Perinatal testicular torsion: ultrasound assessment and differential diagnosis. / Torsión testicular perinatal. Valoración ecográfica y diagnóstico diferencial.

Perinatal testicular torsion, defined as torsion occurring in the prenatal period or in the first month after birth, accounts for 10% of all cases of testicular torsion in pediatric patients. Most are extravaginal, and intravaginal torsion is rare. Its management is controversial, due to the low viability of the testis and the possibility of bilateral torsion. Ultrasonography is the method of choice to study testicular torsion. Combining B-mode and power Doppler imaging facilitates a fast reliable diagnosis. We review the ultrasonographic appearance of neonatal testicular torsion for each presentation, the differential diagnosis with other causes of increased scrotal volume in neonates, and its treatment.

Value of brain MRI when sonography raises suspicion of agenesis of the corpus callosum in fetuses. / Valor de la resonancia magnética cerebral en fetos con sospecha ecográfica de agenesia del cuerpo calloso.

OBJECTIVE: To evaluate the role of magnetic resonance imaging (MRI) in fetuses with a previous sonographic suspicion of agenesis of the corpus callosum (ACC) to confirm the diagnosis and to detect associated intracranial anomalies. MATERIAL AND METHODS: Single-center retrospective and descriptive observational study of the brain MRI performed in 78 fetuses with ACC sonographic suspicion between January 2006 and December 2015. Two experts in fetal imaging reviewed the MRI findings to evaluate the presence and morphology of the corpus callosum. When ACC was detected the whole fetal brain anatomy was thoroughly studied to determine the presence of associated anomalies. Prenatal MR imaging findings were compared to postnatal brain MRI or necropsy findings when available. RESULTS: Fetal MRI diagnosed 45 cases of ACC, 12 were partial (26.7%) and 33 complete (73.3%). In 28 cases (62,2%) associated intracranial anomalies were identified. The most often abnormality was ventriculomegaly (78,6%), followed by cortical malformations (53,6%), posterior fossa (25%) and midline anomalies (10,7%). CONCLUSION: Fetal brain MRI has an important role in the diagnosis of ACC and detection of associated anomalies. To perform a fetal brain MRI is important in fetuses with sonographic suspicion of ACC.

Neonatal ovarian cysts: ultrasound assessment and differential diagnosis. / Quistes de ovario neonatales. Valoración ecográfica y diagnóstico diferencial.

Ovarian cysts are the most common abdominal cysts in female fetuses and newborn girls. Ultrasonography is the imaging technique of choice for diagnosing ovarian cysts because it makes it possible to differentiate them from other cystic lesions. Although most neonatal ovarian cysts regress in the first few months after birth, complications can occur during gestation or after birth. The manifestations of ovarian cysts on ultrasonography will depend on the complications. The management is controversial, although the current trend favors watchful waiting. We describe the different presentations of neonatal ovarian cysts with their complications and their patterns of findings on ultrasonography. We also discuss the differential diagnosis with other cystic abdominal lesions, and finally we discuss the therapeutic management of neonatal ovarian cysts.

Evaluation of the fetal cerebellum by magnetic resonance imaging. / Valoración del cerebelo fetal mediante resonancia magnética.

Obstetric protocols dictate that the fetal cerebellum should always be assessed during sonograms during pregnancy. For various reasons, including technical limitations or inconclusive sonographic findings, suspicion of cerebellar abnormalities is one of the most common indications for prenatal magnetic resonance imaging (MRI). Although sonography is the imaging technique of choice to assess the cerebellum, MRI shows the anatomy of the posterior fossa and abnormalities in the development of the fetal cerebellum in greater detail and thus enables a more accurate prenatal diagnosis. We describe and illustrate the normal anatomy of the fetal cerebellum on MRI as well as the different diseases that can affect its development. Moreover, we review the most appropriate terminology to define developmental abnormalities, their differential diagnoses, and the role of MRI in the prenatal evaluation of the posterior fossa.

The ABCs of transfontanellar ultrasound and more. / El ABC de la ecografía transfontanelar y más.

Transfontanellar ultrasound is widely used to study neonatal neuroanatomy and disease. This technique has many advantages, such as the absence of ionizing radiation and its wide availability, portability, and low cost. The development of more powerful ultrasound scanners and improved microcurved and linear probes of different frequencies have resulted in improved image quality. To take full advantage of this technique, it is important to know the normal and pathologic anatomy in neonates. Transfontanellar ultrasound is the first-line technique for studying short-term and mid-term complications in premature newborns. In full-term newborns, it is very useful in many clinical situations, making it possible to select which patients will benefit from other techniques that are more invasive or more expensive, or that require sedation, such as MRI. The disadvantages of the technique are that it is operator dependent and that an appropriate acoustic window is necessary. It also has limitations in the study of obstetric trauma, in the evaluation of complex malformations, and in the assessment of damage to white matter. With a basic understanding of neonatal neurology, the appropriate equipment, and a careful technique taking advantage of the different fontanels, transfontanellar ultrasound is a reliable method that makes it possible to diagnose and follow up both congenital and acquired conditions in neonates.

Low-dose computed tomography to diagnose fetal bone dysplasias. / Tomografía computarizada fetal de baja dosis para diagnosticar displasias óseas.

We present a case of cleidocranial dysplasia diagnosed by low-dose fetal computed tomography (CT) in the 25th week of gestation. Severe bone dysplasia was suspected because of the fetus' low percentile in long bones length and the appearance of craniosynostosis on sonography. CT found no abnormalities incompatible with life. The effective dose was 5 mSv, within the recommended range for this type of examination. Low-dose fetal CT is a new technique that makes precision study of the bony structures possible from the second trimester of pregnancy. In Spain, abortion is legal even after the 22nd week of gestation in cases of severe fetal malformations. Therefore, in cases in which severe bone dysplasia is suspected, radiologists must know the strategies for reducing the dose of radiation while maintaining sufficient diagnostic quality, and they must also know which bony structures to evaluate.

Intestinal ultrasound in pediatrics. / Ecografía intestinal en pediatría.

Ultrasonography is the imaging technique of choice for studying the digestive tract in pediatric patients from the neonatal period to adolescence. Its dynamic character, absence of radiation, and scant preparation required make ultrasonography preferable to contrast-enhanced fluoroscopy, computed tomography, or magnetic resonance imaging. Technical advances in ultrasound, including high-resolution multifrequency probes, panoramic studies, color Doppler, Doppler with microvascularization, elastography, and contrast agents for use in children, have increased the sensitivity and specificity of this technique. Intestinal ultrasound is indicated for conditions with diverse etiologies and pathogenesis: congenital, infectious, inflammatory, tumor-related, and vascular. Knowledge of embryological development and the normal characteristics of the digestive tract help in identifying, recognizing, and interpreting the ultrasound findings of the different conditions in pediatric patients. This paper aims to show the indications for ultrasound studies of the digestive tract in children, the findings on these studies, and the management of the most common gastrointestinal conditions in pediatric patients.

Intrapericardial diaphragmatic hernia following cardiac surgery - A case report. / Hernia diafragmática intrapericárdica tras cirugía cardiaca. A propósito de un caso.

INTRODUCTION: Intrapericardial diaphragmatic hernia is an abdominal organ prolapse inside the pericardium. It is one of the less frequent instances within the diaphragmatic hernia group. CLINICAL CASE: This is the case of a 4-month-old infant undergoing surgery for interventricular communication (IVC). Postoperatively, pulmonary auscultation detected air-fluid sounds, and thoracic radiological control showed an atypical pneumopericardium. Given clinical and radiological findings, and in the absence of additional abdominal symptoms, gastrointestinal transit (GIT) was performed, demonstrating intrapericardial herniation of the intestinal loops. The patient was discharged following abdominal surgical repair, with no further complications. DISCUSSION: Intrapericardial diaphragmatic hernia is an infrequent instance within the diaphragmatic hernia group, with cardiac surgery being a rare potential iatrogenic factor. Clinical suspicion and imaging findings are key to perform early diagnosis and surgical treatment.

INTRODUCCION: La hernia diafragmática intrapericárdica consiste en un prolapso de las estructuras abdominales dentro del pericardio, representando una de las entidades menos frecuentes dentro del conjunto de las hernias diafragmáticas. CASO CLINICO: Se presenta el caso de un lactante de 4 meses intervenido de comunicación interventricular (CIV) que, en el postoperatorio, la auscultación cardiopulmonar detecta ruidos hidroaéreos y el control radiológico de tórax muestra un neumopericardio atípico. Ante los hallazgos clínico-radiológicos, y sin sintomatología abdominal sobreañadida objetivable, se solicita un tránsito gastrointestinal (TGI) donde se pone de manifiesto la herniación intrapericárdica de asas intestinales. Tras la intervención quirúrgica abdominal reparadora, el paciente fue dado de alta, sin otras complicaciones. COMENTARIOS: Se realiza un breve recordatorio de las hernias diafragmáticas intrapericárdicas como una entidad de escasa incidencia dentro del conjunto de hernias diafragmáticas, siendo la cirugía cardiaca un posible factor iatrogénico poco frecuente. La sospecha clínica, junto con los hallazgos de imagen, son fundamentales para llegar a un diagnóstico y tratamiento quirúrgico precoz.

Linear skull fracture in infants after mild traumatic brain injury: influence of computed tomography in management. / Fractura lineal de cráneo en el lactante con traumatismo craneoencefálico leve: influencia de la tomografía computarizada en su manejo.

INTRODUCTION: Traumatic brain injury (TBI) is a common reason for pediatric emergency room visits. Surgical intervention for mild TBI is rarely necessary in children aged <2 years, but the intracranial findings can influence the management of the patient. This paper aims to evaluate the impact of computed tomography (CT) in the management of children aged <2 years with mild TBI and linear skull fractures on plain-film X-rays. MATERIAL AND METHODS: This retrospective descriptive study analyzed skull X-rays obtained in children <2 years old attended for mild TBI in the emergency room of our tertiary hospital over a 4-year period. RESULTS: A total of 88 CT studies were done for suspicion of linear skull fractures on plain-film X-rays. Fractures were confirmed in 74, representing a false-positive rate of 16%. Of the 74 infants with confirmed fractures, intracranial CT findings were normal in 68 (92%) and abnormal in 6 (8%). Two patients (2.7% of all patients with confirmed fractures) required hospital stays longer than 2 days; the other four patients with abnormal intracranial findings were discharged within 48hours of admission. None of the cases required surgery. CONCLUSION: Systematic CT studies do not seem justified for all children aged <2 years with TBI and low/intermediate risk of intracranial lesions, even when they have linear skull fractures. In the absence of risk factors, we propose individualizing the imaging study based on clinical criteria.

Hernia diafragmática intrapericárdica tras cirugía cardiaca. A propósito de un caso / Intrapericardial diaphragmatic hernia following cardiac surgery - A case report

Introducción: La hernia diafragmática intrapericárdica consiste en un prolapso de las estructuras abdominales dentro del pericardio, representando una de las entidades menos frecuentes dentro del conjunto de las hernias diafragmáticas. Caso clínico: Se presenta el caso de un lactante de 4 meses intervenido de comunicación interventricular (CIV) que, en el postoperatorio, la auscultación cardiopulmonar detecta ruidos hidroaéreos y el control radiológico de tórax muestra un neumopericardio atípico. Ante los hallazgos clínico-radiológicos, y sin sintomatología abdominal sobreañadida objetivable, se solicita un tránsito gastrointestinal (TGI) donde se pone de manifiesto la herniación intrapericárdica de asas intestinales. Tras la intervención quirúrgica abdominal reparadora, el paciente fue dado de alta, sin otras complicaciones. Comentarios: Se realiza un breve recordatorio de las hernias diafragmáticas intrapericárdicas como una entidad de escasa incidencia dentro del conjunto de hernias diafragmáticas, siendo la cirugía cardiaca un posible factor iatrogénico poco frecuente. La sospecha clínica, junto con los hallazgos de imagen, son fundamentales para llegar a un diagnóstico y tratamiento quirúrgico precoz

Introduction: Intrapericardial diaphragmatic hernia is an abdomi-nal organ prolapse inside the pericardium. It is one of the less frequent instances within the diaphragmatic hernia group. Clinical Case: This is the case of a 4-month-old infant undergo-ing surgery for interventricular communication (IVC). Postoperatively, pulmonary auscultation detected air-fluid sounds, and thoracic radiologi-cal control showed an atypical pneumopericardium. Given clinical and radiological findings, and in the absence of additional abdominal symptoms, gastrointestinal transit (GIT) was performed, demonstrating intra-pericardial herniation of the intestinal loops. The patient was discharged following abdominal surgical repair, with no further complications. Discussion: Intrapericardial diaphragmatic hernia is an infrequent instance within the diaphragmatic hernia group, with cardiac surgery being a rare potential iatrogenic factor. Clinical suspicion and imag-ing findings are key to perform early diagnosis and surgical treatment

Masa torácica congénita: hemangioma capilar pulmonar, un diagnóstico inusual / Congenital lung mass: Pulmonary hemangioma, an unusual diagnosis

Introducción: Las masas pulmonares congénitas (MPC) presentan una incidencia de 27-33/100.000 habitantes. El diagnóstico varía en función de la sintomatología, la localización y la magnitud de la lesión. La causa más frecuente de MPC son las alteraciones del desa-rrollo de la vía respiratoria, pero en las que no cumplan las características radiológicas debe considerarse el hemangioma pulmonar. Caso clínico: Neonato con hemangioma capilar pulmonar congénito. Se revisan los casos de hemangiomas pulmonares en menores de 1 año publicados en la literatura hasta 2015. Resultados: Se identificaron 6 casos. La sintomatología más frecuente fue la dificultad respiratoria. En todos los casos se realizó una tomografía computarizada pulmonar, que mostraba una masa isodensa en 5 de los 6 casos. Un caso fue estudiado mediante resonancia magnética (RM) con isoseñal al músculo en T1, e hiperintensa en T2. Se procedió a una exéresis quirúrgica en 5 de los 6 casos, el restante recibió tratamiento con propranolol con buen resultado. Conclusiones: Los hemangiomas intratorácicos son inusuales y suelen presentarse como una masa sólida única isodensa en la radiografía. En la ecografía se observan como áreas heterogéneas con vasos visibles y calcificaciones. Consideramos la RM con gadolinio la prueba estándar de referencia para el estudio de las MPC. Los hemangiomas congénitos (HC) se presentan en la RM como masas bien delimitadas hiperintensas en T2, isointensas en T1 y con realce tras gadolinio. La evolución de los HC es impredecible y pueden presentar una resolución completa. El tratamiento debe estar supeditado a la clínica del paciente, y podría considerarse añadir propranolol a las opciones quirúrgicas, aunque es necesaria la comunicación de nuevos casos para valorar su eficacia. Si se procede a la exéresis, el estudio histopatológico con positividad para marcadores CD31 y CD34 y negatividad para GLUT-1 confirmará el diagnóstico (AU)

Introduction: Congenital pulmonary masses (CPM) have an incidence of 27-33/100,000. Timing of diagnosis depends on the sym-ptoms, location and size of the lesion. The most commonly cause are developmental abnormalities of the pulmonary airways and vasculature, but pulmonary hemangioma can occur as a single asymptomatic solid mass. Case report: A case of MPC is presented with a final diagnosis of congenital pulmonary capillary hemangioma. Pulmonary heman-giomas in infants published in English literature until 2015 are reviewed and analyzed. Results: 6 cases were identified. The most common symptoms were respiratory distress. Study was conducted with lung CT in all cases showing a mass isodense. 1 case was studied by MRI; it showed hyperintensity in T2 sequences and isointense to muscle on T1. Surgical resection was the treatment in 5 of the 6 cases; one was treated with propranolol being successful. Conclusions: Intrathoracic hemagiomas are unusual, and usually present as a single solid isodense mass on radiography. In ul-trasound they are heterogeneous with visible vessels and calcifications. We consider gadolinium MRI gold standard for the study of CPM. Congenital hemagiomas in MRI show hyperintensity on T2 sequences and gadolinium enhancement. They can resolve sponta-neously, therefore the management should be subject to the patient's clinical and propranolol should be considered in addition to surgical options. If excision is necessary histopathologic findings with positivity for endothelial markers such as CD31, CD34 and nega-tivity for GLUT-1, will confirm our diagnosis (AU)

El vólvulo gástrico en la edad pediátrica: ¿cuándo sospecharlo y cómo manejarlo? / Gastric volvulus in children: when to suspect and how to manage

INTRODUCCIÓN Y OBJETIVO: El vólvulo gástrico es una entidad que puede manifestarse con un amplio espectro clínico, lo que puede llevar a un retraso en el diagnóstico y tratamiento. El objetivo de nuestro trabajo es definir los tipos de vólvulo gástrico, analizando los factores predisponentes, la clínica, los hallazgos radiológicos y el tratamiento de cada uno de ellos. MATERIAL Y MÉTODOS: Se realizó un estudio descriptivo retrospectivo de los vólvulos gástricos diagnosticados en un hospital terciario durante un periodo de 10 años (2006-2016). Se incluyeron 32 pacientes, que se clasificaron en tres grupos en función de la presentación clínica: 7 con la forma aguda, 12 con la forma crónica y 13 con la forma neonatal-lactante. Se recogieron datos epidemiológicos, clínicos, diagnósticos y de manejo de cada caso. RESULTADOS: El vólvulo gástrico órgano-axial fue el subtipo más frecuente al analizar la totalidad de los pacientes (81%), aunque en la presentación aguda el más prevalente fue el mesentérico-axial (86%). En la forma aguda, la clínica más frecuente fue los vómitos no biliosos (86%), siendo en la forma crónica la sintomatología más variada. El diagnóstico se realizó con tránsito gastroduodenal en la mayoría de los casos. Las opciones de tratamiento fueron cirugía o medidas conservadoras, en función del tipo de vólvulo gástrico. CONCLUSIONES: Existen distintas formas de presentación del vólvulo gástrico (aguda, crónica, neonatal-lactante), cada una con una sintomatología y manejo diferentes. Dada la clínica inespecífica, es importante conocer los factores predisponentes y los hallazgos que aumentan su sospecha en la radiografía. La prueba de elección para su diagnóstico es el tránsito gastroduodenal

INTRODUCTION AND OBJECTIVE: Gastric volvulus is an entity with a broad clinical spectrum, which can lead to a delay in diagnosis and treatment. The purpose of this study is to define the types of gastric volvulus, analyzing the predisposing factors, clinical, radiological findings and treatment of each one. MATERIALS AND METHODS: A retrospective, descriptive study of the gastric volvulus diagnosed at a tertiary hospital was carried out during a period of 10 years (2006-2016). Thirty-two patients were included, which were classified into three groups according to the clinical presentation: 7 with the acute form, 12 with the chronic form and 13 with the neonatal form. Epidemiological, clinical, diagnostic and management data were collected for each case. RESULTS: Organo-axial gastric volvulus was the most frequent subtype of all the sample (81%), although in the acute presentation, the most prevalent subtype was the mesentero-axial (86%). In the acute form, the most common symptom was non-bilious vomiting (86%), whereas in the chronic form the clinical presentation was more varied. The diagnosis was made with upper gastrointestinal series in most cases. Surgical or conservative treatment were chosen depending on the type of gastric volvulus. CONCLUSIONS: There are different forms of presentation of gastric volvulus (acute, chronic, neonatal), with different clinical features and implications with respect to treatment options. Due to its nonspecific clinical presentation, it is important to know the predisposing factors and the common radiological findings highly suggestive of the diagnosis. An upper gastrointestinal series is the study of choice for its diagnosis

Fractura lineal de cráneo en el lactante con traumatismo craneoencefálico leve: influencia de la tomografía computarizada en su manejo / Linear skull fracture in infants after mild traumatic brain injury: influence of computed tomography in management

INTRODUCCIÓN: El traumatismo craneoencefálico (TCE) constituye un motivo frecuente de consulta en urgencias pediátricas. La necesidad de intervención quirúrgica en pacientes menores de 2 años con TCE leve es mínima, pero los hallazgos intracraneales pueden influir en el manejo del paciente. El objetivo de este trabajo es valorar el impacto de la TC en el manejo de los niños menores de 2 años con TCE leve que presentan una fractura lineal de cráneo en la radiografía convencional. MATERIAL Y MÉTODOS: Estudio descriptivo y retrospectivo en el que se analizan las radiografías de cráneo practicadas a pacientes menores de 2 años que fueron atendidos en el área de urgencias de nuestro hospital de nivel terciario por TCE leve en un período de 4 años. RESULTADOS: Se realizaron 88 exploraciones de tomografía computarizada (TC) realizadas por sospecha de fractura lineal de cráneo en radiografía. Se confirmó la fractura en 74 de ellos (16% de falsos positivos). De los 74 niños con diagnóstico confirmado de fractura, la TC fue normal en el 92% de los estudios y mostró hallazgos intracraneales en 6 casos (8% de los casos con fractura). Dos casos requirieron ingreso superior a 2 días (2,7% de todos los casos con fractura) y en los 4 casos restantes la estancia hospitalaria no superó las 48 horas. En ningún caso se requirió cirugía. CONCLUSIÓN: No parece justificada la realización de una TC craneal de forma sistemática en niños menores de 2 años con TCE y bajo/intermedio riesgo de lesión intracraneal, incluso con fractura lineal de cráneo. En ausencia de factores de riesgo, proponemos individualizar el estudio de imagen basándose en el criterio clínico

INTRODUCTION: Traumatic brain injury (TBI) is a common reason for pediatric emergency room visits. Surgical intervention for mild TBI is rarely necessary in children aged <2 years, but the intracranial findings can influence the management of the patient. This paper aims to evaluate the impact of computed tomography (CT) in the management of children aged <2 years with mild TBI and linear skull fractures on plain-film X-rays. MATERIAL AND METHODS: This retrospective descriptive study analyzed skull X-rays obtained in children <2 years old attended for mild TBI in the emergency room of our tertiary hospital over a 4-year period. RESULTS: A total of 88 CT studies were done for suspicion of linear skull fractures on plain-film X-rays. Fractures were confirmed in 74, representing a false-positive rate of 16%. Of the 74 infants with confirmed fractures, intracranial CT findings were normal in 68 (92%) and abnormal in 6 (8%). Two patients (2.7% of all patients with confirmed fractures) required hospital stays longer than 2 days; the other four patients with abnormal intracranial findings were discharged within 48hours of admission. None of the cases required surgery. CONCLUSION: Systematic CT studies do not seem justified for all children aged <2 years with TBI and low/intermediate risk of intracranial lesions, even when they have linear skull fractures. In the absence of risk factors, we propose individualizing the imaging study based on clinical criteria

No es una neumonía, es una hernia diafragmática / It's not pneumonia, it's a diaphragmatic hernia

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¿Seguro que es un granuloma? / Are you sure that it is a granuloma?

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Síndrome de la arteria mesentérica superior en edad pediátrica: ¿infrecuente o infradiagnosticado? / Superior mesenteric artery syndrome in pediatric age: is it rare of underdiagnosed?

Objetivo. Reconocer el síndrome de la arteria mesentérica superior (SAMS) como causa de dolor abdominal recurrente en edad pediátrica y los problemas clínicos relacionados que pueden enmascararlo, siendo el tránsito esófago-gastroduodenal (TEGD) suficiente para su diagnóstico. Pacientes y métodos. Se recogen 12 pacientes afectos de SAMS, entre los años 2006 y 2013, la mayoría remitidos por dolor abdominal, en general con sospecha de reflujo gastroesofágico (RGE) y/o patología intestinal malabsortiva. Las técnicas de imagen empleadas para su estudio son el TEGD y la ecografía abdominal. Se lleva a cabo Tomografía Computarizada (TC) abdominal con contraste únicamente en 2 pacientes. Resultados. El TEGD fue diagnóstico en el 100% de los casos. Ni las ecografías ni los TC abdominales aportaron datos concluyentes ni hallazgos adicionales determinantes para el diagnóstico y tratamiento. Conclusiones. Enfatizamos la contribución del SAMS en el dolor abdominal recurrente en niños, así como los factores predisponentes y desencadenantes de esta entidad, siendo el TEGD la prueba diagnóstica de elección (AU)

Introduction. To recognize the superior mesenteric artery síndrome (SMAS) as a cause of recurrent abdominal pain in childhood and related clinical problems that can mimic it, being the upper gastrointestinal (UGIT) enough to diagnosis. Patients and method. 12 patients with SAMS were collected between 2006 and 2013, most of them presented with abdominal pain and usually suspected of gastroesophageal reflux (GER) and/or malabsorptive intestinal disorders. The imaging techniques used were UGIT and abdominal ultrasound. Abdominal contrast-enhanced Computed Tomography (CDCT) was performed in only 2 patients. Results. UGIT allowed accurate diagnosis in all patients. Neither abdominal ultrasound nor CECT provide conclusive or determining additional findings for diagnostic or therapeutic approach. Conclusions. We emphasize the contribution of SAMS to recurrent abdominal pain in children, as well as predisposing factors and triggers of this entity, being the UGIT the diagnostic test of choice (AU)

Síndrome de fuga aérea pulmonary neonatal: factores de riesgo y patrones radiológicos / Pulmonary air leak syndrome: risk factors and radiological patterns

La insuficiencia respiratoria es una de las causas principales de morbimortalidad en la unidad de cuidados intensivos neonatales (UCIN). Durante las últimas décadas ha habido un cambio sustancial en los avances en respiradores y tratatmientos médicos, así como en la supervivencia de neonatos de muy bajo peso. Sin embargo, el síndrome de fuga aérea pulmonar está todavía presente, incluso en aquellos con técnicas ventilatorias avanzadas. El síndrome de fuga aérea pulmonar (SFAP) se define como el escape de aire del árbol traqueobronquial hacia localizaciones donde normalmente no está presente. El SFAP lo conforman las siguientes entidades: el enfisema intersticial pulmonar, el neumotórax, el neumomediastino, el neumopericardio, el enfisema subcutáneo, el neumoperitoneo y el metabolismo gaseoso masivo. El factor de riesgo más importante es la inadecuada ventilación mecánica en neonatos con pulmonares inmaduros, aunque también puede ocurrir por los propios esfuerzos respiratorios del lactante, por maniobras de reanimación o por patología pulmonar subyacente. El objetivo de este trabajo es describir los patrones radiológicos de las distintas entidades que conforman el SFAP para poder reconocerlas, así como los factores de riesgo que aumentan la incidencia de esta entidad (AU)

Respiratory failure is one of the main causes of morbidity and mortality in the neonatal intensive care unit (NICU). During the last decades of medical ventilators treatments, as well as in survival rates of very low birth weight infants. However, pulmonary air leak syndrome is still present, even in cases with advanced ventilator techniques. Pulmonary air leak syndrome (PALS) is defined as a lead of air from the tracheobronchial tree towards locations where it is not usually presents. PALS comprises the following entities: pulmonary interstitial emphysema, pneumothorax, pneumomediastinum, pneumopericardium, subcutaneous emphysema, pneumoperitoneum and massive air embolism. The most important risk factor is inadequate mechanical ventilation in newborns with immature lungs, although it can also be caused by the respiratory efforts of the infant, by resuscitation procedures or by an underlying pulmonary pathology. The objective of this study id to describe the radiological pattern of the different entities that are part of PALS in order to be able to identify them, as well as to describe the risk factors that increase the incidence of this entity (AU)