CT-guided 14-G cutting needle lung biopsy in children: safe and effective

CT-guided percutaneous lung biopsy was performed in children with chronic respiratory disease to obtain samples for histological examination. An automatic cutting device with a 14-G needle was used with one or two cores obtained in each procedure. Seven procedures were performed in six children, mostly with local anaesthesia. Adequate tissue was obtained in all cases. Although a small pneumothorax and/or haemothorax occurred in most procedures, these were usually visible only on CT and did not require active management. A larger pneumothorax in one child also resolved with conservative management. Percutaneous CT-guided 14-G automatic cutting-needle biopsy of lung parenchyma in children is a minimally invasive alternative to open-lung biopsy with no complications in our series

Fatal and near-fatal encephalopathy with hyponatraemia in two siblings with fluticasone-induced adrenal suppression

<b>AIM:</b> To document previously unreported acute effects of adrenal insufficiency.<p></p> <b>METHODS:</b> We describe two siblings who presented acutely with hyponatraemia and cerebral oedema following prolonged treatment with high dose inhaled fluticasone.<p></p> <b>RESULTS:</b> A girl aged 5.5 years presented with vomiting, headache, visual impairment and seizures. She was hyponatraemic but not hypoglycaemic. Her conscious level continued to deteriorate and she died, post mortem examination showing small adrenal glands and cerebral oedema. Four weeks later her 7-year-old brother presented with similar symptoms. Assessment showed hyponatraemia with cerebral oedema. His illness responded to intensive care. A diagnosis of adrenal insufficiency was made retrospectively in both cases. The siblings had been receiving Fluticasone propionate (FP) in doses of up to 2000 microg/day for several years.<p></p> <b>CONCLUSION:</b> We believe that the hyponatraemia and cerebral oedema was related to cortisol deficiency, leading to impaired excretion of water. We emphasize the need for careful cerebral monitoring in acute adrenal insufficiency presenting with impaired consciousness