We verified the feasibility of telediagnosis of fetal disease by (i) grading telediagnosis by a pediatric cardiologist into five confidence levels; and (ii) comparison of fetal telediagnosis with hands-on fetal diagnosis or postnatal diagnosis. In 114 patients suspected of having heart disease (real time, n = 15; recorded image transmission, n = 99), 79 patients were in level 5 (excellent), 17 in level 4 (good), eight in level 3 (fair), 10 in level 2 (poor), and no patients in level 1 (bad). The average was 4.5, and in 96 patients (84% of all) telediagnosis was accurate (above 4), whereas in 18 patients it was inaccurate (level 2 or 3). In re-examination of 25 patients, telediagnosis was confirmed in patients in level 4 and 5, whereas heart disease was missed in patients in levels 2 or 3. The correct diagnosis matched the high confidence level of a specialist based on recognizable transmitted images.

Information and communication technology has been widely applied to various fields, including clinical medicine. We report here a telediagnosis system using ultrasound image transmission. The effect of telediagnosis, using a medical link between local maternity hospitals and our children's medical center, was verified. The number of fetal telediagnosis for cardiac disease, and cases referred to a perinatal care center and emergent transportation of neonates with congenital heart disease from maternity hospitals, were calculated based on the hospital records. The percentage of patients found to have heart disease was compared between out-patient clinic and telediagnosis cases. Telediagnosis increased, allowing maternity hospital staff to obtain support easily from a specialist when making a diagnosis. Many severe cases were transferred to tertiary centers with the correct diagnosis; consequently, the number of emergent transportations of neonates with severe cardiac anomalies continued to below. Telediagnosis was also useful as an educational tool for maternity hospital staff, who improved their skills during conversations with a specialist. Unlike in the outpatient clinic, consultation by telediagnosis was requested even for cases of mild abnormalities, and the number of false-positives increased, while many cardiac anomalies were found in the early stage. Furthermore, telediagnosis was helpful for pregnant women requiring bed rest, and also had the advantage of allowing a doctor to be able to talk with parents. Establishing a fetal telediagnosis system is a useful strategy to improve neonatal care through a medical link between local maternity hospitals and a tertiary center.

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An infectious aneurysm represents a potentially serious clinical condition because of its tendency to rupture and to be complicated with sepsis. Here we report an infantile case of infectious aneurysms of the brachiocephalic artery, occurring subsequent to mediastinitis. Chest computed tomography (CT) revealed aneurysms of the brachiocephalic artery a er the recurrence of mediastinitis. e patient s trachea was compressed by the brachiocephalic artery, which was displaced backward by the aneurysms. Urgent implantation of a handmade covered stent, which was made of a metallic stent and a roll-shaped expanded polytetra uoroethylene sheet, was performed. A er deployment of the coveresd stent, the size of the aneurysms was diminished and compression of the trachea improved. A er treatment with anti-methicillin-resistant Staphylococcus aureus (MRSA) medications, the mediastinitis has been in remission. e development of Horner s syndrome was recognized as a complication of the stent deployment. Implantation of a covered stent represents an option for the treatment of infectious aneurysms.