Ana Tripalo Batoš

Lemierre Syndrome in Adolescent with Active Ulcerative Colitis

Inflammatory bowel disease (IBD) is a well-recognized risk factor for thrombotic events in adults but data on children are scarce. In the great majority of adult patients, thrombotic events are usually deep vein thrombosis and pulmonary embolism. Other sites such as jugular veins are extremely rare. We present a case of Lemierre syndrome in an adolescent girl with active ulcerative colitis and discuss possible risk factors. This is the first reported case of severe Lemierre syndrome with thrombus extension to cranial veins in a patient with ulcerative colitis. Early recognition of Lemierre syndrome in patients who present with rapidly worsening symptoms of neck pain, fever and signs of pharyngitis is imperative because it increases a chance of favorable prognosis. It is important for pediatricians treating IBD patients not to underestimate possible thrombotic events in children with IBD. Recognition of additional risk factors is crucial for prompt diagnosis and adequate treatment.

The characteristics of transcranial color-coded duplex sonography in children with cerebral arteriovenous malformation presenting with headache.

PurposeCerebral arteriovenous malformations (AVM) are uncommon lesions. They are most often presented in childhood as intracranial hemorrhage. The aim of this report is to present the use of transcranial color-coded duplex sonography (TCCS) in detection of AVMs in children suffering headache.MethodsThis report describes five pediatric patients with headache and cerebral AVM which were initially discovered by TCCS. Diagnosis was confirmed by magnetic resonance imaging and digital subtraction angiography.ResultsIn all patients, TCCS showed saccular enlargement of the vessels with a multicolored pattern corresponding to the different directions of blood flow. Spectral analysis showed significantly high flow systolic and diastolic velocities and low resistance index.ConclusionsIn this report, we describe TCCS as a valuable non-invasive, harmless, low-cost, widely available method for the detection and follow-up of hemodynamic changes of AVMs in children with headache, before and after treatment.

Cervicofacial subcutaneous emphysema after facial cosmetic procedure in an 11-year-old girl

Cervicofacial subcutaneous emphysema resulting from maxillofacial surgery and dental procedures is well described in the literature. Other causes include facial and chest trauma, infections, iatrogenic causes such as endotracheal intubation, positive pressure ventilation and cryotherapy. We report an 11-year-old girl who presented to the emergency department with swelling of her right cheek and neck. The swelling began soon after a cosmetic procedure for acne: mechanical cleaning of the skin pores followed by oxygen facial therapy. She also experienced a popping sensation, along with discomfort and swallowing difficulties. She had no significant medical history. There was no history of other traumatic events. She previously had the same cosmetic procedure four times without complications. On examination she had right hemifacial and neck swelling with crepitus and mild pain on palpation. There were no systemic symptoms of infection or fever. There were no signs of dyspnoea or chest pain. A standard craniogram revealed s.c. air in the right cheek and neck consistent with the diagnosis of cervicofacial s.c. emphysema (Fig. 1a,b). There was no signs of pneumomediastinum on a chest radiogram. Ultrasonography confirmed an echogenic interface anterior to muscles, which obscured the view of the structures other than skin and fat tissue. Her blood test results were unremarkable. The patient was admitted for monitoring and managed conservatively with the antibiotic clindamycin as a prophylaxis for infection. The emphysema gradually resorbed within 2 weeks. S.c. emphysema arises when air is forced beneath the tissues, leading to swelling, crepitus on palpation, and the potential of the air to spread along the fascial planes. Usually cervicofacial s.c. emphysema is a benign and self-limiting condition, although it also may have life-threatening complications such as pneumothorax and pneumomediastinum, cardiac tamponade, air embolism, tracheal compression and mediastinitis. A comprehensive search of medical literature in PubMed showed that s.c. emphysema from a facial injury is rare and its extension into the cervical and mediastinal tissues is uncommon. We could find no case of facial s.c. emphysema caused by cosmetic procedures. Mechanical cleaning of facial skin pores is a commonly used cosmetic procedure for acne, while oxygen facial therapy is a recently introduced method. Oxygen therapy is typically performed using a small pen-like device called an airbrush, which is used to deliver high-pressure oxygen into the epidermis. It is presumed that oxygen has an antibacterial and restorative effect on the skin. We assume that in our patient the s.c. emphysema was a result of a small mechanical skin injury immediately followed by the application of high-pressure oxygen.