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Abstract
A case of Little Leaguer's shoulder in a skeletally immature patient is described with a review of the English literature. This entity manifests as widening of the proximal humeral physis and is well known to our orthopedic colleagues. To our knowledge, however, there is little in the current radiologic literature describing Little Leaguer's shoulder. We describe such a case.
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Affiliation(s)
- J L Fleming
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA.
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2
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Affiliation(s)
- D P Frush
- Department of Radiology, Division of Pediatric Radiology, 1905 McGovern-Davison Children's Health Center, Duke University Medical Center, Erwin Rd., Durham, NC 27710, USA
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3
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Abstract
BACKGROUND Bronchopulmonary dysplasia (BPD) continues to be prevalent, despite new treatment, in part because of increased survival in less mature infants. Investigations of new treatments have been hampered by a lack of universally accepted diagnostic criteria. Radiographic scoring systems have been developed to provide objective assessment of lung injury and risk for chronic lung disease. OBJECTIVE We sought to test the reliability of a recently reported system using chest radiography as the main tool for diagnosis of BPD. MATERIALS AND METHODS One hundred chest radiographs, half demonstrating BPD and the other half without BPD, were analyzed by pediatric radiologists and by a neonatologist, using the Weinstein score (1-6, depending on increasing radiographic severity). The reliability of this scoring system was tested by kappa (k) statistics. RESULTS Reliability at the lowest threshold (dividing score 1 from score > or = 2) was unacceptably low in this population. Reliability increased with inclusion of higher BPD scores in the comparison groups: 1-3 versus 4-6. CONCLUSION Using the chest radiograph for the prediction of BPD is not reliable between different observers except at the two extremes of the disease.
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Affiliation(s)
- M P Moya
- Duke University Medical Center, Department of Pediatrics, Division of Neonatology, 204 Bell Bldg., DUMC 3179, Durham 27710, NC, USA.
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Affiliation(s)
- R S Pobiel
- Department of Radiology, Children's Hospital Medical Center, Cincinnati, Ohio, USA
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6
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Abstract
Lipoma arborescens is an intraarticular lesion characterized by a frond-like mass of mature fat cells, usually involving the suprapatellar bursa. It is a rare lesion in adults and extremely rare in children. Because of the fatty nature of the lesion, the MRI findings of lipoma arborescens are specific. We present the MRI findings of lipoma arborescens of the knee in a 9-year-old girl.
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Affiliation(s)
- L F Donnelly
- Department of Radiology, Children's Hospital Medical Center, Cincinnati, OH 45229-3039
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7
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Abstract
OBJECTIVE To evaluate the safety and efficacy of orally administered perflubron for bowel recognition on MR imaging in a pediatric population. MATERIALS AND METHODS A multicenter trial evaluated 39 pediatric subjects before and after ingestion of perflubron with T1-, proton-density, and T2-weighted sequences through the abdomen and/or pelvis. Post-contrast images were compared with pre-contrast images. Safety was evaluated through assessment of adverse events, clinical laboratory parameters, and vital signs. RESULTS With regard to efficacy analysis, improvement in the percent of bowel darkened was observed for 85 % of the subjects on T1-weighted images and for 95 % of the subjects on proton-density and T2-weighted images. For images of the abdominal region, the percent of bowel darkened was improved for 90-92 % of the subjects across pulse sequences. Improvement rates for the images of the pelvic region ranged from 71 % to 100 %. For at least 75 % of the subjects, proton-density and T2-weighted images of the body and tail of the pancreas, left lobe of the liver, mesenteric fat, and pathological tissue were improved relative to predosing images. Twenty-three percent of the subjects experienced some adverse effects, most of which were minor and related to the digestive system. Clinical laboratory and vital sign evaluations revealed no trends associated with the administration of perflubron. CONCLUSION Perflubron is a relatively safe and effective gastrointestinal MR contrast agent in the pediatric population.
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Affiliation(s)
- G S Bisset
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA
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8
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Comerci SC, Berdon WE, Ruzal-Shapiro C, Levin TL, Krongrad E, Bisset GS, Strife JL. Systemic arterial collateral esophageal indentations in pseudotruncus arteriosus. Pediatr Radiol 2001; 25:192-4. [PMID: 7644300 DOI: 10.1007/bf02021532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Barium esophagrams were obtained in two patients with respiratory problems whose underlying congenital heart disease was pseudotruncus arteriosus type I. The esophagrams revealed vascular indentations on the esophagus, one posteriorly, and the other anteriorly. Both types of indentations were secondary to aorto-pulmonary communicating arteries from the descending aorta.
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Affiliation(s)
- S C Comerci
- Department of Radiology, Columbia Presbyterian Medical Center, Babies & Children's Hospital, New York, NY 10032, USA
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9
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Affiliation(s)
- C E Ravin
- Department of Radiology, Duke University Medical Center, Erwin Rd, Box 3808, Durham, NC 27710, USA
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10
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Donnelly LF, Frush DP, Zheng JY, Bisset GS. Differentiating normal from abnormal inferior thoracic paravertebral soft tissues on chest radiography in children. AJR Am J Roentgenol 2000; 175:477-83. [PMID: 10915698 DOI: 10.2214/ajr.175.2.1750477] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purposes of this investigation were to define the normal appearances, define factors that have the potential to influence appearance, and establish defined criteria to differentiate normal from abnormal appearances of posteroinferior paravertebral soft tissues on chest radiography in children. SUBJECTS AND METHODS Paravertebral soft tissues were evaluated on frontal chest radiographs in 23 children with documented abnormalities and 275 children without abnormalities in the region. The frequency of visualization, course, width, and factors (patient positioning, age, and sex) potentially influencing the appearance of paravertebral soft tissues were determined. Inferolateral course and width greater than that of the adjacent pedicle were evaluated as criteria for abnormality. RESULTS Only 28% of the children without abnormalities had paravertebral soft tissues visualized, and the frequency of visualization directly increased with age (p = 0.001). For identification of abnormal cases on the left side, width greater than the adjacent pedicle had a sensitivity of 100% and a specificity of 98%, and inferolateral course had a sensitivity of 86% and a specificity of 95%. Visualization on the right side (n = 5) was always abnormal. Six normal cases had a width greater than that of the adjacent pedicle on the left side on initial radiographs obtained with supine positioning and met normal criteria on repeated radiographs with upright positioning. CONCLUSION Width greater than the adjacent pedicle is the best radiographic criterion for differentiation of abnormal from normal left-sided paravertebral soft tissues, particularly on radiographs obtained with upright positioning. Identifiable right-sided paravertebral soft tissue is always abnormal. These criteria are useful aids in determining the need for additional imaging, such as CT.
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Affiliation(s)
- L F Donnelly
- Division of Pediatric Radiology, Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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Donnelly LF, Bisset GS, Adams DM. Marked acute tissue swelling following percutaneous sclerosis of low-flow vascular malformations: a predictor of both prolonged recovery and therapeutic effect. Pediatr Radiol 2000; 30:415-9. [PMID: 10876829 DOI: 10.1007/s002470050775] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate the significance of marked, acute swelling in patients after percutaneous sclerosis of low-flow vascular malformations, as a predictor of both prolonged recovery and likelihood of therapeutic effect. MATERIALS AND METHODS In 22 patients who underwent percutaneous ethanol sclerosis of low-flow vascular malformations, we compared the incidence of prolonged recovery and lasting therapeutic effect between those patients with and without marked soft-tissue swelling following the procedure. RESULTS Five patients exhibited marked swelling after sclerosis. Four of these five had causes of prolonged recovery. These four recovered and all five eventually had marked therapeutic effect. Seventeen patients did not meet criteria for severe swelling. Only one of these patients had prolonged recovery. Eighteen of the 22 total patients had therapeutic effect. All 4 of the 22 total patients who had no therapeutic effect were in the group without marked swelling. CONCLUSIONS Marked soft-tissue swelling, which occurs after percutaneous sclerosis of vascular malformations, is both a predictor of prolonged recovery and high likelihood of therapeutic effect.
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Affiliation(s)
- L F Donnelly
- Clinic for the Treatment of Vascular Malformations, Duke University Medical Center, Durham, NC 27710, USA
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12
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Affiliation(s)
- L F Donnelly
- Clinic for the Treatment of Vascular Malformations, Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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13
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Abstract
The spleen in infants and children is commonly involved in a variety of pathologic processes. Some of these processes cause isolated splenic disease, whereas others involve the spleen as part of a systemic illness. To facilitate differential diagnosis of splenic abnormalities, a pattern-oriented approach to the imaging evaluation of the pediatric spleen was developed. With this approach, splenic anomalies are categorized as anomalies of splenic shape (clefts, notches, lobules), location (eg, wandering spleen), number (polysplenia, asplenia), or size (splenomegaly, splenic atrophy); solitary lesions (eg, cysts, lymphangiomas, hemangiomas, hamartomas); multiple focal lesions (eg, trauma, infection and inflammation, neoplasms, storage disorders); and diffuse disease without focal lesions (eg, infarction, heavy metal deposition, hemangioendotheliomas, peliosis). A variety of imaging modalities can be used in splenic assessment, including computed tomography, magnetic resonance imaging, ultrasound, and technetium-99m scintigraphy. The imaging appearance of the pediatric spleen depends on the patient's age and the modality used; however, familiarity with the spectrum of radiologic patterns of splenic involvement will facilitate correct diagnosis and prompt treatment.
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Affiliation(s)
- A Paterson
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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14
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Abstract
PURPOSE To determine the radiographic appearance and features of corrosion in U.S. coins exposed to gastric acid. MATERIALS AND METHODS Six U.S. copper-based pre-1982 pennies, 12 zinc-based post-1982 pennies, a quarter, a nickel, and a dime were exposed to postprandial concentrations of gastric acid (0.15N HCl) for 7 days, and radiographs were obtained daily. Half the zinc-based coins were scraped to disrupt their copper coating. Coins were weighed at the start and completion of the study. RESULTS Post-1982 zinc-based pennies developed radiolucent corrosive changes within 24 hours. Erosions on the coins became more apparent over time. Frank holes were present on day 2. The weights of these coins decreased 5%-8% during the study. Pre-1982 copper pennies and "silver-colored" coins showed no change on radiographs over 7 days. CONCLUSION Unexpected radiolucent corrosions may develop in post-1982 zinc alloy pennies when retained in the stomach. Coins have long been considered innocuous foreign bodies in the gastrointestinal tracts of children. However, because of the potential for ulceration and zinc-related morbidity, closer clinical and radiographic observation is warranted. Coins with scalloped edges or holes should be endoscopically removed, as they have likely been retained longer than 1 or 2 days.
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Affiliation(s)
- S M O'Hara
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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15
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Abstract
The relative paucity of mesenteric fat seen in the pediatric population can make detection and localization of processes in the mesentery difficult. This pictorial essay reviews pediatric mesenteric disorders and presents criteria that help localize processes to the mesentery. Disorders are categorized by specific patterns of involvement, which can readily be identified by imaging: developmental abnormalities of mesenteric rotation, diffuse mesenteric processes, focal mesenteric masses, and multifocal mesenteric masses.
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Affiliation(s)
- Z M Zarewych
- Department of Radiology, Division of Pediatric Radiology, Duke University Medical Center, Durham, NC 27710, USA
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16
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Abstract
PURPOSE To evaluate the frequency of anterior chest wall variations in children. MATERIALS AND METHODS The computed tomographic (CT) images of 200 consecutive infants and children (114 boys and 86 girls; mean age, 10.5 years; age range, 3 months to 19 years) who underwent chest CT during a 20-month period were evaluated for chest wall variations. Children who had undergone chest wall surgery or were suspected of having a chest wall abnormality were excluded. The frequency of chest wall anomalies was compared with age and sex (Fisher exact test). RESULTS The CT scans of 65 children (33%) depicted one or more variations in the anterior chest wall: titled sternum (n = 29), prominent convexity of anterior rib or costal cartilage (n = 19), prominent asymmetric costal cartilage (n = 20), well-defined paracostal subcutaneous nodule (n = 4), mild pectus excavatum (n = 4), or mild pectus carinatum (n = 4). The frequency of these findings did not vary significantly with age (P = .96) or sex (P = .36). CONCLUSION Variations in the anterior chest wall are common, occurring in one-third of children, and should be considered normal. These asymptomatic variations should not be considered alarming when palpated at physical examination.
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Affiliation(s)
- L F Donnelly
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
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17
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Affiliation(s)
- DP Frush
- Department of Radiology, Duke University Medical Center, Durham, NC 27710
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18
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Abstract
The clinical and imaging (magnetic resonance [MR] imaging, radiography, and bone scintigraphy) findings in three adolescent boys with chronic avulsive injury at the deltoid insertion are presented. MR imaging enabled the exclusion of findings suggestive of malignancy and the localization of abnormalities to the deltoid insertion site. Findings included cortical thickening and irregularity of the deltoid tubercle, with or without adjacent soft-tissue edema.
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Affiliation(s)
- L F Donnelly
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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19
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Frush DP, Spencer EB, Donnelly LF, Zheng JY, DeLong DM, Bisset GS. Optimizing contrast-enhanced abdominal CT in infants and children using bolus tracking. AJR Am J Roentgenol 1999; 172:1007-13. [PMID: 10587137 DOI: 10.2214/ajr.172.4.10587137] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Manual administration of IV contrast material results in unpredictable injection rates. Our purpose was to determine the effect of bolus tracking on overall abdominal helical CT scan quality, particularly on hepatic enhancement, in children with manually administered contrast media. MATERIALS AND METHODS We compared 33 abdominal helical CT scans of 29 children in whom bolus tracking was used with 22 CT scans of a control group of 21 children in whom bolus tracking was not used. All contrast material was administered by manual injection. Qualitative assessment was made of organ and vessel enhancement and overall scan appearance. Quantitative assessment using region-of-interest cursors was performed at three anatomic levels, and the results for the two groups of children were compared. RESULTS Qualitative comparison of enhancement parameters between the bolus tracking group (number given first) and the control group (number given second) yielded the following: splenic artifact in 9% versus 23% (p = .24); inferior vena cava flow artifact in 3% versus 27% (p = .01); scanning during the nephrographic phase in 89% versus 59% (p = .02); and good quality grade in 79% versus 64% (p = .23). Significantly greater hepatic enhancement (as measured in mean Hounsfield units) was achieved in the bolus tracking group than in the control group at the superior (48.5 versus 28.6; p < .001), middle (47.9 versus 32.3; p < .001), and inferior (48.2 versus 36.5; p = .01) levels. Hepatic enhancement increased significantly from the superior to the inferior level in the control group (p < .02), whereas enhancement was homogeneous in the bolus tracking group (p > .50). CONCLUSION Bolus tracking provides improved contrast enhancement, including significantly greater hepatic enhancement, during abdominal helical CT in children in whom the rate of injection of contrast material is unpredictable.
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Affiliation(s)
- D P Frush
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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20
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Abstract
PURPOSE To describe the magnetic resonance (MR) imaging findings of subcutaneous granuloma annulare (SGA), a rare mass of early childhood. MATERIALS AND METHODS MR imaging studies and clinical records in six children aged 2 1/2-4 years in whom SGA was diagnosed between 1993 and 1997 were retrospectively reviewed. All MR imaging examinations included T1-weighted and fast spin-echo T2-weighted sequences. Three children received intravenous contrast material. The diagnosis was established by using excisional biopsy results, with confirmation by means of characteristic features in mucin-stained specimens. RESULTS All children presented with a nontender, nonmobile mass. The lesion in all six children was confined to the pretibial (n = 5) or prepatellar (n = 1) soft tissues. MR imaging characteristics were uniform. Masses were subcutaneous in location and had ill-defined margins. On T1-weighted images, the lesion was isointense or slightly hyperintense to muscle. On T2-weighted images, the signal intensity was more heterogeneous, but the lesion was predominantly hyperintense. In three children who received contrast material, the lesion enhanced nearly homogeneously. CONCLUSION Although SGA can often be diagnosed on the basis of clinical characteristics, MR imaging may be requested by practitioners unfamiliar with the lesion. In these cases, with recognition of typical MR imaging features, a limited biopsy and specific histologic preparation that includes mucin staining can be recommended.
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Affiliation(s)
- S Chung
- Department of Radiology, Duke University Medical Center, NC 27710, USA
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21
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Abstract
Children and adolescents are prone to avulsive injuries related to a combination of their propensity for great strength, ability to sustain extreme levels of activity, and immature growing apophyses. Appropriate interpretation of imaging studies showing chronic avulsive injuries is essential so that the irregularity and periostitis that can be associated with chronic avulsions is not misinterpreted as probable malignancy. This article reviews the chronic avulsive injuries of childhood.
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Affiliation(s)
- L F Donnelly
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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22
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Abstract
PURPOSE To (a) determine the appearances and timing of heterogeneous splenic enhancement at spiral computed tomography (CT) and (b) identify variables influencing heterogeneous splenic enhancement. MATERIALS AND METHODS Sequential isolevel (24-mAs) CT images of the spleen obtained at 6-second intervals after initiation of contrast material injection in 112 children (mean age, 4.5 years) were reviewed. Heterogeneity characteristics assessed included type, onset, maximum, and resolution. Relationship to variables (injection rate, age, splenomegaly) was assessed with the Fisher exact test. RESULTS Eighty-one of the 112 patients (72%) had transient heterogeneity: archiform (45 patients), diffuse (25 patients), and focal (11 patients). Mean times were as follows: initial visualization after onset of contrast material injection, 19.2 seconds; maximum heterogeneity, 27.3 seconds; and resolution, 47.4 seconds. Statistically significant relationships were seen between frequency of heterogeneity and injection rate (> or = 1 mL/sec, 82%; < 1 mL/sec, 50% [P = .001]), age (> 1 year, 76%; < or = 1 year, 46% [P = .04]), and splenomegaly (present, 20%; absent, 77% [P = .048]). CONCLUSION Heterogeneous splenic contrast enhancement is common, has several patterns of appearance, and is predictably encountered during the 70 seconds after the initiation of contrast material injection. Injection rate, age, and presence of splenic disease influence the frequency with which these artifacts are encountered.
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Affiliation(s)
- L F Donnelly
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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23
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Abstract
OBJECTIVE The objective is to describe the appearance and evaluate the significance of postoperative extrapleural fluid collections in neonates who have undergone esophageal atresia repair in which an extrapleural surgical approach was used. CONCLUSION Extrapleural effusion in a neonate who has undergone repair of esophageal atresia by an extrapleural approach is associated with a high incidence of anastomotic leakage. Such patients may also be at increased risk for developing a delayed esophageal stricture. On chest radiography, these extrapleural effusions look like fluid in the pleural space.
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Affiliation(s)
- L F Donnelly
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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24
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Affiliation(s)
- L F Donnelly
- Department of Radiology, Duke University Medical Center, Durham NC 27710, USA
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25
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Abstract
OBJECTIVE To determine how well MRI can detect tarsal coalition compared with CT, the current imaging standard. MATERIALS AND METHODS Coronal and axial CT and MRI were performed within 3 weeks of each other on 40 feet in 20 consecutive patients referred with symptoms of possible tarsal coalition. Scans were read independently in blinded fashion by different imagers. Coalitions were either complete (osseous) or incomplete (non-osseous). Results were compared with available surgical data and clinical follow-up. RESULTS Both modalities prospectively identified 15 coalitions (9 patients) and each missed 1 calcaneonavicular coalition. Twenty-three of the remaining 24 feet were negative for coalition on both CT and MRI. An atypical incomplete talocalcaneal coalition seen on CT was not identified prospectively on MRI. CONCLUSION MRI is very good for detecting tarsal coalition and has a high rate of agreement with CT, the imaging "gold standard." When clinical suspicion for coalition is high, CT remains a more cost-effective diagnostic modality. If other causes for ankle pain are also entertained, MRI can be performed and provide nearly equivalent diagnostic accuracy for detecting tarsal coalition.
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Affiliation(s)
- K H Emery
- Department of Radiology, Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-8145, USA
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26
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Affiliation(s)
- G S Bisset
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
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27
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28
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Affiliation(s)
- L F Donnelly
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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29
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Abstract
Common indications for liver imaging in children include trauma, suspected mass, pre-liver transplantation, monitoring after liver transplantation, jaundice, or liver dysfunction. This article highlights areas where the pathology or imaging approach in children differs from that seen in adults. Topics covered include imaging of a suspected hepatic mass, neonatal jaundice, and segmented liver transplantation.
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Affiliation(s)
- L F Donnelly
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
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30
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Abstract
Vascular disease in the pediatric population is a poorly understood process which is often underestimated in its incidence. The common beginnings of such ubiquitous diseases as atherosclerosis manifest themselves at a cellular level shortly after birth. Other common systemic disorders, including congestive heart failure and sepsis, are also intricately associated with dysfunctional vasculature. Progress in the understanding of normal and pathophysiologic processes within the vascular system begins with the "control center"--the endothelial cell. The purpose of this review is to consolidate a body of knowledge on the processes that occur at the cellular level within the blood vessel wall, and to simplify the understanding of how imbalances in these physiologic parameters result in vascular disease.
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Affiliation(s)
- G S Bisset
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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31
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Abstract
PURPOSE To assess the clinical and imaging findings in children with severe tracheal or bronchial compression caused by abnormal thoracic configuration. MATERIALS AND METHODS Clinical and imaging findings, care, and outcome were reviewed in six patients with airway compression caused by abnormal thoracic configuration. Radiographs and magnetic resonance (MR) images were available in all patients. RESULTS Mechanisms of airway compression included alteration of mediastinal anatomy and direct airway compression secondary to a narrow anteroposterior chest diameter. In three patients, the trachea was compressed at the level of the thoracic inlet. In the other three patients, the left main bronchus was compressed. Four patients underwent surgery for the thoracic deformity, with resolution of airway symptoms. In all four patients, the presence, location, and cause of airway obstruction determined at MR imaging were confirmed at surgery. CONCLUSION Abnormal thoracic configuration, in addition to causing restrictive lung disease, can cause respiratory distress secondary to severe compression of the central airways.
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Affiliation(s)
- L F Donnelly
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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32
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Affiliation(s)
- L F Donnelly
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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33
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Abstract
We report the case of an immunocompromised 15-year-old boy who presented with symptoms mimicking an "acute abdomen" related to necrotizing myofasciitis of the anterior abdominal wall. CT demonstrated the abdominal wall process as the cause of the patient's symptoms and sonographically guided aspiration confirmed the diagnosis. Despite prompt diagnosis and aggressive surgical debridement, the infection continued to progress and the patient died within 24 h of presentation.
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Affiliation(s)
- L F Donnelly
- Department of Radiology, Section of Pediatric Radiology, Box 3808, Duke University Medical Center, Durham, NC 27710, USA
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34
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Donnelly LF, Klosterman LA, Ball WS, Bisset GS. Comparison of duodenal intubation techniques during conversion of gastrostomy to gastrojejunostomy tubes in children. AJR Am J Roentgenol 1997; 169:1633-4. [PMID: 9393180 DOI: 10.2214/ajr.169.6.9393180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- L F Donnelly
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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35
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Abstract
OBJECTIVE Our objective is to describe the clinical entity and MR imaging appearance of fat necrosis after trauma, a benign cause of palpable soft-tissue lesions in children. A related objective is to establish MR imaging criteria that can be used reliably to differentiate this entity from other more serious causes of soft-tissue masses. CONCLUSION Fat necrosis after trauma is a common cause of palpable lumps in children and has a benign course on long-term follow-up. When characteristic MR imaging findings are seen, conservative therapy is appropriate.
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Affiliation(s)
- T S Tsai
- Department of Radiology, Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA
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36
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Abstract
Spiral technology has expanded the usefulness of computed tomography (CT) in the evaluation of pediatric diseases. Even though spiral CT requires shorter total scanning times, image degradation by patient motion is still a problem in very young patients, and oral and intravenous sedatives are administered to minimize this problem. Optimal parenchymal enhancement depends on the amount and injection rate of contrast material and the timing of the onset of scanning. All these are more variable in studies of children than in adults, with the latter being the most complicated. Spiral CT of the pediatric chest is most useful for evaluating anastomotic dehiscence and stenosis in lung transplant recipients, pulmonary nodules in children with malignant disease likely to disseminate to the lung, and great vessel anomalies; for staging pulmonary tumors; and for dynamic imaging to identify various diseases that cause pulmonary dysfunction. Important applications of spiral CT of the pediatric abdomen and pelvis include evaluating the liver for acquired vascular abnormalities and vascular tumors, staging and preoperative assessment of renal tumors, and evaluating inflammatory pelvic lesions.
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Affiliation(s)
- D P Frush
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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37
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Frush DP, Bisset GS. Sedation of children for emergency imaging. Radiol Clin North Am 1997; 35:789-97. [PMID: 9216624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Successful and safe sedation is an important technical aspect of pediatric imaging for the radiologist. Sedation of children requiring acute diagnostic evaluation presents additional challenges including uncertain past medical history and nothing-by-mouth status, unknown allergies, and unstable clinical status. This article focuses on the techniques and problems of sedating children in an acute setting.
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Affiliation(s)
- D P Frush
- Department of Radiology, Duke University Medical Center, Durham, North Carolina 27710, USA
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38
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Affiliation(s)
- L F Donnelly
- Department of Radiology, Children's Hospital Medical Center, Cincinnati, OH 45229, USA
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39
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Abstract
Children will probably always need to be sedated for some radiologic procedures, and controlling the state of consciousness of a child involves more than selecting an agent. The safe and effective sedation process emanates from a carefully designed sedation program. This program begins even before it is determined that sedation is necessary to properly perform a radiologic examination or procedure. Although several issues, controversies, and choices are involved, the context and dialogue of sedation must originate from the principle of protecting the health and safety of children.
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Affiliation(s)
- D P Frush
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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40
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Affiliation(s)
- D P Frush
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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41
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Affiliation(s)
- D P Frush
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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42
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Dentino CM, Frush DP, Bisset GS. Pediatric radiology case of the day. Multifocal infantile fibromatosis. AJR Am J Roentgenol 1995; 165:209-10. [PMID: 7785602 DOI: 10.2214/ajr.165.1.7785602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- C M Dentino
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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43
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Dentino CM, Frush DP, Bisset GS. Pediatric radiology case of the day. Congenital goiter secondary to inherited thyroid dyshormonogenesis. AJR Am J Roentgenol 1995; 165:208-9. [PMID: 7785601 DOI: 10.2214/ajr.165.1.7785601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- C M Dentino
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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44
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Affiliation(s)
- C M Dentino
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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45
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Affiliation(s)
- C M Dentino
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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46
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Moulton JS, Blebea JS, Dunco DM, Braley SE, Bisset GS, Emery KH. MR imaging of soft-tissue masses: diagnostic efficacy and value of distinguishing between benign and malignant lesions. AJR Am J Roentgenol 1995; 164:1191-9. [PMID: 7717231 DOI: 10.2214/ajr.164.5.7717231] [Citation(s) in RCA: 141] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the efficacy of MR imaging in predicting the pathologic diagnosis of soft-tissue masses, both neoplastic and nonneoplastic, and in distinguishing benign from malignant lesions. MATERIALS AND METHODS The imaging features of 225 soft-tissue tumors (179 benign, 46 malignant) in 222 patients were analyzed. Univariate analysis of multiple individual imaging features was done, along with stepwise logistic regression analysis of combinations of imaging features, to determine how useful these are for predicting malignancy or benignity. A subjective (group consensus) analysis of each case was done prospectively, and each tumor was placed into one of three diagnostic categories: (1) benign, diagnostic of a specific entity; (2) nonspecific, most likely benign; or (3) nonspecific, most likely malignant. Results were compared with the final diagnosis established by pathologic examination (n = 184) or imaging/clinical data (n = 41). RESULTS By quantitative analysis, no single imaging feature or combination of features could reliably be used to distinguish benign from malignant lesions. For the subjective analysis, a correct and specific benign diagnosis could be made on the basis of MR imaging findings in 100 (44%) of the 225 tumors. For the entire cohort, the sensitivity was 78%, the specificity was 89%, the positive predictive value was 65%, and the negative predictive value was 94% for a malignant diagnosis. When the diagnostic benign tumors were excluded, the specificity and negative predictive value decreased to 76% and 86%, respectively, whereas the sensitivity and positive predictive value remained the same. CONCLUSION Many benign soft-tissue masses can be correctly and confidently diagnosed with MR imaging. The prevalence of benign lesions among soft-tissue masses accounts for the relatively high specificity and negative predictive value that can be achieved with MR imaging for tissue characterization. However, the accuracy of MR imaging declines when these characteristic benign tumors are excluded from analysis. A significant percentage of malignant lesions may appear deceptively "benign" with the currently used criteria. For lesions whose imaging appearance is nonspecific, MR imaging is not reliable for distinguishing benign from malignant tumors, and these lesions warrant biopsy in most cases.
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Affiliation(s)
- J S Moulton
- Department of Radiology, University of Cincinnati Medical Center, OH 45267-0742, USA
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47
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Donnelly LF, Bisset GS, McDermott B. Anomalous midline location of the descending aorta: a cause of compression of the carina and left mainstem bronchus in infants. AJR Am J Roentgenol 1995; 164:705-7. [PMID: 7863899 DOI: 10.2214/ajr.164.3.7863899] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- L F Donnelly
- Department of Radiology, Children's Hospital Medical Center, Cincinnati, OH 45229-3039
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48
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Affiliation(s)
- B L Koch
- Department of Radiology, Children's Hospital Medical Center, Cincinnati, OH 45229
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49
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Abstract
PURPOSE To assess the usefulness of magnetic resonance (MR) imaging in the diagnosis of distal biceps tendon ruptures. MATERIALS AND METHODS MR images of the elbow in 20 patients with suspected distal biceps injury were retrospectively reviewed along with those of eight asymptomatic volunteers. Surgical confirmation was obtained in nine cases. RESULTS MR imaging helped diagnose 10 complete ruptures with depiction of the absence of the tendon distally (n = 10), a fluid-filled tendon sheath (n = 9), an antecubital fossa mass (n = 3), muscle edema (n = 3), and atrophy (n = 2). Six partial tears were depicted with high signal intensity within the tendon (n = 6), fluid in the biceps tendon sheath (n = 6), and thinning (n = 3) or thickening (n = 3) of the distal tendon. Of the remaining patients, one each had tendinosis, tenosynovitis, a biceps hematoma, and a brachialis contusion. CONCLUSION MR imaging helped confirm distal biceps tendon ruptures because it distinguished complete from partial ruptures and other entities that may mimic ruptures.
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Affiliation(s)
- F S Falchook
- Department of Radiology, University of Miami School of Medicine, Jackson Memorial Hospital, Fla
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50
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Abstract
A case is presented of the fracture and embolization of a peripherally inserted central venous catheter. This novel complication is discussed in the context of patients in alternate care settings with emphasis on retrieval of the embolized catheter fragment, morbidity of catheter embolization, and precautions against inadvertent fracture in the home care setting.
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Affiliation(s)
- D N Linz
- Division of Pediatric Surgery, Children's Hospital Medical Center, Cincinnati, OH 45229-3039
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