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Dear colleagues,
we recently saw a five year old child, coming to the emergency
department just before noon in severe respiratory distress. He had
never had such problems before; he had a cough for two days with low
grade fever; a family physician had prescribed beta-mimetic
inhalation .In the course of the morning he became increasingly
more dyspnoeic.
The clinical picture was that of a very severe attack of
laryngotracheitis. We found a bit atypical: the hour of presentation,
age at first presentation, clinical severity (the breathing sounds
were grotesque in relation to the objective respiratory problems). To
exclude a foreign body, we took X-rays and did a radioscopy; these
showed a penciltip-sign, but also an unexpected finding, for which I
would like your opinion: the stomach was filled with air, but not
very large; however, the left part of the diaphragm stood slightly
above the right part. The oesophagus was air filled and grossly
distended.
We placed a nasogastric tube, which reached the oesophagus without
problem, at which moment a lot of air escaped under some pressure via
the tube; after overcoming a limited resistance the stomach could be
reached, again with evacuation of air under pressure.
I know, that a dyspnoeic child can swallow a lot of air, but I don't
see a reason, why this should get stuck in the oesophagus.
After high dose dexamathason i.v. and some adrenalin inhalation the
child recovered completely within a few hours; the next day only a
slightly horse voice remained.
I'm curious about your opinions.
Thanks,
 
Nikolaus
 
Dr. Nikolaus Lutz-Dettinger
PICU
Dept. of Intensive Care
University Hospital Gent
De Pintelaan 185
B 9000 Gent
Belgium
tel.: **32 - 9 - 240 21 11
fax: **32 - 9 - 240 49 95
email: [log in to unmask]
 
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