title: Bubbles in the heart as first sign of gastric pneumatosis.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors: Department of Intensive Care and Neonatology, University Children's Hospital, Zurich, Switzerland, beatrice.mueller2@kispi.uzh.ch.
authors: Béatrice
authors: B
authors: Müller
authors: Nikolai
authors: N
authors: Stahr
authors: Walter
authors: W
authors: Knirsch
authors: Irene
authors: I
authors: Hoigné
authors: Bernhard
authors: B
authors: Frey
mesh_terms: D000388:Air; D020345:Enterocolitis, Necrotizing / Q000175:diagnosis* / Q000209:etiology; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D008297:Male; D012770:Shock, Cardiogenic / Q000150:complications*; D013272:Stomach Diseases / Q000175:diagnosis* / Q000209:etiology; D014463:Ultrasonography
references: Klin Padiatr. 2010 Jul;222(4):273
references: 20306382
references: J Pediatr Gastroenterol Nutr. 2006 Oct;43(4):539-41
references: 17033533
references: Pediatr Int. 2006 Dec;48(6):599-603
references: 17168981
references: Pediatr Cardiol. 2012 Dec;33(8):1427-9
references: 22391766
references: Curr Opin Infect Dis. 2011 Jun;24(3):183-9
references: 21455063
references: Clin Perinatol. 2013 Mar;40(1):69-78
references: 23415264
references: J Paediatr Child Health. 2003 Sep-Oct;39(7):560-2
references: 12969216
references: Arch Dis Child Fetal Neonatal Ed. 1997 Sep;77(2):F131-4
references: 9377136
references: Eur J Pediatr. 2000 Jul;159(7):553-4
references: 10923240
references: Pediatrics. 2000 Nov;106(5):1080-7
references: 11061778