RESUMEN
A three and a half-year-old boy developed stridor after insertion of grommets for bilateral secretory otitis media. Despite treatment with steroids systemically and locally, antibiotics and an antihistamine, the stridor worsened. Microlaryngotracheobronchoscopy (MLB) demonstrated laryngeal granulations, in which, by auramine and Ziehl-Neelsen staining, acid-fast bacilli were seen, and from which subsequently Mycobacterium tuberculosis grew in culture. Following the MLB the child became comatosed and a clinical diagnosis of tuberculosis involving the central nervous system was made. Despite quadruple antituberculous chemotherapy he died 8 days later. A Mantoux test was negative and a chest radiograph was normal. Acid-fast bacilli were not demonstrated on repeated examinations of cerebrospinal fluid, nor were they grown ante mortem or post mortem from samples of cerebrospinal fluid.
Asunto(s)
Ruidos Respiratorios/etiología , Tuberculosis Laríngea/diagnóstico , Tuberculosis Miliar/diagnóstico , Preescolar , Humanos , Inyecciones Intramusculares , Inyecciones Espinales , Isoniazida/uso terapéutico , Laringe/patología , Pulmón/patología , Masculino , Pirazinamida/uso terapéutico , Rifampin/uso terapéutico , Estreptomicina/uso terapéutico , Tomografía Computarizada por Rayos X , Tuberculosis Laríngea/diagnóstico por imagen , Tuberculosis Laríngea/patología , Tuberculosis Miliar/patologíaRESUMEN
Computed tomography is replacing contrast radiography as the method of choice in evaluating congenital posterior choanal atresia. Careful preparation of the patient, however, is necessary prior to the examination in order to obtain the maximum of information pre-operatively. We present patients with inadequate preparation and illustrate their misleading scans. The proper method of examination is discussed, with a review of the literature; it is essential to remove nasal secretions by suction and instill vasoconstrictor nose drops, shortly before scanning.