Spontaneous pneumothorax: Diagnosis may be a click away.

We report the case of a 14-year-old boy presenting to our unit because of a spontaneous left pneumothorax. Over the 3 preceding weeks, he described a rhythmic precordial click and the sensation of bubbles floating inside his chest. This noise, audible to the patient and his family without a medical device, proved to be the Hamman sign, a rare although typical sound formerly related to pneumomediastinum that can be exceptionally encountered in isolated left pneumothorax. Its pathophysiology remains unclear. Small pockets of air close to the heart may be pushed inside pleura and amplified by the chest wall, hence provoking a recurrent rhythmic sound. A small left pneumothorax must be suspected whenever the Hamman sign is elicited in the absence of pneumomediastinum. Chest tomography must be precociously considered if plain x-rays are not contributive.

[Airbag-related death in a toddler. A poorly known danger?]. / Conséquences fatales de l'ouverture d'un « airbag ¼ chez un nourrisson. Un danger méconnu ?

We report the case of an 8-month-old baby killed by the deployment of an airbag. He was correctly positioned, in a safety seat designed for his age class, on the passenger side, and rear-facing. The accident occurred at low speed, on the left front of the car, without provoking any harm to the mother who was driving the vehicle, but the impact led to airbag deployment. A CT scan showed an occipital fracture, hemorrhagic parenchymal contusions, subarachnoid hemorrhage and edema, which quickly led to fatal intracranial hypertension. Severe retinal hemorrhages were also noted. Brain death was declared 24h later. Both direct impact and violent projection of the head are involved in the severity of brain lesions. Retinal hemorrhages are similar to what is observed in shaken-baby syndrome. To our knowledge, this is the first French publication on this topic in childhood. In France, children are allowed to be positioned on the passenger side seat, but the airbag, if present, is supposed to be deactivated, which is not always possible. In recent cars, depowering the airbag is easy, with on/off switches, but these systems are not uniform between models. Moreover, it is very likely that this possibility is ignored by numerous parents. A widespread communication on this topic should be initiated in France to prevent such events. Banning infants from front passenger seats completely does not seem possible. Nevertheless, greater attention on the part of police departments and better information to drivers appear necessary.

[Extrarespiratory manifestations of Mycoplasma pneumoniae: a case report]. / Atteintes extra-respiratoires dues à Mycoplasma pneumoniae : à propos d'un cas.

Extrapulmonary manifestations of Mycoplasma pneumoniae are sometimes severe and may even be life-threatening. A 10-year-old patient was hospitalized due to a flu-like illness lasting 48 h with impaired general condition, after an extended stay in Africa. There was an inflammatory syndrome associated with hyponatremia, but malaria was negative. A triple antibiotic therapy with ceftriaxone, amikacin, and josamycin was started. The progression was marked by the appearance of hypoxemia pneumoniae associated with extrarespiratory manifestations. He initially presented with acute polyradiculoneuropathy, followed by thrombotic events associated with polyserositis, polyarthritis, a maculopapular rash, and then a hemophagocytic syndrome. Bacteriological samples isolated M. pneumoniae in nasopharyngeal secretions with a positive serology. The appropriate antibiotic therapy associated with corticosteroids and immunoglobulins led to clinical improvement and the patient progressed toward complete recovery. The pathogenesis of M. pneumoniae infection remains largely unknown. However, two main categories have been proposed. The lung injury is caused by the invasion of the respiratory epithelium, whereas the extrarespiratory manifestations are probably due to immunological disorders. The knowledge of extrarespiratory manifestations and their pathomechanisms allows further adjustments to therapeutic management.

[Candida albicans endocarditis after pulmonary artery banding]. / Endocardite àCandida albicans sur cerclage de l'artère pulmonaire.

Endocarditis is uncommon in infants and is exceptionally related to Candida albicans on pulmonary banding. We report on a case in a 7-month-old infant who had pulmonary artery banding for a ventricular septal defect and who presented with candidal endocarditis. Banding was chosen because of the patient's poor trophic and unstable status, which could be risky for surgery involving extracorporeal circulation. A few weeks after the banding, the patient developed systemic Candida infection, which was treated successfully. At 7 months, cardiac failure appeared without fever or inflammatory signs. Cardiac echography showed that the banding was not protective as well as a hyperechogenic image on the pulmonary bifurcation. The angioscan showed a hypodense thrombus. Emergency surgery was performed consisting of pulmonary artery exploration, thrombectomy, and ventricular septal defect closure. The exploration showed a pulmonary artery perforation caused by the infected pseudoaneurysm and the migration of the banding into the pulmonary artery. The anatomopathologic analysis of the vegetation identified multisensitive Candida albicans. After surgery and prolonged antifungal treatment, progression was satisfactory.

[Cases of imported cholera in France, summer 2005. A. Tarantola for the incident management teams]. / Cas de choléra d'importation en France, été 2005. A. Tarantola pour les groupes de gestion des incidents.

Cholera is a bacterial infection, which causes digestive symptoms and massive diarrhoea. It may lead to dehydration and death if appropriate medical management is not rapidly initiated. Most cases of infection by choleric vibrio, however, remain symptom-free or may mimic common gastroenteritis. A review of two cases of imported cholera in France in the summer of 2005 and the community- and hospital-based investigation, which they triggered, enabled the incident management teams to assess risks of transmission. There were no secondary cases among 58 hospital contacts and 15 family contacts of the cases. Clinicians will find a discussion of possible clinical presentations and the risk of secondary transmission, in the context of progressing epidemics in countries, which have maintained close ties with France.

[Neonatal nonbacterial thrombotic endocarditis]. / Les endocardites thrombotiques néonatales non bactériennes.

UNLABELLED: Nonbacterial thrombotic endocarditis is not widely known in neonates. CASE REPORTS: We report three new cases which illustrate some specific aspects of this pathology. Respiratory distress with severe pulmonary hypertension, systemic hypotension and disseminated intravascular coagulopathy in a full-term newborn were characteristic findings. CONCLUSION: An early echocardiography should lead to accurate diagnosis. Hypoxemia and genetic factors could be determining factors in its pathogenesis.

Abdominal lymphatic dysplasia and 22q11 microdeletion.

We report the case of a child with 22q11 microdeletion who presented with abdominal lymphatic dysplasia resulting in exsudative enteropathy. This primitive and localized lymphatic malformation is consistent with the vascular theory in the velocardiofacial syndrome.

[Radiotherapy for a massive hepatic hemangioma in a six-week-old infant]. / Radiothérapie d'un hémangiome massif du foie chez une enfant d'un mois et demi.

We report the case of a six-week-old baby who underwent irradiation for a giant hepatic hemangioma. After medical treatment including corticosteroids and interferon, no response was observed. She progressed to respiratory failure, requiring the use of mechanical ventilation. An emergency radiation therapy of the liver was decided. We observed a rapid improvement of the child, with the recovery of autonomous breathing without mechanical ventilation and a normalization of cardiac functions. Two months later, a partial left hepatic embolization was needed due to a progression of a localized blood flow. Six months later, she finally came back home. Cardiac output was normal and hepatomegaly began to regress. One year later, ponderal status is satisfactory, and it remains a localized hepatic right lobe hypertrophy without functional consequence.