Images in Paediatrics
A case of neonatal tuberous sclerosis diagnosed by lung ultrasound
Esclerosis tuberosa diagnosticada por ecografía torácica POCUS
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RM de cráneo a los 6 ddv con secuencias TSE T2 axial A y B), T1 IR axial C y D) T13D coronal E), T13D sagital F), TSE T2 sagital G) y T13D sagital tras la administración de contraste intravenosos sagital H). Se observan tubers corticales hipointensos en T2 e hiperintensos en T1 –flechas amarillas en A y C)–, líneas de migración radial en la sustancia blanca –flechas azules en A, C y F)–, nódulos subependimarios –flechas rojas en B, D, E y F)– y quistes en la sustancia blanca que se muestran hiperintensos en T2 sin realce tras la administración de contraste –círculo verde en G y H)–. 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Axial (A and B) and coronal (C and D) images showed small micronodular opacities in a diffuse tree-in-bud pattern, without involvement of the subpleural region. Images B and D evince the presence of consolidations in the right lower lobe.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Rebeca López Gómez, Ana Itziar Ladrón de Guevara, Genoveva del Río Camacho" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Rebeca" "apellidos" => "López Gómez" ] 1 => array:2 [ "nombre" => "Ana Itziar" "apellidos" => "Ladrón de Guevara" ] 2 => array:2 [ "nombre" => "Genoveva" "apellidos" => "del Río Camacho" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403323000103" "doi" => "10.1016/j.anpedi.2023.01.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403323000103?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287923001266?idApp=UINPBA00005H" "url" => "/23412879/0000009900000001/v1_202307031305/S2341287923001266/v1_202307031305/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S234128792300128X" "issn" => "23412879" "doi" => "10.1016/j.anpede.2023.06.007" "estado" => "S300" "fechaPublicacion" => "2023-07-01" "aid" => "3397" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "An Pediatr (Barc). 2023;99:69-70" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Paediatrics</span>" "titulo" => "Cortical hyperostosis secondary to chronic treatment with prostaglandins" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "69" "paginaFinal" => "70" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hiperostosis cortical secundaria a tratamiento crónico con prostaglandinas" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 461 "Ancho" => 1340 "Tamanyo" => 72455 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Plain radiographs taken after heart transplantation and at the end of treatment with prostaglandins. (A) At 3 months, (B) at 4 months, (C) at 6 months. They continue to show hyperostosis and bone thickening, without improvement or resolution after discontinuation of prostaglandin treatment. There seem to be no involvement of the pelvis or spine. The mandible was not affected either.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Javier Toledano-Revenga, José Ignacio Camuña Correa, Laura García Fernández, Sara de la Mata Navazo" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Javier" "apellidos" => "Toledano-Revenga" ] 1 => array:2 [ "nombre" => "José Ignacio Camuña" "apellidos" => "Correa" ] 2 => array:2 [ "nombre" => "Laura García" "apellidos" => "Fernández" ] 3 => array:2 [ "nombre" => "Sara de la Mata" "apellidos" => "Navazo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403323000085" "doi" => "10.1016/j.anpedi.2023.01.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403323000085?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S234128792300128X?idApp=UINPBA00005H" "url" => "/23412879/0000009900000001/v1_202307031305/S234128792300128X/v1_202307031305/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Paediatrics</span>" "titulo" => "A case of neonatal tuberous sclerosis diagnosed by lung ultrasound" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "71" "paginaFinal" => "73" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Rebeca Gregorio-Hernández, Paz Chimenti-Camacho, Alejandra Aguado del Hoyo, Manuel Sánchez-Luna" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Rebeca" "apellidos" => "Gregorio-Hernández" "email" => array:1 [ 0 => "rebeca.gregorio@salud.madrid.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Paz" "apellidos" => "Chimenti-Camacho" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Alejandra" "apellidos" => "Aguado del Hoyo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Manuel" "apellidos" => "Sánchez-Luna" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Neonatología, Hospital Gregorio Marañón, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Radiología, Hospital Gregorio Marañón, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Esclerosis tuberosa diagnosticada por ecografía torácica POCUS" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2232 "Ancho" => 905 "Tamanyo" => 156858 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Point-of-care ultrasound of the chest. Linear probe. (A) Transverse plane at the level of the intermammary line. Visualization of sternum (*) and the masses (tubers) in the myocardium (homogeneous, hyperechoic, X). This contrasted with the decreased echogenicity of the myocardium (+). B) Left longitudinal plane: anterior arc of ribs (*), tubers (X), mediastinum (+). gr1.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Lung ultrasound has been integrated in neonatal care units as an essential tool in the evaluation of neonatal respiratory distress due to its quickness, harmlessness and high sensitivity and specificity.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However, there are some images that pose a challenge.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a term newborn infant that underwent a bedside ultrasound examination of the chest due to respiratory distress. Transverse-plane scanning with a linear probe can be used to rule out pneumothorax,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and in this patient it revealed several well-demarcated hyperechoic lesions up to 2 cm in diameter confined to the myocardium (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>, Appendix B, supplemental material). The lung parenchyma presented an interstitial pattern in a gradient with a thin pleural line and lung sliding, compatible with transient tachypnoea (respiratory support for 48 h). The echocardiogram confirmed the presence of cardiac tubers, and a brain magnetic resonance evidenced subependymal tubers and nodules (major criteria), radial migration lines, subependymal nodules and cysts in the white matter (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) which, combined with the results of genetic testing, led to the diagnosis of tuberous sclerosis type 2 (Bourneville syndrome, pathogenic <span class="elsevierStyleItalic">TSC2</span> gene variant).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">At present, the patient is 10 months old and receiving vigabatrin for treatment of epileptic seizures. The chest ultrasound scan allowed early diagnosis that improved the follow-up and outcomes of the patient, as he was diagnosed in the presymptomatic stage.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-11-11" "fechaAceptado" => "2023-01-14" "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0025" class="elsevierStylePara elsevierViewall">The following is Supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0010" ] ] ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2232 "Ancho" => 905 "Tamanyo" => 156858 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Point-of-care ultrasound of the chest. Linear probe. (A) Transverse plane at the level of the intermammary line. Visualization of sternum (*) and the masses (tubers) in the myocardium (homogeneous, hyperechoic, X). This contrasted with the decreased echogenicity of the myocardium (+). B) Left longitudinal plane: anterior arc of ribs (*), tubers (X), mediastinum (+). gr1.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1839 "Ancho" => 3250 "Tamanyo" => 570010 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Magnetic resonance imaging of the head at 6 days post birth. Axial turbo spin echo (TSE) sequence T2-weighted images (A and B), axial T1 inversion recovery (T1IR) sequence image (C and D) Coronal T1-weigthed 3D image (E), sagittal T1-weighted 3D image (F), sagittal TSE T2-weighted image (G) and sagittal T1-weighted 3D following intravenous contrast administration (H). Visualization of cortical tubers that appeared hypointense on T2-weighted imaging and hyperintense on T1-weighted images (yellow arrows in A and C), radial migration lines in white matter (blue arrows in A, C and F), subependymal nodules (red arrows in B, D, E and F) and white matter cysts that appear hyperintense in T2-weighted images and without enhancement after contrast administration (green circle in G and H). The colour features of the figures can only be discerned in the digital version.</p>" ] ] 2 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 595339 "Video" => array:2 [ "mp4" => array:5 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Usefulness of lung ultrasound in the diagnosis and follow-up of respiratory diseases in neonates" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:9 [ 0 => "L.R. Fernández" 1 => "R.G. Hernández" 2 => "I.S. Guerediaga" 3 => "J.M. Gato" 4 => "J.R. Fanjul" 5 => "V.A. Bilbao" 6 => "P.A. Quintela" 7 => "A.A. Ojembarrena" 8 => "Pulmonary Ultrasound Section of the Neonatal Ultrasound Working Group of the Spanish Society of Neonatology" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.anpede.2022.01.002" "Revista" => array:6 [ "tituloSerie" => "An Pediatr (Engl Ed)" "fecha" => "2022" "volumen" => "96" "numero" => "3" "paginaInicial" => "252.e1" "paginaFinal" => "252.e13" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound of pneumothorax in neonates: diagnostic value of the anterior transverse plane and of mirrored ribs" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Montero-Gato" 1 => "L. Rodeño-Fernández" 2 => "I. Serna-Guerediaga" 3 => "A. Aguirre-Unceta-Barrenechea" 4 => "A. Aguirre-Conde" 5 => "A. Perez-Legorburu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ppul.25829" "Revista" => array:7 [ "tituloSerie" => "Pediatr Pulmonol." "fecha" => "2022" "volumen" => "57" "numero" => "4" "paginaInicial" => "1008" "paginaFinal" => "1014" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35029063" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000009900000001/v1_202307031305/S2341287923001278/v1_202307031305/en/main.assets" "Apartado" => array:4 [ "identificador" => "77701" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Paediatrics" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000009900000001/v1_202307031305/S2341287923001278/v1_202307031305/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287923001278?idApp=UINPBA00005H" ]
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