Indian Journal of Radiology Indian Journal of Radiology  

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CASE REPORT Table of Contents   
Year : 2019  |  Volume : 29  |  Issue : 1  |  Page : 94-97
Ultrasonography and X-Ray guided drain placement to evacuate a pneumopericardium/pneumomediastinum in a 1-day-old infant

1 Department of Radiology, Vascular and Interventional Radiology, University of Missouri, Columbia, USA
2 Division of Pediatric Surgery, Department of Surgery, University of Missouri Health Care, Children's Hospital, Columbia, USA
3 Children's Hospital Cardiology Center, Women's and Children's Hospital, University of Missouri Health Care, Columbia, USA

Correspondence Address:
Ambarish P Bhat
Vascular and Interventional Radiology, Department of Radiology, University of Missouri, Columbia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijri.IJRI_447_18

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Ultrasonographic (US) guided procedures have wide range of application in the abdomen and pelvis, however their role is somewhat limited in the chest due to complete reflection of the ultrasound beam by the air in the lungs, preventing the direct imaging of the tissues deep to the air-sound interface. Most of the chest procedures, other than the exception of thoracentesis, rely on the use of CT (computed tomography) scan. The disadvantages of using CT scan is the cost, lack of portability, and most importantly the radiation involved, particularly in case of infants and children, whose tissues are more radiosensitive than the adults. Identification of air by Ultrasonography can help direct needles and wires, to accomplish procedures which may otherwise need CT. A 1-day-old infant with respiratory distress syndrome (RDS) on a ventilator, developed an expanding symptomatic pneumopericardium/pneumomediastinum. The patient was too unstable to leave the neonatal intensive care unit (NICU), so a pericardial/mediastinal drain was placed under ultrasonographic and radiographic guidance. This case, highlights a method for bedside treatment of pneumopericardium/pneumomediastinum in an unstable neonate. This procedure may be equally effective in older children and adults.

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