RESUMO
Congenital superior vena cava (SVC) anomalies are not uncommon. However, an absence of a left SVC and an anomalous right SVC without additional congenital heart defects is very rare. We present a 38-year-old male with an 'anomalous SVC' that was found to be descending anterior to the pleural space and draining into the inferior vena cava (IVC) at the level of the right atrium. This was associated with an anomalous right upper and lower pulmonary vein draining into this anomalous SVC. To our knowledge, this combination of congenital anomalies has not been previously described in the medical literature.
RESUMO
We analyzed the chest radiographs (CXRs) of 249 clinically healthy children, 230 from southwest Mexico City and 19 from Tlaxcala. In contrast to children from Tlaxcala, children from southwest Mexico City were chronically exposed to ozone levels exceeding the U.S. National Ambient Air Quality Standards for an average of 4.7 hr/day and to concentrations of particulate matter (PM) with aerodynamic diameters = 2.5 microm (PM2.5) above the annual standard. CXRs of Mexico City children demonstrated bilateral hyperinflation (151 of 230) and increased linear markings (121 of 230) . Hyperinflation and interstitial markings were significantly more common in Mexico City children (p < 0.0002 and 0.00006 respectively) . Mexico City boys had a higher probability of developing interstitial markings with age (p = 0.004) . Computed tomography (CT) scans were obtained in 25 selected Mexico City children with abnormal CXRs. Mild bronchial wall thickening was seen in 10 of 25, prominent central airways in 4 of 25, air trapping in 8 of 21, and pulmonary nodules in 2 of 21. Only 7.8% of Mexico City children had abnormal lung function tests based on predicted values. These findings are consistent with bronchiolar, peribronchiolar, and/or alveolar duct inflammation, possibly caused by ozone, PM, and lipopolysaccharide exposure. The epidemiologic implications of these findings are important for children residing in polluted environments, because bronchiolar disease could lead to chronic pulmonary disease later in life.
Assuntos
Poluentes Atmosféricos/toxicidade , Pulmão/efeitos dos fármacos , Ozônio/toxicidade , Doença Pulmonar Obstrutiva Crônica/induzido quimicamente , Saúde da População Urbana , Poluentes Atmosféricos/análise , Criança , Humanos , Exposição por Inalação , Pulmão/diagnóstico por imagem , Masculino , México , Ozônio/análise , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Radiografia , Fatores de TempoRESUMO
Southwest Metropolitan Mexico City (SWMMC) children are chronically exposed to complex mixtures of air pollutants. In a cross-sectional arm of our study, we investigated the association between exposure to SWMMC atmosphere and nasal abnormalities, hyperinflation, and interstitial markings assessed by chest X-rays, lung function changes, several serum cytokines, and endothelin-1 in 174 children aged 5-17 years vs. 27 control children residents in low-polluted areas. Control children had no nasal lesions, and only one child showed an abnormal chest X-ray. SWMMC children exhibited nasal abnormalities (22%), hyperinflation (67%), interstitial markings (49%), and a mild restrictive pattern by spirometry (10%). Interstitial markings were associated with a decrease in predicted values of FEF(25-75), FEF(75), and the FEV(1)/FVC ratio. Boys had a higher probability of developing interstitial markings with age (P = 0.004). Blood smear findings included toxic granulations in neutrophils and schistocytes. SWMMC children had more serum IL10 and IL6 and less IL8 than controls. In a longitudinal arm of our study, we found a significant seasonal drop in FVC and FEV(1) associated with a 6-month period of high ozone and PM(10) levels. Our data strongly suggest that a lifelong exposure to urban air pollution causes respiratory damage in children. Moreover, a cytokine network becomes imbalanced, with a shift towards upregulation of anti-inflammatory cytokines. Consequently, these children are potentially at risk for developing chronic lung disease and other systemic effects later in life.
Assuntos
Poluentes Atmosféricos/toxicidade , Exposição por Inalação/efeitos adversos , População Urbana , Adolescente , Fatores Etários , Poluentes Atmosféricos/análise , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos Transversais , Grânulos Citoplasmáticos/patologia , Endotelina-1/sangue , Eritrócitos Anormais/patologia , Feminino , Humanos , Hiperemia/diagnóstico , Interleucinas/sangue , Estudos Longitudinais , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Masculino , México/epidemiologia , Cavidade Nasal/anormalidades , Neutrófilos/patologia , Ozônio/análise , Radiografia , Estações do Ano , Fatores SexuaisRESUMO
Fibular hemimelia is a congenital deficiency or absence of the fibula. There is a spectrum of disease from mild fibular hypoplasia to fibular aplasia. The ipsilateral tibia may be hypoplastic, bowed or normal. Fibular hemimelia can be an isolated deformity of the lower leg but frequently it is associated with proximal focal femoral deficiency, deficiencies of the lateral aspect of the foot, or is part of a malformation syndrome. In this article, we review the embryology of the extremities, discuss proposed etiologies for fibular hemimelia, highlight associated abnormalities, and present the radiographic and imaging findings. Surgical treatment options and long-term outcomes are discussed.