Should pulmonary radiographs be taken routinely following paediatric tracheostomy?

AIM: As the rates of complications related to tracheostomy procedures have fallen in recent years, the routine taking of pulmonary radiographs following tracheostomy has become a matter of debate. The aim of this study was to compare the incidence of complications developing in 120 children who had pulmonary radiographs taken following surgical tracheostomy and to thereby evaluate the necessity of routine pulmonary radiographs after tracheostomy. METHODS: The data were retrospectively reviewed of 120 children who had pulmonary radiographs taken following surgical tracheostomy between January 2012 and January 2018. The pulmonary radiographs taken before and immediately after tracheostomy were evaluated independently by two paediatric radiology specialists and the results were recorded. RESULTS: The incidence of complications after tracheostomy was determined as 23.3%, and no pneumothorax was determined in any patient. An increase was not seen in the complication incidence in those who had undergone emergency tracheostomy and patients aged < 2 years, which are accepted as high-risk groups. In the evaluation of the pre- and post-tracheostomy radiographs, new findings were determined on the post-tracheostomy radiograph that had not been there previously in eight patients (6.6%). These findings were newly formed infiltration in seven patients (5.8%), and malposition of the tracheostomy tube in one patient (0.8%). No pathology requiring intervention was determined on the radiographs of any patient. CONCLUSION: The results of this study support the view that it is not necessary to take pulmonary radiographs routinely following tracheostomy in the paediatric age group, including those at higher risk.

Diffusion-weighted imaging of normal appearing corticospinal tracts in patients with multiple sclerosis.

Aim To determine if there are differences in ADC values between normal appearing corticospinal tracks in patients with MS compared to ADC values in controls. Material and methods The study population comprised 62 consecutive MS patients (36 women and 26 men; mean age 36.45±8.63 years). 50 control subjects with no neurological disabilities or intracranial were included the study (32 women and 18 men; mean age 40.18±12.25 years). All ADC maps were independently evaluated by two experienced radiologists. ROI of approximately 15-18 mm2 in capsula interna and 10-12 mm2 in mesencephalon were placed bilaterally for measurement of ADC values. Three circular ROIs were placed-one each side for internal capsule-and 6 total ROIs from right and left internal capsule were averaged for each patient. Mesencephelon ADC measurements were performed similarly. Result The mean ADC values of the left internal capsule in MS patients were significiantly lower than the control group (p:0.002). No statistically significant difference was found between the MS patients and control group mean ADC values of the right internal capsule (p>0.05). The mean ADC values of the right and left mesencephalon in MS patients were significiantly lower than the control group (respectively; p:0.031, p<0.001). The mean ADC values of the left internal capsule were significiantly lower than the right internal capsule in MS patients (p<0.001). The mean ADC values of the left mesencephalon were significiantly lower than the right mesencephalon in MS patients (p<0.001). Conclusion The mean ADC values of the normal-appearing corticospinal tract in MS patients were significantly lower than the control group except for the right internal capsule.