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Rapidly involuting congenital hemangioma (RICH) is a recently recognized entity in which the vascular tumor is fully developed at birth and undergoes rapid involution. Angiographic findings in two infants with congenital hemangioma are reported and compared with a more common postnatal infantile hemangioma and a congenital infantile fibrosarcoma. Congenital hemangiomas differed from infantile hemangiomas angiographically by inhomogeneous parenchymal staining, large and irregular feeding arteries in disorganized patterns, arterial aneurysms, direct arteriovenous shunts, and intravascular thrombi. Both infants had clinical evidence of a high-output cardiac failure and intralesional bleeding. This congenital high-flow vascular tumor is difficult to distinguish angiographically from arteriovenous malformation and congenital infantile fibrosarcoma.

ABSTRACT. Objective. To assess the outcome of image-guided needle aspiration when compared with image-guided percutaneous catheter drainage in the management of parapneumonic effusions in children.Methods. A retrospective chart review was conducted of the medical records, microbiology, and radiology reports of 67 children who presented with parapneumonic effusions and underwent primary image-guided drainage between April 1, 1995, and April 1, 2000.Results. Thirty-four patients had aspiration only, and 33 patients had pigtail catheters placed. The 2 drainage methods had similar median length of stay and complication rates. The reintervention rate in this study was 27% (18 patients). Children who underwent primary aspiration without catheter placement had significantly higher rates of reintervention. Method of drainage, pH lower than 7.2, and loculation of the fluid collection were independent predictors of reintervention. A low glucose level was an additive predictor of reintervention when the pH was low.Conclusions. Aspiration and catheter drainage of parapneumonic effusions had similar complication rates and lengths of stay, but children who underwent primary aspiration had significantly higher reintervention rates, particularly when pH and glucose levels were low. Therefore, primary catheter placement for parapneumonic effusions should be considered in children who undergo diagnostic thoracentesis. The decision regarding tube placement could be facilitated by the on-site availability of a pH meter and a glucometer. Pediatrics 2002; 110(3). URL: http://www.pediatrics.org/cgi/content/full/ 110/3/e37; pneumonia, pleural effusions, parapneumonic effusion, drainage, thoracentesis, simple aspiration, percutaneous catheter drainage.ABBREVIATIONS. VATS, video assisted thoracoscopic surgery; LDH, lactate dehydrogenase; WBC, white blood cell; OR, odds ratio; CI, confidence interval. P neumonia is the most common cause of the development of thoracic fluid collections in children. Evidence-based guidelines for the treatment of parapneumonic effusions in adults 1 have recently become available, but the optimal treatment of children remains controversial. The reasons for draining parapneumonic pleural effusions include reliable diagnosis of the infectious agent, removal of infected fluid or pus, and, less frequently, alleviation of symptoms related to the volume effect of fluid accumulation.Various procedures are available to drain pleural effusions. These include needle aspiration, tube thoracostomy, video-assisted thoracoscopy, and thoracotomy with or without decortication. Image-guided percutaneous procedures are precise and relatively noninvasive alternatives to surgical management. 2,3 Two such image-guided techniques are aspiration and percutaneous catheter drainage.Although it is standard practice to analyze the pleural fluid in children with parapneumonic effusions at our institution, the decision of whether to proceed to percutaneous catheter drainage after aspiration is not based on evidence-based data. This retro...