Fábio H.Á. Contelli

Bronchoscopic removal of foreign body from airway through tracheotomy or tracheostomy

OBJECTIVE Most foreign bodies in the airway are removed by respiratory endoscopy. Rarely, the removal of the foreign body has to be performed through endoscopic control by tracheotomy or tracheostomy. This article reports three cases of foreign body removal in children performed by tracheal opening. DESCRIPTION Retrospective review of records with report of three cases of children who aspirated foreign bodies into the airway. In the first case, there was rupture of the tracheostomy tube, with aspiration of its distal portion. Endoscopic removal was performed by tracheostomy. The second child aspirated a pen cap. It could not be removed by endoscopy because it would not pass through the subglottic region. Cervical tracheotomy was performed and the foreign body was removed with endoscopic control. In the last case, the foreign body was in the left main bronchus. It was removed by bronchoscopy through tracheostomy opening. All children presented good outcome after the endoscopic procedure. The trachea of the patient submitted to tracheotomy was sutured after the foreign body removal. Tracheostomy was not necessary. In the children with previous tracheostomy, the tube was put back after the foreign body removal. COMMENTS Most foreign bodies in the airway of children can be removed by endoscopy. When the foreign body is too large to pass through the subglottic region, or so sharp that it can injure the airway, the use of tracheotomy or tracheostomy is indicated.

Surgical treatment of congenital pulmonary arteriovenous fistula in children

Congenital pulmonary arteriovenous fistulas are rare vascular malformations in which an abnormal connection develops between an artery and a vein in the lung. We report the case of a 5-year-old boy with a history of cyanosis since birth and cough for 2 days. Physical examination revealed cyanosis of oral mucosa and extremities, digital clubbing, and 82% O(2) saturation on room air. Chest radiograph showed a nodule in left lower lobe; echocardiogram was normal, but chest computed tomography showed 2 nodules in left lower lobe. Arteriography showed 2 large arteriovenous fistulas in left lower lobe. Patient underwent left lower lobectomy, and surgical outcome was excellent. At hospital discharge, mucosal color was normal and O(2) saturation was 96% on room air. Congenital pulmonary arteriovenous fistulas should be suspected in children with cyanosis but no cardiac malformations. Symptomatic congenital pulmonary arteriovenous fistulas should be treated with embolization when fistulas are small and multiple, or with lung resection when they are large and localized.

Tumores do mediastino em crianças

BACKGROUND: Mediastinal tumors in children comprise a heterogeneous group of lesions that have a range of embryonic origins. They may present as benign cysts, as well as malignant lesions. OBJECTIVE: To describe the diagnostic procedures, the treatments and outcomes of a group of children and adolescents with mediastinal tumors. METHOD: A retrospective analysis of twenty children and adolescents with mediastinal tumors who were treated at the Hospital de Clinicas de Porto Alegre from July, 1996 to July, 2002. All patients were submitted to some kind of surgical procedure: diagnostic, therapeutic, or both. RESULTS: Twelve boys and eight girls were studied. Mean age at diagnosis was 6 years and 8 months (ranging from 3 months to 16 years). Fourteen tumors (70%) were located at the anterior, and six (30%) at the posterior mediastinum. Hodgkin and non-Hodgkin lymphomas were the most common tumors found in anterior mediastinum, whereas neuroblastoma was the most common among posterior malignancies. The most used surgical procedure for anterior tumors was Chamberlain anterior thoracotomy; posterolateral thoracotomy was usually performed for posterior tumors. Six patients died during the follow-up period but none of the deaths was considered related to the surgical procedure. CONCLUSION: Mediastinal tumors in children and adolescents represent an important cause of morbidity/mortality. The most common tumors at the anterior mediastinum were lymphomas, whereas at the posterior mediastinum the most common were neurogenic tumors. Surgery is an important step for the diagnosis and treatment of such lesions