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.