0
Special Feature |

Radiological Case of the Month FREE

John G. Walsh, MB, MRCPCH; Martin J. O'Sullivan, MB, FRCI; C. Anthony Ryan, MB, MRCPCH
[+] Author Affiliations

Section Editor: Beverly P. Wood, MD


Arch Pediatr Adolesc Med. 2001;155(4):523-524. doi:10.1001/archpedi.155.4.523.
Text Size: A A A
Published online

AN INFANT weighing 1530 g and born at 31 weeks' gestation by emergency cesarean delivery was intubated in the delivery room because of respiratory distress. Endotracheal surfactant was administered, and she was transferred to the neonatal intensive care unit. Within an hour, high-frequency oscillation ventilation was started because of difficulty maintaining oxygenation with conventional ventilation. A double-lumen 3F catheter was inserted into an umbilical vein. The baby's clinical condition improved rapidly over the next 2 days, and she was extubated and maintained on continuous positive airway pressure. At age 4 days, she was breathing room air spontaneously.

On day 5, her abdomen was distended, and she developed respiratory distress and was intubated. The umbilical venous catheter (UVC) was removed because of clinical suspicion of necrotizing enterocolitis. A radiograph of the abdomen was obtained (Figure 1). An ultrasound examination of the abdomen showed echolucency in both flanks indicating free fluid. The kidneys were not identified, but the liver and spleen were normal. Pigtail catheters (4F) were inserted by ultrasound guidance into the flank regions bilaterally. Ninety milliliters of opalescent, blood-stained fluid was aspirated, 50 mL from the right flank and 40 mL from the left flank. Contrast medium was injected via the catheters (Figure 2). Ultrasound following this procedure showed normal kidneys. A laparotomy was performed and showed no necrotizing enterocolitis, perforated viscus, or any other intraperitoneal abnormality. The infant recovered, and findings from ultrasound examination of the abdomen prior to discharge on day 53 was normal.

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles
JAMAevidence.com

The Rational Clinical Examination
Evidence Summary and Review 2

The Rational Clinical Examination
Detecting Pleural Effusion by Chest Radiograph