Repair of Pectus Excavatum at the Time of Reoperative Cardiac Surgery.

Severe pectus excavatum at the time of redo cardiac surgery presents unique challenges for sternal reentry and reconstruction. We present the case of a 14-year-old boy with tetralogy of Fallot, prior transannular patch repair, and severe pectus excavatum who presented for pulmonary valve replacement and pectus repair. A modified Ravitch procedure with subperichondrial resection of the costal cartilages allowed for sternal mobilization, safe reentry, and excellent reconstruction.

Dermatitis in patients undergoing the Nuss procedure for correction of pectus excavatum.

Background: The Nuss procedure was introduced in 1987 for the correction of pectus excavatum. In this procedure, a stainless steel bar is placed underneath the sternum.

Objectives: To report cutaneous reactions associated with Nuss bar placement.

Unexpected diagnosis of superficial neurofibroma in a lesion with imaging features of a vascular malformation.

Plexiform neurofibroma is a pathognomonic, often disabling feature of neurofibromatosis type I. Although the target-like appearance of deep plexiform neurofibroma on T2-weighted MRI has been well-described, a second superficial form of plexiform neurofibroma has differing imaging features. We report a 15-year-old boy who presented with multiple cutaneous lesions exhibiting clinical and imaging characteristics of a venolymphatic malformation.

Fate of the pouch in 151 pediatric patients after ileal pouch anal anastomosis.

Background/purpose: Ileal pouch anal anastomosis (IPAA) offers many pediatric patients a surgical cure for mucosal ulcerative colitis (MUC) with preservation of anal continence. However, some patients incur serious problems after surgery including chronic pouchitis and pouch failure. The goal of this study is to identify clinical and pathologic factors that are associated with an adverse outcome of IPAA.

Thoracic outlet syndrome in a child--transaxillary resection of anomalous first rib.

Thoracic outlet syndrome (TOS) is extremely rare in children. Only several pediatric cases have been reported, and all presented with neurologic symptoms. The authors report on a 6-year-old boy with an asymptomatic left subclavian artery aneurysm caused by compression of the subclavian artery by an anomalous first rib with poststenotic aneurysmal dilatation.

Congenital bronchobiliary fistula in association with right-sided congenital diaphragmatic hernia.

A case of congenital bronchobiliary fistula is reported in conjunction with another congenital anomaly, right-sided congenital diaphragmatic hernia. The liver was herniated through the diaphragmatic defect into the right chest where a fistula tract was identified from the surface of the liver to the right mainstem bronchus. The patient was treated successfully.

Triangular tapered duodenoplasty for the treatment of congenital duodenal obstruction.

Background/purpose: To evaluate the safety and efficiency of triangular tapered duodenoplasty, a modified procedure for the treatment of congenital duodenal obstruction was designed.

Methods: Eight children underwent triangular tapered duodenoplasty over a 5-year period with a minimum follow-up of 27-months. Study parameters include morbidity and mortality postsurgical time to feedings, hospital length of stay, and weight gain.

Thoracic outlet syndrome with subclavian aneurysm in a very young child: the complementary value of MRA and 3D-CT in diagnosis.

Thoracic outlet syndrome (TOS) is rare in childhood. In adults, TOS results in compression of the neurovascular bundle (branches of the brachial plexus and the subclavian artery), but more than 95% of cases present solely with neurologic compression. We present a case of TOS in a very young child and describe the rare finding of subclavian artery compression and post-stenotic aneurysm.