Metabolomics Reveals Anaerobic Bacterial Fermentation and Hypoxanthine Accumulation for Fibrinous Pleural Effusions in Children with Pneumonia.

Fibrin formation in infectious parapneumonic effusion (IPE) characterizes complicated parapneumonic effusion and is important for providing guidelines for the management of IPEs that require aggressive interventions. We aim to identify metabolic mechanisms associated with bacterial invasion, inflammatory cytokines, and biochemical markers in cases of fibrinous infectious pleural effusions in children with pneumonia. Pleural fluid metabolites were determined by 1H nuclear magnetic resonance spectroscopy. Metabolites that contributed to the separation between fibrinous and nonfibrinous IPEs were identified using supervised partial least squares discriminant analysis ( Q2/ R2 = 0.84; Ppermutation < 0.01). IL-1ß in the inflammatory cytokines and glucose in the biochemical markers were significantly correlated with 11 and 9 pleural fluid metabolites, respectively, and exhibited significant overlaps. Four metabolites, including glucose, lactic acid, 3-hydroxybutyric acid, and hypoxanthine, were significantly correlated with plasminogen activator inhibitor type 1 in the fibrinolytic system enzymes. Metabolic pathway analysis revealed that anaerobic bacterial fermentation with increased lactic acid and butyric acid via glucose consumption and adenosine triphosphate hydrolysis with increased hypoxanthine appeared to be associated with fibrinous IPE. Our results demonstrate that an increase in lactic acid anaerobic fermentation and hypoxanthine accumulation under hypoxic conditions are associated with fibrin formation in IPE, representing advanced pleural inflammatory progress in children with pneumonia.

Chest Wall Constriction after the Nuss Procedure Identified from Chest Radiograph and Multislice Computed Tomography Shortly after Removal of the Bar.

BACKGROUND: This study radiographically examined the changes in the chest walls of patients with pectus excavatum (PE) after Nuss bar removal, to define the deformation caused by the bar and stabilizer. In the first part of the study, we compared the changes in chest radiographs of patients with PE to a preoperation PE control group. In the second part, we used multislice computed tomography (CT) scans to provide three-dimensional reconstructions with which to evaluate the changes to the thoracic wall. METHODS: Part 1 From June 2006 to August 2011, 1,125 patients with PE who had posteroanterior chest radiographs taken before undergoing the Nuss procedure at four hospitals were enrolled as a preoperative control group. At the same time, 203 patients who had the bar removed were enrolled as the study group. The maximum dimensions of the outer boundary of the first to ninth rib pairs (R1-R9, rib pair width), chest height, and chest width were measured. Part 2 Thirty-one consecutive patients with PE (20 males and 11 females) who underwent Nuss bar removal were evaluated 7 to 30 days after operation. During this period, a further 34 patients with PE who had undergone CT imaging before bar insertion were evaluated and compared with the postoperative group. RESULTS: Part 1 The width of the lower ribs (R4-R9) after bar removal was significantly less than in the age-matched controls. The ribs adjacent to the bar (R5-R7) showed the greatest restriction. The width of the upper ribs (R1-R3) 2 to 3 years after bar placement did not differ significantly from the controls. Patients who were operated on after 10 years of age had less of a restrictive effect. Three years of bar placement resulted in more restriction than a 2-year period, particularly in patients younger than 10 years old. Part 2: A significant constriction of the chest wall was observed in 13 patients after removal of the Nuss bar. Constriction at ribs 5 to 8 was found to be present adjacent to the site of bar insertion. However, constriction of the chest wall was found in only 3 of the 34 patients in the preoperative group. The severity of constriction (as graded by the spline model) also increased in the postoperative group. CONCLUSION: The growth of the chest wall was restricted after placement of the Nuss bar for PE correction. Long-term follow-up of chest wall growth is needed to clarify whether such constriction resolves with time.

A Cross-Sectional Study of Chest Wall Development in Patients with Pectus Excavatum.

BACKGROUND: We conducted a cross-sectional study to quantify the developmental changes of the thoracic cage in patients with pectus excavatum (PE). METHODS: The preoperative posteroanterior standing chest radiographs (chest PAs) of 1,197 consecutive patients with PE, together with 1,661 age- and sex-matched minor surgery patients, as a control group, who were seen between June 2005 and February 2013, were reviewed. The maximum width of each rib pair and chest height (H) were measured on the chest PA. RESULTS: In the PE group, the normal thoracic contour in younger patients was replaced by a characteristic can-shaped chest wall, which showed protrusion of the upper ribs, an increased H, and a straightened lateral border of the chest cage, as they grew into adulthood. The chest height difference between the PE and control groups increased progressively, from the age of 8 years and most significantly from age 13 to 17 years. No difference was observed in the middle and lower rib widths. Sex did not influence these trends. CONCLUSION: The PE chest wall shows a significant increment in chest height, and upper rib width starts during the period of rapid growth and is maintained into adulthood. The thoracic deformity in patients with PE includes more than just the sternal deformity.

Factors associated with proceeding to surgical intervention and recurrence of primary spontaneous pneumothorax in adolescent patients.

UNLABELLED: Primary spontaneous pneumothorax (PSP) is not uncommon, and its recurrence is often a challenging clinical problem. Surgical management and predisposing factors for the recurrence of PSP, however, have not yet been well elucidated in adolescent patients. The major aim of this study was to investigate factors associated with proceeding to surgical intervention and recurrence of PSP in adolescents. Two hundred and nineteen episodes of PSP in 171 adolescent patients were retrospectively reviewed. The clinical and radiological spectrum of PSP and factors for proceeding to surgical intervention were assessed in these 171 patients. Risk factors for the recurrence of PSP were further analyzed in 128 patients with first attack of PSP. The male-to-female ratio of the 171 PSP patients was 9:1, and the mean age was 17.6 ± 1.5 years. The median body mass index (BMI) percentile was 11 (range 2-31), and 45 (34 %) patients had underweight BMI. The incidence of recurrent PSP was high with a total recurrence rate of 21 %. Ipsilateral recurrence rate of PSP after video-assisted thoracoscopic surgery (VATS) was much less than that of the conservative treatment (4 vs. 18 %). A large-size pneumothorax with a persistent air leak was the most significant factor for proceeding to VATS surgery (P = 0.001). In addition, it was a significant factor influencing the recurrence of PSP (P = 0.014). Other factors that did not significantly affect the recurrence rate were BMI, smoking status, and the number of bullae. CONCLUSION: Adolescent PSP has a high recurrence rate of 21 % after a 2-year follow-up. A large-size pneumothorax with a persistent air leak may not only lead to surgical intervention but also the risk of a recurrence of PSP. The initial size of pneumothorax may not only guide the management process but also predict the risk of a recurrence in adolescent patients with PSP.

Macrolide-resistant Mycoplasma pneumoniae in children in Taiwan.

The aim of this study was to estimate the prevalence of macrolide-resistant Mycoplasma pneumoniae in Taiwan and to compare the clinical courses of pediatric patients with macrolide-resistant (MR) M. pneumoniae and macrolide-susceptible (MS) M. pneumoniae infection. Patients were among the children admitted to Chang Gung Children's Hospital with mycoplasmal pneumonia between February and December 2011. Detection for macrolide resistance was performed after informed consent was obtained. We retrospectively reviewed medical records and compared the clinical courses of two groups of patients of 73 children enrolled into our study. The rate of macrolide resistance in M. pneumoniae was 12.3 %. Longer hospital stay was observed in the MR patients than MS patients [median, 7 days vs. 5 days (P = 0.019)]. Clinical features or radiographic or laboratory findings are not helpful to differentiate MR from MS mycoplasmal pneumonia. Early diagnosis of MR mycoplasmal pneumonia is crucial for the best management of these patients and obviates the need for extensive etiological searches of these nonresponding cases.

Cardiovascular-associated tracheobronchial obstruction in children.

Tracheobronchial compression of cardiovascular origin is an uncommon and frequently unrecognised cause of respiratory distress in children. The compression may be due to encircling vessels or dilated neighbouring cardiovascular structures. Bronchoscopy and detailed radiography, especially computed tomography and magnetic resonance imaging, are among the most powerful diagnostic tools. Few previous reports have addressed the relationship between bronchoscopic findings and underlying cardiovascular anomalies. The objective of this study was to correlate bronchoscopic and radiographic findings in children with cardiovascular-associated airway obstruction. A total of 41 patients were recruited for the study. Patients with airway obstruction were stratified on the basis of the aetiology of the cardiovascular structures and haemodynamics into an anatomy-associated group and a haemodynamics-associated group. In the anatomy-associated group, stenosis and malacia were found with comparable frequency on bronchoscopy, and the airway obstructions were mostly found in the trachea (71% of patients). In the haemodynamics-associated group, malacia was the most common bronchoscopic finding (85% of patients), and nearly all locations of airway involvement were in the airway below the carina (90% of patients). The tracheal compression was usually caused by aberrant systemic branching arteries in the anatomy-associated group. In the haemodynamics-associated group, the causal relationships varied. Tracheal compression was often caused by lesions of the main pulmonary artery and aorta, whereas obstruction of the right main bronchus was caused by lesions of the main pulmonary artery and right pulmonary artery. The causes of left main bronchus compression were more diverse. In summary, the bronchoscopic presentations and locations are quite different between these two groups.

Spontaneous pneumomediastinum: analysis of 87 pediatric patients.

OBJECTIVES: Early reports on pneumomediastinum studied the adult population, and recent analyses of pneumomediastinum in pediatric patients contain small numbers of patients. We aimed to summarize the experience of a larger number of pediatric patients with spontaneous pneumomediastinum (SPM) in a tertiary children's facility in northern Taiwan. METHODS: We performed a retrospective chart review of clinical manifestations and outcome of SPM on pediatric patients who were admitted to our hospital during a 10-year period. RESULTS: Forty-three patients (49.4%) had primary SPM, with a male predominance in adolescents. None of the 16 patients younger than 6 years had primary SPM; 43 of 71 patients older than 6 years had secondary SPM (0% vs 60.6%, P < 0.05). The common causes of secondary SPM were asthmatic exacerbation, pneumonia or lower respiratory tract infections, or choking. Ten patients had normal frontal chest radiograph finding (sensitivity, 89.1%); the lateral neck radiographs clearly demonstrated subcutaneous emphysema in 9 of these 10 patients. CONCLUSIONS: All patients younger than 6 years with SPM were secondary; therefore, they should be vigilantly examined for predisposing causes. For adolescent patients with SPM with no catastrophic events, asthma with exacerbation should be considered first, and extensive or invasive diagnostic examinations are not needed. Primary SPM usually requires conservative treatment only with no sequel or recurrence. Lateral neck radiograph has a higher sensitivity for the demonstration of subcutaneous emphysema in doubtful cases.

Diaphragmatic paralysis among very low birth weight infants following ligation for patent ductus arteriosus.

Management of diaphragmatic paralysis (DP) among newborn infants remains controversial, especially for very low birth weight (VLBW) infants following ligation for patent ductus arteriosus (PDA). This study aimed to characterize the impact of DP after PDA ligation among VLBW infants. Clinical characteristics of DP cases treated with either diaphragmatic plication or conservative methods were described as well. The medical records of VLBW infants who underwent PDA ligation in Chang Gung Memorial Hospital between January 2000 and December 2011 were retrospectively reviewed, and DP was suspected if postligation chest X-rays showed an elevation of the left diaphragm as confirmed by a chest ultrasonograph. For each DP case, three other infants that received PDA ligation with proximate birth dates and who were closely matched in terms of gestational age (±1 week) and birth weight (±10 %) were selected as the control group. A total of eight preterm infants were diagnosed as having DP and 24 infants were selected as the control group. The affected infants usually presented with respiratory distress and extubation failure. The study demonstrated that, among our patient population, DP was associated with a significantly longer duration of ventilator dependency (56.1 ± 16.0 vs. 29.8 ± 17.7 days, p = 0.001) and a higher incidence of severe bronchopulmonary dysplasia (87.5 vs. 23 %, p = 0.002). For selective infants with DP-related ventilatory failure after PDA ligation, surgical plication may facilitate extubation. Diaphragmatic paralysis should be evaluated carefully among VLBW infants receiving PDA ligation because of its adverse impact on ventilator dependency and correlation to a higher incidence of severe bronchopulmonary dysplasia.

Self-supervised classification of subcellular morphometric phenotypes reveals extracellular matrix-specific morphological responses.

Cell morphology is profoundly influenced by cellular interactions with microenvironmental factors such as the extracellular matrix (ECM). Upon adhesion to specific ECM, various cell types are known to exhibit different but distinctive morphologies, suggesting that ECM-dependent cell morphological responses may harbour rich information on cellular signalling states. However, the inherent morphological complexity of cellular and subcellular structures has posed an ongoing challenge for automated quantitative analysis. Since multi-channel fluorescence microscopy provides robust molecular specificity important for the biological interpretations of observed cellular architecture, here we develop a deep learning-based analysis pipeline for the classification of cell morphometric phenotypes from multi-channel fluorescence micrographs, termed SE-RNN (residual neural network with squeeze-and-excite blocks). We demonstrate SERNN-based classification of distinct morphological signatures observed when fibroblasts or epithelial cells are presented with different ECM. Our results underscore how cell shapes are non-random and established the framework for classifying cell shapes into distinct morphological signature in a cell-type and ECM-specific manner.

The respiratory impacts of air pollution in children: Global and domestic (Taiwan) situation.

Air pollution is a global issue that threatens the health of human beings. Epidemiologic reports have shown air pollution exposures to result in millions of deaths annually. Infancy and childhood, the period of organ and lung development, is most susceptible to these environmental hazards; as a result, the risks of respiratory diseases are increased after air pollution exposure. These pollutants can originate from indoor and ambient environment, presenting as vapor or particles, and differ in chemical compositions. This review will give brief introduction to various major pollutants and their origin, as well the correlation with respiratory diseases after exposure. We will also present several current facts in domestic area (Taiwan), regarding the status of local air-pollution, and discuss its impacts on pediatric respiratory health. This report will provide useful information for clinicians and offer advice for policy makers to develop public health guidelines of pollution control and prevention.

Pulmonary function evaluation in pediatric patients with primary immunodeficiency complicated by bronchiectasis.

BACKGROUND: Primary immunodeficiency (PID) accompanying with recurrent respiratory infections is thought to have a devastating effect on lung function. However, the associations between the airway structural abnormalities on chest computed tomography (CT), severity of dyspnea, and deterioration of pulmonary function test (PFT) have not been fully addressed. METHODS: Children diagnosed with PID in a tertiary referred center in northern Taiwan were enrolled. Demographic and clinical data including age, sex, age at diagnosis of PID, and follow-up period were collected. Chest CT images (modified Reiff scores), parameters of PFT, and life quality questionnaires (mMRC dyspnea scale) were analyzed and correlated using Spearman's rank correlation test. RESULTS: A total of nineteen children with PID were enrolled and thirteen patients were diagnosed as having bronchiectasis based on chest CT scans. Modified Reiff scores of chest CT scan were negatively correlated with FEV1 (% predicted) and FEV1/FVC ratio (P < 0.05). A strongly negative correlation was found between the mMRC dyspnea scale and FEV1 (% predicted) and FVC (% predicted), but positively correlated with RV (% predicted) and RV/TLC ratio (P < 0.05). Furthermore, there was a negative correlation between FVC (% predicted) with increasing follow-up period (P < 0.05). CONCLUSIONS: In pediatric patients with PID, chest CT scan appears to be a good tool for not only the diagnosis of bronchiectasis, but also the degree of pulmonary function impairment. Further quality of life impairments could be particularly due to the airflow obstruction and air trapping related to bronchiectasis.

Plethysmographic lung volumes in children with sighing dyspnea.

BACKGROUND: This study compared the plethysmographic lung volumes of children with sighing dyspnea with healthy children and tested the hypothesis that sighing children suffer from hyperinflation or gas trapping as a cause of dyspnea. METHODS: From January 2006 to December 2006, pediatric patients with sighing dyspnea presenting to the pulmonary clinic of a tertiary children's hospital who had no apparent cardiopulmonary diseases were prospectively enrolled; normal healthy children were invited to participate for comparison. Baseline pre-bronchodilator spirometry and post-inhaled bronchodilator spirometry were measured for the determination of bronchodilator response. Plethysmographic lung volumes were determined solely for total lung capacity, residual volume (RV) and functional residual capacity (FRC) without the use of inhaled bronchodilator according to standard procedure. RESULTS: Eighteen sighing children (10 boys) and 10 healthy subjects (six boys) were included in the present study. They had a median age of 13 years (range, 8-15 years) and 13 years (range, 8-17 years), respectively. The mean baseline forced vital capacity (FVC) of subjects with dyspnea was 79.4 +/- 16.7% of predicted, while that of the normal control children was 88.4 +/- 6.7%, which was not statistically significantly different. Forced expiratory volume in 1 s (FEV(1)), FEV(1)/FVC % of predicted were within normal limits and indicated no bronchodilator response. RV and RV/total lung capacity (TLC) were elevated in children with sighing dyspnea that were not measured by spirometry, but TLC and FRC measured on plethysmography (FRC(pleth)) were not increased. CONCLUSIONS: RV and RV/TLC were higher in children with sighing dyspnea that were not measured by spirometry, but TLC and FRC(pleth) were not increased. The causal link between dysfunctional breathing patterns and changes in static lung volumes was not able to be determined in the present study. The possibility of heterogeneity of patients with sighing dyspnea obscures the significance of lung volume discrepancy in this population; further subdivision of children with sighing dyspnea in a larger cohort of patients is required.

Heliox as the rescue therapy for a neonate with congenital tracheal stenosis, pulmonary artery sling, and intracardiac anomalies.

Congenital tracheal stenosis (CTS) is a rare disease associated with high mortality and morbidity, especially if it is associated with intracardiac anomalies or vascular rings. Heliox, a "carrier gas" with low density, has been used in pediatric intensive care units for treating acute respiratory failure due to obstructive airway disease. Here we report a 3100-g, 39-week newborn with long-segment CTS complicated with a pulmonary artery sling and tetralogy of Fallot, to whom heliox was given as the rescue therapy during near-complete airway obstruction and cardiopulmonary failure. Although this patient finally died from failure of corrective surgery, our experience with heliox has suggested that its effects in improving oxygenation and eliminating CO (2) can be a rescue strategy in a mechanically ventilated infant with severe airway obstruction.

Diagnostic pitfalls of acute eosinophilic pneumonia in an adolescent boy following cigarette smoking: A case report.

RATIONALE: Acute eosinophilic pneumonia (AEP) is characterized by acute febrile respiratory symptoms, bilateral lung infiltrates, and pulmonary eosinophilia. AEP is closely related to cigarette smoking but is rarely suspected in pediatric cases despite the fact that there is a relatively high incidence of cigarette smoking among adolescents in Taiwan. PATIENT CONCERNS: We report a case of a previously healthy 15-year-old boy who presented with fever and acute progressive dyspnea. Due to lack of awareness of cigarette smoking history in adolescents and the nonspecific signs and symptoms of AEP at early stages, the patient was initially treated as community-acquired pneumonia (CAP) but was unresponsive to antibiotics treatment. DIAGNOSES: A combination of a recent onset smoking history and pulmonary eosinophilia on bronchoalveolar lavage confirmed the diagnosis of cigarette-induced AEP. INTERVENTIONS: Corticosteroid treatment was prescribed. OUTCOMES: The condition improved within 24 hours, with resolution of alveolar infiltrates on chest radiographs. LESSONS: With the increasing incidence of smoking amongst adolescents in Taiwan, careful history questioning regarding cigarette smoking is necessary. Due to similarities in initial clinical and radiographic features of AEP and CAP, adolescents with suspected CAP who are unresponsive to antibiotic treatment but have a subsequent rise in peripheral eosinophils should raise the clinician's suspicion of AEP related to cigarette smoking.

Proinflammatory cytokines, fibrinolytic system enzymes, and biochemical indices in children with infectious para-pneumonic effusions.

BACKGROUND: In children, pleural empyema is a recognized complication of severe pneumonia and is characterized by loculated effusions with fibrin septations. The aim of this study was to evaluate the relationship between proinflammatory cytokines [tumor necrosis factor-alpha (TNF-alpha), interleukin-1beta (IL-1beta), and IL-6], intrapleural fibrinolytic system enzymes [tissue-type plasminogen activator (tPA) and plasminogen activator inhibitor type 1 (PAI-1)], and common biochemical indices during pleural infection. METHODS: Children with pneumonia complicated by para-pneumonic effusions were enrolled into our study and underwent real-time chest sonography. The patients were divided into 3 groups by ultrasound using a recognized staging system of pleural effusions. Staging of progressive pleural infection was used to correlate with the characteristics of pleural effusions. The correlation of various pleural variables with the formation of complicated para-pneumonic effusions (CPE) was performed and pleural variables for predicting subsequent intervention procedures were also analyzed. RESULTS: A total of 57 patients were enrolled in the present study. Univariate analysis revealed that the amounts of biochemical indices (pH, glucose, lactate dehydrogenase), proinflammatory cytokines (TNF-alpha, IL-1beta, IL-6), and fibrinolytic system enzymes (tPA, PAI-1) were significantly different with the progressive stages of para-pneumonic effusions (Ptrend < 0.05). For all proinflammatory cytokines, a positive correlation was found with lactate dehydrogenase and PAI-1, whereas a negative correlation was found with pH, glucose, and tPA. Moreover, these cytokines were also significantly correlated with PAI-1 in both non-CPE and CPE. The pleural fluid findings of IL-1beta (> or =50 pg/mL), PAI-1 (> or =1252 ng/mL), and pH (< or =7.30) were the most significant predictive factors for subsequent intervention procedures (P < 0.001). CONCLUSIONS: The increased release of proinflammatory cytokines in pleural fluid caused by bacteria may result in an imbalance of the fibrinolytic system, which can subsequently lead to fibrin deposition and intervention procedures.

Spontaneous pneumomediastinum due to gastroesophageal reflux disease in an adolescent boy.

The presence of free air in the mediastinum, without traumatic injury or underlying disease, is known as spontaneous pneumomediastinum. The diagnosis is based on CXR and CT scan. Oesophagography is essential for the exclusion of oesophageal rupture. We present a case of pneumomediastinum in a 17-year-old boy with gastroesophageal reflux disease (GERD) and emphasize that the association of pneumomediastinum and symptoms of GERD warrants oesophageal pH monitoring.

Nontuberculous mycobacterial pulmonary disease in an immunocompetent adolescent.

We report a 16-year-old previously healthy boy who presented with a 6-week history of fever, anorexia, weight loss, and respiratory distress. The chest radiograph showed bilateral upper infiltrates and cavitations indistinguishable from Mycobacterium tuberculosis infection. He was actually infected with M. kansasii. Treating Mycobacterium in an immunocompetent child requires multiple antimycobacterial drugs, including isoniazid, rifampicin, and ethambutol for at least 12 months after negative sputum culture.

Bronchiolitis obliterans in children: clinical presentation, therapy and long-term follow-up.

AIM: To delineate the predisposing factors, clinical, radiological features and outcomes of bronchiolitis obliterans (BO) in children for minimising morbidity and mortality. METHODS: Ten children who had BO from July 1995 to July 2005 were retrospectively reviewed at a tertiary paediatric facility in northern Taiwan. RESULTS: Bronchiolitis obliterans complicated by infections, Stevens-Johnson syndrome was found in eight and two patients, respectively. In children with post-infectious BO, adenoviruses were the most common etiologic agents (7/8). Among them, six patients needed intensive management and five patients needed mechanical ventilation. All patients presented persistent dyspneic respirations and wheezing since the initial lung infection. Initial focal atelectasis (n = 3) on chest radiographs progressed to atelectasis/lobar collapse (n = 8) when the diagnosis of BO was made. After adequate supportive management, atelectatic bronchiectasis was the most common complication (n = 5). CONCLUSION: Severe adenovirus bronchiolitis and/or pneumonia appear to have higher risk of development of BO in children. In order to minimise associated complications of BO, meticulous respiratory care for preventing pulmonary collapse may be considered in such instances.

Peripheral hypoechoic spaces in consolidated lung: a specific diagnostic sonographic finding for necrotizing pneumonia in children.

The aim of this study was to investigate the diagnostic usefulness and clinical values of the sonographic feature of peripheral hypoechoic spaces (PHES) in children with necrotizing pneumonia (NP). Between July 2002 and July 2004, 23 consecutive children with NP in whom we performed real-time chest ultrasound were enrolled into our study. Details of demographics, clinical characteristics, laboratory data, causative pathogens, complications and outcomes of these children were recorded and analyzed. PHES in ultrasonography (US) were defined as peripheral cavitations seen as hypoechoic areas in consolidated lung. The sonographic feature of PHES was correlated with the diagnosis of NP and was also used to correlate with the clinical characteristics, complications and outcomes in children with NP. Sensitivity, specificity, and positive predictive value of this sonographic finding for the diagnosis of NP were 35%, 100%, and 100%, respectively. Pneumothorax was seen more commonly in children who presented PHES in US, with a significant difference (p < 0.05). In conclusion, the sonographic feature of PHES appears to be more specific for detecting NP in childhood pneumonia. In children with pneumonia with PHES in consolidated lung, the diagnosis of NP can be suggested with confidence, and it is important to be aware of the life-threatening complication of pneumothorax to decrease morbidity.

Congenital tuberculosis: case report and review of the literature.

Congenital tuberculosis is rare, even where tuberculosis (TB) is endemic. A 14-day-old girl presented with a 3-day history of fever and respiratory distress. Her mother was diagnosed with a disseminated TB infection immediately after the delivery which was confirmed by a positive TB-polymerase chain reaction (TB-PCR) and subsequent culture from ascites and sputum. The infant was separated from her mother at birth. Her chest radiograph showed bilateral miliary nodules. Congenital TB was strongly suspected because of the symptoms, signs and maternal TB history, and was confirmed by TB-PCR and culture from the gastric lavage. Timely administration of standard anti-TB therapy resulted in a good outcome. The case highlights the importance of maternal TB history and typical miliary pattern on chest radiography for early diagnosis of congenital or neonatal TB which in turn facilitates prompt treatment and the prognosis.