Kook Sang Oh

Characteristic Pulmonary Finding in Traumatic Complete Transection of a Main-stem Bronchus

The incidence of severe chest injuries and direct trauma to the tracheobronchial tree has risen sharply during the past two decades, owing to the widespread increase in mechanization and high-speed travel (1, 2). Prompt diagnosis and immediate surgical reconstruction of the trachea and bronchi are mandatory to prevent stricture, loss of function, and death. A radiologic pulmonary finding apparently not recorded previously has been observed—the lung appears to fall away from the mediastinum. It is believed to be characteristic, at least in the case reported below, of complete transection of a main-stem bronchus. Case Report A 35-year-old woman was involved in an automobile accident and brought to the Emergency Ward of the Massachusetts General Hospital. She was semiconscious and in respiratory distress. The right half of the chest showed a flailing motion, massive subcutaneous emphysema was spread over the chest and neck, and the abdomen was soft and not distended. A drainage tube was inserted into the rig...

Occult Fractures In Preschool Children

Five hundred consecutive radiographic examinations of acutely limping infants and toddlers were analyzed retrospectively. One hundred of the 500 (20%) had a fracture as the underlying etiology. Although the most common sites of involvement were the tibia/fibula (56 cases) and femur (30 cases), fractures in the pelvis and feet, notably the metatarsals (11 cases), also were seen. We therefore recommend obtaining radiographs of the pelvis and both lower extremities including the feet, when occult trauma is suspected and the exact area of injury cannot be pinpointed clinically.

B scan ultrasound in the evaluation of pediatric abdominal masses

The use of B-mode ultrasound in the preoperative evaluation of abdominal masses in the pediatric age group is described. Using this technique it is possible to delineate the extent and site of origin of the mass. Cystic lesions can be distinguished from tumors by the degree of echo penetrance through the mass and the pattern of echoes within the mass. Lesions such as hydronephrosis and renal cysts were successfully distinguished from neuroblastomas and Wilmss tumors preoperatively. B-mode ultrasound was felt to be of as much value as arteriography, which was performed in many of the cases.

Abnormal intestinal motility in gastroschisis.

The authors describe abnormal intestinal motility with a very slow transit time in eight children with gastroschisis. Other abnormal findings include malrotation, dilatation, and fixation of the loops of the bowel.

Pediatric chest trauma.

Blunt and penetrating chest trauma in children results from many causes but the major cause is motor vehicle accidents. The trauma induces a variety of injuries to the bony thorax, the pulmonary parenchyma, and mediastinal structures. In recent years, a disturbing increase in iatrogenic chest trauma has occurred in patients, particularly small infants, receiving intensive hospital care. Radiologic evaluation plays an important role in documenting and diagnosing these traumatic and iatrogenic injuries. The various radiologic manifestations of these injuries are described and discussed.

Computed tomographic positive contrast peritoneography.

Despite the use of intravenous and oral contrast material and antiperistaltic pharmaceuticals, abdominal computed tomography has limitations in the morphological study of the gastrointestinal tract, retroperitoneum, and pelvis. To better define these regions, positive contrast material was infused into the peritoneal space prior to abdominal CT. Results included: improved visualization of the peritoneal cavity and its contents; evident demarcation between the retroperitoneal space and intraperitoneal structures; sharp delineation of serosal surfaces of the bowel and solid viscera; and an obvious distinction between impinging bowel loops and pelvic organs.

Positive-Contrast Peritoneography and Herniography

Positive-contrast peritoneography is a reasonably safe and quite accurate method of identifying patent vaginal processes, hernias, communicating hydroceles, and undescended testes. It is especially valuable in the evaluation of an infant or child who appears to have a unilateral hernia or hydrocele or who has cryptorchidism. The examination is simple to perform and interpret and can also be used to evaluate diaphragmatic abnormalities such as hernias and eventrations, the size and shape of the liver and spleen, and some intraperitoneal masses.

Inferior vena caval varix.

A case of localized varix in the cardiac segment of the inferior vena cava is reported. The diameter of the inferior vena cava in various conditions is described and the differential diagnosis briefly discussed. No similar case was found in the literature.

Normal mediastinal mass in late childhood.

Three cases of large but normal thymus in late childhood are presented. Since there is no accurate method for radiographically differentiating normal thymus in late childhood from tumors of the thymus and other anterior mediastinal masses, exploratory thoracotomy was performed in each case. The procedure is considered necessary for definitive diagnosis and treatment. The nature and behavior of the normal thymus are briefly reviewed.

Radiographic Exhibit: Internal Auditory Canal Enlargement in Neurofibromatosis without Acoustic Neuroma

Acoustic neuroma has always been reported to accompany neurofibromatosis in patients with enlargement of the internal auditory canal. The authors describe a case in which the internal auditory canal was enlarged but there was no tumor. This may represent a normal variant or a manifestation of the bony dysplasia of neurofibromatosis.