Arthur B. Meyers

Characterization of pediatric liver lesions with gadoxetate disodium.

Gadoxetate disodium (Gd-EOB-DTPA) is a relatively new hepatobiliary MRI contrast agent. It is increasingly used in adults to characterize hepatic masses, but there is little published describing its use in children. The purpose of this paper is to describe our pediatric MRI protocol as well as the imaging appearance of pediatric liver lesions using gadoxetate disodium. As a hepatocyte-specific MRI contrast agent, Gd-EOB-DTPA has the potential to improve characterization and provide a more specific diagnosis of pediatric liver masses.

Magnetic resonance imaging of the temporomandibular joint in children with juvenile idiopathic arthritis

For more than a century, it has been known that juvenile idiopathic arthritis (JIA) can affect the temporomandibular joint. With advances in medical imaging in more recent decades, there has been an increase in awareness of the spectrum of pathology that can affect the temporomandibular joint in children with JIA. This pathology can lead to symptoms ranging from decreased chewing ability, jaw and facial pain, headaches and malocclusion to craniofacial morphological changes such as a retrognathic mandible. The purpose of this review is to suggest an MR imaging protocol for the temporomandibular joint and to illustrate normal and abnormal appearances of the joint in children with JIA.

Elbow plica syndrome: presenting with elbow locking in a pediatric patient

This case report is of a symptomatic posterior-lateral elbow plica in a child who presented with elbow locking. MR images demonstrated thickening of a posterior-lateral plica between the radius and capitellum of the elbow. Surgery confirmed a thickened and inflamed posterior-lateral plica, which was resected with subsequent improvement of the child’s symptoms. This case shows the clinical importance of identifying thickening of posterior-lateral plicae in children and suggesting the diagnosis of plica syndrome, an entity that has not been previously reported in children in the radiologic literature.

Imaging assessment of patellar instability and its treatment in children and adolescents

Transient patellar dislocation is a common entity in children and adolescents, characterized by lateral dislocation of the patella, usually with spontaneous reduction. Many predisposing conditions have been described, including trochlear dysplasia, excessive lateral patellar tilt, patella alta and lateralization of the tibial tuberosity. Associated injuries are bone bruises of the patella and lateral femoral condyle, tears of the medial retinaculum that include the medial patellofemoral ligament (MPFL), tears of the vastus medialis obliquus muscle, injuries of articular cartilage, and intra-articular bodies. Children who are refractory to conservative management, have a large cartilage defect, or are at substantial risk for recurrent dislocations are candidates for surgical procedures to prevent future dislocations. Procedures can include MPFL repair or reconstruction, tibial tubercle repositioning and lateral retinacular release. The purpose of this review is to illustrate the imaging findings of transient patellar dislocation in the acute setting, the normal imaging appearance after surgical intervention, and post-surgical complications.

Post-operative imaging of anterior cruciate ligament reconstruction techniques across the spectrum of skeletal maturity

Due to an increased frequency of anterior cruciate ligament (ACL) injuries in young patients and improved outcomes in athletic performance following ACL reconstruction, surgery is increasingly being performed across the spectrum of skeletal maturity. We present a review of the range of reconstruction techniques performed in skeletally immature patients (physeal sparing techniques, which may involve epiphyseal tunnels or the utilization of an iliotibial band autograft), those performed in patients nearing skeletal maturity (transphyseal techniques), and the more conventional ACL reconstruction techniques performed in skeletally mature adolescents. It is important that radiologists be aware of the range of techniques being performed throughout the spectrum of skeletal maturity in order to accurately characterize the expected post-operative appearance as well as to identify complications, including those unique to this younger population.

Imaging neonates and children with Pierre Robin sequence before and after mandibular distraction osteogenesis: what the craniofacial surgeon wants to know

Pierre Robin sequence is characterized by micrognathia and glossoptosis causing upper airway obstruction. Mandibular distraction osteogenesis is a mandibular lengthening procedure performed in neonates and children with Pierre Robin sequence to alleviate airway compromise. This pictorial review demonstrates the role of imaging in the preoperative and postoperative assessment of these children. It is important for pediatric radiologists to know what information about the mandible and airway the craniofacial surgeon needs from preoperative imaging and to identify any complications these children may encounter after surgery.

Stump entrapment of the anterior cruciate ligament in late childhood and adolescence

Displacement of a portion of the torn anterior cruciate ligament (ACL) into the intercondylar notch can cause a focal fibrotic reaction similar to that seen following ACL reconstruction. This displacement, which can result in locking or limitation of knee extension, is termed stump entrapment and is described in adult MR imaging literature. We present a pictorial essay of the etiology and appearance of stump entrapment on MR imaging of the knee in an older child and adolescents and review the significance of this finding.

Perihepatic abscesses caused by dropped appendicoliths in a child

A dropped appendicolith is a well-known complication of laparoscopic appendectomy that may occur because of stone expulsion from the appendix, before or during surgery, and typically manifests as a focal, subcentimeter area of high attenuation with or without associated abscess. Dropped appendicoliths may act as niduses for infection and may result in the future development of abscess formation. We report the case of a 10-year-old pediatric patient who developed 2 perihepatic abscesses caused by 2 appendicoliths that were inadvertently dropped during laparoscopic surgery.

Non–Catheter-related Venous Thromboembolism in Children: Imaging Review from Head to Toe

Non-catheter-related venous thromboembolism (VTE) is less common in children than in adults. Although the presence of a central venous catheter is the most common cause of venous thrombosis in children, infection and inflammation, malignancy, hypercoagulability, dehydration, and certain sites of normal variant and pathologic anatomic narrowing all predispose to VTE in children. The mortality and morbidity of VTE vary according to the underlying cause, including whether malignancy is present. Various modalities including ultrasonography (US), computed tomography, and magnetic resonance imaging can be used to image VTE, with some modalities better suited to particular parts of the body and clinical scenarios than others. When feasible, US is the initial test of choice for the diagnosis of VTE. US findings of acute VTE include a dilated noncompressible vein, intraluminal echoes, lack of color flow, and abnormal spectral venous waveforms. Serial US examinations are useful for monitoring patient response to therapy; a normal compressible vein will be seen after complete resolution of thrombus, and chronic venous changes including wall thickening, intraluminal webs, and phleboliths, which are readily apparent at US. Accurate and timely diagnosis of VTE must take into account the various advantages and disadvantages of each modality including speed, accuracy, availability, exposure to ionizing radiation, and need for sedation, as well as the clinical stability and transportability of the child. This article reviews some of the more common causes of VTE in children (other than those related to a central venous catheter) according to body part and discusses the associated imaging findings. ©RSNA, 2017.

Langerhans cell histiocytosis of the digestive tract identified on an upper gastrointestinal examination.

Langerhans cell histiocytosis (LCH) with involvement of the gastrointestinal tract is rare and typically identified in patients with systemic disease. We describe a 16-month-old girl who initially presented with bilious vomiting, failure to thrive and a rash. An upper gastrointestinal (GI) examination revealed loss of normal mucosal fold pattern and luminal narrowing within the duodenum, prompting endoscopic biopsy. Langerhans cell histiocytosis of the digestive tract was confirmed by histopathology. A skeletal survey and skin biopsy identified other systemic lesions. Although uncommon, it is important to consider LCH in the differential diagnosis for gastrointestinal symptoms of unclear origin, especially when seen with concurrent rash. Findings of gastrointestinal involvement on upper GI examination include loss of normal mucosal fold pattern and luminal narrowing in the few published case reports.