Hae Kyung Lee

High-Resolution Sonography for Nasal Fracture in Children

OBJECTIVEnWe describe the sonographic findings of nasal fracture in children, and we evaluate the diagnostic value of sonography as compared with conventional radiography and clinical findings to determine whether sonography can be a primary technique for evaluating nasal fracture in children.nnnMATERIALS AND METHODSnConventional radiographs and sonographic scans were obtained in 26 consecutive children with nasal trauma who were seen at our hospital from March 2003 to March 2005. There were five girls and 21 boys, and their ages ranged from 1 year 9 months to 15 years 11 months (mean age, 9.9 years). The following sonographic scans (HDI-5000 unit with a 7-15-MHz linear array transducer) were used to evaluate the nasal bone at different levels: a midline longitudinal image; axial scans of the nasal bones at the upper, middle, and lower levels; images of the nasal septum; and transverse and longitudinal scans of both lateral walls. Ten children also underwent CT.nnnRESULTSnConventional radiographs depicted 14 (54%) of 26 fractures. Sonographic scans were able to show all the fracture lines. One case was diagnosed as an old nasal fracture on the basis of a physical examination, even though a visible fracture line was seen on sonography. The sonographic findings of nasal fracture were disruption of the bone continuity with or without separation of the fractured segment (7/26), displacement of the bone segment as being depressed or overriding (20/26), associated septal deviation (7/26), and separation of the pyriform aperture of the maxilla and nasal bone (2/26). The associated findings were soft-tissue edema and hypoechoic hematoma near the fracture lines in 25 cases. The fractures involved both sides of the nasal bones in 11 of 26 cases, the midline part of the bones in six of 26 cases, and the unilateral paramedian or lateral part of the bones in 12 of 26 cases. Among the 10 CT scans, one CT scan did not depict the fracture, showing only soft-tissue swelling, and one scan showed fractures of the orbital floor and maxilla.nnnCONCLUSIONnSonography can be a primary diagnostic technique for evaluating nasal fracture in children. It inflicts no radiation, provides various imaging planes without positional change, and can be used to evaluate the cartilaginous septum. Potential pitfalls are the nasofrontal suture, the junction between the nasal bone and the pyriform aperture of the maxilla, the vascular groove, and the presence of an old fracture. CT can be used in addition to sonography in cases of suspected complex facial bone trauma.

Preoperative Diagnosis of Small-Bowel Intussusception in Pregnancy With the Use of Sonography

Intestinal obstruction during pregnancy is a rare condition and ranges from 0.067% to 0.0015%. 1 When it happens, however, it causes considerable morbidity and mortality for the pregnant woman and the fetus. Intussusception is one cause of intestinal obstruction, occurring in up to 6% in pregnant women. 2 In addition, intussusception in pregnancy usually results in a potentially serious complication because detection is difficult and commonly delayed. If more preoperative diagnosis were possible, fetomaternal morbidity and mortality would be reduced by appropriate management, including immediate surgery for correction of intussusception, aggressive fluid resuscitation to ensure uterine blood flow and to optimize fetal viability, electrolyte and acid-base balance correction, gastrointestinal decompression by nasogastric intubation, and antibiotic prophylaxis. 1 Despite specific radiologic findings, preoperative diagnosis of small-bowel intussusception in late pregnancy is difficult because of superior displacement of small-bowel loops by the enlarged uterus. We describe a preoperatively diagnosed case of small-bowel intussusception with the use of sonography in pregnancy.

Homocystinuria presenting with portal vein thrombosis and pancreatic pseudocyst: a case report.

Abstract Homocystinuria is a rare, inherited metabolic disease frequently associated with severe multisystemic involvement such as dislocated lenses, skeletal deformities, mental retardation, and premature vascular occlusion. Arterial and venous thromboembolic events present frequent and life-threatening complications in homocystinuric patients. It has been suggested that mild homocystinemia would be a risk factor for vascular disease.