RESUMO
UNLABELLED: OBJECTIVE/PATIENT: Gas-containing encephalitis is rarely associated with neonatal meningitis. We report a case of a 19-day-old baby who presented with a rapid onset of septic shock complicated by progressively increasing gas accumulation within the brain and anterior chamber of the eye. We describe the evolution of the clinical picture and the management. INTERVENTIONS: Ventilatory support, fluid resuscitation, and continuous venovenous hemofiltration were provided in view of multiple system failure. Despite effective antibiotic therapy and supportive management, the patient died with worsening accumulation of gas within the brain, resulting in brainstem death. RESULTS: Computed tomographic images were characteristic of diffuse necrotizing meningo-encephalitis. Postmortem examination showed friable brain tissue with venous infarction and extensive gas accumulation. Citrobacter koseri was identified from the blood and cerebrospinal fluid cultures. CONCLUSION: This case re-emphasises the importance of C. koseri as both a community-acquired and nosocomial neonatal pathogen. Radiologic evidence suggestive of diffuse necrotizing meningo-encephalitis in combination with pneumocephalus and pneumatosis oculi in Citrobacter infections has never been described before. Diagnostic imaging with computed tomographic scanning of the brain and initiation of broad-spectrum antibiotics with good penetration into cerebrospinal fluid are indicated as soon as infection with Citrobacter species is suspected clinically, with appearance of pneumatosis oculi as a rare, late finding.
Assuntos
Citrobacter koseri/isolamento & purificação , Infecções por Enterobacteriaceae/complicações , Meningoencefalite/microbiologia , Pneumocefalia/etiologia , Infecções por Enterobacteriaceae/diagnóstico , Evolução Fatal , Hidratação , Hemofiltração , Humanos , Recém-Nascido , Masculino , Meningoencefalite/diagnóstico , Necrose , Pneumocefalia/diagnóstico , Respiração ArtificialRESUMO
INTRODUCTION: The inflammatory response caused by extracorporeal membrane oxygenation (ECMO) is clearly visible within the first 24 h of cannulation. The inflammatory process affects all areas of the lung, even areas previously spared by the primary disease. OBJECTIVE: To compare the change in the radiographic signs of inflammatory response to ECMO between poly-methyl pentene and silicon oxygenators. STUDY DESIGN: Retrospective review of neonates and adults pre- and post-replacement of silicon oxygenators with poly-methyl pentene devices. Data were collected from Extracorporeal Life Support Organisation (ELSO) registry forms and patient records. Results were analysed by quantitative and semi-quantitative methods. RESULTS: There was a significant reduction in the radiographic signs of inflammatory response to ECMO, and a reduction in the time taken to revert to pre-ECMO state in the neonatal poly-methyl pentene group compared to silicon. However, there was no significant reduction in the duration of ECMO runs and the percentage survival between these groups in the neonates. In adults, there was no difference in severity of radiographic signs between groups. However, the inflammatory changes were relatively delayed in the adult poly-methyl pentene group. CONCLUSION: Polymethyl pentene (Medos) oxygenators have reduced the host's response phenomenon 'white out' in neonates, and caused a delayed response in adults. This is most likely a consequence of smaller blood contact surface area combined with the effect of heparin coating of the oxygenator membrane. However, recovery was not a function of the type of gas exchange device used.
Assuntos
Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenadores de Membrana/normas , Pneumonia/diagnóstico por imagem , Adulto , Humanos , Recém-Nascido , Oxigenadores de Membrana/efeitos adversos , Pneumonia/etiologia , Polienos , Radiografia , Estudos Retrospectivos , SilícioAssuntos
Anormalidades Múltiplas/diagnóstico , Dextrocardia/diagnóstico , Hipertelorismo/diagnóstico , Anormalidades Múltiplas/patologia , Dextrocardia/patologia , Feminino , Testes Genéticos , Humanos , Hipertelorismo/patologia , Lactente , Rim/anormalidades , Fenótipo , Doenças Renais Policísticas/diagnóstico , Doenças Renais Policísticas/diagnóstico por imagem , UltrassonografiaRESUMO
We describe the technique of partial liquid ventilation and outline its indications. We present our imaging experience with this infrequently used therapy using a wide variety of radiographs from neonatal and adult patients. The radiographic appearance of white lungs, due to the perfluorocarbons used in partial liquid ventilation, may initially be rather perplexing, but can be an advantage in diagnosing certain complications of mechanical ventilation, outlining pathology and demonstrating normal anatomy in an unusual manner.