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Guler S, Hull NC, Arteta M, Allen-Rhoades W, Shahi M, Ishitani MB, Demirel N. An unusual case of metastatic trophoblastic neoplasm presenting with diffuse cystic lung disease and pulmonary artery pseudoaneurysms in a teenager. Pediatr Pulmonol 2024; 59:1482-1486. [PMID: 38390771 DOI: 10.1002/ppul.26936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 01/07/2024] [Accepted: 02/12/2024] [Indexed: 02/24/2024]
Abstract
Diffuse cystic lung diseases (DCLDs) are a diverse group of lung disorders characterized by the presence of multiple air filled cysts within the lung tissue. These cysts are thin walled and surrounded by normal lung tissue. In adults, DCLD can be associated with various conditions such as lymphangioleiomyomatosis (LAM), Langerhans cell histiocytosis, cancers, and more. In children, DCLD is often linked to lung developmental abnormalities, with bronchopulmonary dysplasia being a common cause. Patients with pulmonary cysts are typically asymptomatic, but some may experience mild symptoms or pneumothorax. While DCLD in children is rarely due to malignancy, metastatic lung disease can be a cause. It is important for clinicians to be aware of the possibility of metastatic lung disease when encountering DCLD.
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Affiliation(s)
- Sevim Guler
- Istanbul University-Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Nathan C Hull
- Division of Pediatric Radiology, Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Manuel Arteta
- Division of Pediatric Pulmonology, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Wendy Allen-Rhoades
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Maryam Shahi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael B Ishitani
- Division of Pediatric Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Nadir Demirel
- Division of Pediatric Pulmonology, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
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2
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Kocer SY, Hull NC, Dean Potter D, Madigan T, Boland JM, Demirel N. Late development of pneumatoceles in necrotizing pneumonia. Pediatr Pulmonol 2024; 59:502-505. [PMID: 38014600 DOI: 10.1002/ppul.26777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/09/2023] [Accepted: 11/18/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Sila Y Kocer
- Ondokuz Mayis University School of Medicine, Samsun, Turkey
| | - Nathan C Hull
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Donald Dean Potter
- Department of Surgery, Division of Pediatric Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Theresa Madigan
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Jennifer M Boland
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nadir Demirel
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Pulmonology, Mayo Clinic, Rochester, Minnesota, USA
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3
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Brown MJ, Kolbe AB, Hull NC, Hilscher M, Kamath PS, Yalon M, Gu CN, Amawi ADT, Venkatesh SK, Wells ML. Imaging of Fontan-Associated Liver Disease. J Comput Assist Tomogr 2024; 48:1-11. [PMID: 37574655 DOI: 10.1097/rct.0000000000001533] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
ABSTRACT The Fontan procedure is the definitive treatment for patients with single-ventricle physiology. Surgical advances have led to a growing number of patients surviving into adulthood. Fontan-associated liver disease (FALD) encompasses a spectrum of pathologic liver changes that occur secondary to altered physiology including congestion, fibrosis, and the development of liver masses. Assessment of FALD is difficult and relies on using imaging alongside of clinical, laboratory, and pathology information. Ultrasound, computed tomography, and magnetic resonance imaging are capable of demonstrating physiologic and hepatic parenchymal abnormalities commonly seen in FALD. Several novel imaging techniques including magnetic resonance elastography are under study for use as biomarkers for FALD progression. Imaging has a central role in detection and characterization of liver masses as benign or malignant. Benign FNH-like masses are commonly encountered; however, these can display atypical features and be mistaken for hepatocellular carcinoma (HCC). Fontan patients are at elevated risk for HCC, which is a feared complication and has a poor prognosis in this population. While imaging screening for HCC is widely advocated, no consensus has been reached regarding an optimal surveillance regimen.
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Affiliation(s)
- Mark J Brown
- From the Mayo Graduate School of Medicine: Mayo School of Graduate Medical Education
| | - Amy B Kolbe
- Department of Radiology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | - Nathan C Hull
- Department of Radiology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | - Moira Hilscher
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Patrick S Kamath
- Department of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Mayo Clinic
| | | | - Chris N Gu
- Department of Radiology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | - Ali Dean T Amawi
- Department of Internal Medicine, NYC Health and Hospital/Lincoln Medical Center, New York City, NY
| | - Sudhakar K Venkatesh
- Department of Radiology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | - Michael L Wells
- Department of Radiology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
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Horst KK, Yu L, McCollough CH, Esquivel A, Thorne JE, Rajiah PS, Baffour F, Hull NC, Weber NM, Thacker PG, Thomas KB, Binkovitz LA, Guerin JB, Fletcher JG. Potential benefits of photon counting detector computed tomography in pediatric imaging. Br J Radiol 2023; 96:20230189. [PMID: 37750939 PMCID: PMC10646626 DOI: 10.1259/bjr.20230189] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/27/2023] Open
Abstract
Photon counting detector (PCD) CT represents the newest advance in CT technology, with improved radiation dose efficiency, increased spatial resolution, inherent spectral imaging capabilities, and the ability to eliminate electronic noise. Its design fundamentally differs from conventional energy integrating detector CT because photons are directly converted to electrical signal in a single step. Rather than converting X-rays to visible light and having an output signal that is a summation of energies, PCD directly counts each photon and records its individual energy information. The current commercially available PCD-CT utilizes a dual-source CT geometry, which allows 66 ms cardiac temporal resolution and high-pitch (up to 3.2) scanning. This can greatly benefit pediatric patients by facilitating high quality fast scanning to allow sedation-free imaging. The energy-resolving nature of the utilized PCDs allows "always-on" dual-energy imaging capabilities, such as the creation of virtual monoenergetic, virtual non-contrast, virtual non-calcium, and other material-specific images. These features may be combined with high-resolution imaging, made possible by the decreased size of individual detector elements and the absence of interelement septa. This work reviews the foundational concepts associated with PCD-CT and presents examples to highlight the benefits of PCD-CT in the pediatric population.
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Affiliation(s)
- Kelly K. Horst
- Pediatric Radiology Division, Department of Radiology, Mayo Clinic, Rochester, United States
| | - Lifeng Yu
- Department of Radiology, Mayo Clinic, Rochester, United States
| | | | - Andrea Esquivel
- Department of Radiology, Mayo Clinic, Rochester, United States
| | | | | | - Francis Baffour
- Department of Radiology, Mayo Clinic, Rochester, United States
| | - Nathan C. Hull
- Pediatric Radiology Division, Department of Radiology, Mayo Clinic, Rochester, United States
| | | | - Paul G. Thacker
- Pediatric Radiology Division, Department of Radiology, Mayo Clinic, Rochester, United States
| | - Kristen B. Thomas
- Pediatric Radiology Division, Department of Radiology, Mayo Clinic, Rochester, United States
| | - Larry A. Binkovitz
- Pediatric Radiology Division, Department of Radiology, Mayo Clinic, Rochester, United States
| | - Julie B. Guerin
- Department of Radiology, Mayo Clinic, Rochester, United States
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5
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Penfold MP, Annankra WB, Hull NC, Corredor M. Congenital Hepatic Fibrosis in a 2-Year-Old Child Presenting with Fever of Unknown Origin. Case Rep Pediatr 2023; 2023:4497784. [PMID: 37946748 PMCID: PMC10632057 DOI: 10.1155/2023/4497784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 11/12/2023] Open
Abstract
Congenital hepatic fibrosis is a rare, autosomal recessive, fibro-polycystic disease resulting from ductal plate malformation, leading to proliferation and fibrosis of bile ducts. Progressive hepatic fibrosis leads to portal hypertension and varices which can present with life threatening gastrointestinal hemorrhage. We report a case of congenital hepatic fibrosis in a 2-year-old child who presented with 8 days of fever without any significant medical history or physical examination findings.
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Chen C, Milbrandt TA, Babadi E, Duong SQ, Larson DR, Shaughnessy WJ, Stans AA, Hull NC, Peterson HA, Larson AN. Normative Femoral and Tibial Lengths in a Modern Population of Twenty-First-Century U.S. Children. J Bone Joint Surg Am 2023; 105:468-478. [PMID: 36727888 DOI: 10.2106/jbjs.22.00690] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The Green-Anderson (GA) leg-length data remain the gold standard for the age-based assessment of leg lengths in children despite their methodologic weaknesses. We aimed to summarize current growth trends among a cross-sectional cohort of modern U.S. children using quantile regression methods and to compare the median femoral and tibial lengths of the modern U.S. children with those of the GA cohort. METHODS A retrospective review of scanograms and upright slot-scanning radiographs obtained in otherwise healthy children between 2008 and 2020 was completed. A search of a radiology registry revealed 3,508 unique patients between the ages of 2 and 18 years for whom a standard-of-care scanogram or slot-scanning radiograph had been made. All patients with systemic illness, genetic conditions, or generalized diseases that may affect height were excluded. Measurements from a single leg at a single time point per subject were included, and the latest available time point was used for children who had multiple scanograms made. Quantile regression analysis was used to fit the lengths of the tibia and femur and overall leg length separately for male patients and female patients. RESULTS Seven hundred patients (328 female and 372 male) met the inclusion criteria. On average, the reported 50th percentile tibial lengths from the GA study at each time point were shorter than the lengths in this study by 2.2 cm (range, 1.4 to 3.3 cm) for boys and 2 cm (range, 1.1 to 3.1 cm) for girls. The reported 50th percentile femoral lengths from the GA study at each time point were shorter than the lengths in this study by 1.8 cm (range, 1.1 to 2.5 cm) for boys and 1.7 cm (range, 0.8 to 2.3 cm) shorter for girls. CONCLUSIONS This study developed new growth charts for femoral and tibial lengths in a modern U.S. population of children. The new femoral and tibial lengths at nearly all time points are 1 to 3 cm longer than traditional GA data. The use of GA data for epiphysiodesis could result in underestimation of expected childhood growth. LEVEL OF EVIDENCE Prognostic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Chunho Chen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.,Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.,School of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Orthopedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Todd A Milbrandt
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Elham Babadi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Stephanie Q Duong
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Dirk R Larson
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | | | - Anthony A Stans
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Nathan C Hull
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | - A Noelle Larson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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7
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Hull NC, Granberg CF, Gargollo PC, Thacker PG. Imaging of pre- and post-cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for pediatric intraperitoneal malignancy. Pediatr Radiol 2022; 52:2254-2266. [PMID: 36207454 DOI: 10.1007/s00247-022-05424-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/09/2022] [Accepted: 06/02/2022] [Indexed: 11/24/2022]
Abstract
Although rare, pediatric peritoneal carcinomatosis does occur in primary abdominopelvic tumors. Additionally, peritoneal carcinomatosis has been described to occur as metastatic disease where the primary tumor is outside the abdominopelvic cavity. Where amenable, cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) can be beneficial in disease management. However, favorable outcomes are predicated on specific tumor histology as well as proper patient selection, which significantly relies on preoperative imaging. This review gives a comprehensive, up-to-date summary on pediatric peritoneal carcinomatosis pre-surgical evaluation; where imaging is beneficial and limited; pediatric radiologists' role in helping to quantify disease; and how we, as pediatric radiologists, can help the surgeons and oncologists in the selection of patients for cytoreductive surgery and HIPEC.
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Affiliation(s)
- Nathan C Hull
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | | | | | - Paul G Thacker
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
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8
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Hull NC, Young PM, Thacker PG. Performing chest computed tomography on pediatric patients on extracorporeal membrane oxygenation (ECMO): a stepwise approach. Pediatr Radiol 2022; 52:1877-1887. [PMID: 35364682 DOI: 10.1007/s00247-022-05336-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/07/2022] [Accepted: 02/23/2022] [Indexed: 11/30/2022]
Abstract
Chest CT in pediatric patients on extracorporeal membrane oxygenation (ECMO) can be done safely and provide valuable high-quality diagnostic images to help guide patient management. An understanding of the basics of the ECMO circuit, cannula locations, where and how to inject contrast media, and how to time image acquisition is vital for the radiologist. Additionally, understanding the precautions associated with performing these exams is essential to ensure the safety of the child. This article provides a brief review of pediatric ECMO and its challenges and considerations, as well as a stepwise approach to perform and optimize these exams safely.
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Affiliation(s)
- Nathan C Hull
- Department of Radiology, Division of Pediatric Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
| | - Phillip M Young
- Department of Radiology, Division of Cardiovascular Radiology, Mayo Clinic, Rochester, MN, USA
| | - Paul G Thacker
- Department of Radiology, Division of Pediatric Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
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9
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Maxfield CM, Thorpe MP, Desser TS, Heitkamp D, Hull NC, Koontz NA, Welch TJ, Grimm LJ. Can the use of deception be justified in medical education research? A point/counterpoint and case study. Acad Radiol 2022; 29:1091-1094. [PMID: 34172348 DOI: 10.1016/j.acra.2021.05.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/07/2021] [Accepted: 05/08/2021] [Indexed: 11/16/2022]
Abstract
Deception is a common feature of behavioral research design, although not commonly employed in the medical literature. It can promote scientific validity but is ethically controversial because it compromises subject autonomy and incurs additional costs. In this Point/Counterpoint monograph, we review the nature of deception in research and present arguments for and against its ethical use as a research methodology in behavioral studies. We describe the necessary guidelines, safeguards, and oversight, when deceptive methodology is considered, and report our experiences and lessons learned from conducting a multi-institutional audit study that relied upon deception of academic radiology faculty.
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Affiliation(s)
- Charles M Maxfield
- Department of Radiology, Duke University Medical Center, Durham, North Carolina.
| | | | - Terry S Desser
- Department of Radiology, Stanford University Medical Center, Stanford, California
| | | | - Nathan C Hull
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Nicholas A Koontz
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Lars J Grimm
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
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10
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Cooper KS, Hull NC, Horst KK, Kolbe AB, Zingula SN, Thacker PG. NUT carcinoma of the thorax in a 7-year-old child. Radiol Case Rep 2022; 17:1549-1553. [PMID: 35282323 PMCID: PMC8914253 DOI: 10.1016/j.radcr.2022.01.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 11/04/2022] Open
Abstract
We present a rare case of NUT midline carcinoma of the thorax in a 7-year-old-male who presented with nonspecific abdominal pain. The patient was initially evaluated with an abdominal ultrasound, which was negative, followed by an abdominopelvic CT that demonstrated a partially visualized infiltrative mediastinal mass. Subsequent, chest CT showed a large, aggressive appearing heterogenous middle mediastinal mass with pulmonary parenchyma, hilar, and posterior mediastinal invasion. Given its epicenter in the middle mediastinum and its irregular and invasive appearance, the primary consideration was NUT midline carcinoma, subsequently confirmed on biopsy.
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Affiliation(s)
- Kendall S Cooper
- Department of Radiology, Mayo Clinic Rochester, 200 1st St SW, Rochester, MN 55902, USA
| | - Nathan C Hull
- Department of Radiology, Mayo Clinic Rochester, 200 1st St SW, Rochester, MN 55902, USA
| | - Kelly K Horst
- Department of Radiology, Mayo Clinic Rochester, 200 1st St SW, Rochester, MN 55902, USA
| | - Amy B Kolbe
- Department of Radiology, Mayo Clinic Rochester, 200 1st St SW, Rochester, MN 55902, USA
| | - Shannon N Zingula
- Department of Radiology, Mayo Clinic Rochester, 200 1st St SW, Rochester, MN 55902, USA
| | - Paul G Thacker
- Department of Radiology, Mayo Clinic Rochester, 200 1st St SW, Rochester, MN 55902, USA
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11
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Pai PK, Gudmundsdottir H, Hull NC, Thacker PG, Klinkner DB. Chylolymphatic mesenteric cyst with midgut volvulus in an adolescent: a peculiar presentation. Radiol Case Rep 2022; 17:420-422. [PMID: 34934468 PMCID: PMC8654696 DOI: 10.1016/j.radcr.2021.10.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 10/30/2021] [Indexed: 11/18/2022] Open
Abstract
Mesenteric cysts are rare intra-abdominal masses in the pediatric population, with the chylolymphatic variant comprising only 7.3% of all abdominal cysts. These cysts can have a varied clinical presentation, ranging from asymptomatic cystic masses to intestinal obstruction. We report a 16-year-old female, who presented with acute abdominal pain and vomiting, and was diagnosed with an intra-abdominal cystic mass with midgut volvulus accompanied by the classical "whirlpool sign" on imaging. She underwent laparoscopic abdominal exploration, which revealed a large chylolymphatic mesenteric cyst associated with feeder lymph vessels. This cyst had resulted in volvulus of the small bowel. The bowel was detorsed and found to be viable, and the cyst was removed en bloc after suction evacuation with ligation of the lymphatic feeder vessels. Midgut volvulus in the pediatric population is usually secondary to malrotation, but in this case the patient's small intestine was not found to be malrotated, and hence we present this case and urge physicians to consider a diagnosis of midgut volvulus even in the absence of malrotation in a child with a cystic abdominal mass presenting as intestinal obstruction.
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Affiliation(s)
- Priya K Pai
- Division of Pediatric Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905 USA
| | | | - Nathan C Hull
- Division of Pediatric Radiology, Mayo Clinic, Rochester, MN, USA
| | - Paul G Thacker
- Division of Pediatric Radiology, Mayo Clinic, Rochester, MN, USA
| | - Denise B Klinkner
- Division of Pediatric Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905 USA
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Petri CA, Perez Y, Heidenreich LS, Cramer CH, Olson TM, Hull NC, Hanna C. New-onset cough and fever in a toddler with stage 5 chronic kidney disease: Questions. Pediatr Nephrol 2022; 37:121-122. [PMID: 34633528 PMCID: PMC8503712 DOI: 10.1007/s00467-021-05294-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Cassandra A. Petri
- grid.66875.3a0000 0004 0459 167XDepartment of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN USA
| | - Yalile Perez
- grid.66875.3a0000 0004 0459 167XDivision of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN USA
| | - Leah S. Heidenreich
- grid.66875.3a0000 0004 0459 167XDepartment of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN USA
| | - Carl H. Cramer
- grid.66875.3a0000 0004 0459 167XDivision of Pediatric Nephrology and Hypertension, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN USA
| | - Timothy M. Olson
- grid.66875.3a0000 0004 0459 167XDivision of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN USA
| | - Nathan C. Hull
- grid.66875.3a0000 0004 0459 167XDivision of Pediatric Radiology, Mayo Clinic, Rochester, MN USA
| | - Christian Hanna
- Division of Pediatric Nephrology and Hypertension, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
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13
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Petri CA, Perez Y, Heidenreich LS, Cramer CH, Olson TM, Hull NC, Hanna C. New-onset cough and fever in a toddler with stage 5 chronic kidney disease: Answers. Pediatr Nephrol 2022; 37:123-125. [PMID: 34633530 DOI: 10.1007/s00467-021-05301-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Cassandra A Petri
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Yalile Perez
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Leah S Heidenreich
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Carl H Cramer
- Division of Pediatric Nephrology and Hypertension, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Timothy M Olson
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nathan C Hull
- Division of Pediatric Radiology, Mayo Clinic, Rochester, MN, USA
| | - Christian Hanna
- Division of Pediatric Nephrology and Hypertension, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
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Khan MR, Ulrich JA, Hull NC, Inoue A, Harmsen WS, Faubion WA, Fletcher JG, Absah I. Perianal magnetic resonance imaging findings and their potential impact on outcome in children with perianal fistulizing Crohn disease. Pediatr Radiol 2021; 51:2481-2491. [PMID: 34490496 DOI: 10.1007/s00247-021-05158-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/25/2021] [Accepted: 07/20/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Children with perianal fistulizing Crohn disease require intensive medical management but also have a higher risk for subsequent surgical interventions. OBJECTIVE We performed a retrospective study to identify patient factors and perianal anatomical features by pelvic MR that are associated with surgical interventions in these children. MATERIALS AND METHODS We included children with Crohn disease and perianal fistula who underwent pelvic MR with available, archived images and collected demographic, clinical and laboratory data. Radiologists reviewed pelvic MR exams and identified Park classification and additional anatomical features of perianal fistulas, including fistula branching, horseshoe ramifications, abscess, inflammatory mass, supralevator extension, anal sphincter damage, proctitis and posterior anal space involvement. We performed univariate and subsequent multivariate analysis to determine features associated with subsequent surgical intervention. RESULTS Ninety-nine children with Crohn disease underwent pelvic MR. In this cohort, 69 children had no surgical interventions prior to baseline MRI, with subsequent median clinical follow-up of 5.5 years. Univariate analysis demonstrated that branching (P=0.009), supralevator extension (P=0.015) and anal sphincter damage (P=0.031) were significantly associated with subsequent surgical intervention. Age at baseline MRI was also associated with intervention (hazard ratio [HR] every 5 years: 2.13; 95% confidence interval [CI]: 1.18-3.83; P=0.012). A multivariable model identified only fistula branching (HR: 2.31; 95% CI: 1.28-4.15; P=0.005) and age (HR: 5.18; CI: 1.57-17.14; P=0.007) as independent predictors of subsequent surgery. No demographic, clinical or laboratory parameter predicted subsequent surgical intervention. CONCLUSION Age and anatomical MR features indicating fistula complexity (branching, supralevator extension) and sphincter damage confer a higher risk of subsequent surgical intervention in children with perianal Crohn disease.
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Affiliation(s)
- Muhammad Rehan Khan
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Illinois College of Medicine at Peoria, Children's Hospital of Illinois, 530 NE Glen Oak Ave., Peoria, IL, 61637, USA. .,Department of Pediatrics & Child Health, Aga Khan University, Karachi, Pakistan.
| | | | - Nathan C Hull
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Akitoshi Inoue
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - William S Harmsen
- Department of Biomedical Statistics and informatics, Mayo Clinic, Rochester, MN, USA
| | - William A Faubion
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | | | - Imad Absah
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.,Division of Pediatric Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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15
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Kim HHR, Hull NC, Lee EY, Phillips GS. Pediatric Abdominal Masses: Imaging Guidelines and Recommendations. Radiol Clin North Am 2021; 60:113-129. [PMID: 34836559 DOI: 10.1016/j.rcl.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pediatric abdominal masses are commonly encountered in the pediatric population, with a broad differential diagnosis that encompasses benign and malignant entities. The primary role of abdominal imaging in the setting of a suspected pediatric abdominal mass is to establish its presence, as nonneoplastic entities can mimic an abdominal mass, and to identify characteristic imaging features that narrow the differential diagnosis. In the setting of a neoplasm, various imaging modalities play an important role to characterize the mass, stage extent of disease, and assist in presurgical planning. The purpose of this article is to discuss a practical imaging algorithm for suspected pediatric abdominal masses and to describe typical radiological findings of the commonly encountered abdominal masses in neonates and children with emphasis on imaging guidelines and recommendations.
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Affiliation(s)
- Helen H R Kim
- Department of Radiology, Seattle Children's Hospital and University of Washington, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA.
| | - Nathan C Hull
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 330 Longwood Avenue, Boston, MA 02115, USA
| | - Grace S Phillips
- Department of Radiology, Seattle Children's Hospital and University of Washington, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA
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16
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Hull NC, Kim HHR, Phillips GS, Lee EY. Neonatal and Pediatric Bowel Obstruction: Imaging Guidelines and Recommendations. Radiol Clin North Am 2021; 60:131-148. [PMID: 34836560 DOI: 10.1016/j.rcl.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Pediatric bowel obstructions are one of the most common surgical emergencies in children, and imaging plays a vital role in the evaluation and diagnosis. An evidence-based and practical imaging approach to diagnosing and localizing pediatric bowel obstructions is essential for optimal pediatric patient care. This article discusses an up-to-date practical diagnostic imaging algorithm for pediatric bowel obstructions and presents the imaging spectrum of pediatric bowel obstructions and their underlying causes.
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Affiliation(s)
- Nathan C Hull
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Helen H R Kim
- Department of Radiology, Seattle Children's Hospital and University of Washington, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA
| | - Grace S Phillips
- Department of Radiology, Seattle Children's Hospital and University of Washington, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 330 Longwood Avenue, Boston, MA 02115, USA
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17
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Maxfield CM, Montano-Campos JF, Chapman T, Desser TS, Ho CP, Hull NC, Kelly HR, Kennedy TA, Koontz NA, Knippa EE, McLoud TC, Milburn J, Mills MK, Morgan DE, Morgan R, Peterson RB, Salastekar N, Thorpe MP, Zarzour JG, Reed SD, Grimm LJ. Factors Influential in the Selection of Radiology Residents in the Post-Step 1 World: A Discrete Choice Experiment. J Am Coll Radiol 2021; 18:1572-1580. [PMID: 34332914 DOI: 10.1016/j.jacr.2021.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/06/2021] [Accepted: 07/09/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Reporting of United States Medical Licensing Examination Step 1 results will transition from a numerical score to a pass or fail result. We sought an objective analysis to determine changes in the relative importance of resident application attributes when numerical Step 1 results are replaced. METHODS A discrete choice experiment was designed to model radiology resident selection and determine the relative weights of various application factors when paired with a numerical or pass or fail Step 1 result. Faculty involved in resident selection at 14 US radiology programs chose between hypothetical pairs of applicant profiles between August and November 2020. A conditional logistic regression model assessed the relative weights of the attributes, and odds ratios (ORs) were calculated. RESULTS There were 212 participants. When a numerical Step 1 score was provided, the most influential attributes were medical school (OR: 2.35, 95% confidence interval [CI]: 2.07-2.67), Black or Hispanic race or ethnicity (OR: 2.04, 95% CI: 1.79-2.38), and Step 1 score (OR: 1.8, 95% CI: 1.69-1.95). When Step 1 was reported as pass, the applicant's medical school grew in influence (OR: 2.78, 95% CI: 2.42-3.18), and there was a significant increase in influence of Step 2 scores (OR: 1.31, 95% CI: 1.23-1.40 versus OR 1.57, 95% CI: 1.46-1.69). There was little change in the relative influence of race or ethnicity, gender, class rank, or clerkship honors. DISCUSSION When Step 1 reporting transitions to pass or fail, medical school prestige gains outsized influence and Step 2 scores partly fill the gap left by Step 1 examination as a single metric of decisive importance in application decisions.
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Affiliation(s)
- Charles M Maxfield
- Vice-Chair of Education, Department of Radiology, Duke University Medical Center, Durham, North Carolina.
| | - J Felipe Montano-Campos
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Teresa Chapman
- Residency Program Director, Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Terry S Desser
- Department of Radiology, Stanford University Medical Center, Stanford, California
| | - Christopher P Ho
- Residency Program Director, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Nathan C Hull
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Hillary R Kelly
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Tabassum A Kennedy
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Nicholas A Koontz
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
| | - Emily E Knippa
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Theresa C McLoud
- Vice-Chair of Education, Residency Program Director, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - James Milburn
- Residency Program Director, Department of Radiology, Ochsner Health System, New Orleans, Louisiana
| | - Megan K Mills
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Desiree E Morgan
- Vice-Chair of Education, Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rustain Morgan
- Residency Program Director, Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Ryan B Peterson
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Ninad Salastekar
- Department of Radiology, SUNY Upstate Medical University, Syracuse, New York
| | | | - Jessica G Zarzour
- Radiology Residency Program Director, Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Shelby D Reed
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Lars J Grimm
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
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18
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Kolbe AB, Ibirogba ER, Thomas KB, Hull NC, Thacker PG, Hathcock M, Sangi-Haghpeykar H, Ruano R. Reproducibility of Lung and Liver Volume Measurements on Fetal Magnetic Resonance Imaging in Left-Sided Congenital Diaphragmatic Hernia. Fetal Diagn Ther 2021; 48:258-264. [PMID: 33756472 DOI: 10.1159/000512491] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/22/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Congenital diaphragmatic hernia (CDH) affects 1 in 3,000 live births and is associated with significant morbidity and mortality. METHODS A review of fetal magnetic resonance imaging (MRI) examinations was performed for fetuses with left CDH and normal lung controls. Image review and manual tracings were performed by 4 pediatric radiologists; right and left lung volumes in the coronal and axial planes as well as liver volume above and below the diaphragm in the coronal plane were measured. Intra- and interreviewer reproducibility was assessed using intraclass correlation coefficient (ICC) and Bland-Altman analysis. RESULTS Excellent intra- and interreviewer reproducibility of the right and left lung volume measurements was observed in both axial planes (interreviewer ICC: right lung: 0.97, 95% CI: 0.95-0.99; left lung: 0.97, 95% CI: 0.95-0.98) and coronal planes (interreviewer ICC: right lung: 0.97, 95% CI: 0.95-0.98; left lung: 0.96, 95% CI: 0.93-0.98). Moderate-to-good interreviewer reproducibility was observed for liver volume above the diaphragm (ICC 0.7, 95% CI: 0.59-0.81). Liver volume below the diaphragm had a good-to-excellent interreviewer reproducibility (ICC 0.88, 95% CI: 9.82-0.93). CONCLUSIONS The present study demonstrated an excellent intra- and interreviewer reproducibility of MRI lung volume measurements and good-to-moderate inter- and intrareviewer reproducibility of liver volume measurements after standardization of the methods at our fetal center.
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Affiliation(s)
- Amy B Kolbe
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Eniola R Ibirogba
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Kristen B Thomas
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Nathan C Hull
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Paul G Thacker
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Matthew Hathcock
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Haleh Sangi-Haghpeykar
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Rodrigo Ruano
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA,
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19
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Xiao L, Granberg CF, Hull NC. Bladder hemangioma: An arduous diagnosis of hematuria. Radiol Case Rep 2021; 16:1042-1046. [PMID: 33680273 PMCID: PMC7917461 DOI: 10.1016/j.radcr.2021.02.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/12/2021] [Accepted: 02/12/2021] [Indexed: 01/03/2023] Open
Abstract
Urinary bladder hemangiomas are a rare cause of gross hematuria in young patients. Multimodality imaging with ultrasound, computed tomography, and magnetic resonance imaging help define the site and extent of hemangioma. We describe a case of an otherwise healthy 9-year-old male presenting with recurrent gross hematuria. The initial US did not demonstrate a bladder mass, but subsequent cystoscopies showed progressive enlargement of an extensive sessile and partially pedunculated vascular mass. Imaging with ultrasound, computed tomography, and magnetic resonance imaging persistently demonstrated a hypervascular bladder mass without extravesical extension. Ultimately, biopsy of the mass made the diagnosis of bladder hemangioma.
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Affiliation(s)
- Lekui Xiao
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55902, USA,Corresponding author.
| | - Candace F. Granberg
- Department of Urology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55902, USA
| | - Nathan C. Hull
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55902, USA
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20
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Browne JE, Bruesewitz MR, Thomas V, Thomas KB, Hull NC, McCollough CH, Yu L. Procedure for optimal implementation of automatic tube potential selection in pediatric CT to reduce radiation dose and improve workflow. J Appl Clin Med Phys 2020; 22:194-202. [PMID: 33338314 PMCID: PMC7882104 DOI: 10.1002/acm2.13098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/21/2020] [Accepted: 10/21/2020] [Indexed: 11/30/2022] Open
Abstract
It is important to employ radiation dose reduction techniques in pediatric computed tomography (CT) to reduce potential risks of radiation‐induced malignancy. Automatic tube potential (kV) selection tools have been developed and become available on many CT scanners, which select the optimum kV based on the patient size and clinical task to improve the radiation dose efficiency. However, its use in pediatric CT has been mostly empirical, following manufacturer’s default recommendation without solid demonstration for quality improvement. This study aimed to implement an automatic tube potential tool (CAREkV, Siemens Healthcare) into routine pediatric CT practice, using the “Plan‐Do‐Study‐Act” quality improvement process, in place of an existing kV/mAs technique chart. The design of this quality improvement project involved Plan‐Do‐Study‐Act stages. Plan and Do stages identified the criteria for optimal automatic kV selection; a range of phantoms representing typical pediatric groups were scanned on a dual‐source 128‐slice scanner using a fast‐pitch scanning mode. The identified CAREkV settings were implemented into the CT protocol and evaluated after a 6‐month period. In the Study stage, an objective evaluation of the image metrics and radiation dose for two similar patient cohorts using CAREkV and the technique‐chart, respectively, were compared. The kV selected, image quality and radiation dose determined by CAREkV were comparable to those obtained while using the technique‐chart. The CAREkV was successfully implemented into our pediatric abdominopelvic CT practice. By utilizing the “PDSA” process optimal image quality and radiation dose reduction were achieved with an automatic kV selection tool to improve CT workflow.
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Affiliation(s)
| | | | - Vrieze Thomas
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Nathan C Hull
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Lifeng Yu
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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21
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St Jeor JD, Thomas KB, Thacker PG, Hull NC. Multifocal subacute osteomyelitis in adjacent bones in the ankle without septic joint. Radiol Case Rep 2020; 15:1927-1930. [PMID: 32874386 PMCID: PMC7452080 DOI: 10.1016/j.radcr.2020.07.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/24/2020] [Accepted: 07/25/2020] [Indexed: 11/27/2022] Open
Abstract
Osteomyelitis is an inflammation involving bone and/or bone marrow most often the result of bacterial infection of the bone. In children, osteomyelitis most often has an acute presentation and is caused by hematogenous spread. When osteomyelitis is seen in the extremities, conventional radiography is the first-line imaging modality preformed for diagnosis with magnetic resonance imaging employed for further delineation or as a problem-solving tool. A healthy 6-year-old female presented with a history of nonspecific left leg pain for 3-5 weeks which gradually progressed to focal left ankle pain and swelling. Further workup revealed multifocal subacute osteomyelitis with Brodie's abscesses seen on imaging in the absence of a septic joint. This was an uncommon presentation for the following reasons: Patients with multifocal osteomyelitis usually present in the acute setting, as opposed to the subacute setting. When osteomyelitis is multifocal or Brodie's abscesses are present adjacent to the joint capsule, concomitant septic joint is commonly seen.
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Affiliation(s)
- Jeffery D St Jeor
- Mayo Clinic School of Medicine, 200 1st St SW, Rochester, MN 55902, USA
| | | | - Paul G Thacker
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Nathan C Hull
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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22
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Thacker PG, Kolbe AB, Hull NC, Thomas KB, Geske JR, Binkovitz LA. Pediatric Patients and Diagnostic Thoracentesis: Utility for Identifying a Microorganism and Guiding Patient Management. Radiology 2020; 297:449-450. [PMID: 32840471 DOI: 10.1148/radiol.2020201511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Paul G Thacker
- From the Departments of Radiology (P.G.T., A.B.K., N.C.H., K.B.T., L.A.B.) and Health Sciences Research (J.R.G.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Amy B Kolbe
- From the Departments of Radiology (P.G.T., A.B.K., N.C.H., K.B.T., L.A.B.) and Health Sciences Research (J.R.G.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Nathan C Hull
- From the Departments of Radiology (P.G.T., A.B.K., N.C.H., K.B.T., L.A.B.) and Health Sciences Research (J.R.G.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Kristen B Thomas
- From the Departments of Radiology (P.G.T., A.B.K., N.C.H., K.B.T., L.A.B.) and Health Sciences Research (J.R.G.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Jennifer R Geske
- From the Departments of Radiology (P.G.T., A.B.K., N.C.H., K.B.T., L.A.B.) and Health Sciences Research (J.R.G.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Larry A Binkovitz
- From the Departments of Radiology (P.G.T., A.B.K., N.C.H., K.B.T., L.A.B.) and Health Sciences Research (J.R.G.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
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Maxfield CM, Thorpe MP, Desser TS, Heitkamp D, Hull NC, Johnson KS, Koontz NA, Mlady GW, Welch TJ, Grimm LJ. Awareness of implicit bias mitigates discrimination in radiology resident selection. Med Educ 2020; 54:637-642. [PMID: 32119145 DOI: 10.1111/medu.14146] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/25/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Implicit bias is common and is thought to drive discriminatory behaviour. Having previously demonstrated discrimination against specific applicant demographics by academic radiology departments in a simulated resident selection process, the authors sought to better understand the relationship between implicit bias and discrimination, as well as the potential and mechanisms for their mitigation. METHODS A total of 51 faculty reviewers at three academic radiology departments, who had participated in a 2017 audit study in which they were shown to treat applicants differently based on race or ethnicity and physical appearance, were invited to complete testing for implicit racial and weight bias using the Implicit Association Test in 2019. Respondents were also surveyed regarding awareness of their own personal racial and weight biases, as well as any prior participation in formal diversity training. Comparisons were made between implicit bias scores and applicant ratings, as well as between diversity training and self-awareness of bias. RESULTS A total of 31 out of 51 faculty reviewers (61%) completed and submitted results of race and weight Implicit Association Tests. A total of 74% (23/31) reported implicit anti-obese bias, concordant with discrimination demonstrated in the resident selection simulation, in which obese applicants were rated 0.40 standard deviations (SDs) lower than non-obese applicants (P < .001). A total of 71% (22/31) reported implicit anti-Black bias, discordant with application ratings, which were 0.47 SDs higher for Black than for White applicants (P < .001). A total of 84% (26/31) of participants reported feeling self-aware of potential racial bias at the time of application review, significantly higher than the 23% (7/31) reporting self-awareness of potential anti-obese bias (P < .001). Participation in formal diversity training was not associated with implicit anti-Black or anti-fat bias, nor with self-reported awareness of potential racial or weight-based bias (all P > .2). CONCLUSIONS These findings suggest that implicit bias, as measured by the Implicit Association Test, does not inevitably lead to discrimination, and that personal awareness of implicit biases may allow their mitigation.
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Affiliation(s)
- Charles M Maxfield
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Terry S Desser
- Department of Radiology, Stanford University Medical Center, Stanford, California, USA
| | | | - Nathan C Hull
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Karen S Johnson
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Nicholas A Koontz
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Gary W Mlady
- Department of Radiology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Timothy J Welch
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lars J Grimm
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
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24
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St Jeor JD, Thacker PG, Benson JC, Hull NC. Anaplastic ependymoma metastases though a ventriculoperitoneal shunt. Radiol Case Rep 2020; 15:650-654. [PMID: 32280394 PMCID: PMC7136589 DOI: 10.1016/j.radcr.2020.02.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 11/20/2022] Open
Abstract
Ependymomas are rare glial tumors that comprise 10% of intracranial pediatric malignancies. Primary central nervous system malignancies can rarely metastasize extracranially. When metastases occur, it usually does so in the setting of surgical manipulation of the central nervous system and can spread through the blood, lymph, or artificial means, for example, a ventriculoperitoneal shunt. We describe the presentation and progression of an 18-month-old boy diagnosed with an ependymoma. Initially managed with surgery, radiation, and ventriculoperitoneal shunt placement for symptomatic hydrocephalus, the tumor later recurred with drop metastasis to the thoracic spinal cord. The patient subsequently developed extensive metastases within the abdominal cavity, which were seeded through a ventriculoperitoneal shunt. We present a case of a rare complication of intra-abdominal tumor seeding and carcinomatosis from an intracranial ependymoma through a ventriculoperitoneal shunt. This is a rare presentation of a possible complication, which requires awareness of both surgeons and radiologists.
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Affiliation(s)
| | - Paul G. Thacker
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55902, USA
| | - John C. Benson
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55902, USA
| | - Nathan C. Hull
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55902, USA
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25
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Maxfield CM, Thorpe MP, Desser TS, Heitkamp DE, Hull NC, Johnson KS, Koontz NA, Mlady GW, Welch TJ, Grimm LJ. Bias in Radiology Resident Selection: Do We Discriminate Against the Obese and Unattractive? Acad Med 2019; 94:1774-1780. [PMID: 31149924 DOI: 10.1097/acm.0000000000002813] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
PURPOSE To evaluate for appearance-based discrimination in the selection of radiology residents. METHOD A deception study simulating the resident selection process examined the impact of attractiveness and obesity on resident selection. Seventy-four core faculty from 5 academic radiology departments reviewed mock residency applications in September and October 2017. Each application included demographic information and a photograph, representing a prespecified distribution of facial attractiveness and obesity, combined with randomized academic and supporting variables. Reviewers independently scored applications for interview desirability. Reviewer scores and application variables were compared using linear mixed fixed- and random-effects models. RESULTS Reviewers evaluated 5,447 applications (mean: 74 applications per reviewer). United States Medical Licensing Examination Step 1 scores were the strongest predictor of reviewer rating (B = 0.35 [standard error (SE) = 0.029]). Applicant facial attractiveness strongly predicted rating (attractive vs unattractive, B = 0.30 [SE = 0.056]; neutral vs unattractive, B = 0.13 [SE = 0.028]). Less influential but still significant predictors included race/ethnicity (B = 0.25 [SE = 0.059]), preclinical class rank (B = 0.25 [SE = 0.040]), clinical clerkship grades (B = 0.23 [SE = 0.034]), Alpha Omega Alpha membership (B = 0.21 [SE = 0.032]), and obesity (vs not obese) (B = -0.14 [SE = 0.024]). CONCLUSIONS Findings provide preliminary evidence of discrimination against facially unattractive and obese applicants in radiology resident selection. Obesity and attractiveness were as influential in applicant selection for interview as traditional medical school performance metrics. Selection committees should invoke strategies to detect and manage appearance-based bias.
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Affiliation(s)
- Charles M Maxfield
- C.M. Maxfield is vice chair of education, Department of Radiology, Duke University Medical Center, Durham, North Carolina. M.P. Thorpe is a radiology resident, Department of Radiology, Duke University Medical Center, Durham, North Carolina. T.S. Desser is professor, Department of Radiology, Stanford University Medical Center, Stanford, California. D.E. Heitkamp is staff radiologist and associate residency program director, Florida Hospital, Orlando, Florida. N.C. Hull is assistant professor, Department of Radiology, Mayo Clinic, Rochester, Minnesota. K.S. Johnson is residency program director, Department of Radiology, Duke University Medical Center, Durham, North Carolina. N.A. Koontz is director of fellowship programs, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana. G.W. Mlady is chair, Department of Radiology, University of New Mexico, Albuquerque, New Mexico. T.J. Welch is associate chair of education, Department of Radiology, Mayo Clinic, Rochester, Minnesota. L.J. Grimm is assistant professor, Department of Radiology, Duke University Medical Center, Durham, North Carolina
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Cousin MA, Conboy E, Wang JS, Lenz D, Schwab TL, Williams M, Abraham RS, Barnett S, El-Youssef M, Graham RP, Gutierrez Sanchez LH, Hasadsri L, Hoffmann GF, Hull NC, Kopajtich R, Kovacs-Nagy R, Li JQ, Marx-Berger D, McLin V, McNiven MA, Mounajjed T, Prokisch H, Rymen D, Schulze RJ, Staufner C, Yang Y, Clark KJ, Lanpher BC, Klee EW. RINT1 Bi-allelic Variations Cause Infantile-Onset Recurrent Acute Liver Failure and Skeletal Abnormalities. Am J Hum Genet 2019; 105:108-121. [PMID: 31204009 DOI: 10.1016/j.ajhg.2019.05.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 05/13/2019] [Indexed: 01/12/2023] Open
Abstract
Pediatric acute liver failure (ALF) is life threatening with genetic, immunologic, and environmental etiologies. Approximately half of all cases remain unexplained. Recurrent ALF (RALF) in infants describes repeated episodes of severe liver injury with recovery of hepatic function between crises. We describe bi-allelic RINT1 alterations as the cause of a multisystem disorder including RALF and skeletal abnormalities. Three unrelated individuals with RALF onset ≤3 years of age have splice alterations at the same position (c.1333+1G>A or G>T) in trans with a missense (p.Ala368Thr or p.Leu370Pro) or in-frame deletion (p.Val618_Lys619del) in RINT1. ALF episodes are concomitant with fever/infection and not all individuals have complete normalization of liver function testing between episodes. Liver biopsies revealed nonspecific liver damage including fibrosis, steatosis, or mild increases in Kupffer cells. Skeletal imaging revealed abnormalities affecting the vertebrae and pelvis. Dermal fibroblasts showed splice-variant mediated skipping of exon 9 leading to an out-of-frame product and nonsense-mediated transcript decay. Fibroblasts also revealed decreased RINT1 protein, abnormal Golgi morphology, and impaired autophagic flux compared to control. RINT1 interacts with NBAS, recently implicated in RALF, and UVRAG, to facilitate Golgi-to-ER retrograde vesicle transport. During nutrient depletion or infection, Golgi-to-ER transport is suppressed and autophagy is promoted through UVRAG regulation by mTOR. Aberrant autophagy has been associated with the development of similar skeletal abnormalities and also with liver disease, suggesting that disruption of these RINT1 functions may explain the liver and skeletal findings. Clarifying the pathomechanism underlying this gene-disease relationship may inform therapeutic opportunities.
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Hull NC, Schooler GR, Lee EY. Hepatobiliary MR Imaging in Children:. Magn Reson Imaging Clin N Am 2019; 27:263-278. [DOI: 10.1016/j.mric.2019.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Binkovitz LA, Kolbe AB, Orth RC, Mahmood NF, Thapa P, Hull NC, Thacker PG, Moir C. Correction to: Pediatric ileocolic intussusception: new observations and unexpected implications. Pediatr Radiol 2019; 49:429. [PMID: 30683960 DOI: 10.1007/s00247-019-04343-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In this article, the fourth author's name is misspelled. The correct spelling, as shown above, should be "Nadia F. Mahmood."
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Affiliation(s)
- Larry A Binkovitz
- Division of Pediatric Radiology, Mayo Clinic, 2107 Folwell Ridge St. SW, Rochester, MN, 55902, USA.
| | - Amy B Kolbe
- Division of Pediatric Radiology, Mayo Clinic, 2107 Folwell Ridge St. SW, Rochester, MN, 55902, USA
| | - Robert C Orth
- Department of Radiology, Texas Children's Medical Center, Houston, TX, USA
| | - Nadia F Mahmood
- Department of Radiology, Texas Children's Medical Center, Houston, TX, USA
| | - Prabin Thapa
- Department of Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Nathan C Hull
- Division of Pediatric Radiology, Mayo Clinic, 2107 Folwell Ridge St. SW, Rochester, MN, 55902, USA
| | - Paul G Thacker
- Division of Pediatric Radiology, Mayo Clinic, 2107 Folwell Ridge St. SW, Rochester, MN, 55902, USA
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Binkovitz LA, Unsdorfer KML, Thapa P, Kolbe AB, Hull NC, Zingula SN, Thomas KB, Homme JL. Appendiceal ultrasound: the importance of determinacy. Pediatr Radiol 2015; 45:1932-3. [PMID: 26280636 DOI: 10.1007/s00247-015-3429-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 07/02/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Larry A Binkovitz
- Department of Diagnostic Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
| | | | - Prabin Thapa
- Department of Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Amy B Kolbe
- Department of Diagnostic Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Nathan C Hull
- Department of Diagnostic Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Shannon N Zingula
- Department of Diagnostic Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Kristen B Thomas
- Department of Diagnostic Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - James L Homme
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA
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Viers BR, Viers LD, Hull NC, Hanson TJ, Mehta RA, Bergstralh EJ, Vrtiska TJ, Krambeck AE. The Difficult Ureter: Clinical and Radiographic Characteristics Associated With Upper Urinary Tract Access at the Time of Ureteroscopic Stone Treatment. Urology 2015; 86:878-84. [DOI: 10.1016/j.urology.2015.08.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 08/10/2015] [Accepted: 08/10/2015] [Indexed: 11/28/2022]
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Volandes AE, Ferguson LA, Davis AD, Hull NC, Green MJ, Chang Y, Deep K, Paasche-Orlow MK. Assessing end-of-life preferences for advanced dementia in rural patients using an educational video: a randomized controlled trial. J Palliat Med 2011; 14:169-77. [PMID: 21254815 DOI: 10.1089/jpm.2010.0299] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Few studies have evaluated the end-of-life preferences of elderly patients in rural communities and whether preferences are associated with level of health literacy. DESIGN Randomized controlled trial of a goals-of-care video decision aid of advanced dementia. PARTICIPANTS Elderly subjects (65 years or older) at a primary care clinic in rural Louisiana. METHODS Half of subjects heard a verbal description of advanced dementia and the goals of care; the other half heard the same verbal description and then viewed the video decision aid. End points were the preferred goal of care in advanced dementia: life-prolonging care (cardiopulmonary resuscitation [CPR], etc.), limited care (hospitalization but not CPR), or comfort care (symptom relief). The principal category for analysis was the difference in proportions of subjects preferring comfort care for each characteristic including randomization group and health literacy level. RESULTS Seventy-six subjects were randomized to the verbal (n = 43) or video (n = 33) arms of the study. Among subjects receiving the verbal description of advanced dementia and the goals of care, 31 (72%) preferred comfort; 5 (12%) chose limited; and 7 (16%) desired life-prolonging. In the video group, 30 (91%) preferred comfort; 3 (9%) chose limited; and none desired life-prolonging (χ(2) = 6.3, df = 2, p = 0.047). Factors associated with greater likelihood of opting for comfort included greater health literacy (unadjusted odds ratio [OR] 12.1; 95% confidence interval [CI], 2.4-62.6) and randomization to the video (unadjusted OR 3.9; 95% CI, 1.0-15.1). CONCLUSION Rural subjects with higher health literacy were more likely to want comfort care compared to those with lower levels of health literacy. Furthermore, subjects who viewed a video decision aid were more likely to opt for comfort compared to those who solely listened to a verbal description. These findings suggest that video can help elicit preferences and that interventions to empower such patients need to be designed in a manner that is sensitive to health literacy.
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Affiliation(s)
- Angelo E Volandes
- General Medicine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.
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