Aparna Joshi

Aerosol delivery in ventilated newborn pigs: an MRI evaluation.

Pulmonary deposition of inhaled drugs in ventilated neonates has not been studied in vivo. The objective of this study was to evaluate pulmonary delivery of gadopentetate dimeglumine (Gd-DTPA) following nebulization in ventilated piglets using magnetic resonance imaging. Seven ventilated piglets (5 ± 2 d old, weight 1.8 ± 0.5 kg) were scanned in the Bruker/Siemens 4T magnetic resonance scanner using T1 weighted spin-echo sequence. Aerosols of Gd-DTPA were generated continuously using the MiniHeart jet nebulizer. Breath-hold coronal images were obtained before and every 10 min during aerosolized Gd-DTPA for 90 min. Signal intensity (SI) changes over the lungs, kidneys, liver, skeletal muscle, and heart were evaluated. A significant increase in SI was observed in the lungs, kidney, and liver at 10, 20, and 40 min respectively after start of aerosol. At the end of 90 min, the SI increased by 95%, 101%, and 426% over the right lung, left lung, and kidney, respectively. A much smaller increase in SI was observed over the liver. In conclusion, we have demonstrated effective pulmonary aerosol delivery within 10 min of contrast nebulization in ventilated piglets. Contrast visualization in the kidneys within 20 min of aerosol initiation reflects alveolar absorption, glomerular filtration and renal concentration.

Positron emission tomography in subcutaneous panniculitis-like T-cell lymphoma

Subcutaneous panniculitis‐like T‐cell lymphoma (SPTCL), an uncommon disorder, was diagnosed in a 17‐year‐old female when she presented with multiple hard subcutaneous masses that developed over 3 years. She was treated on chemotherapy consisting of cyclophosphamide, doxorubicin, vincristine, and prednisone. Pre‐ and post‐treatment positron emission tomography study demonstrated dramatic resolution of the subcutaneous lesions indicating its usefulness in SPTCL staging and treatment response monitoring. Pediatr Blood Cancer 2009;52:406–408.

Congenital Absence of Bilateral Common Carotid Arteries

Congenital bilateral absence of the internal carotid arteries (CA) is a rare vascular abnormality, in which cerebral perfusion is maintained solely by the vertebral arteries [1]. Congenital absence of the common CA has not been described, to our knowledge. A full-term infant received a diagnosis of aortic valve atresia, severely hypoplastic (1.5 mm) ascending aorta (AAo), a large perimembranous ventricular septal defect, and a large ductus on echocardiogram. Magnetic resonance imaging obtained to assess the arch anatomy showed an interrupted aortic arch and aortic atresia without visualization of the AAo or the transverse aortic arch (Fig 1; MPA main pulmonary artery). The left subclavian artery (LSA) arose from the proximal descending aorta (dsAo), where the left-sided arterial duct (LAD) was connected and gave rise to the left vertebral artery (LVA). The right-sided arterial duct (RAD) arose from the right pulmonary artery and

Volume US of the urinary tract in pediatric patients—a pilot study

Three-dimensional ultrasonography (3DUS) adds functionality to two-dimensional ultrasonography (2DUS) by allowing examiners to explore volume datasets using multiplanar or rendering methods already familiar to radiologists. In this pilot study, 30 patients referred for ultrasound examination of the urinary tract were examined by 3DUS. Three abnormalities initially not detected by 2DUS were seen: bilateral bladder diverticulae, urachal remnant and bilateral accessory renal arteries. Rendered images of the bladder trigone were feasible in the majority of patients. Potential applications of this technology in pediatric uroradiology and technical pitfalls are illustrated.

Radiographic Evaluation of the Child with Heart Disease

Despite the development of advanced imaging techniques, the chest radiograph remains an important tool in evaluation of the child with heart disease in the acute care setting. A systematic approach should be used in reviewing chest radiographs, with the “ABCD’S” mnemonic serving as a useful checklist of items to evaluate. On the chest radiograph, abnormalities in cardiac size and shape, pulmonary vasculature, airway position and morphology, and situs and osseous structures may be encountered in children with heart disease. The differential diagnoses of massive cardiothymic silhouette enlargement are relatively limited. Specific chamber enlargement may be determined in older children. Abnormalities in the radiographic appearance of the pulmonary vasculature reflect underlying alterations in pulmonary blood flow. Airway position deviates from normal in the presence of a vascular ring/pulmonary sling or mediastinal mass. Situs abnormalities detected on chest radiographs should prompt additional cardiac evaluation since the incidence of congenital heart disease is greater than normal in such cases. Osseous abnormalities may be seen on the chest radiograph in association with cardiovascular lesions or as a result of medical and surgical treatment for cardiovascular disease.