Chest wall, intra thoracic lesions, and airway Latest Topics

30/8/2026

Sun, 30 Aug 2026 03:41:38 +0000

[size=6]A 4-year-old was admitted to the PICU in ARDS. Ventilator settings include 100% FiO2, PRVC with TV of 5.5 ml/kg, RR 28, PEEP 12mmHg. Arterial blood gas showed: pH 7.42, pCO2 53, pO2 75, HCO3 34, base excess 8. You were called to help manage this finding on her CXR. It was interpreted as “significant pneumomediastinum, no pneumothorax, and significant subcutaneous emphysema."

On examination, patient has crepitus to the forehead and upper extremities to the wrist, back to iliac crests.

Examination did not show any pharyngeal injury. Esophagoscopy and bronchoscopy demonstrated mucosal integrity. The next best step is

a jet ventilation or high frequency oscillatory ventilation

b multiple incisions in areas of crepitus

c mediastinal tube placement

d bilateral chest tubes

e bilateral infraclavicular incisions[/size]

29/6/2025

Sun, 29 Jun 2025 10:44:33 +0000

A 27-week neonate weighing 950g is born at an outside hospital. The neonate is in respiratory distress. The airway is secured after three attempts, There are also several attempts to pass an NG tube each of which meets resistance at 8 cm.The infant has stabilized after intubation and an umbilical venous catheter is inserted for vascular access. Vital signs are currently normal for gestational age.The neonate is being transferred to your center for suspected esophageal atresia and tracheo-esophageal fistula. Upon arrival, a chest radiograph to confirm endotracheal and nasogastric tube position is performed. Based on the accompanying image, what is the most likely diagnosis?

[size=20px]A Pyriform sinus

B Esophageal atresia

C Phayngeal perforation

D Esophageal perforation

E Esophageal diverticulum[/size]

22/6/2025

Sun, 22 Jun 2025 14:20:32 +0000

[size=20px]A 14-year-old girl presents to your clinic with a palpable, non-tender right breast mass noted for the past 3 weeks. She denies trauma, fever, or nipple discharge. On exam, the mass is firm, mobile, and measures approximately 4 cm in diameter. An ultrasound shows a solid, well-circumscribed lesion with features consistent with a fibroadenoma. She has no family history of breast cancer or known genetic syndromes. What is the most appropriate next step in management?

a Core needle biopsy

b Immediate excisional biopsy without a margin

c Immediate excisional biopsy with a 1 cm margin

d Observation with ultrasound surveillance at 6 and 12 months[/size]

In diagnosis of Gynecomastia

Sat, 07 Jun 2025 17:45:12 +0000

Quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth -

"The breast tissue present in gynecomastia is most often tender, firm, and subareolar. One third of boys will present with unilateral gynecomastia. A mass in the breast that is not subareolar and is asymmetric should raise concern for other conditions. A testicular exam is a key component of the physical exam to rule out hypogonadism, suggestive of Klinefelter’s syndrome, a varicocele, or possible estrogen-secreting tumors of the testes, such as germ cell tumors, Sertoli cell tumors, or Leydig cell tumors."

1/6/2025

Sun, 01 Jun 2025 12:16:36 +0000

You are consulted on a sixteen-year-old who is being evaluated for wheezing unresponsive to bronchodilators. A computerized tomography (CT) scan of the chest is obtained. The most likely diagnosis in this patient with wheezing is

[size=20px]a congenital pulmonary airway malformation

b intralobar pulmonary sequestration.

c bronchial atresia.

d extralobar pulmonary sequestration.

e lobar emphysema.[/size]

Selection of Intercostal Space during thoracotomy

Sat, 25 Nov 2023 07:43:03 +0000

Right Robotic-Assisted Thoracoscopic Paraspinal Mass Resection

Thu, 01 May 2025 13:02:59 +0000

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Emergency Tracheotomy

Wed, 27 Apr 2022 17:24:51 +0000

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6/10/2024

Sun, 06 Oct 2024 11:59:17 +0000

A 14 year old boy presents with a 6 month history of a painless palpable mass on his chest wall. An MRI is shown below. The best next step in management is

[size=20px]a primary excision of the lesion

b arterial embolization

c percutaneous sclerotherapy with polidocanol

d systemic treatment with denosumab

e local curettage with autologous bone grafting[/size]

16/6/2024

Sun, 16 Jun 2024 11:38:02 +0000

[size=20px]A 17-year-old girl complains of 6 months of pain at her left costal margin when playing gymnastics. She notes that she feels a "click" with sudden shooting pain with certain movements. On physical exam, you can recreate a “click” sound and pain by hooking the lower rib cartilages with your finger as you feel it move. The best next step in management for this patient is

A NSAIDS and activity restriction

B Lower rib excision

C Intercostal nerve block

D Steroid injection

E Lower disconnected rib chondrectomy[/size]

7/4/2024

Sun, 07 Apr 2024 11:28:34 +0000

A 12-year-old girl presents with some chest discomfort after playing soccer with her friends. She denies any trauma. She is hemodynamically stable. A chest x ray is performed and reveals a moderate pneumomediastinum. The best next step in her management should be

[center][/center]

[size=20px]A Bronchoscopy

B Esophagram

C Chest CT

D No further imaging[/size]

cbclips Episode 8

Mon, 20 Dec 2021 21:12:16 +0000

In pediatric surgery clinic, you see a 2-year old girl referred for an asymptomatic left breast mass. No significant medical history. You palpate a firm, rubbery circular mass under the nipple. Remainder of physical exam is normal. What is your next step?

Pediatric Surgery Quiz 2

Mon, 30 Oct 2023 15:16:01 +0000

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dealing with deep lung lesions

Fri, 29 Sep 2023 15:23:55 +0000

Muscle sparing thoracotomy incision

Tue, 14 Feb 2023 13:54:08 +0000

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6/3/2022

Sun, 06 Mar 2022 12:32:43 +0000

A five-week-old, former 25-week gestational age infant required high pressure mechanical ventilatory support during the first several weeks of life. The baby is now clinically improved and weaning from mechanical ventilation.The attached CXR was obtained. The best next step in management is:

[center][/center]

[size=20px]A observation

B chest CT

C segmental resection

D lobectomy

E tube thoracostomy[/size]

laryngoscopy in a Child with Normal Anatomy

Mon, 20 Dec 2021 14:27:20 +0000

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Thoracoscopic lymph node biopsy

Tue, 23 Nov 2021 09:03:06 +0000

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Benjamin Inglis classification of laryngeal clefts

Fri, 10 Sep 2021 05:21:34 +0000

Congenital Lung Malformations Pathology

Sun, 15 Aug 2021 15:00:39 +0000

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Diagnostic Esophagoscopy showing partial Laryngeal cleft

Mon, 09 Aug 2021 17:41:04 +0000

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Bronchoscopy In pediatric surgery

Mon, 09 Aug 2021 09:39:59 +0000

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Thoracoscopic management of Pulmonary hydatid cyst in 3 year old child

Tue, 03 Aug 2021 15:47:09 +0000

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Thoracoscopic excision of thoracic component of Dumbbell Neurofibroma

Tue, 20 Jul 2021 07:33:58 +0000

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Thoracoscopic pericardial windows lecture

Thu, 27 May 2021 04:16:50 +0000

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