Aims: To determine the clinical course and long term outcome of empyema treated without decortication. Methods: Fourteen consecutive admissions to one hospital were studied; radiological resolution and lung function were subsequently followed. The children were aged 2-14 years. All were treated with intravenous antibiotics and chest drain only. Results: All patients had extensive pleural thickening evident on chest x ray examination at the time of discharge, which resolved entirely over a period of 2-16 months. Lung function was measured in 13 children, and showed no evidence of restrictive or obstructive deficit: mean (SD) values as per cent predicted for height were: forced expiratory volume in one second (FEV 1 ) 107.5 (9.6), forced vital capacity (FVC) 95.5 (8.8), total lung capacity (TLC) 98.6 (20.7). Individual children all had values in the normal range (80-120 per cent predicted). Conclusion: Results suggest that decortication is not necessary in children to prevent long term problems with pleural thickening, and should be undertaken on the basis of the clinical picture (failure of fever resolution), rather than radiological appearance.T he management of thoracic empyema in children continues to evoke controversies from the past five decades.

Three-dimensional (3D) printing is a method by which two-dimensional (2D) virtual data is converted to 3D objects by depositing various raw materials into successive layers. Even though the technology was invented almost 40 years ago, a rapid expansion in medical applications of 3D printing has only been observed in the last few years. 3D printing has been applied in almost every subspecialty of medicine for pre-surgical planning, production of patient-specific surgical devices, simulation, and training. While there are multiple review articles describing utilization of 3D printing in various disciplines, there is paucity of literature addressing applications of 3D printing in breast cancer management. Herein, we review the current applications of 3D printing in breast cancer management and discuss the potential impact on future practices.

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We present a rare case of double-outlet right ventricle with pulmonary atresia and discontinuous branch pulmonary arteries supplied by bilateral ducti from a right aortic arch. To our knowledge, this is only the second documented case of double-outlet right ventricle with bilateral ducti. ( Level of Difficulty: Advanced. )

Introduction: The patent ductus arteriosus (PDA) is a common lesion in infants. Two-dimensional echocardiography (2DE) is standard for PDA imaging. Three-dimensional echocardiography (3DE) is often used for complex anatomy and for procedural planning. Very limited data exist on use of 3DE of the PDA in infants despite its value in planning interventions. We aim to determine the agreement between 2DE and 3DE in measuring PDAs in infants. Hypothesis: Significant agreement exists between 2DE and 3DE for PDA measurements. Methods: Infants with a known PDA underwent 2DE and 3DE imaging by an IRB-approved protocol. Subjects were <1 year old, >32 weeks corrected gestation (CGA), >1kg, and clinically stable. Parasternal short axis (PSAX) and suprasternal notch (SSN) PDA images were taken. Two blinded observers measured the pulmonic (PA) and aortic (Ao) end of the PDA. Interobserver variability was assessed by interclass correlation (ICC), Bland-Altman (BA), and coefficient of variability (COA). 2DE to 3DE agreement was assessed by BA. Results: For 19 subjects acquired, median CGA 38.0 weeks (IQR 35.6-39.1), median weight 3.07kg (IQR 2.83-4.34). ICC for 2DE and 3DE in all views was >0.98 with narrow limits of agreement (LOA) (Table 1). BA showed low bias and narrow LOA. COA was <3.6%. Paired 2DE-3DE comparison had low bias and narrow LOA (Table 2). Conclusions: PDA measures by 2DE and 3DE have strong interobserver agreement. Paired 2DE-3DE measures show low bias and variability. A larger cohort will test agreement with variable subject size, ductal size & type, and compare to angiography. Preliminary data show promise for 3DE in future use for PDA procedural planning.