House

No, I’m not playing Bingo. It’s just that House and I have been treating a patient with the same condition. Congenital Cystic Adenomatoid Malformation. You’re fully aware of this disease, of course? I wasn’t. I hadn’t even seen the episode where House and his gallant team saved the day by operating on the foetus inside the womb.

My patient had been born in a village in Burma. At the age of three months, the mother brought her to the clinic. The child was having difficulty breathing. Now rapid respiration is a sign of a lung infection in babies, so the child was admitted one weekend and started intravenous antibiotic therapy.

The babe did not have a high temperature, but was obviously in distress. Breast feeding was difficult because of the breathlessness. I examined the child and there was marked rapid breathing, some wheeze, but no crackles. I diagnosed bronchiolitis (baby was a bit young for this) and we gave oxygen via nasal cannula. An attempt to open up the child’s airways using nebuliser salbutamol didn’t help much, and caused the child to scream blue murder. I told the nurses to stop, but they called me a wimp. The baby needed the treatment, doctor.

A few days later, we added some oral steroids, and the child seemed to improve. Not for long. I discussed the baby with a colleague, who requested a chest X-ray. This showed the baby’s heart was shifted over to the right side of its chest. I’d missed dextrocardia! Medical student mistake. But more tests showed that the heart had been pushed over to the right by a Congenital Cystic Adenomatoid Malformation, in the left lung.

This is a pretty rare condition. It occurs once in every 30,000 pregnancies. With antenatal ultrasound, it can be diagnosed and treated surgically before birth. But this mother had had no formal antenatal care. The baby is ineligible for free treatment in Thailand. The malformation needs to be removed. Perhaps Child’s Dream will agree to pay for specialist surgery. Perhaps not.

 

 

In the 17th episode of season 3 of House entitled “Fetal Position”, the primary patient is a pregnant woman whose fetus is ultimately diagnosed with CCAM. In the climax of the episode, the team performs open fetal surgery to remove the cysts. Thanks to Wikipedia

Advertisements

2 Replies to “House”

  1. Just for info, mostly we don’t treat in-utero, in the UK at least. Many CCAM’s diagnosed in utero resolve by delivery and only a few cause problems for the infant. Pretty unpredictable antenatal ly what the natural history will be. Can also cause heart failure due to increased blood supply, and therefore work needed to be done by the heart, either in utero or neonatally.

    1. Thanks Nikki. The comparison with House was tongue in cheek. Given that the baby is not entitled to Thai health care, I’m not optimistic about its chances.

      Sent from my iPad

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s