Gael J. Lonergan

Neuroblastoma, ganglioneuroblastoma, and ganglioneuroma: radiologic-pathologic correlation.

Sickle cell anemia (SCA) is a disease caused by production of abnormal hemoglobin, which binds with other abnormal hemoglobin molecules within the red blood cell to cause rigid deformation of the cell. This deformation impairs the ability of the cell to pass through small vascular channels; sludging and congestion of vascular beds may result, followed by tissue ischemia and infarction. Infarction is common throughout the body in the patient with SCA, and it is responsible for the earliest clinical manifestation, the acute pain crisis, which is thought to result from marrow infarction. Over time, such insults result in medullary bone infarcts and epiphyseal osteonecrosis. In the brain, white matter and gray matter infarcts are seen, causing cognitive impairment and functional neurologic deficits. The lungs are also commonly affected, with infarcts, emboli (from marrow infarcts and fat necrosis), and a markedly increased propensity for pneumonia. The liver, spleen, and kidney may experience infarction as well. An unusual but life-threatening complication of SCA is sequestration syndrome, wherein a considerable amount of the intravascular volume is sequestered in an organ (usually the spleen), causing vascular collapse; its pathogenesis is unknown. Finally, because the red blood cells are abnormal, they are removed from the circulation, resulting in a hemolytic anemia. For the patient with SCA, however, the ischemic complications of the disease far outweigh the anemia in clinical importance.

Homicidal commotio cordis: the final blow in a battered infant.

OBJECTIVE This report describes in detail the occurrence of inflicted commotio cordis (cardiac concussion) in a previously abused 7-week-old. Though inflicted commotio cordis has been reported in three toddlers, this is the first report in a young infant. METHOD Following documentation of abuse in a living child, the case of a death of a prior sibling--previously regarded as natural--was re-opened for further investigation. Original autopsy materials were reviewed, and the body of the deceased child was exhumed. RESULTS Exhumation and second autopsy documented more than 50 fractures in the deceased child. When re-interviewed, the childrens father admitted to causing the injuries in both children, and gave a textbook description of commotio cordis as the mechanism of death in the fatal case. CONCLUSIONS Commotio cordis is a rare event in which a fatal dysrhythmia--usually ventricular fibrillation--is precipitated by a blow to the precordial chest. Previous reports have indicated that homicidal commotio cordis can occur in small children. This report demonstrates that commotio cordis can occur even in the very young, previously abused infant.

Pulmonary disease in the immunocompromised child

Immune deficiency states in children may be related to primary immunodeficiency syndromes or secondary disorders of the immune system. The secondary immunodeficiencies in children include human immunodeficiency virus-associated acquired immunodeficiency, as well as immunosuppression secondary to antineoplastic chemotherapeutic agents, bone marrow transplantation, and drugs given to prevent transplant rejection. This article discusses the common primary and secondary immunocompromised states of childhood, with emphasis on their attendant infectious, lymphoproliferative, and neoplastic complications.

Imaging body armor.

This study examined the feasibility of performing radiographic studies on patients wearing standard-issue body armor. The Kevlar helmet, fragmentation vest, demining suit sleeve, and armor plate were studied with plain film and computed tomography in a simulated casualty situation. We found that the military helmet contains metal screws and metal clips in the headband, but diagnostic computed tomographic images can be obtained. Kevlar, the principal component of soft armor, has favorable photon attenuation characteristics. Plate armor of composite material also did not limit radiographic studies. Therefore, when medically advantageous, patients can be examined radiographically while wearing standard military body armor. Civilian emergency rooms should be aware of these observations because law enforcement officers wear similar protective armor.

How well do we prepare pediatric radiologists regarding child abuse? Results of a survey of recently trained fellows

BackgroundPediatric radiologists serve an important role in the radiologic diagnosis, investigation, and in legal proceedings in cases of child abuse. The Society for Pediatric Radiology should evaluate and insure the adequacy of training of pediatric radiologists for this important role.ObjectiveThe Society for Pediatric Radiology Committee on Child Abuse, 2002, conducted a 24-question survey to evaluate the scope and perceived adequacy of training received by pediatric radiology fellows regarding the radiologic diagnosis of child abuse and the associated legal process.Materials and methodsEighty-four surveys were mailed to radiologists who had completed a year in pediatric radiology fellowship training during the years 1999 and 2000. There were 33 surveys returned for an overall response of 39%.ResultsRespondents’ perception of adequacy of training was best for the radiologic diagnosis of child abuse. The majority perceived they were not well trained in the investigative and legal processes regarding child abuse. The majority would welcome standardized training.ConclusionCurrent pediatric radiology training programs do not sufficiently prepare pediatric radiologists for their role in the legal system regarding child abuse. A standardized program to train pediatric radiologists about the imaging diagnosis of child abuse and their role in the legal system is recommended.

Childhood Pyelonephritis: Comparison of Gadolinium-Enhanced MR Imaging and Renal Cortical Scintigraphy for Diagnosis

PURPOSE To compare gadolinium-enhanced inversion-recovery magnetic resonance (MR) imaging with renal cortical scintigraphy in the diagnosis of childhood pyelonephritis. MATERIALS AND METHODS Thirty-seven patients with fever-producing urinary tract infection underwent gadolinium-enhanced inversion-recovery MR imaging and technetium-99m renal cortical scintigraphy. Each study was read in double-blind fashion by two radiologists. The kidney was divided into three zones, and each was graded as positive, equivocal, or negative for pyelonephritis. RESULTS Seventy kidneys (210 zones) were imaged. Twenty-six kidneys (54 zones) had evidence of pyelonephritis at both MR imaging and scintigraphy. Twenty-four kidneys (100 zones) were negative on both studies. Twelve kidneys (42 zones) were positive at MR imaging but negative at scintigraphy, and four kidneys (seven zones) were negative at MR imaging but positive at scintigraphy. The results of MR imaging for pyelonephritis were not equivalent to the results of scintigraphy (P = .001 for renal zones). The proportion of positive agreement between readers for the presence of pyelonephritis was 0.85 and 0.57 for MR imaging and scintigraphy, respectively. The proportion of negative agreement was 0.88 and 0.80 for MR imaging and scintigraphy, respectively. CONCLUSION Gadolinium-enhanced inversion-recovery MR imaging enabled detection of more pyelonephritic lesions than did renal cortical scintigraphy and had superior interobserver agreement.