An unusual case of obstructed total anomalous pulmonary venous return with gastric varices.

Total anomalous pulmonary venous return with obstruction to the venous pathway is a life-threatening emergency. We report a neonate with unusual infradiaphragmatic drainage into the ductus venosus and gastric veins. Neonatal gastric varices with obstructed pulmonary venous return are extremely rare with potential for catastrophic gastrointestinal haemorrhage. The complex anatomy first detected by echocardiography was clarified on CT.

Conservative management of iatrogenic esophageal perforation during neonatal cardiac surgery.

Esophageal perforation is a rare, but life threatening, entity in children. The most common iatrogenic causes include nasogastric tube insertion, stricture dilation, or endotracheal intubation. Recently, transesophageal echocardiography (TEE) has been increasingly used in pediatric cardiac surgery to assess cardiac function and structural abnormalities. The safety of TEE in children is still controversial and complications such as airway obstruction, hemodynamic compromise, and esophageal injury have been reported. We recently experienced a case of esophageal perforation caused by TEE probe insertion during neonatal cardiac surgery; two weeks of conservative management resulted in complete resolution of the injury.

Superior herniation of the mediastinum presenting as an anterior neck mass on straining.

We report an infant with an anterior neck mass present only on straining. Airway fluoroscopy revealed this to be due to superior mediastinal herniation. Neck masses apparent only during Valsalva maneuver are rare and awareness of the differential diagnosis is important to avoid unnecessary investigation or surgery.

The congenital intrahepatic arterioportal fistula syndrome: elucidation and proposed classification.

Congenital intrahepatic arterioportal fistula is a rare but treatable cause of portal hypertension for which early recognition may lead to successful radiological management. We report an infant presenting with severe failure to thrive, melena and splenomegaly due to a congenital intrahepatic arterioportal fistula, successfully ablated after multiple trials of superselective transarterial embolization. Comprehensive review of congenital cases provides an understanding of the key clinical features defining this syndrome. A classification system is proposed, upon which treatment decisions may be based.