Grace S. Phillips

A pediatric CT dose and risk estimator

We present a web-based pediatric CT dose tool that estimates effective dose based on dose length product, patient age and region of body scanned. The tool also provides an estimate of additional lifetime risk of cancer from CT exams. These estimations are based on the interpolation of factors from published methods. The calculator serves as an educational tool that can be used by radiologists and clinicians to better understand CT dose and its associated risks.

Usual and unusual causes of pediatric gastric outlet obstruction

Gastric outlet obstruction in children encompasses a spectrum of disorders that extends beyond hypertrophic pyloric stenosis. Each condition can result in the clinical syndrome of persistent nonbilious vomiting, which can progress to dehydration and electrolyte imbalances. This paper reviews the spectrum of both the common and uncommon entities that cause partial or complete gastric outlet obstruction and their imaging appearances. The correct diagnosis of those with gastric outlet obstruction can be achieved by combining clinical presentation with appropriate imaging, leading to optimal and timely patient management.

Correlating Haller Index and cardiopulmonary disease in pectus excavatum.

BACKGROUNDnThe Haller Index (HI) has become standard for determining the severity of pectus excavatum. We compared patterns of cardiopulmonary dysfunction and their relationship with HI in patients with pectus excavatum.nnnMETHODSnWe performed cardiopulmonary exercise testing and chest computed tomography scans on 90 patients with pectus excavatum deformities at a regional pediatric hospital.nnnRESULTSnThe median HI was 4.9 in patients with combined dysfunction, 4.4 in patients with isolated pulmonary dysfunction, 3.6 in patients with isolated cardiac dysfunction, and 3.4 in patients with normal function. HI varied significantly by disease group (P < .009). HI was significantly lower in patients with normal forced vital capacity than with abnormal forced vital capacity (P = .001). However, HI was similar in patients with normal and abnormal oxygen pulse (P = .24) or peak oxygen consumption (P = .37).nnnCONCLUSIONSnFifty-nine percent of patients had cardiac and/or pulmonary limitation. A HI greater than 3.6 is associated with pulmonary dysfunction, but not cardiac dysfunction.

Labyrinthine dehiscence in a child

A 4-year-old boy presented with moderate to profound mixed hearing loss in the right ear and moderate to severe mixed hearing loss in the left ear, prompting a temporal bone CT scan. Images revealed partial dehiscence of the right posterior semicircular canal. Semicircular canal dehiscence and its associated clinical syndrome have been described in adults. We present this case as a unique finding in a child and discuss the possible clinical and research implications.

Upper thoracic shape in children with pectus excavatum: Impact on lung function

Pectus excavatum (PE) can present with respiratory complaints in childhood. However severity of the PE, measured by the Pectus Severity Index (PSI), correlates only modestly with reduced vital capacity (VC). We hypothesized that another upper thoracic feature, a pectus gracilis (PG) or slender chest, co‐exists with PE, and impacts lung function.

Neonatal skeletal dysplasias

Skeletal dysplasias are a large diverse group of disorders characterized by abnormal bone and cartilage growth. Approximately one-quarter of them are considered lethal in the perinatal period. This paper will review the components of the skeletal survey, the primary imaging tool for diagnosing dysplasias postnatally, emphasizing the use of an organized approach and appropriate descriptive terminology. Several illustrative cases of lethal and nonlethal dysplasias will be shown, with additional discussion of commonly associated genetic mutations and classification systems.

Cecal volvulus: classic imaging appearance of an uncommon pediatric entity

A 13-year-old boy presented with a 1-day history of coffeeground emesis. Pertinent medical history included trisomy 17, developmental delay, and chronic constipation. Supine abdominal radiograph (Fig. 1) demonstrated gaseous distention of malpositioned colon located in the left upper quadrant. Upper GI (not shown) revealed malrotation without midgut volvulus. Enema (Fig. 2) showed beaked cut-off of contrast column (arrow), typical of cecal volvulus, and residual contrast agent from UGI (C). Both malrotation and cecal volvulus were surgically confirmed.

Aneurysmal dilation of bowel mimicking an abscess in pediatric primary gastrointestinal lymphoma

Primary gastrointestinal lymphoma, though rare, is the most common gastrointestinal malignancy in children. Signs and symptoms are nonspecific, and include abdominal pain, nausea, emesis, and a palpable abdominal mass. Imaging is therefore typically required to differentiate gastrointestinal lymphoma from other abdominal conditions. We present a pediatric case of primary gastrointestinal lymphoma involving the distal bowel that was initially misdiagnosed as an intra-abdominal abscess. This case highlights the imaging findings of primary gastrointestinal lymphoma, potential pitfalls in imaging diagnosis, and the role of accurate imaging diagnosis in expediting patient management to reduce associated morbidity and mortality.

A hairy situation: trichobezoar presenting with intussusception, and intestinal and biliary perforation in a child

Trichobezoars are an uncommon cause of acute abdominal pain. We present a case of a 12-year-old girl with a history of a trichobezoar who presented to the emergency department with acute abdominal pain. Abdominal sonography was performed which suggested portal venous gas and showed complex peritoneal fluid. Subsequent computed tomography demonstrated both gastric and small bowel bezoars, with a jejunojejunal intussusception, and confirmed portal venous gas and complex ascites. At the time of surgery, there was evidence of intestinal and biliary perforation. Our case illustrates a constellation of complications in association with a long-standing trichobezoar.

Interhemispheric lipoma: Interval development of an associated cyst

We report a case of an 11-year-old patient who underwent CT imaging for complications of sinusitis, and showed incidental development of an interhemispheric cyst in association with an intracranial lipoma over a 10-year interval. Cysts and lipomas are well described in association with dysgenesis of the corpus callosum. We present an uncommon association, of a new cyst in association with an intracranial lipoma, in a patient with a normal corpus callosum.