The Role of Imaging During Extracorporeal Membrane Oxygenation in Pediatric Respiratory Failure
Alex M. Barnacle1,
Liz C. Smith2 and
Melanie P. Hiorns1
1 Department of Radiology, Great Ormond Street Hospital for Children, Great
Ormond St., London WC1N 3JH, England.
2 ECMO Coordinator, Great Ormond Street Hospital for Children, London WC1N 3JH,
England.
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Fig. 1 —Chest radiograph of 2-day-old male shows venous cannula with
radiopaque tip (arrow) just below level of ninth rib, within right
atrium.
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Fig. 2 —Chest radiograph of 23-month-old male shows optimal
positioning of two venous cannulae and also shows expected lung "white
out" present during extracorporeal membrane oxygenation.
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Fig. 3 —Chest radiograph of 29-month-old female illustrates incorrect
placement of arterial cannula (arrow), which is too high and resulted
in inadvertent displacement of cannula with subsequent life-threatening
hemorrhage.
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Fig. 4 —Chest radiograph of 1-month-old male shows arterial cannula
has distal radiolucent segment. Tip of cannula is gauged by position of
radiopaque tip (arrow), which lies approximately at level of aortic
arch. Echocardiography (not shown) would confirm position of cannula. There is
also kink in upper venous catheter.
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Fig. 5 —Chest radiograph of 20-month-old female illustrates optimal
position of cannula for venovenous extracorporeal membrane oxygenation.
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Fig. 6 —Chest radiograph of 3-week-old male reveals kinking of
venovenous cannula (arrow) within soft tissues of neck.
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Fig. 7A —Sonographic images of 2-day-old female. Cranial image shows
intraparenchymal hemorrhage within right frontal lobe (between
calipers).
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Fig. 7B —Sonographic images of 2-day-old female. Coronal image shows
large left-sided extraaxial hemorrhage (arrows).
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Fig. 8 —Coronal cranial sonographic image of 6-week-old female
illustrates typical widening of CSF spaces around both frontal lobes
(arrows).
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Fig. 9 —Sagittal sonographic image of 4-week-old male shows echogenic
hemorrhagic focus within posterior fossa (arrows).
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Fig. 10 —Cranial sonographic image of 4-day-old male obtained using
high-frequency linear probe shows right-sided echogenic subdural hemorrhage
abutting falx (arrow). Extraaxial space (between calipers)
on left side remains typically widened.
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Fig. 11A —Chest radiographs of two infants with pneumothorax.
5-week-old male. Image shows spontaneous right-sided tension pneumothorax that
occurred during treatment.
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Fig. 11B —Chest radiographs of two infants with pneumothorax.
12-month-old female. Image shows mediastinal free air and left-sided
pneumothorax, with thymus gland (arrows) outlined by mediastinal
air.
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Fig. 12 —Chest sonographic image of 5-day-old female shows small
pleural effusion (short arrow) with associated consolidation of right
lower lobe (long arrow).
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Fig. 13A —Chest radiographs of two infants. 5-month-old male. Image
illustrates displacement of mediastinal soft tissues and support apparatus to
right with intercostal drain decompressing left-sided hemothorax.
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Fig. 13B —Chest radiographs of two infants. 7-month-old male. Image
shows displacement of mediastinum to left secondary to collapse of left
lung.
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Copyright © 2006 by the American Roentgen Ray Society.
