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Pneumothorax & pneumopericardium

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  1. Pneumothorax & pneumopericardium

  2. Pneumothorax, pneumopericardium pneumoperitoneum, subcut. emphysema

  3. Pulmonary interstitial emphysema

  4. CATHETERANDTUBEPOSITION 1. ENDOTRACHEAL TUBE : 1 cm below vocal cord & 2 cm above carina 2. NASOGASTRIC TUBE : In stomach 3. UVC : in IVC or RA proper 4. UAC : in thoracic aorta below level of DA ( T4 ) and above origin of celiac artery ( T11 )

  5. UAC at T3- 4 level

  6. UAC tip is at T11

  7. UVC tip is in portal vein

  8. RESPIRATORY DISTRESS IN NEWBORNSURGICAL CAUSES DIAPHRAGMATIC HERNIA • Common on left side • Multiple lucencies or cysts ( bowel loops ) in the chest • Shifting of heart and mediastinum to the other side • Decreased bowel gas or gasless abdomen

  9. FOREIGN BODY ASPIRATION • Common in children 1 - 3 years old • Tracheal obstruction • Bronchial obstruction Incomplete - check valve : Air trapping Complete : Atelectasis • S/S : Dyspnea, hyperpnea, cough, +/- Hx of FB aspiration

  10. F 11 mo , หายใจหอบหลังกินถั่วติดคอมา 1อาทิตย์

  11. IiInInspiration film

  12. Expiration film , more air trapping in right lung

  13. Scope : peanut in Rt.main bronchus Post F.B. removal film

  14. F 4mo, cough, หายใจหอบหลังสำลักเม็ดส้มมา 1 wk

  15. Post F.B.removal

  16. Alimentary Tract Disease in Children

  17. ALIMENTARY TRACT OBSTRUCTION IN NEWBORN Normal abdominal bowel gas pattern : ‘Polygonal pattern’ • Stomach : immediate after birth • Small bowel : within 3 hours • Colon : within 5 hours • Rectum : within 6-8 hours • Pronefilm to demonstrate air in rectum ( R/O obstruction ) • Upright or left lateral decubitus film to demonstrate free air

  18. Normal bowel pattern = polygonal

  19. ESOPHAGEAL ATRESIA ( EA ) • MC = proximal eso. atresia with distal TEF • High incidence of associated anomalies : VACTERL ( V-vertebral, A-anorectal , C-cardiovascular , TE-tracheoesophageal ,R-renal , L-limb )

  20. GASTRIC OUTLET OBSTRUCTIONIDIOPATHIC HYPERTROPHIC PYLORIC STENOSIS S/S : Non-billous vomitting Onset ~ 1 month old Minimal upper abdominal distension +/-palpable mass ( olive ) at epigastrium

  21. IDIOPATHIC HYPERTROPHIC PYLORIC STENOSIS ( IHPS ) X-RAY FINDINGS : • Plain film : Gastric dilatation with large amount of air/fluid content , Decreased small bowel gas • US : Elongation with thickening of muscle wall of pyloric canal • UGI : Narrowing and elongation of pyloric canal ‘String sign’ Muscle indentation on lumen of stomach and duodenum ‘shoulder sign’

  22. M 5 mo , vomiting for 5 d.