Ventricular septal defect following blunt chest trauma in childhood: a case report

We report a case of a six-year-old male who sustained a ventricular septal defect following blunt trauma to the chest. Traumatically acquired VSD is rare in children. The diagnosis is made by characteristic history and physical examination and confirmed by echocardiogram or cardiac catheterization. Treatment is medical until surgical repair can be safely accomplished.     

Postinfarction ventricular septal defect following blunt chest trauma in a 7-year-old child

Blunt cardiac injury may result in traumatic ventricular septal defect (VSD) in the pediatric population, but presence of postinfarction VSD with accompanying coronary artery thrombosis has not been reported in the literature thus far. We present a seven-year-old patient who underwent surgery for posttraumatic VSD closure and bypass grafting of thrombotic left anterior descending coronary artery (LAD) occlusion following blunt chest trauma. A high index of suspicion and early use of the appropriate imaging studies are essential for diagnosis and surgical treatment of this condition.     

经导管封闭幼儿主动脉-肺动脉间隔缺损一例

患儿女,2岁,于出生后2 d例行查体时被发现心脏杂音.出生3 d至1岁在当地多家医院诊断"先天性心脏病",具体诊断未定,建议体重20 kg后手术.患儿平日多汗,因家长觉孩子一般情况良好,体力与正常同龄儿无明显差别,未进一步诊治.婴儿期患肺炎1次,无心衰病史.     

Congenital double-orifice mitral valve associated with atrioventricular septal defect: a case report

The case of an eight-year-old girl with congenital double-orifice mitral valve associated with atrioventricular septal defect is reported. This rare mitral valve anomaly was diagnosed with two-dimensional echocardiography. The associated atrioventricular septal defect was repaired successfully. The central fibrous bridge between anterior and posterior mitral valve leaflets was left undivided to avoid iatrogenic mitral regurgitation. Preoperative diagnosis may provide some useful information to the surgeon. The surgical method can be individualized in each case.     

Clitoral epidermoid cyst secondary to blunt trauma in a 9-year-old child

Epidermoid cysts are slowly growing tumors arising from invagination of the epidermis into the dermis traumatically or spontaneously. This implantation in the clitoris is most commonly induced by female genital mutilation. The reported cases with spontaneous onset of this clitoral lesion are scarce. Trauma other than female circumcision predisposing to the onset of the cyst has not been mentioned before. A nine-year-old girl was presented for swelling in the pubic region with the onset following an accidental trauma; the diagnosis was determined to be epidermoid cyst of the clitoris after a brief preoperative evaluation and an accurate surgical management.     

Stricture of the common bile duct secondary to blunt abdominal trauma

A 3-year- 8-month-old girl developed obstructive jaundice associated with stricture of the distal end of the common bile duct 7 months after blunt abdominal trauma. Ultrasonography, computerised tomography, and percutaneous trans-hepatic cholangiography made the anatomical diagnosis before surgical reconstruction. Histological examination of the retroperitoneal tissue near the site of the stricture showed evidence of previous bile leakage due to rupture of the duct. Relief of obstruction was achieved by a Roux-en-Y choledochojejunostomy with complete resolution of symptoms and restoration of normal liver function. Offprint requests to: H. C. O Martin     

Microcephaly, lymphedema, chorioretinopathy and atrial septal defect: a case report and review of the literature

Background: The rare congenital combination of microcephaly, lymphedema and chorioretinopathy (MLCD) has been described. Recently, three cases with these clinical characteristics have been diagnosed as having, in addition, various congenital cardiac anomalies, which may be part of this genetic entity that presents with variable expression.
Clinical observation: Here we present a new case of a one-year-old infant who was born with microcephaly and lymphedema and atrial septal defect (ASD) and developed chorioretinopathy at the age of 6 months. This infant had normal neurodevelopment at one year of age.
Conclusion: We recommend that cardiac evaluation and long-term ophthalmologic follow-up should be part of the evaluation in each child born with microcephaly and lymphedema. Family counseling should include the fact that normal to near-normal development may be possible, despite the presence of microcephaly.     

Neonatal hemochromatosis: a case report with unique presentation

Acute liver failure (ALF) is a relatively rare condition in neonates, and early diagnosis and treatment are crucial for the treatable conditions. Neonatal hemochromatosis (NH) is a rare clinical condition that is clinically defined as severe neonatal liver disease associated with hepatic and extrahepatic iron deposition in a distribution similar to that seen in hereditary hemochromatosis. Although a few cases have been reported with spontaneous remission, early and aggressive medical treatment is essential for improving the outcome. Despite aggressive treatment, some patients may require liver transplantation. We report a five-day-old male infant with NH and associated Duarte variant galactosemia, renal tubulopathy and hypertyrosinemia, who was successfully treated with combination medical treatment. Combination therapy may reduce the need for liver transplantation in infants with NH. Early diagnosis and aggressive treatment are important as in galactosemia or tyrosinemia for the outcome. Thus, NH may be listed as a treatable cause of ALF in neonates.     

合并室间隔缺损的主动脉闭锁一例

患儿男,5岁5个月,因"查体发现心脏杂音"入院.体检:血压:双上肢100/50 mm Hg(1 mm Hg=0.133 kPa),双下肢130/60 mm Hg;肺动脉瓣区第二心音亢进,胸骨左缘2～4肋间可闻及4/6级收缩期杂音,并可触及震颤;口唇及指端无发绀.经皮测四肢动脉血氧饱和度91%～93%.     

Trisomy 18 with ectopia cordis, omphalocele, and ventricular septal defect: case report

A case of thoracoabdominal ectopia cordis was diagnosed by ultrasonography at 21 weeks' gestation. Chromosomal analysis showed full trisomy 18. This case supports the associational of thoracoabdominal ectopia cordis (Cantrell's pentad) with chromosomal errors, specifically trisomy 18.     

经导管介入治疗主-肺动脉间隔缺损一例

患儿女,8岁。运动性心悸气短5年于2 0 0 3年5月2 0日入院。体检:身高12 0cm ,体重18 5kg ,血压10 0 / 5 0mmHg ,发育较差,无紫绀和杵状指(趾)。颈静脉轻度怒张,心前区隆起,心界增大,心率110次/min ,节律整齐,胸骨左缘第2～3肋间有连续性机器样杂音,心尖部有Ⅱ/Ⅵ级收缩期返流样杂音,肺动脉瓣区第二心音增强、分裂,两肺呼吸音粗糙有干湿啰音,腹软,肝大肋下3 0cm ,周围血管征阳性。心电图示左心室肥厚;X线胸片示肺血多,肺动脉段突出,心胸比值为0 72 ;彩色多普勒超声心动图示左房左室内径增大,主动脉根部有异常血流束,二尖瓣轻度关闭不全。入…     

Tracheobronchial rupture due to blunt trauma in children: report of two cases.

Tracheobronchial tree injuries occur in a small number of patients after blunt chest trauma, and their occurrence is uncommon in the pediatric trauma population. The authors report two male children, one with a tracheal rupture, and the other with disruption of the main right bronchus. Mediastinal and subcutaneous emphysema resulting in airway obstruction were noted in Case 1 and soft-tissue emphysema, pneumomediastinum and tension pneumothorax were evident in Case 2 at the time of presentation. In the child with bronchial disruption, a major airway injury was suspected early on, because of a massive air leak despite two properly placed chest tubes. The definitive diagnosis was established bronchoscopically, and thoracotomy and primary repair were performed. The child with rupture of the posterior tracheal wall was diagnosed at an early stage by bronchoscopy and he was successfully managed without surgery.     

Intra-utero diagnosis of anomalous right ventricular muscle bundles in association with a ventricular septal defect: A case report

Summary The morphology and natural history of anomalous right ventricular muscle bundles (ARVMB) have been described in a number of postnatal studies. Whether this is a congenital or acquired cardiac lesion remains obscure. A fetal echocardiogram performed in a 32-week gestation mother showed a large ventricular septal defect and anomalous right ventricular muscle bundles, which were easily appreciated at the ostium-infundibular level. The diagnosis was confirmed postnatally and at 6 months of age the child underwent surgical repair. This report documents the presence of ARVMB in a fetus, at a time when hemodynamics cannot explain the development of right ventricular muscle bundles. It suggests that at least, the morphologic substrate for this disease is congenital.     

腹部闭合伤致儿童胰腺外伤的诊治探讨

目的 探讨儿童腹部闭合性损伤导致胰腺外伤的病因及诊断和治疗方法.方法 回顾性分析我院1999年1月至2008年5月间收治14例闭合性腹部损伤导致胰腺外伤患儿的临床资料.结果 男11例,女3例,男∶女=3.7∶1.致伤原因依次为自行车把致伤5例、交通事故4例、踢伤或殴伤3例、跌伤2例.临床表现有腹痛、腹部压痛、白细胞及血清淀粉酶升高和发热.实验室检查14例均有不同程度白细胞升高.10例(71.5%)血清淀粉酶升高,二者升高水平与胰腺损伤程度无关;重复血清淀粉酶值测定对胰腺外伤具有诊断意义.11例(78.6%)CT检查发现胰腺损伤6例(54.5%),5例CT检查正常但剖腹探查胰腺外伤2例;12例B超检查发现胰腺损伤8例;内镜逆行胰胆管造影(ERCP)检查1例.保守治疗成功9例,包括轻微损伤6例,远端胰管损伤1例,入院时有胰管损伤但未发现2例.剖腹探查及胰腺外引流术5例.胰腺假性囊肿形成后手术4例.结论 胰腺外伤在儿童腹部闭合性损伤中并不常见.诊断以血清淀粉酶升高、CT及B超检查为主,少数需剖腹探查.白细胞及血清淀粉酶升高水平与胰腺损伤程度无关.重复血清淀粉酶测定及CT检查对胰腺外伤具有诊断意义.大多数胰腺创伤包括胰管近端损伤儿童可以先保守治疗而不是冒风险手术干预,如果形成假性囊肿再后期引流.胰管远端损伤(Ⅲ级)最好选择保脾胰尾切除术.剖腹探查术中发现轻微胰腺损伤而采用腹部闭式引流措施意义不大.     

Peri-cardiac arrest following blunt bicycle handlebar trauma to the iliac vessels: management of a rare case

Iliac vessel disruption following blunt trauma is an unusual presentation, particularly in the absence of an orthopaedic injury. We present the unique case of a 14-year-old boy who sustained a blunt bicycle handlebar impalement that resulted in complete transection of the external iliac artery and laceration of the external iliac vein, without a skeletal fracture. The patient deteriorated rapidly, entering hypovolaemic shock and peri-cardiac arrest at anaesthetic induction. Once haemodynamic stability was achieved, the lacerated external iliac vein was used to form an interposition graft to repair the external iliac artery. The rare occurrence and lack of familiarity with this injury, combined with the potential for fatal exsanguination if not swiftly diagnosed makes this case crucial to highlight. Blunt bicycle handlebar injury should carry a high suspicion of severe vascular compromise. If diagnosed this should be rapidly managed with aggressive resuscitation and revascularisation.