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Expect the Unexpected Neonatal Oral Mass Diagnosed at Birth Anesthesiology May 2013 A full-term, 3.5-kg neonate was transferred for management of a large, mobile intraoral mass. The infant demonstrated no signs of airway obstruction or respiratory  distress and had normal oxygen saturation without support. The child did not seem dysmorphic and the mass was isolated  to the anterior maxillary alveolar ridge, easily mobilized out of mouth. A prenatal ultrasound at 20 weeks did not identify any anomalies. Adequate ventilation was achieved after mobilizing the mass extraorally and achieving adequate mask seal. At this point, a mask induction with spontaneous ventilation was performed, followed by uneventful intubation. The mass was considered low risk for airway obstruction during induction  because it did not disturb the airway anatomy, and was easily mobilized out of the mouth. Epulis, or congential granular cell tumor, is a rare tumor of variable size and number ori...

A 28-year-old Man with Air in the Mediastinal Space after  a Car Accident (Anesthesiology, Oct 2012) A 28-YR-OLD man was admitted to a level I trauma center because of blunt high-energy chest trauma. The chest radiograph ray showed a radiolucent line left of the heart, suggestive of pneumomediastinum (fig. A: radiograph on admission; fig. B: magnification of the white rectangle in fig. A; white arrows mark the radiolucent line. In figs. A and B, an electrocardiogram cable is visible). Chest and pericardial drains were inserted, after which hemodynamic function improved. Bronchoscopy revealed a 2-cm full-thickness longitudinal airway tear. The lesion began at the carina and continued into the right main bronchus (RB) (fig. C: a bronchoscopic picture of the right main bronchus; the outlined area shows the bronchial lesion [LB left bronchus]). Tracheobronchial injuries are life threatening and often are no...

Subdural intracranial hematoma is a very rare consequence of accidental dural puncture.  The bleeding results from cerebrospinal fluid loss (cerebral hypotension) related to traction on the intracranial bridging veins. Postdural puncture headache may complicate the diagnosis.  Atypical headache (absence of postural component, persistence for more than 7 days, unresponsiveness to analgesics), signs of increased  intracranial pressure, or mass effect on brain parenchyma (vomiting, seizures, altered level of consciousness,focal motor and sensory  deficits) should lead to consideration of subdural intracranial hematoma. Presence of semilunar extraparenchymal liquid over the convexity on computed tomography (more sensitive in acute situations) or magnetic resonance imaging (more sensitive in older “denser” hematomas) scans confirms the diagnosis (arrows). In view of the small size of the hematomas, in our case con...