Page 375 - Abstract Book KONIKA 18

Pediatric Imaging

P-PI-011
The Role of Cranial Ultrasound in Diagnosing Alobar Holoprosencephaly:
A Case Report

Ayu Sasmita Rany , Haryanti Fauzia Wulandari , Evita Karianni Bermanshah 2
2
1
1
2
Department of Child Health and Pediatric Imaging Division, Departement of Child Health ,
Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Abstract
Background Holoprosencephaly (HPE) is a brain malformation resulting from incomplete cleavage
of the prosencephalon. It is the most common structural anomaly of the developing forebrain. Alobar
holoprosencephaly is the most severe type with poor prognosis. Cranial ultrasound can be performed as
diagnostic procedure, as it is widely available, easy to use, less expensive, with no radiation exposure and
sedation risk. Objective To demonstrate the cranial ultrasound findings of alobar holoprosencephaly patient.
Case A neonate was born via caesarean section with gestational age of 38 weeks and birth weight of 2840
g. There were no history of maternal infection, smoking, alcohol consumption, diabetes mellitus, and use of
any medications. Antenatal ultrasound examination showed widening of bilateral lateral ventricles. Findings
on physical examination include microcephaly, dysmorphic facial features, hypotelorism, flattened nose,
labiognatopalatoschizis, and hypotonia. The patient had severe asphyxia and demonstrated repeated seizure.
We performed cranial ultrasound on the 7th day. It showed single ventricle, fused thalami, absent corpus
callosum, absent interhemispheric fissure, and absent cavum septum pellucidum, that were typical of alobar
holoprosencephaly. The patient was scheduled to do MRI, as it can provide the highest quality data. The
risks of sedation required in neurologically impaired patients make this impractical. So, cranial ultrasound
is enough as early imaging method for this patient. Conclusion HPE is a structural anomaly of developing
forebrain. Ascertainment of HPE type using brain imaging is critical for prognosis determination. Cranial
ultrasound is one of the easiest and safest imaging method to diagnose and determine the HPE type.
Keywords: alobar holoprosencephaly; cranial ultrasound; radiology

P-PI-012
Pneumothorax in Pulmonary Interstitial Emphysema
as a Complication of Ventilator Use in An Extremely Preterm Infants
Bagus Budi Santoso , Naela Fadhila , Evita Karianni Bermanshah 2
2
1
1
2
Department of Child Health and Pediatric Imaging Division, Departement of Child Health ,
Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Abstract
Background Pulmonary interstitial emphysema (PIE) is a rare disease that most commonly occurs in
premature infant. Diagnosis is based on imaging and histopathology. The etiology of PIE are respiratory
distress syndrome, prematurity, positive pressure ventilation or mechanical ventilation with high peak
pressures. Its incidence increases with lower birth weight. Serious complication can occurs, such as
pneumothorax, pneumopericardium, and requirement of higher pressure of mechanical ventilation.
Objective To describe a case of PIE in an extremely preterm neonate. Case An extremely preterm infant (27
weeks gestation, 770 grams) was born by C-section. The baby was intubated and put on mechanical ventilator.
During observation, the baby had increased ventilatory support and her CXR showed PIE. Later evaluation
showed worsening of PIE with collapsed left lung and displacement of mediastinum to contralateral side
indicating tension pneumothorax. Conclusion Pulmonary interstitial emphysema occurs more commonly in
premature infants with mechanical ventilation support. Chest x-ray should be done regularly to detect PIE and
to adjust ventilator setting. Pneumothorax should be considered as the cause of worsening infant with PIE.
Keywords: pulmonary interstitial emphysema; preterm neonate; chest x-ray; pneumothorax

KONIKA XVIII Abstract Book 327