Computed tomography imaging-guided parasternal approach drainage for children with tension pneumomediastinum: a case
Jun-Jie Hong1, Song-Ming Hong1, Xiu-Hua Chen1
1Department of Cardiothoracic Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fuzhou, China.
Insights
Computed tomography (CT) imaging-guided parasternal drainage is a safe and effective treatment for children with tension pneumomediastinum. This minimally invasive approach successfully drained the condition in all patients without major complications.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Medical Imaging
Background:
- Tension pneumomediastinum is a rare but life-threatening condition in children.
- Prompt diagnosis and intervention are crucial for patient survival.
- Existing treatment options may carry significant risks for pediatric patients.
Purpose of the Study:
- To evaluate the safety and feasibility of a computed tomography (CT) imaging-guided parasternal approach for draining tension pneumomediastinum in children.
- To assess the efficacy of this minimally invasive technique in pediatric patients.
Main Methods:
- A prospective study enrolled 19 children diagnosed with tension pneumomediastinum.
- A pigtail catheter was inserted into the anterior mediastinum using a CT-guided parasternal approach.
- The catheter was connected to a negative-pressure water seal system for continuous drainage.
Main Results:
- The mean procedure time was 11.8 minutes, and the mean drainage duration was 6.7 days.
- All 19 patients achieved effective drainage without requiring additional surgical intervention.
- No major complications, including hemothorax, infection, or catheter displacement, were observed during the follow-up period of over two months.
Conclusions:
- CT-guided parasternal approach drainage is a safe, minimally invasive, and effective treatment for pediatric tension pneumomediastinum.
- This technique offers a viable alternative to more invasive procedures for managing this critical condition in children.
Purpose:
Tension pneumomediastinum is a rare and dangerous complication in children that can be fatal, and timely detection and treatment are critical. The aim of this study was to evaluate the safety and feasibility of computed tomography (CT) imaging-guided parasternal approach drainage for tension pneumomediastinum in children.
Methods:
From June 2018 to February 2023, we consecutively enrolled 19 children with tension pneumomediastinum in our institution. A pigtail catheter was inserted into the anterior mediastinum by a CT imaging-guided parasternal approach. The catheter was connected to a negative-pressure water seal bottle to drain the pneumomediastinum. Clinical data and outcomes were summarized.
Results:
The mean age was 3.1 ± 3.4 years, the mean weight was 15 ± 9.1 kg, the mean procedure time was 11.8 ± 2.4 min, and the drainage time was 6.7 ± 3.4 days. No major complications were identified, such as haemothorax, catheter displacement, or mediastinal infection. Effective drainage was obtained in all patients as assessed by comparing images and ventilatory parameters, and no additional surgical treatment was needed. There was no recurrence during the follow-up, which was more than 2 months. In our data, two children with COVID-19 were discharged from the hospital after effective drainage and other clinical treatment.
Conclusion:
CT-guided parasternal approach drainage is safe, minimally invasive, and effective for children with tension pneumomediastinum.
More Related Videos
Related Concept Videos
01:27Pneumothorax-II
Clinical Manifestations:
01:26Endoscopic Studies II: Thoracocentesis
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
01:13Radiological Investigation III: Pulmonary Angiogram and PET Scan
Pulmonary Angiogram
A Pulmonary Angiogram is an invasive procedure involving injecting a contrast medium through a catheter threaded into the pulmonary artery or the right side of the heart to visualize the pulmonary vasculature. Computed Tomography (CT) scans have mainly replaced this...