Imagen en "reloj de arena" por hernia hiatal posquirúrgica / "Hourglass" image due to a post-surgical hiatal hernia

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Hipoplasia pulmonar: cauda de errores diagnósticos / Lung hypoplasia: a source of diagnostic errors

La hipoplasia pulmonar es una entidad clínica con escasa incidencia dentro de la patología broncopulmonar. En muchas ocasiones no se diagnostica. Otras veces, el retraso en la catalogación de dicho cuadro clínico puede originar graves problemas al paciente o llevar a la realización de múltiples pruebas diagnósticas molestas para el enfermo y sus familiares o generadoras de un importante gasto para el Servicio Nacional de Salud. En cuanto a la etiopatogenia, hoy en día se concede importancia a otras causas de hipoplasia pulmonar diferentes a las habitualmente descritas, relacionadas con la ocupación del espacio intratorácico o con malformaciones del tracto urinario. Así, los estudios más recientes se dirigen a evaluar los efectos de la disminución de la presión intramniótica y los movimientos respiratorios fetales sobre el pulmón; estos dos factores mantendrían una expansión pulmonar adecuada, fundamental para el crecimiento y la maduración estructural del pulmón fetal. Los enfermos con hipoplasia pulmonar presentan una sintomatología muy diversa, desde infecciones respiratorias recurrentes a cuadros más o menos graves de dificultad respiratoria. El diagnóstico se establece mediante una radiografía simple de tórax con una buena visualización de las vías respiratorias centrales, como la tráquea y los bronquios principales. En determinados casos, se debe efectuar una tomografía computarizada (TC) torácica, con reconstrucción tridimensional de la vía respiratoria y el árbol vascular si se dispone de la técnica (TC multidetector), gammagrafía de ventilación-perfusión o fibrobroncoscopia, que pueden ser muy útiles en el diagnóstico, el seguimiento y el tratamiento de estos pacientes. El diagnóstico prenatal también se puede establecer mediante ecografía Doppler. Este trabajo pretende llamar la atención sobre este tipo de enfermedad que todo pediatra debe conocer para evitar los problemas que acabamos de señalar

Lung hypoplasia is an uncommon bronchopulmonary disease that is often misdiagnosed or diagnosed after an unnecessary delay. This delay or error in diagnosis can result in an increase in the associated risks, as well as the performance of diagnostic tests that may cause discomfort to the patient and concern to the family. Furthermore. needless and costly expenditures of the limited resources of the National Health Service system are accrued. The most commonly reported causes of lung hypoplasia are related to invasion of the intrathoracic space or to anomalies of the urinary tract. Currently, investigation is being focused on the effects of reduced intra-amniotic pressure and fetal breathing movements that main tain a high level of lung expansion on the normal growth and structural maturation of the fetal lung as possible causes of lung hypoplasia. Patients with lung hypoplasia frequently present a wide range of symptoms, ranging from recurrent respiratory infections to more or less severe respiratory distress. Diagnosis is based on a chest x-ray in which the central airways, such as the trachea and main bronchi, can be clearly seen. A computed tomography(CT) scan, multiplanar and three-dimensional multi-detector row CT in special cases, ventilation-perfusion scintiscan or bronchoscopy should also be performed, as they are very useful in the diagnosis and follow-up of these patients. Prenatal diagnosisis possible using Doppler ultrasonography. This study focuses attention on the clinical conditions and symptoms that all pediatricians and specialists in respiratory medicine should take into account when making the diagnosis of lung hypoplasia

[Pancreatic pseudocysts in childhood]. / Pseudoquistes pancreáticos en la infancia.

Pancreatic pseudocysts do not occur frequently in infants, although more cases have been reported in the last years probably due to a more accurate and early diagnosis. These cases have been related to the increasing frequency of blunt abdominal injuries. Half of the four patients presented in this report were found to have suffered from previous blunt abdominal injuries and the common characteristic in all cases was a polymorphic clinical course prior to the discovery of an abdominal mass or progressive abdominal distension. All cases required surgical intervention, including external diversion (marsupialization) in two patients and internal derivation (cystogastrostomy) in the remaining patients. All patients recovered uneventfully after appropriate surgical treatment, although the mean hospital stay in those treated with external drainage was longer. These four cases were observed during a long period of time enabling us to register the variations in diagnostic and therapeutic procedures.

[Cervical thymic cysts in children]. / Quistes tímicos cervicales en niños.

Two cases of Cervical Thymic Cysts are communicated, a seven old year boy and a four year old girl, operated on the last three years. Both children suffered for one month an asymptomatic cervical mass. Preoperative studies included: Roentgenogram study, Ultrasound, CT scan and 131 I scan. The diagnosis was established by excision and Histological study. The clinical, anatomical and histological characteristics, were similar to the few published cases (79 cases).