Subaponeurotic Fluid Collection (SFC) in an Infant

Subaponeurotic fluid collection is an infrequent cause of scalp swelling in infants. We report a 10-week-old male who had a scalp swelling for five days without any recent history of head injury. There was a soft, mobile, non-tender, transilluminating, fluctuant swelling over posterior parieto-occipital area and it was not limited by suture lines. Cranial ultrasonography showed a subaponeurotic collection at the posterior parieto-occipital area without definite communication with the intracranial space or the brain parenchyma. This infant was treated conservatively. The swelling resolved spontaneously after 4 weeks. The lack of awareness of some doctors in the Emergency Department about this condition may lead to unnecessary investigations, ward admission and intervention. It is hoped that this case report will provide emergency health care professionals the confidence to make accurate diagnosis and treat patient with subaponeurotic fluid collection optimally.

Use of Ultrasound in the Planning of Spring-Assisted Cranioplasty for Correction of Scaphocephaly

Craniosynostosis describes the congenital, premature fusion of 1 or more cranial sutures. Prior studies have confirmed the ability of spring-assisted cranioplasty to expand the cranial vault in patients with craniosynostosis. Historically, preoperative planning for spring-assisted cranioplasty was performed using mainly computed tomography (CT). In particular, osteotomies were planned and bone thickness was measured to determine the gauge of spring required. Despite the benefits for presurgical planning, CT scans have several drawbacks including ionizing radiation to a newborn and increased healthcare expense. The authors describe a clinical case of using solely cranial ultrasonography in the preoperative planning of spring-assisted cranioplasty for a patient with scaphocephaly. Ultrasonography can be used as alternative means of measuring parietal bone thickness and preoperative planning for spring-assisted cranioplasty, while also decreasing the risk of ionizing radiation and minimizing healthcare costs.

CRANIAL ULTRASOUND IN DETECTION OF NEUROLOGICAL LESIONS IN PRETERM NEONATES IN A TERTIARY CARE HOSPITAL – A PROSPECTIVE OBSERVATIONAL STUDY.

BACKGROUND: Incomplete formation and maturation of the central nervous system makes it extremely vulnerable to injury, in the case of premature neonates. This can result in a broad range of neurodevelopmental abnormalities. Cranial ultrasound is a sensitive tool for the early detection of these.Preterm neonates, defined as childbirth occurring at less than 37 completed weeks of gestation, is a major determinant of neonatal mortality and morbidity because of their greater risk for intraventricular hemorrhage (IVH) and hypoxic ischemic encephalopathy (HIE). The morbidity associated with preterm birth often extends to later life, resulting in enormous physical, psychological and economic costs. Currently, many imaging modalities are available like Cranial Ultrasonography, Computed Tomography and Magnetic Resonance Imaging to detect the intracranial abnormalities in these neonates. However advantages of Cranial Ultrasonography are easy availability, not expensive, easy to perform, quick, can be done at bedside, repeatable and radiation free. The aims of the study were to identify the severity of brain injuries by grading the neurosonographic findings and to correlate the clinical presentations with the neurosonographic findings. MATERIALS AND METHODS: This study is done in Department of pediatrics in Neonatal Intensive Care Unit in Universal College of Medical Sciences ,a tertiary care hospital, Bhairahawa. This cross-sectional study comprise of 60 preterm neonates, referred to Department of Radio diagnosis for cranial ultrasonogram. Ultrasound examination of the neonatal brain done through anterior fontanelle in coronal and sagittal planes within 1st week using healthcare logiq p6 pro ultrasound machine. RESULTS: In this cross-sectional study of 60 neonates, 46 were male and 14 were female. Among 60 babies, 30 (50%) showed normal study and remaining 30 (50%) showed abnormal scan. Among the cases which were abnormal on scan most common finding was GMH (33.3%) and next commonest was periventricular leucomalacia (PVL- 16.7%) noted in 10 babies. CONCLUSION: Cranial ultrasonography is the best point of care neuroimaging method available for high-risk neonates. It is critical as an investigatory modality in NICU and effectively documents morphology of cerebral damage.