An unusual presentation of necrotizing enterocolitis on an echocardiogram

Microbubbles in the venous and arterial circulations due to intestinal pathology in a child with unrepaired CHD: is all gas bad?

This is a unique case of microbubbles incidentally found on echocardiogram in a child with unpalliated CHD. The microbubbles were found in both the venous and arterial circulations and spontaneously resolved. A detailed evaluation was done to identify the source of air in the circulation. The child did have concurrent necrotising enterocolitis, and it was felt that the bubbles were secondary to this and intestinal translocation of air.

Noninvasive Tools to Predict Necrotizing Enterocolitis in Infants with Congenital Heart Diseases: A Narrative Review

BACKGROUND

Necrotizing enterocolitis (NEC) is the most frightening gastrointestinal emergency in newborns. Despite being primarily a disease of premature infants, neonates with congenital heart disease (CHD) are at increased risk of development. Acute and chronic hemodynamic changes in this population may lead to mesenteric circulatory insufficiency.

OBJECTIVES

In this narrative review, we describe monitoring tools, alone or in multimodal use, that may help in the early recognition of patients with CHD at major risk of NEC development.

METHODS

We focused on vital parameters, echocardiography, Doppler flowmetry, abdominal near-infrared spectroscopy (aNIRS), and abdominal ultrasound (aUS).

RESULTS

The number of studies on this topic is small and includes a wide range of patients' ages and types of CHD. Peripheral oxygen saturation (SpO2) and certain echocardiographic indices (antegrade and retrograde velocity time integral, cardiac output, etc.) do not seem to differentiate infants with further onset of NEC from those not developing it. Hypotensive events, persistent diastolic flow reversal in the descending aorta, and low mesenteric oxygen saturation (rsSO2) measured by aNIRS appear to occur more frequently in infants who later develop NEC. aUS may be helpful in the diagnosis of cardiac NEC, potentially showing air contrast tracked to the right atrium in the presence of pneumatosis.

CONCLUSIONS

This narrative review describes the current knowledge on bedside tools for the early prediction of cardiac NEC. Future research needs to further explore the use of easy-to-learn, reproducible instruments to assist patient status and monitor patient trends.

Stress With Bubbles: Echocardiographic Visualization of a Typical Pathway Between the Spine and the Heart

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Right atrial bubbles were detected without active infusion during stress echocardiography.

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Bubbles can be caused by the VP.

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The VP occurs as a result of degeneration of intervertebral disks.

Bubbles in the heart as first sign of gastric pneumatosis

This case report describes a 5-week-old boy with an unusual presentation of gastric pneumatosis caused by suspected necrotizing enterocolitis (NEC) after cardiogenic shock. Postnatally, a pulmonary atresia with intact ventricular septum was supplied by a modified Blalock-Taussig shunt. On transthoracic echocardiography in week 5, primarily performed to rule out pericardial effusion, air bubbles have been apparent in the right atrium. Intracardiac air found on echocardiogram is generally associated with an indwelling venous catheter but-as exemplified by this case report-may also occur in the setting of NEC. An abdominal radiograph showed an isolated gastric pneumatosis, which is an unusual location of NEC. It is speculated that air moved through the connecting veins to the right atrium, the pneumatosis located in the gastric wall being a prerequisite to this pathophysiology.

CONCLUSION

The suspected NEC was located in the stomach enabling the intramural air to pass through connecting veins to the right atrium. The first specific sign of NEC in our case was air bubbles in the right atrium on echocardiography.