Download PDF
CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2013; 23(01): 8-14
DOI: 10.4103/0971-3026.113612
ORIGINAL ARTICLE

Inadvertent chest tube insertion in congenital cystic adenomatoid malformation and congenital lobar emphysema-highlighting an important problem

Shailesh M Prabhu
Department of Radiodiagnosis, Lady Hardinge Medical College and Assoc. Kalawati Saran Childrens Hospital, New Delhi
,
Subhasis Roy Choudhury
Department of Pediatric Surgery, Lady Hardinge Medical College and Assoc. Kalawati Saran Childrens Hospital, New Delhi
,
Ravi S Solanki
Department of Radiodiagnosis, Lady Hardinge Medical College and Assoc. Kalawati Saran Childrens Hospital, New Delhi
,
Gurucharan S Shetty
Department of Radiodiagnosis, Lady Hardinge Medical College and Assoc. Kalawati Saran Childrens Hospital, New Delhi
,
Surender kumar Agarwala
Department of Pediatric Surgery, Lady Hardinge Medical College and Assoc. Kalawati Saran Childrens Hospital, New Delhi
› Author Affiliations Source of Support: Nill.
› Further Information
  PDF Download Permissions and Reprints

Abstract

Background: Chest tube insertion in congenital cystic lung lesions is an important problem in children with acute respiratory distress having a cystic lucent lesion on chest radiograph. Objective: To evaluate the imaging findings and complications in cases of congenital cystic lung lesions with chest tube insertion and suggest the role of appropriate imaging for management of these patients. Materials and Methods: Chest radiographs and CT scans of children with congenital cystic lung lesions who had inadvertent chest tube insertion preoperatively were retrospectively reviewed for imaging appearances and complications. Results: Fifteen patients comprising 10 cases of congenital cystic adenomatoid malformation (CCAM) and 5 cases of congenital lobar emphysema (CLE) were included. Majority of the cases were infants. CCAM was misdiagnosed as complicated pneumatocele (n = 5) and pneumothorax (n = 5), while CLE was misdiagnosed as tension pneumothorax (n = 5) on the chest radiograph findings. Final diagnosis was made on CT and operative findings with histopathology. Complications noted were pneumothorax, hydropneumothorax, and infection in cases of CCAM, and change in imaging appearance and pneumothorax in cases of CLE. Conclusion: Chest tube insertion in congenital cystic lesions increases the rate of associated complications. Chest CT has a definite role in early diagnosis and deciding appropriate management in these cases.

Keywords

Chest tube insertion - cases of congenital cystic adenomatoid malformation - congenital lobar emphysema - cystic lucent lesion - pneumatocele - pneumothorax


Publication History

Article published online:
04 October 2021

© 2013. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Godwin JD, Webb WR, Savoca CJ, Gamsu G, Goodman PC. Multiple, thin-walled cystic lesions of the lung. AJR Am J Roentgenol 1980;135:593-604.
  • 2 Dillman JR, Sanchez R, Ladino-Torres MF, Yarram SG, Strouse PJ, Lucaya J. Expanding upon the unilateral hyperlucent hemithorax in children. Radiographics 2011;31:723-41.
  • 3 Visrutaratna P, Euathrongchit J, Kattipattanapong V. Clinics in diagnostic imaging (86). Ruptured bronchogenic cyst. Singapore Med J 2003;44:325-9.
  • 4 Schwartz MZ, Ramachandran P. Congenital malformations of the lung and mediastinum-a quarter century of experience from a single institution. J Pediatr Surg 1997;32:44-7.
  • 5 Kunyoshi V, Cataneo D, Cataneo A. Complicated pneumonias with empyema and/or pneumatocele in children. Pediatr Surg Int 2006;22:186-90.
  • 6 Nandi M, Mondal R. Congenital cystic disorders of lung masquerading as complicated pneumonia and pneumothorax: A case series. Eastern J Med 2010;15:125-7.
  • 7 Powers JE, Counselman FL. Congenital lobar emphysema: tube thoracostomy not the treatment. Pediatr Emerg Care 2005;21:760-2.
  • 8 Kumar B, Agrawal LD, Sharma SB. Congenital bronchopulmonary malformations: A single-center experience and a review of literature. Ann Thorac Med 2008;3:135-9.
  • 9 Tempe DK, Virmani S, Javetkar S, Banerjee A, Puri SK, Datt V. Congenital lobar emphysema: Pitfalls and management. Ann Card Anaesth 2010;13:53-8.
  • 10 Ulku R, Onat S, Ozçelik C. Congenital lobar emphysema: differential diagnosis and therapeutic approach. Pediatr Int 2008;50:658-61.
  • 11 Sittig SE, Asay GF. Congenital cystic adenomatoid malformation in the newborn: Two case studies and review of the literature. Respir Care 2000;45:1188-95.
  • 12 Choudhury SR, Chadha R, Mishra A, Kumar V, Singh V, Dubey NK. Lung resections in children for congenital and acquired lesions. Pediatr Surg Int 2007;23:851-9.
  • 13 Stocker JT, Madewell JE, Drake RM. Congenital cystic adenomatoid malformation of the lung. Classification and morphologic spectrum. Hum Pathol 1977;8:155-71.
  • 14 Aurora P, McHugh K. Pleural pneumatocoeles mimicking congenital cystic adenomatoid malformation of the lung. A case report. Acta Radiol 1998;39:520-2.
  • 15 Wilson RD, Baxter JK, Johnson MP, King M, Kasperski S, Crombleholme TM, et al. Thoracoamniotic shunts: Fetal treatment of pleural effusions and congenital cystic adenomatoid malformations. Fetal Diagn Ther 2004;19:413-20.
  • 16 Schrey S, Kelly EN, Langer JC, Davies GA, Windrim R, Seaward PG, et al. Fetal thoracoamniotic shunting for large macrocystic congenital cystic adenomatoid malformations of the lung. Ultrasound Obstet Gynecol 2012;39:515-20.
  • 17 Lichtenstein DA, Mezière G, Lascols N, Biderman P, Courret JP, Gepner A, et al. Ultrasound diagnosis of occult pneumothorax. Crit Care Med 2005;33:1231-8.
  • 18 Noble VE. Think ultrasound when evaluating for pneumothorax. J Ultrasound Med 2012;31:501-4.
  • 19 Coley BD. Pediatric Chest Ultrasound. Radiol Clin North Am 2005;43:405-18.
  • 20 Kim OH, Kim WS, Kim MJ, Jung JY, Suh JH. US in the diagnosis of pediatric chest diseases. Radiographics 2000;20:653-71.