt per 8-oz glass of water to yield a concentration of approximately 0.5% sodium chloride.--David L. Collins
In spite of the physical limitations imposed on ultrasonography by the aerated lung and surrounding bony thorax, both of which transmit sound poorly, the authors feel that diagnostic ultrasound is valuable in the diagnosis of chest disease in children. In order to avoid interference from the thorax there are certain ultrasonic windows in the suprasternal region, xiphoid, and subcostal margin, which are illustrated, which can be used, to examine the mediastinum and lungs. Several cases are illustrated including one that appeared to be pleural effusion on plain x-ray but on sonography turned out to be a solid tumor. Another example that was a pleural effusion was shown where the ultrasonogram showed an echo free accumulation in the pleural space. A pericardiac mass examined and found to be solid suggesting that it is a neoplasm rather than a pericardial cyst. Opacification in a child with esophageal perforation is demonstrated to be echo free suggesting the diagnosis of abscess rather than consolidation. It is thus felt that sonography generally compliments radiographic and radionuclide examinations of the chest and is particularly helpful in distinguishing solid from cystic lesions. David L. Collins
Cervical Thymic Cysts in Children. M. Reiner, A. R. Beck, and B. Rybak. A m J Surg 139:704-707, (May), 1980.
Two case reports of boys aged 5 and 9 yr with thymic cysts are presented. Normal thymic embryology is reviewed. Pathogenesis of thymic cysts is attributed to: (1) embryonic remnants of thymus, thymopharyngeal ducts, or branchial cysts; (2) degenerating Hassel's corpuscles; (3) neoplastic processes involving lymphoid or connective tissues; (4) sequestration of elements during thymic involution; or (5) lymph vessels, blood vessels, or connective tissues in various stages of thymic development. This lesion appears at its highest incidence in children. A series of 45 children was reviewed in which 73% were male and 27% were female, although there is no known reason for male predominance. Thymic cysts usually appear suddenly in the anterior cervical triangle and there is no predisposition to malignant degeneration. Differential diagnosis includes branchial cysts, dermoid cysts, cystic hygroma, parathyroid and thyroid cysts, and thyroglossal duct cysts. Complete surgical excision, as was done in these patients, is the treatment of choice.--Jane F. Gotdthorn THORAX Computed Tomography for Chest Examination in Children.
Asymmetric
Congenital
Deformity of the Ribs. M. M.
Ravitch. Ann Surg 191:534-538, (May), 1980. Four females and one male who had asymmetric chest deformities consisting of deeply sunken right ribs and variable degrees of sternal rotation are reported. There were minimal, but definite, left-sided deformities and no pulmonary or cardiovascular abnormalities appreciated. The surgical procedure is well-illustrated.--Jane F. Goldthorn Rare Posterior Mediastinal Tumors in Children. F. G u i l l e -
rain, M. Schmitt, P. Gautry, et al. Chir P6diatr 2 0 : 4 1 3 4 1 6 , (November/December), 1979. The authors report three cases in a series of 15 of rare posterior mediastinal tumors: a bronchogenic cyst, an esophageal cyst and a pheochromocytoma. They suggest angiography as a good preoperative diagnostic method in differentiating these from the more common neurogenic t u m o r s . ~ . Deevey Pulmonary Hypoplasia: Lung W e i g h t and Radial Alveolar Count as Criteria of Diagnosis. S. S. Zskenazi and M.
D. R. Kirks and M. Korobkin. Pediatr Ann 9:(5)31-43, (May), 1980.
Perlman. Arch Dis Child 54:614-618, (August), 1979.
The authors recommend the use of rapid scanners for chest examinations in children with less than a 5-see scan time. Sedation will usually not be needed for children 4 yr of
A postmortem study of the lungs of liveborn and stillborn infants has produced a working definition of pulmonary hypoplasia (PH). About 200 infants in whom PH was