Anna Blask

Color Doppler sonography and scintigraphy of the testis: a prospective, comparative analysis in children with acute scrotal pain.

Objective To compare testicular color Doppler sonography with testicular scintigraphy in differentiating between surgical and nonsurgical conditions of the pediatric testis, and to evaluate the role of testicular color Doppler sonography in the pediatric population. Materials and Methods Forty-six children (age range, 1 day to 18 years; median age, 11 years) with acute scrotal pain were evaluated with both scintigraphy and color Doppler sonography by two separate groups of radiologists who had no knowledge of the results of the other modality. The final radiologic diagnosis was classified as a surgical condition, nonsurgical condition, or indeterminate and was compared with the patient’s surgical diagnosis or clinical diagnosis, which was established by response to treatment and follow-up. Results Sonography correctly diagnosed 11 of 14 surgical conditions and 31 of 32 nonsurgical conditions. There was one indeterminate sonogram. There were no false-positive examinations, and there were three false-negative examinations (sensitivity = 78.6% [95% CI, 66.7–90.5%], specificity = 96.9% [95% CI, 94.3–99.5%], accuracy = 91.3%). Color flow was demonstrated in the asymptomatic testis in 34 of 44 boys. Scintigraphy correctly diagnosed 11 of 14 surgical conditions and 29 of 32 nonsurgical conditions. There were two indeterminate scintigrams. There were two false-positive examinations and two false-negative examinations (sensitivity = 78.6% [95% CI, 66.7%–90.5%], specificity = 90.6% [95%CI, 82.2%–99.0%], accuracy = 87.0%). Conclusions Color Doppler sonography and scintigraphy show similar sensitivity for the diagnosis of testicular torsion. A small number of false-negative cases can occur with either modality. The two studies may provide complementary information in indeterminate cases.

Sonographic Appearance of the Epididymis in Pediatric Testicular Torsion

OBJECTIVE The purpose of this study was to determine the frequency of an enlarged epididymis in pediatric patients with testicular torsion and to determine whether an altered epididymis might be a helpful ancillary sonographic sign of testicular torsion. MATERIALS AND METHODS The sonograms of 50 pediatric patients (age range, neonate-17 years) with testicular torsion were retrospectively reviewed for the size, appearance, and blood flow of the epididymis. Medical records were reviewed for surgical and pathologic findings and to determine whether testicular salvage had been possible. RESULTS The epididymis was enlarged (maximum dimension, 5.5 cm) in 47 of the 50 patients with acute or late phase torsion and after manual or spontaneous detorsion. The average difference in volume between the ipsilateral epididymis and the contralateral epididymis was 30 cm3, highly significant (p < 0.0001). The shape of the epididymis was altered in 92% of the cases (globular, bilobular, or multilobular). Seventy-three percent showed increased echogenicity and 27% appeared isoechoic. Of those with active torsion, 93% of the epididymides were avascular; 2%, hypovascular; and 5%, hypervascular. After detorsion, 100% of the epididymides (10/10) had blood flow. In patients with testicular loss due to infarction, pathology showed engorgement and enlargement of the epididymis with hemorrhagic infarction. In one patient with a hypervascular epididymis, surgery showed inflammation and erythema of the epididymis. Testicular loss occurred in each type of epididymal flow pattern. CONCLUSION A markedly enlarged, echogenic, and avascular or hypovascular epididymis is an ancillary sonographic sign in pediatric patients with testicular torsion. A hypervascular enlarged epididymis infrequently occurs (5% of cases) and should not be mistaken for epididymitis. In addition, the return of epididymal blood flow is an ancillary sign of successful testicular detorsion.

Clinical Utility of Fetal Magnetic Resonance Imaging in Tetralogy of Fallot With Absent Pulmonary Valve

A 28-year-old woman was referred to an outside center at 20 weeks’ gestation for fetal echocardiogram, which revealed the diagnosis of tetralogy of Fallot with absent pulmonary valve. There were an anterior malalignment-type ventricular septal defect, overriding aorta, and severe pulmonary insufficiency in the setting of severely dysplastic, rudimentary pulmonary valve leaflets. The patient presented to our center at 31 weeks for follow-up evaluation and delivery management planning. Fetal echocardiogram confirmed the diagnosis. The main and branch pulmonary arteries were markedly dilated (Figure 1A and 1B and Movies I and II in the online-only Data Supplement), and there was no ductus arteriosus. The cardiac silhouette was shifted leftward with a cardiac axis of 112°, deviating significantly from a normal fetal cardiac axis of 45° (Figure 1C). The left lung appeared small and diffusely hyperechoic relative to the right lung, suggesting atelectasis or consolidation. Figure 1. A , Fetal echocardiogram image demonstrating massively dilated main and branch pulmonary arteries. Arrow indicates the rudimentary pulmonary valve. LPA indicates left pulmonary artery; and RPA, right pulmonary artery. B , Sagittal fetal echocardiogram image demonstrating a cross section of the massively dilated right pulmonary artery. Ao indicates aorta. C , Axial echocardiographic view of the fetal chest demonstrating marked leftward deviation of the cardiac axis in the setting of right lung overexpansion and left lung hypoplasia vs compressive volume loss. The angle demonstrates a cardiac axis of 112°. Note that the left lung appears more echo-bright compared with the right lung. LL indicates left lung; LV, left ventricle; RL, …

Neuroimaging Findings in Normocephalic Newborns With Intrauterine Zika Virus Exposure

BACKGROUND Congenital Zika infection can result in a spectrum of neurological abnormalities in the newborn. Newborns exposed to Zika virus in utero often have neuroimaging as part of their clinical evaluation. METHODS Through the Congenital Zika Program at Childrens National Health System in Washington DC, we performed fetal or neonatal neuroimaging, including magnetic resonance imaging and ultrasound, on over 70 fetuses or neonates with intrauterine Zika exposure. Novel findings on neonatal brain magnetic resonance imaging were observed in two instances. RESULTS Gadolinium-contrast magnetic resonance imaging showed enhancement of multiple cranial nerves at three days of age on one infant. Another infant underwent magnetic resonance imaging at 16 days of age and was shown to have a chronic ischemic cerebral infarction. This infant had previously normal fetal magnetic resonance imaging. CONCLUSION Cranial nerve enhancement and cerebral infarction may be among the expanding list of neurological findings in congenital Zika infection. Postnatal brain magnetic resonance imaging should be considered for newborns exposed to Zika virus in utero.

Ovary and Testicle and Everything in Between: Lesions and Imaging in the Newborn

Assessment of the neonatal reproductive tract requires an understanding of embryology, awareness of common clinical presentations, and familiarity with normal newborn variation. This review of the neonatal reproductive tract emphasizes the use of sonography in the evaluation of developmental, acquired, and neoplastic conditions in male and female newborns. Anchored in embryologic origins, the discussion also includes descriptions of findings that may be encountered in prenatal imaging. Comments on clinical correlation are included to guide appropriate triaging of these complex cases. Imaging pearls and pitfalls are incorporated into this review, including the recognized effects of maternal hormones in female infants.

Achondroplasia in the Premature Infant: An Elusive Diagnosis in the Neonatal Intensive Care Unit

Achondroplasia is a difficult prenatal diagnosis to make before the late second and third trimester. We describe two cases where an infant was born prematurely with no overt signs of achondroplasia. Despite multiple chest and abdominal radiographs during the neonatal course, the diagnosis was not made until term equivalent age was reached. We retrospectively reviewed these two cases to highlight the elusive findings of achondroplasia in the premature infant.

Testicular torsion with preserved flow: key sonographic features and value-added approach to diagnosis

Testicular sonography has contributed greatly to the preoperative diagnosis of testicular torsion in the pediatric patient and is the mainstay for evaluation of acute scrotal pain. Despite its high sensitivity and specificity, both false-negative and false-positive findings occur. Presence of documented Doppler flow within the testis might be a dissuading factor for surgical exploration with resultant testicular loss in the false-negative cases. Our goal is to illustrate key sonographic features in the spectrum of testicular torsion with preserved testicular flow, and to describe how to differentiate testicular torsion from epididymitis in order to avoid the under-diagnosis of testicular torsion. We simplify the anatomy of the bell clapper testis. We also describe our sonographic protocol for testicular torsion and share valuable tips from our approach to challenging cases.