Serious complications of an obstructive upper airway infection in a young child (Views : 1952 times)
Sandra Kralik, Ivačica Škarić, Diana Butković, Lili Mikecin, Karmen Kondža, Jasminka Jakobović
Abstract
A 15-month old boy was admitted to our intensive care unit (ICU) cyanotic, unresponsive, apneic, pulseless, with fixed, dilated pupils and a Glasgow Coma Score (GCS) of 3/15. Prompt cardiopulmonary resuscitation (CPR) was initiated and cardiac function was resumed after 10 minutes. The boy was intubated but could not be ventilated because of a thick, viscous secretion obstructing the trachea and causing total airway obstruction. Bronchoscopy revealed laryngotracheitis as the reason for airway obstruction. A computed tomography (CT) scan of the brain showed diffuse edema and ischemic brain injury, which were considered responsible for the boy's comatose situation. Clinical status remained unchanged for 11 days, after which the boy was transported to another hospital. In children presenting with upper airway obstructing syndromes, not responding to therapy, the diagnosis of bacterial tracheitis should be considered and the child should be monitored in a pediatric intensive care unit.
Key words: children, respiratory infection, airway obstruction, bacterial tracheitis
Mediastinal tube placement in a premature infant with cardiorespiratory derangement due to ventilator associated pneumomediastinum (Views : 1571 times)
Sandro Dessardo, Kristina Lah Tomulić, Neven Frleta, Nada Sindičić Dessardo
Abstract
While mediastinal free air in the ventilated newborn is usually benign, tension pneumomediastinum can lead to further cardiorespiratory compromise due to the compression of mediastinal structures, including the heart and large blood vessels. The authors present a case of life-threatening pneumomediastinum in a ventilated preterm leading to abrupt onset of cardiorespiratory failure. An 8 French (Fr) drainage catheter was placed in the anterior mediastinum using the 2nd right intercostal space as an insertion site, with prompt hemodynamic improvement. A brief description of the drainage technique and a literature review is presented.
Key words: hemodynamics, mechanical ventilation, pneumomediastinum, pneumothorax, thoracocentesis
Urinary peritonitis caused by gangrenous cystitis (Views : 1431 times)
Boubaker Charra, Abdelhamid Hachimi, Mustapha Sodki, Houda Gueddari, Abdellatif Benslama, Said Motaouakkil
Abstract
We report a case of a young man who developed severe urinary sepsis, on the 21st day of hospitalization (DH), which was treated with ciprofloxacin and gentamicin. On the 30th DH, he developed bloodstream and urinary infections due to Acinetobacter baumannii which had been treated with colistin and rifampicin. On the 55th DH, he developed urinary peritonitis and necrosis of the anterior and posterior bladder wall. Bilateral ureterostomy was performed. The patient was treated with colistin and imipenem. Peritoneal fluid culture yielded Enterobacter cloacae susceptible to imipenem. An enterocystoplasty was performed. The outcome was favourable.
Keywords: peritonitis, Acinetobacter baumannii, colistin, rifampicin
Variation of vascular ring as a cause of extubation failure (Views : 1136 times)
Ivančica Škarić, Jasminka Jakobović, Maja Karaman Ilić, Karmen Kondža, Irena Babić
Abstract
We report on an unexpected extubation failure in a two year old boy. In our patient, failure of extubation led to a diagnostic examination. The result of our examination was discovery of a congenital anomaly of the aortic arch and great vessels (vascular ring) with compression of the trachea. The presence of this anomaly in this patient was unknown to us before. A successful surgical procedure eliminated the underlying cause of the persistent extubation failures.
Key words: tracheal compression, vascular ring, extubation failure
Acute isolated sphenoid sinusitis in a 4-year-old child: a rare case with an atypical presentation (Views : 3579 times)
Aikaterini Monti, Maria Farini, Constantine Katsanoulas
Abstract
Acute, isolated, sphenoid sinusitis is unusual, especially in children. Its incidence is about 2.7% of all sinus infections and is even rarer in children under the age of six years. It is frequently misdiagnosed because of its atypical presentation and it can cause serious complications because of the sphenoid sinus' anatomical relations with many intracranial structures.
We report a case of a previously healthy 4 year old boy, whose sole symptom at presentation was drowsiness. Physical examination and initial laboratory investigations were normal. Diagnosis was made after computed tomography of the head revealed left sphenoiditis. Although under treatment, the child manifested meningism during the first day of hospitalization, which subsided the next day. He was treated with ceftriaxone plus clindamycin and had a good outcome, without complications or neurological sequelae.
Key words: sphenoiditis, intracranial complications, children
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