Journal of Pediatric Surgery Case Reports最新文献_第3页

Intraductal papilloma presenting as a breast mass in an 8-month-Old male infant: A case report 8 个月大男婴乳房肿块中出现的导管内乳头状瘤：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-09-28 DOI: 10.1016/j.epsc.2024.102894

Maen Kamal , Nesma Ghanim , Raima Hashmi , Zachary Patterson , Qazi Azher , Antonio J. Williams Sr

Introduction

Intraductal papilloma is an exceptionally rare condition in the pediatric population, particularly among males in infancy and early childhood, typically most prevalent among women aged between 35 and 55 years presenting as sanguineous or serosanguineous nipple discharge and a discrete breast mass. Despite its historical classification as benign, emerging research indicates a potential for malignant transformation, prompting a reevaluation of its clinical significance.

Case presentation

We present the case of a healthy 8-month-old male infant with a right subareolar breast swelling that appeared non tender, well-circumscribed, smooth, mobile, rubbery, without any associated nipple discharge or regional lymphadenopathy, clinically measuring 10 × 10 mm in diameter, and exhibited a bluish green hue with no associated changes in overlying skin. Ultrasound confirmed presence of a right retro areolar breast mass, characterized as a multiseptated complex cyst-like structure with tubular anechoic formations within, measuring 21 x 20 × 6 mm. The findings were suggestive of possible duct ectasia classified as Bi-Rads Category 3 with a benign probability. Due to parental concern for increase in size over 2 months, the mass was resected under general anesthesia through a subareolar incision. Microscopic analysis confirmed dilated cystic ducts and an intraductal papilloma with calcifications. The patient recovered well from the operation, and follow-up at nine months, he has experienced no recurrences.

Conclusion

Although rare, this case underscores the importance of including intraductal papilloma in the differential diagnosis of breast nodules in male infants.

导言导管乳头状瘤在儿科人群中是一种极为罕见的疾病，尤其是在婴幼儿期的男性中，通常在 35 至 55 岁的女性中最为常见，表现为血色或血清样乳头溢液和离散性乳房肿块。本病例中，一名 8 个月大的健康男婴右侧乳晕下乳房肿胀，无触痛，边界清楚，光滑，可移动，呈橡胶样，无任何相关的乳头溢液或区域淋巴结病，临床上直径为 10 × 10 毫米，呈蓝绿色，上覆皮肤无相关变化。超声波检查证实了右侧乳晕后肿块的存在，其特征为多隔复合囊肿样结构，内有管状无回声形成，大小为 21 × 20 × 6 毫米。检查结果提示可能存在导管异位，被归为 Bi-Rads 3 类，良性可能性大。由于父母担心肿块会在两个月内增大，因此在全身麻醉下通过乳晕下切口切除了肿块。显微镜分析证实，囊性导管扩张，导管内乳头状瘤伴有钙化。患者术后恢复良好，9 个月后随访，未见复发。结论虽然罕见，但该病例强调了将导管内乳头状瘤纳入男婴乳腺结节鉴别诊断的重要性。

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引用次数: 0

Traumatic rupture of a yolk sac tumor: A case report 卵黄囊肿瘤的外伤性破裂：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-09-27 DOI: 10.1016/j.epsc.2024.102893

Hannah Z. Weiss , Michael Dedwylder , Faris Azar , Thomas Bolton , Melanie Altizer , Anne Fischer

Introduction

Yolk sac tumors are rare neoplasms with a risk of rupture due to their rapid growth and vascularity. There is only one reported case of a ruptured yolk sac tumor in the literature.

Case presentation

A nine-year-old girl presented to an outside hospital with worsening bilateral lower quadrant abdominal pain following a handlebar injury. The patient was tachycardic and tachypneic with a hemoglobin of 7.4 g per deciliter, lactic acid of 7.7 mmol/L, and white blood cell count of 45,000 per μL. A Computed Tomography (CT) scan revealed a large, hypodense 19.1 × 11.4 cm abdominal mass and free fluid concerning for a hematoma with possible peritoneal carcinomatosis. The patient was transfused with one unit of packed red blood cells (PBRCs) given her tachycardia. After transfer from the outside hospital, the patient continued to be tachycardic (143 beats per minute) and tachypneic (36 breaths per minute). A repeat CT was performed, revealing a 6 × 5.5 cm right subhepatic mass and a 16 × 12 cm pelvic mass. In the OR (operating room), a large, multi-cystic hemorrhagic tumor measuring 16.8 cm was discovered in the left pelvis. A second mass was found in the subhepatic space that was a large tumor nodule. The patient underwent left oophorectomy and salpingectomy for tumor resection. An omentectomy was performed due to omental carcinomatosis, with tumor nodules reaching up to 9.5 cm in length. A smaller tumor nodule was resected from the left round ligament. During the operation, the patient received a transfusion of five units of PBRCs, four units of fresh frozen plasma, one unit of platelets, and 2.5 units of crystalloids. Labs taken at the time of surgery revealed an alpha fetal protein (AFP) level of 17,523 ng/mL. The patient was staged as a stage IIIC mixed germ cell tumor with 99% yolk sac and 1% mature teratoma cells. Post-operatively, the patient was treated with BEP chemotherapy, achieving normalization of AFP levels by the end of the fourth cycle.

Conclusion

The aggressive growth pattern of yolk sac tumors places patients at risk of tumor rupture, potentially leading to an acute abdomen. These patients require prompt surgical intervention followed by chemotherapy.

导言卵黄囊肿瘤是一种罕见的肿瘤，因其生长迅速、血管丰富而有破裂的风险。文献中仅报道过一例卵黄囊肿瘤破裂的病例。病例介绍一名 9 岁女孩因手把受伤后双下腹痛加剧而到外院就诊。患者心动过速、呼吸急促，血红蛋白为 7.4 克/分升，乳酸为 7.7 毫摩尔/升，白细胞计数为 45,000 个/微升。计算机断层扫描（CT）显示，患者腹部有一个 19.1 × 11.4 厘米的巨大低密度肿块，腹腔内有游离液体，可能是腹膜癌变的血肿。由于患者心动过速，医生为其输注了一个单位的包装红细胞（PBRCs）。从外院转院后，患者仍然心动过速（每分钟 143 次），呼吸急促（每分钟 36 次）。再次进行CT检查，发现一个6 × 5.5厘米的右肝下肿块和一个16 × 12厘米的盆腔肿块。在手术室，发现左侧盆腔有一个 16.8 厘米大的多囊出血性肿瘤。在肝下腔发现了第二个肿块，是一个大肿瘤结节。患者接受了左侧输卵管切除术和输卵管切除术以切除肿瘤。由于网膜癌变，患者接受了网膜切除术，肿瘤结节长达 9.5 厘米。从左侧圆韧带切除了一个较小的肿瘤结节。手术期间，患者接受了 5 个单位的 PBRCs、4 个单位的新鲜冰冻血浆、1 个单位的血小板和 2.5 个单位的晶体液输注。手术时的化验结果显示，α胎儿蛋白（AFP）水平为 17,523 纳克/毫升。患者被分期为IIIC期混合生殖细胞瘤，卵黄囊细胞占99%，成熟畸胎瘤细胞占1%。结论卵黄囊肿瘤的侵袭性生长模式使患者面临肿瘤破裂的风险，可能导致急腹症。这些患者需要及时进行手术治疗，然后进行化疗。

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引用次数: 0

Sigmoid perforation after endoscopic clip placement in an infant: A case report 婴儿内镜夹置入术后发生乙状结肠穿孔：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-09-26 DOI: 10.1016/j.epsc.2024.102892

Lucia Fein, Gabriela Carro, Bernardo Berazategui

Introduction

Intestinal perforation following endoscopic clip placement is an uncommon complication that has been reported in adult patients but, as far as we now, not in pediatric patients.

Case presentation

An 8-month-old female infant with a history of metabolic encephalopathy was admitted with a convulsive disorder requiring mechanical ventilation. On the seventh day of hospitalization in the intensive care unit, the patient experienced three bowel movements with dark blood clots. Despite being hemodynamically stable upon physical examination, her hemoglobin level decreased to 8.6 g/dL. Upper endoscopy findings were normal, and exploratory laparoscopy ruled out Meckel's diverticulum or other visible parietal causes of bleeding. Lower gastrointestinal endoscopy revealed ulcers in the rectum, sigmoid, and terminal ileum, where hemostatic clips were placed. No repeated bleeding events occurred. However, 20 days later she presented with fever, abdominal pain, and distension. Abdominal radiography revealed pneumoperitoneum, leading to an emergency exploratory laparotomy. A perforation of the sigmoid colon from one of the clips was found. We resected the short segment of sigmoid colon that contained the perforation and did an end-to-end anastomosis. She recovered well and had no complications.

Conclusion

Hemostatic clips placed endoscopically in the colon can lead to perforation even several weeks after placement.

导言：内窥镜夹置入术后发生肠穿孔是一种不常见的并发症，在成人患者中已有报道，但就目前而言，在儿童患者中还没有报道。在重症监护室住院的第七天，患者出现了三次大便，并伴有深色血块。尽管体格检查时血流动力学稳定，但她的血红蛋白水平降至 8.6 g/dL。上消化道内镜检查结果正常，探查性腹腔镜检查排除了梅克尔憩室或其他可见的顶叶出血原因。下消化道内窥镜检查发现直肠、乙状结肠和回肠末端有溃疡，在这些部位放置了止血夹。没有再发生出血事件。然而，20 天后，她出现了发烧、腹痛和腹胀。腹部放射线检查发现腹腔积气，于是紧急进行了剖腹探查术。发现其中一个夹子导致乙状结肠穿孔。我们切除了包含穿孔的一段乙状结肠，并进行了端对端吻合术。结论内镜下放置在结肠中的止血夹即使在放置数周后也可能导致穿孔。

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引用次数: 0

Rectosigmoid intussusception presenting as rectal prolapse in a premature baby: A case report 早产儿直肠乙状结肠肠套叠表现为直肠脱垂：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-09-24 DOI: 10.1016/j.epsc.2024.102890

Cesar Kattini , Meagan E. Wiebe , Marc-Olivier Deguise , Brigitte Lemyre , Ahmed Nasr

Introduction

Rectosigmoid intussusception in premature infants is a rare condition. We present a case of rectosigmoid intussusception initially presenting as rectal prolapse.

Case presentation

A premature male baby born at 24 weeks gestation was transferred to our center at two months of age due to recurrent rectal prolapse with minimal straining, despite repeated reductions. The etiology of the prolapse was unclear. An abdominal X-ray showed bowel dilation with air-fluid levels. The gas pattern in the abdomen indicated a mid to distal bowel obstruction. An abdominal ultrasound revealed an intussusception behind the bladder, measuring 3.8 cm in cranio-caudal dimension, appearing to be in the rectum or distal sigmoid colon. The patient underwent a diagnostic laparoscopy. We found a rectosigmoid intussusception, which we reduced laparoscopically. After the laparoscopy we did a flexible sigmoidoscopy and saw that the bowel wall appeared edematous and bruised but was not compromised. There were no polyps or any other intraluminal lesions. We concluded that the recurrent prolapse was the intussusception protruding through the anus (likely originating from mesenteric lymph nodes) rather than a rectal prolapse. There were no perioperative or postoperative complications, the patient tolerated the procedure well and had an uneventful recovery.

Conclusion

Rectosigmoid intussusception can resemble rectal prolapse and should be ruled out if prolapse recurs immediately after reduction.

导言早产儿直肠乙状结肠肠套叠是一种罕见病。病例介绍一名妊娠 24 周时出生的早产男婴在两个月大时因反复出现直肠脱垂而转入本中心，尽管反复进行了减压，但脱垂仍很小。脱肛的病因尚不清楚。腹部 X 光片显示肠道扩张，并伴有气液水平。腹腔内的气体形态显示中远端肠梗阻。腹部超声波检查显示，膀胱后方有一个肠套叠，头尾尺寸为 3.8 厘米，似乎位于直肠或乙状结肠远端。患者接受了腹腔镜诊断。我们发现了直肠乙状结肠肠套叠，并在腹腔镜下将其缩小。腹腔镜检查后，我们进行了柔性乙状结肠镜检查，发现肠壁出现水肿和淤血，但没有受损。没有息肉或其他任何腔内病变。我们的结论是，复发性脱垂是肠套叠通过肛门突出（可能源自肠系膜淋巴结），而不是直肠脱垂。没有围手术期或术后并发症，患者对手术的耐受性良好，术后恢复顺利。

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引用次数: 0

Late presentation of type-I jejunal atresia in an infant: A case report 婴儿I型空肠闭锁的晚期表现：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-09-24 DOI: 10.1016/j.epsc.2024.102891

Sunnie Wong , Rachel Landisch , Rachel Ruiz , Sumit Datta , Julie Fuchs

Introduction

Intestinal atresia is an uncommon cause of intestinal obstruction. In the vast majority of the cases, signs and symptoms develop early in the neonatal period. Presentations beyond the neonatal period are rare.

Case presentation

A former premature female infant who was otherwise healthy developed recurrent, non-bilious vomiting associated with feedings at the age of 8 months. Up until that time her weight gain had been appropriate, and she had regular bowel movements. Over the course of the following weeks, the vomiting became more frequent. A few days after her 9-month well-child visit during which she still appeared to be in good health, her vomiting turned bilious and was not related to feedings. Her parents brought her to the emergency room. She was admitted to the hospital and underwent imaging studies to investigate the source of what seemed to be an intestinal obstruction. The upper gastrointestinal series (UGI) showed delayed passage of contrast, and a caliber change in the proximal small bowel. The computerized tomography (CT) confirmed the findings, which were suggestive of a partial proximal intestinal obstruction. She underwent a laparotomy. We identified an area of caliber change 15 cm distal to the ligament of Treitz. We opened the proximal side and identified a jejunal membrane that had a pinhole opening in the center. We resected a 4-cm segment of jejunum that included the caliber transition and the membrane and did an end-to-end anastomosis. She tolerated the operation well and was discharged home 12 days later. At the age of 1 year, she is thriving well.

Conclusion

Although type-I jejunal atresia typically presents in the neonatal period, it should be included in the differential diagnosis of infants with recurrent vomiting and signs of a partial bowel obstruction.

导言：肠闭锁是导致肠梗阻的一种不常见原因。在绝大多数病例中，症状和体征出现在新生儿早期。病例介绍一名曾是早产儿的女婴原本身体健康，但在8个月大时出现反复、非淤积性呕吐，并伴有喂食困难。在此之前，她的体重增长一直很正常，排便也很规律。在接下来的几周里，呕吐变得越来越频繁。在她 9 个月大时进行的健康检查中，她看起来仍然健康状况良好，但几天后，她的呕吐变成了胆汁性呕吐，而且与喂食无关。她的父母带她来到急诊室。她被送进了医院，并接受了影像学检查，以确定似乎是肠梗阻的原因。上消化道造影（UGI）显示，造影剂通过延迟，近端小肠口径发生变化。计算机断层扫描（CT）证实了这一结果，提示部分近端肠梗阻。她接受了开腹手术。我们在特雷兹韧带远端 15 厘米处发现了一个口径改变的区域。我们打开近端，发现空肠膜中央有一个针孔开口。我们切除了一段 4 厘米长的空肠，其中包括口径变化区和空肠膜，并进行了端对端吻合术。她对手术的耐受性很好，12 天后就出院回家了。结论虽然I型空肠闭锁通常发生在新生儿期，但对于反复呕吐并伴有部分肠梗阻症状的婴儿，应将其纳入鉴别诊断。

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引用次数: 0

Preoperative percutaneous catheter drainage for symptomatic macrocystic congenital pulmonary airway malformation: A case report 症状性大囊状先天性肺气道畸形的术前经皮导管引流术：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-09-23 DOI: 10.1016/j.epsc.2024.102889

Ilaria Acquaviva , Edoardo Bindi , Giovanni Cobellis

Introduction

Infants with congenital pulmonary airway malformation (CPAM) are generally asymptomatic and the surgical treatment can be planned using a thoracoscopic technique. We report the case of a newborn with a large type 1 CPAM who presented with severe respiratory distress and was treated with percutaneous transthoracic drainage before open surgery.

Case report

A full-term male patient was born via vaginal delivery. Antenatal imaging had raised suspicion of type 1 CPAM in the right lung. At birth, he was admitted to the neonatal intensive care unit (NICU) due to ventilatory insufficiency and oxygen dependence. A chest X-ray confirmed the antenatal diagnosis of a large type 1 CPAM. On the first days of life (DOL), we inserted a percutaneous transthoracic chest tube to drain the large cyst and initiated high-frequency oscillatory ventilation (HFOV). Although the patient initially showed clinical improvement, his condition subsequently deteriorated. Suspecting tube dislocation, on the seventh DOL a second drainage was placed in the cyst. On the tenth DOL, given the persistent clinical severity, a right upper lobectomy was performed. Postoperatively, the patient was supported by conventional ventilation with a reduced oxygen requirement. On the thirteenth DOL, the infant was successfully extubated. Histological analysis confirmed the diagnosis of type 1 CPAM. After nearly a month, the infant was transferred to the pediatric surgery ward and later discharged. During multidisciplinary follow-up, the patient maintained good general health with no signs of recurrence.

Conclusion

In newborns with large, symptomatic type-1 CPAMs a percutaneous catheter drainage can be used as a temporizing measure before the definitive surgical resection.

导言：患有先天性肺气道畸形（CPAM）的婴儿通常没有症状，可以计划使用胸腔镜技术进行手术治疗。我们报告了一例患有巨大 1 型 CPAM 的新生儿，该患儿出现严重呼吸困难，经皮经胸腔引流术治疗后进行了开胸手术。产前造影检查怀疑右肺存在 1 型 CPAM。出生时，由于通气不足和氧气依赖，他被送入新生儿重症监护室（NICU）。胸部 X 光检查证实了大面积 1 型 CPAM 的产前诊断。在患者出生后的第一天（DOL），我们为其插入了经皮经胸腔穿刺胸管以引流大囊肿，并启动了高频振荡通气（HFOV）。虽然患者最初的临床症状有所改善，但随后病情恶化。由于怀疑插管脱位，在第七个 DOL 日，在囊肿中放置了第二个引流管。第 10 个 DOL 日，鉴于临床症状持续严重，医生对患者进行了右上肺叶切除术。术后，患者接受常规通气支持，氧气需求量减少。DOL 第 13 天，婴儿成功拔管。组织学分析证实了 1 型 CPAM 的诊断。近一个月后，婴儿被转到小儿外科病房，随后出院。在多学科随访期间，患者保持良好的一般健康状况，没有复发迹象。

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引用次数: 0

Unusual variant of esophageal atresia and tracheo-esophageal fistula: A case report 食管闭锁和气管食管瘘的异常变异：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-09-17 DOI: 10.1016/j.epsc.2024.102886

Rachael Stottlemyre , David M. Notrica , Mark McOmber , Erin Garvey

Introduction

Esophageal atresia (EA) is the most common congenital anomaly affecting the esophagus. We describe an unusual variant of EA, which shares similarities with Type A but features a mid-esophageal segment attached to the trachea.

Case presentation

A 38-week gestational age baby girl had prenatal diagnoses of EA and congenital cardiac anomalies. Postnatal attempts to advance an orogastric tube were unsuccessful, and EA was confirmed by chest X-ray showing the tube at the T2/T3 level without distal bowel air. Further workup included bronchoscopy, which identified a posterior tracheal outpouching without an apparent connection to the esophagus, and Cardiac CT, which revealed a mid-esophageal segment with a tracheo-esophageal fistula. Workup was consistent with complex esophageal anatomy with distinct proximal and distal pouches and a mid-esophageal segment attached to the trachea. A gastrostomy tube was placed for decompression and enteral feeds. Surgical intervention included closure and excision of the mid-esophageal fistula. The gap between the proximal and distal pouches was impressive, requiring cervical esophageal mobilization and two esophageal myotomies to add length, and concluded in a primary esophago-esophagostomy. Postoperative complications included a contained leak at the anastomosis, which was managed conservatively with placement of a feeding tube past the anastomotic site and resolved after 4 weeks. The patient required multiple esophageal dilations during the first two years of life and achieved successful closure of the gastrostomy at 25 months of age without further complications.

Conclusion

Awareness of rare subtypes of EA enables surgeons to anticipate and address unique challenges that may arise during surgical intervention.

导言食道闭锁（EA）是影响食道的最常见先天性畸形。我们描述了一种不同寻常的食管闭锁变异型，它与A型食管闭锁相似，但食管中段与气管相连。病例介绍一名妊娠38周的女婴产前被诊断为食管闭锁和先天性心脏畸形。产后尝试推进口胃管未成功，胸部 X 光片显示插管位于 T2/T3 水平，且远端肠道无空气，证实为 EA。进一步检查包括支气管镜检查和心脏 CT，前者发现气管后部有一个气管外口，但没有明显的食管连接；后者发现食管中段有一个气管食管瘘。检查结果显示食管解剖结构复杂，近端和远端有明显的小囊，食管中段与气管相连。为减压和肠道进食放置了胃造瘘管。手术治疗包括关闭和切除食管中段瘘管。近端和远端瘘袋之间的间隙非常大，需要进行颈部食管移动和两次食管肌切开术来增加长度，最后进行了食管-食管造口术。术后并发症包括吻合口处的渗漏，当时采取了保守治疗，在吻合口处放置了一根喂食管，4周后渗漏消失。该患者在出生后的头两年需要进行多次食管扩张，在 25 个月大时成功关闭了胃造口，没有再出现并发症。

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引用次数: 0

Totally implantable venous access device (TIVAD) migration into the pleural space: A case report 全植入式静脉通路装置 (TIVAD) 移入胸膜腔：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-09-16 DOI: 10.1016/j.epsc.2024.102887

Fatemeh Shahrahmani , Reza Shojaeian

Introduction

Totally implantable venous access devices (TIVADs) offer significant advantages for long-term intravenous therapy, but their use is not without potential complications. Catheter migration is one of them.

Case presentation

An 11-year-old boy with a primitive neuro-ectodermal tumor (PNET) undergoing chemotherapy was a candidate for a TIVAD placement. A TIVAD was implanted through the right internal jugular vein and secured to the pectoralis major in a right thoracic subcutaneous pouch without complications. Approximately six months later, port malfunction was noticed. Physical examination revealed that the port was no longer palpable, and a chest X-ray confirmed that the port was displaced. Subsequent chest X-rays showed different locations of the port and the catheter. With the hypothesis that the port had entered the pleural space and was moving freely, we did an exploratory thoracoscopy. We confirmed the intrapleural position of the port and catheter and removed both without complications. The patient was discharged four days later.

Conclusion

Although rare, TIVADs can migrate from the chest wall into the pleural cavity. Frequent evaluation of their function and position is critical for the early detection of complications.

导言完全植入式静脉通路装置（TIVAD）为长期静脉治疗提供了显著优势，但其使用并非没有潜在并发症。病例介绍一名患有原始神经外胚层肿瘤（PNET）并正在接受化疗的 11 岁男孩是 TIVAD 植入的候选者。通过右侧颈内静脉植入了 TIVAD，并将其固定在右胸皮下袋的胸大肌上，未出现并发症。大约六个月后，发现端口出现故障。体格检查发现已无法触及端口，胸部 X 光检查证实端口移位。随后的胸部 X 光片显示端口和导管的位置不同。我们假设移植口已进入胸膜腔并可自由移动，于是进行了探查性胸腔镜检查。我们确认了接口和导管在胸膜内的位置，并在没有并发症的情况下将两者移除。结论尽管罕见，但 TIVAD 仍有可能从胸壁移入胸膜腔。经常评估其功能和位置对于早期发现并发症至关重要。

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引用次数: 0

Massive thymic hyperplasia in a toddler masquerading as a loculated pleural effusion: A case report 伪装成定位性胸腔积液的幼儿大面积胸腺增生：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-09-16 DOI: 10.1016/j.epsc.2024.102885

Emily J. Zolfaghari , Matthew Shaughnessy , Hao Wu , Michael Caty , Emily Christison-Lagay , Matthew A. Hornick

Introduction

Pediatric massive thymic hyperplasia is a rare condition that can masquerade as a respiratory illness, making diagnosis challenging.

Case presentation

An 18-month-old female with a 3-month history of multiple admissions for suspected pneumonia warranting antibiotics presented with recurrent respiratory distress, fevers, and fatigue. Work-up for possible parapneumonic effusion, including six chest x-rays and an ultrasound, eventually led to a computed tomography (CT) of the chest, which revealed a large homogeneous mass occupying much of the right-hemithorax. Percutaneous core biopsy showed thymocytes suggestive of either a massive thymic hyperplasia or a thymoma. Consensus was to proceed with upfront surgical resection of the mass, which was performed via right thoracotomy. Pathology was consistent with true thymic hyperplasia. The post-operative course was uncomplicated, and no issues were identified at 3-month follow-up. We plan to follow the patient at 6 months, 1 year, and then annually with surveillance chest x-rays to monitor for recurrence case-report.

Conclusion

Thymic hyperplasia should be included in the differential diagnosis of pediatric patients with persistent respiratory symptoms and abnormal findings on chest x-ray.

导言小儿胸腺大量增生是一种罕见疾病，可伪装成呼吸道疾病，因此诊断具有挑战性。病例介绍一名 18 个月大的女性患者，曾因疑似肺炎多次入院治疗，并使用抗生素，病史长达 3 个月，反复出现呼吸困难、发热和乏力。检查结果显示可能存在肺旁积液，包括六次胸部 X 光检查和一次超声波检查，最终进行了胸部计算机断层扫描（CT），发现一个巨大的均匀肿块占据了右侧胸腔的大部分。经皮核心活检显示，胸腺细胞提示大块胸腺增生或胸腺瘤。大家一致同意对肿块进行前期手术切除，手术是通过右胸廓切开术进行的。病理结果与真正的胸腺增生一致。术后过程并不复杂，3 个月随访时未发现任何问题。我们计划对患者进行 6 个月、1 年的随访，然后每年进行一次胸部 X 光检查，以监测复发情况。

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引用次数: 0

Capillary hemangioma of the external oblique muscle: A case report 外斜肌毛细血管瘤：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-09-13 DOI: 10.1016/j.epsc.2024.102881

K.K. Athish , Venkat Hariharan Marimuthu , Vamsi Krishna Reddy Kurri , Suggula Vamsi Krishna , Anwadevi Arun , Dinesh Kumar Sathanantham

Introduction

Intramuscular hemangiomas (IMH) are rare benign vascular tumors. They can occur anywhere in the body but are more common in the head and neck. Their location in the muscles of the abdominal wall is uncommon.

Case presentation

A 14-year-old girl presented with 5 months of progressive swelling on the right side of her abdomen followed by intermittent pain. On examination, a solitary mass with ill-defined borders was noted fixed to the subcutaneous tissue in the right lumbar quadrant. After elevating the right leg, the swelling became more prominent. Doppler ultrasonography revealed a mixed echogenic mass in the subcutaneous plane of the anterior abdominal wall of the right lumbar region. Magnetic resonance imaging of abdomen was suggestive of hemangioma, and the patient underwent surgical excision. Histopathological examination confirmed the diagnosis of capillary hemangioma. During follow-up at 3 and 6 months, the patient did not present with recurrence and was healthy.

Conclusion

Although IMH is a rare soft-tissue tumor, it should be considered when diagnosing symptomatic intramuscular swelling.

导言肌血管瘤（IMH）是一种罕见的良性血管肿瘤。它们可以发生在身体的任何部位，但更常见于头颈部。病例介绍一名 14 岁女孩因腹部右侧进行性肿胀 5 个月，随后出现间歇性疼痛而就诊。检查发现，右腰部皮下组织固定着一个边界不清的单发肿块。抬高右腿后，肿块变得更加突出。多普勒超声检查显示，右腰部前腹壁皮下有一个混合性回声肿块。腹部磁共振成像提示为血管瘤，患者接受了手术切除。组织病理学检查确诊为毛细血管瘤。结论虽然IMH是一种罕见的软组织肿瘤，但在诊断无症状的肌肉内肿物时应考虑到它。

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