title: Surgicel packing and an erroneous diagnosis of mediastinitis in a neonate.
abstract: Internal accumulation of the topical hemostatic agent Surgicel can mimic fluid collections that might be misdiagnosed as an abscess or a hematoma upon 3 common postoperative imaging methods. Herein, we report the unusual case of a neonate who underwent surgical repair of complex congenital heart conditions and then required early re-exploration, prompted by initial suspicion of mediastinitis on the basis of computed tomographic findings. During reoperation, it was determined that the mass on computed tomography was an accumulation of oxidized Surgicel. We discuss the capabilities and limitations of various imaging methods in the achievement of an accurate differential diagnosis.
authors.affiliation: Division of Thoracic & Cardiovascular Surgery, Department of Surgery & Anatomy, Riberão Preto Faculty of Medicine, University of São Paolo, 14040-900 São Paolo, Brazil.
authors.forename: Lafaiete
authors.initials: L
authors.lastname: Alves Júnior
authors.forename: Walter Villela Andrade
authors.initials: WV
authors.lastname: Vicente
authors.forename: César Augusto
authors.initials: CA
authors.lastname: Ferreira
authors.forename: Paulo Henrique
authors.initials: PH
authors.lastname: Manso
authors.forename: Lidiane Ramos
authors.initials: LR
authors.lastname: Arantes
authors.forename: Karina Simonelly
authors.initials: KS
authors.lastname: Pinheiro
authors.forename: Paula Menezes
authors.initials: PM
authors.lastname: Luciano
authors.forename: Alfredo José
authors.initials: AJ
authors.lastname: Rodrigues
authors.forename: Paulo Roberto Barbosa
authors.initials: PR
authors.lastname: Evora
mesh_terms: D006348:Cardiac Surgical Procedures; D002483:Cellulose, Oxidized / Q000009:adverse effects*; D003951:Diagnostic Errors; D006330:Heart Defects, Congenital / Q000601:surgery*; D006489:Hemostatic Techniques / Q000009:adverse effects*; D006490:Hemostatics / Q000009:adverse effects*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008480:Mediastinitis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D012086:Reoperation; D014057:Tomography, X-Ray Computed; D019564:Unnecessary Procedures
chemical_list: D002483:Cellulose, Oxidized; D006490:Hemostatics; C013695:Surgicel