Slobodanka Petrovic

Stethoscope vs. ultrasound probe - which is more reliable in children with suspected pneumonia?

OBJECTIVE To compare lung ultrasound (LUS) with auscultation findings in children with clinical suspicion of pneumonia. PATIENTS AND METHODS A prospective study including 95 patients (age: from 2 months to 17.5 years; mean age: 5.1 y, SD 4.5 y) with referral diagnosis of suspected pneumonia. In all patients LUS and auscultatory examinations were performed within an hour. These findings were compared separately in each hemithorax. The radiologist performing LUS was blinded to the patients clinical information. Positive auscultatory findings included: crackles and/or abnormal breath sounds (decreased, asymmetric, absent, or bronchial). For LUS examinations a combined transthoracic - transabdominal approach was used. A pneumonia-positive LUS finding included subpleural consolidation with air-bronchogram, or an adjacent area of interstitial edema. For each subpleural consolidation the cranio-caudal (CC) diameter was measured, and 95% confidence intervals (CI) of the sizes of subpleural consolidations for positive and negative auscultatory findings were compared. The p-value between LUS and auscultation was calculated using McNemars test. RESULTS LUS and auscultation showed pneumonia-positive findings in 98 and 64 hemithoraces, i.e. in 67 and 45 patients respectively. In positive auscultatory findings the CI for CC diameters of subpleural consolidations ranged from 32.46 to 54.14 mm, and in negative auscultatory findings the CI was between 16.52 and 29.83 mm, which showed a statistically significant difference. McNemars test showed a statistically significant difference between LUS and auscultation. CONCLUSIONS LUS showed positive findings in more hemithoraces than auscultation in children with suspected pneumonia. A cranio-caudal size of subpleural consolidation of less than 30 mm significantly reduces the possibility of auscultatory detection.

Persistent wheezing as manifestation of esophageal tubular duplication cyst

Abstract Duplications of esophagus are rare congenital anomalies and the second most common duplications of the gastrointestinal tract. This form of bronchopulmonary foregut malformation may appear as a cystic mediastinal mass. On chest radiographs they may be visible as middle or posterior masses. On CT they are well marginated and oppose the esophagus. Usually they are asymptomatic, unless they become infected or cause obstruction. We report a case of thoracic tubular duplication cyst in a 10-month-old boy who presented with persistent wheezing that was unsuccessfully treated in out-patient services.

[Perinatal tuberculosis--diagnostic and therapeutic approach].

INTRODUCTION The number of people suffering from tuberculosis has increased rapidly in the whole world over the past three decades. The classical age distribution of disease has also changed. According to the epidemiological data the number of pregnant women having tuberculosis has also risen with the resulting increase in the incidence of perinatal tuberculosis. PREGNANCY AND TUBERCULOSIS The presentation of tuberculosis in pregnancy varies. The effects of tuberculosis on pregnancy depend upon various factors: site and extent of the disease. nutritional status and immune status of mother, concomitant diseases, stage of pregnancy when the treatment started and others. A delay between the onset and diagnosis occurs regularly. Treatment response, time to clearance of bacilli from sputum. and prognosis are similar to non pregnant women. PRINATAL TUBERCULOSIS Perinatal tuberculosis is extremely rare if the mother is effectively treated in pregnancy. but disease is usually fatal if untreated. Diagnosis of perinatal tuberculosis is very often problematic and difficult. The reason of this is the fact that the initial manifestations of disease are nonspecific and may be delayed. In practice, congenital and early neonatal infections have almost the same mode of presentations, treatment and prognosis. Epidemiological data on the active tuberculosis in mother or some other family member are of the utmost importance in diagnoing tuberculosis. Differences in immune responses in the fetus and neonate add to the diagnostic difficulties already recognised in young children. Tuberculin tests are negative in at least 75% of cases. CONCLUSION If the condition is recognised and treated according to existing tuberculosis protocols, the outcome is favourable.