The causative agent of legionellosis is the Gram-negative intracellular bacteria Legionella spp. Its clinical presentation varies from a mild febrile illness called Pontiac fever to the severe and possible fatal pneumonia, Legionnaires’ disease. Immunocompromised patients, in particular, are affected. Only a small number of infected neonates are described in the literature. Most of them have been associated with water birth or the use of air humidifiers. In the last five years, a growing number of cases have been reported in Germany by the national institute of disease surveillance and prevention (Robert-Koch Institute). Here, we describe a fatal case report of pulmonary legionellosis with acute respiratory distress syndrome (ARDS), sepsis, associated cutaneous manifestation, and extracorporeal membrane oxygenation in a full-term neonate. Moreover, we present a review of the literature discussing the epidemiology, risk factors, clinical features, diagnostics, treatment options, and prevention for this rare condition in neonates.

To prospectively evaluate the diagnostic value and radiation dose of time-resolved CT-Angiography (4D-CTA) in pediatric patients with venous malformations using 3rd generation dual-source CT (DSCT) at 70 kVp tube voltage. Between November 2014 and August 2015, seven children (2 male, 5 female; median age, 9 years; range 3-12 years) with suspected peripheral, non-cerebral, venous malformations were included in this feasibility study and underwent US, MRI and 4D-CTA. All three imaging modalities were analyzed and compared individually by an experienced interventional radiologist and a pediatric surgeon using a 5-point Likert scale, with regard to diagnosis of the vascular anomaly, additional information like presence of thrombophlebitis and lesion extension, flow dynamics, localization, volume and significance for treatment planning. For quantitative statistical analysis, an unifactorial analysis of variance was performed for every parameter and all three imaging modalities. Radiation dose values as expressed by the volume CT dose index (CTDIvol) and dose-length product (DLP) were recorded for of all patients. Three out of six patients had isolated type I venous malformations without peripheral venous drainage which could be demonstrated on MRI and CT. In two out of six patients a type II venous malformation with drainage into normal veins was diagnosed. In one case, 4D-CT was the only imaging modality that revealed a slow-flow venous malformation with shunting supply by a hypodynamic arterial feeder. 4D-CTA was rated as the best imaging modality for treatment planning with agreement between radiologist and surgeon, especially with respect to the hemodynamics of the venous malformation. 4D-CTA at 70 kVp is a fast imaging modality that provides comprehensive diagnostic information of venous malformations in pediatric patients and is very valuable for therapy planning. Radiation dose of 4D-CTA must be weighted against the diagnostic information as well as the potential risk for sedation and contrast administration during MRI.

Zusammenfassung Die Corona-Virus-Pandemie stellt die Gesundheitssysteme weltweit vor eine große Herausforderung. Für die Urologie gilt es, den Ausbau der Strukturen zur Behandlung der unter COVID-19 („corona virus disease 2019“) leidenden Patienten bestmöglich zu unterstützen. Gleichzeitig muss es das Ziel sein, eine angemessene gesundheitliche Versorgung von urologischen Notfällen und dringlichen urologischen Behandlungen auch während der Pandemie möglichst zu gewährleisten. Hierzu müssen Patienten individuell priorisiert, alternative Therapiekonzepte erwogen und regionale und überregionale Kooperationen genutzt werden. Den Praxen kommt bei der Versorgung, Sichtung und Koordination urologischer Notfälle eine große Bedeutung zu. Urologische Kliniken müssen sich durch geeignete Maßnahmen wie dem Schaffen eines separaten, entsprechend ausgestatteten Notfalloperationssaals darauf vorbereiten, Notfalloperationen und Interventionen an SARS-CoV-2-positiven Patienten („severe acute respiratory syndrome corona virus 2“) durchzuführen und Hygienemaßnahmen zum Schutz der Mitarbeiter festlegen.