Jeremy Neuman

Prenatal imaging of amniotic band sequence: utility and role of fetal MRI as an adjunct to prenatal US

BackgroundAmniotic band sequence and its US manifestations have been well-described. There is little information, however, regarding the accuracy and utility of fetal MRI.ObjectiveTo describe the MRI findings in amniotic band sequence and to compare the diagnostic accuracy of MRI and US.Materials and methodsPrenatal MRI and US studies were retrospectively reviewed in 14 consecutive pregnancies with confirmed amniotic band sequence. Both studies were evaluated for amniotic band visualization, body part affected, type of deformity, umbilical cord involvement and vascular abnormality.ResultsAmniotic bands were confidently identified with MRI in 8 fetuses (57%), suggested with MRI in 3 fetuses (21%) and confidently seen by US in 13 fetuses (93%). Neither modality detected surgically proven bands on one fetus. Both techniques were equally able to define the body part affected and the type of deformity. At least one limb abnormality was visualized in all cases and truncal involvement was present in two cases. Cord involvement was identified in seven cases, with one case detected only by MRI.ConclusionFetal MRI is able to visualize amniotic bands and their secondary manifestations and could be complementary to prenatal US when fetal surgery is contemplated.

Pulmonary Systemic Lupus Erythematosus Mimicking a Pneumonia in a Postpartum Female

The pulmonary manifestations of systemic lupus erythematosus can range in severity from mild to life threatening and can be particularly marked in women who are recently postpartum. We present below a seventeen-year-old female patient, one month postpartum, who had findings consistent with an acute infectious pneumonia whom upon further query and passage of time was diagnosed with severe pneumonitis due to systemic lupus erythematosus.

Another Case of Multilevel Cervical Disconnection Syndrome Presenting as Neonatal Encephalopathy

Multilevel cervical disconnection syndrome (MCDS) is a rare malformation of the cervical spine previously documented in two toddlers. We present a case of a newborn first thought to have hypoxic-ischemic encephalopathy who was subsequently diagnosed with MCDS. The possibility of in utero presentation of the syndrome in this patient and the categorization of this syndrome in the spectrum of basilar skull/upper cervical malformation syndromes is discussed.

Newborn with a depression to her skull

A 9 week-old female, born via normal spontaneous vaginal delivery at 40 weeks, presented to the emergency department for a depression to her left skull, first noticed 3 three weeks prior. Ping Pong Fractures should be recognized and appropriately treated by an emergency physician.

Viral Appendiceal Lymphoid Hyperplasia

A 9-year-old boy presented to the emergency department (ED) with right lower quadrant (RLQ) abdominal pain. On examination, the patient exhibited RLQ tenderness without peritoneal signs. Laboratory evaluation showed a normal white blood cell count, with a normal differential. Ultrasound showed a 6.5-mm appendix with circumferential wall thickening and collapsed lumen, without surrounding inflammation or fluid (Figure 1A). Doppler interrogation demonstrated hyperemia of the appendix (Figure 1B). A computed tomography (CT) scan of the abdomen and pelvis revealed a thick-walled appendix without luminal distension or

Visual Diagnosis: Periorbital Edema in a 7-year-old Girl

1. Chantel Cacciotti, MD* 2. Claudia Vicetti Miguel, MD* 3. Jeremy Neuman, MD† 4. Sarah Vaiselbuh, MD* 1. *Department of Pediatrics, Staten Island University Hospital, The Children’s Cancer Center, Staten Island, NY. 2. †Department of Radiology, Staten Island University Hospital, Staten Island, NY. A previously healthy 7-year-old girl presents to the emergency department with a 2-week history of worsening left-sided periorbital erythema, edema, and conjunctival injection. The patient had completed a 10-day course of amoxicillin prescribed for presumptive periorbital cellulitis without clinical improvement. Her parents deny any history of fever, recent respiratory tract infections, insect bite, or trauma. She has had no sick contacts. She denies polyuria, polydipsia, weight changes, diarrhea, or vomiting. Physical examination reveals left periorbital erythema with temporal soft-tissue swelling that is tender to palpation. The conjunctivae are injected without discharge, sclera are clear, and no proptosis is evident. Extraocular movements are normal. Visual acuity is 20/20 in both eyes. Results of a complete blood cell count, complete metabolic profile, and urine homovanillic acid and vanillylmandelic acid measurement are within normal limits. C-reactive protein and erythrocyte sedimentation rate are mildly elevated at 20.8 mg/L (198.1 nmol/L) and 38 mm/hr, respectively. Orbital computed tomography (CT) scan reveals an erosive left superolateral orbital bone lesion with a soft-tissue component extending to the postseptal extraconal orbit, the lacrimal gland, and the epidural space (Figs 1 …

Canal of Nuck cyst masquerading as a testicle in a neonate: A case report and review of the literature

Canal of Nuck cysts/hydroceles are rare occurrences in females of all age groups. We describe a case of a female neonate presenting with a labial mass which sonographically resembled a testicle. Upon surgical exploration, it was found to be a hydrocele of the canal of Nuck. We also review the literature on canal of Nuck cysts/hydroceles in the pediatric age group.

Intranasal foreign body mimicking a fat-containing lesion

We present a 21-month-old child with a foreign body (an intranasal almond) measuring fat attenuation on CT. To the best of our knowledge, this appearance has not been previously described and can be confused with other diagnoses resulting in inappropriate or delayed treatment.