David F. Merten

Neonatal hypoxia and pulmonary vasospasm: response to tolazoline.

Forty-six neonates with hypoxemia were treated with tolazoline, a pulmonary vasodilator, within the first two days of life. Eight of ten (80%) infants without apparent lung disease responded with a mean increase in PaO2 of 116 torr within one hour of beginning tolazoline infusions. One of the responding infants and two nonresponders died. Thirty-six additional infants with a variety of pulmonary disorders had severe hypoxemia which was refractory to mechanical ventilation. Twenty-one (58%) responded with a mean increase in PaO2 of 130 torr within one hour after beginning tolazoline and 13 (62%) of these survived. Fifteen patients had little or no improvement in PaO2 following tolazoline and only three (20%) of these infants survived. Responders could not be distinguished from nonresponders by clinical or laboratory features prior to therapy with tolazoline. Fourteen infants experienced complications possibly related to tolazoline.

Cervical spine fractures and dislocations in children

A retrospective analysis of pediatric admissions over 10 years revealed 29 patients with cervical spine injuries. Eleven patients were below 12 years of age, and 10 of these had injuries involving C1, C2, or the occipitoatlantal articulation. Eighteen patients were between 12 and 16 years of age with injuries distributed throughout the cervical spine similar to injuries in the adult population. Our results suggest that teenagers with suspected cervical injuries are best evaluated by an adult radiographic series including trauma oblique views. In younger patients, careful evaluation of occipitoatlantoaxial alignment and the prevertebral soft tissues is required for diagnosis and selection of additional imaging evaluation.

The Currarino triad: complex of anorectal malformation, sacral bony abnormality, and presacral mass

The Currarino triad is a unique complex of congenital caudal anomalies including anorectal malformation, sacral bony abnormality, and presacral mass. The usual symptomatology is constipation due to anorectal stenosis. Contrast enema and computed tomographic myelography are the imaging modalities of choice for diagnostic confirmation and clarification of the anomalies. The clinical features, unique radiologic appearance, and importance of a correct diagnosis of the Currarino triad are reviewed.

The sonographic diagnosis of neonatal adrenal hemorrhage.

Neonatal adrenal hemorrhage can be diagnosed with a combination of ultrasound and excretory urography without resorting to surgical exploration or invasive diagnostic procedures. The radiologic findings of adrenal hemorrhage on excretory urography include downward displacement of the kidney on the affected side and a radiolucent suprarenal mass on the body nephrogram phase. Ultrasound studies reveal a sonolucent suprarenal mass. Four cases of varying degrees of adrenal hemorrhage are presented together with the radiographic and sonographic findings.

Craniocerebral Trauma in the Child Abuse Syndrome

Craniocerebral trauma, and more specifically intracranial injury, is the most devastating consequence of child abuse. Cranial computed tomography provides a sensitive method for evaluation of the abused child for craniocerebral injury. CT may be particularly useful for demonstrating intracranial lesions that might not be immediately evident from clinical examination. The CT findings may also clarify the nature of the trauma, both cranial and intracranial, with detail not otherwise possible. It is therefore surprising that an expanded role for CT in evaluation of child abuse has not received wider general consideration or acceptance. Discussions of child abuse either fail to note CT in evaluation of the abused child or give the subject only cursory attention. Caffeys initial admonition that the presence of unexplained fractures in the long bones warrants investigation for subdural hematoma has gone largely unheeded. A high index of suspicion for abuse, especially in the young infant, should be sufficient reason to request cranial CT. In some cases of abuse without acute neurologic abnormality chronic sequelae, otherwise unsuspected, may be demonstrated by follow-up CT.

Hyperimmunoglobulinemia E Syndrome: Radiographic Observations

Susceptibility to recurrent staphylococcal cutaneous and respiratory infections beginning in infancy associated with extreme hyperimmunoglobulinemia E is a recently described primary immunodeficiency syndrome. Other clinical features include depressed cellular immunity and deficient antibody formation. Recurrent pneumonia and cyst formation with variable persistence and expansion characterized the radiographic couse in 11 patients. Five cysts resolved with continuous antistaphylococcal therapy; 2 were resected without recurrence; and 4 persisted after surgery and/or antibiotics (2--8 years). The cysts had dense, necrotic surfaces with fibrous walls, eosinophilic and other inflammatory cell infiltrates, and frequent, persistent, bronchial connections. Sinusitis (9/9) and mastoiditis (3/4) were also observed radiographically.

Renovascular Hypertension as a Complication of Umbilical Arterial Catheterization

Renovascular hypertension (RVH) in the neonatal period is frequently associated with thromboembolic complications of umbilical artery catheterization. Seven newborn infants with RVH were studied by angiography and/or radionuclide examination. Aortography and, in one case, selective angiography showed variable degrees of renal artery occlusion or attenuation. Thromboembolic defects were frequently present in other vessels. Radionuclide flow studies, renograms, and computer analysis of data (ADAC) demonstrated defects in renal function, indicative of renal ischemia. There was a high degree of correlation between angiographic and radionuclide studies. Successful medical management suggests a more conservative alternative to nephrectomy in the hypertensive newborn.

Computed Tomography in the Evaluation of Herpes Simplex Encephalitis

A case of newborn congenital herpes simplex type 2 viral infection is presented. Computed tomography (CT) revealed diffuse hydrocephalus, and confirmed the periventricular nature of the brain calcifications. The pathologic, radiographic, and CT findings are discussed.

Diagnostic Imaging of Pediatric Abdominal Masses

This overview delineates the clinical and pathological features of various abdominal mass lesions found in neonates and in older infants and children. The application and limitations of imaging procedures currently available are reviewed with emphasis on the principles and advantages of advanced imaging techniques. Selected pediatric abdominal masses are discussed and their radiologic features illustrated. Integrated imaging strategies for abdominal masses in the newborn and in the older infant and child are proposed.

Occult humeral epiphyseal fracture in battered infants

Complete fracture-separation of humeral epiphyses, proximal or distal, represents unusual skeletal injuries in the battered infant. Radiographic identification of the type and extent of epiphyseal injury may be difficult due to lack of ossified epiphyseal centers. While arthrography can be a useful diagnostic and therapeutic supplement, radionuclide scintigraphy appears to be of limited value in the detection of such epiphyseal-metaphyseal injuries.