Kushaljit Singh Sodhi

Role of tissue harmonic imaging in focal hepatic lesions: comparison with conventional sonography.

Background: The purpose of the present study was to compare iissue harmonic imaging (THI) and conventional sonography in focal hepatic lesions.

Torsion of a wandering spleen: acute abdominal presentation

Torsion of a wandering spleen is a rare but fulminant condition and is part of the differential diagnosis in patients presenting with acute abdominal pain. It results due to absence or laxity of the various ligaments supporting the spleen. Patients may be asymptomatic or may present with acute abdominal pain. It may occur in people of all ages, with a predilection for male patients under 10 years of age and for female patients in older age groups, being most common in multiparous women. Early intervention is necessary to reduce the risk of splenic infarction and other complications. An awareness of the condition together with use of appropriate medical imaging can lead to the correct diagnosis.

Utility of multidetector CT and virtual bronchoscopy in tracheobronchial obstruction in children

Purpose:  The aim of this study was to evaluate the potential use of multidetector CT (MDCT) and virtual bronchoscopy (VB) in the evaluation of tracheobronchial patency in children with suspected bronchial obstruction and to compare its findings with fibreoptic/rigid bronchoscopy or surgery.

Rapid lung MRI in children with pulmonary infections: Time to change our diagnostic algorithms

To determine the diagnostic utility of a new rapid MRI protocol, as compared with computed tomography (CT) for the detection of various pulmonary and mediastinal abnormalities in children with suspected pulmonary infections.

Etiology of community acquired pneumonia among children in India: prospective, cohort study.

Background Childhood community acquired pneumonia (CAP) is a significant problem in developing countries, and confirmation of microbial etiology is important for individual, as well as public health. However, there is paucity of data from a large cohort, examining multiple biological specimens for diverse pathogens (bacteria and viruses). The Community Acquired Pneumonia Etiology Study (CAPES) was designed to address this knowledge gap. Methods We enrolled children with CAP (based on WHO IMCI criteria of tachypnea with cough or breathing difficulty) over 24 consecutive months, and recorded presenting symptoms, risk factors, clinical signs, and chest radiography. We performed blood and nasopharyngeal aspirate (NPA) bacterial cultures, and serology (Mycoplasma pneumoniae, Chlamydophila pneumoniae). We also performed multiplex PCR for 25 bacterial/viral species in a subgroup representing 20% of the cohort. Children requiring endotracheal intubation underwent culture and PCR of bronchoalveolar lavage (BAL) specimens. Findings We enrolled 2345 children. NPA and blood cultures yielded bacteria in only 322 (13.7%) and 49 (2.1%) children respectively. In NPA, Streptococcus pneumoniae (79.1%) predominated, followed by Haemophilus influenzae (9.6%) and Staphylococcus aureus (6.8%). In blood, S. aureus (30.6%) dominated, followed by S. pneumoniae (20.4%) and Klebsiella pneumoniae (12.2%). M. pneumoniae and C. pneumoniae serology were positive in 4.3% and 1.1% respectively. Multiplex PCR in 428 NPA specimens identified organisms in 422 (98.6%); of these 352 (82.2%) had multiple organisms and only 70 (16.4%) had a single organism viz. S. pneumoniae: 35 (50%), Cytomegalovirus (CMV): 13 (18.6%), Respiratory Syncytial Virus (RSV): 9 (12.9%), other viruses: 6 (8.7%), S. aureus: 5 (7.1%), and H. influenzae: 2 (2.9%). BAL PCR (n = 30) identified single pathogens in 10 (S. pneumoniae–3, CMV–3, S. aureus–2, H. influenzae–2) and multiple pathogens in 18 children. There were 108 (4.6%) deaths. The pattern of pathogens identified did not correlate with pneumonia severity or mortality. Conclusions The majority of children with CAP have multiple pathogens (bacteria and viruses). S. pneumoniae and S. aureus predominate in NPA and blood respectively. CMV and RSV were the dominant respiratory viruses in NPA and BAL. The presence of multiple pathogens, especially organisms associated with nasopharyngeal carriage, precludes confirmation of a causal relationship in most cases.

Rapid lung MRI - paradigm shift in evaluation of febrile neutropenia in children with leukemia: a pilot study

Immunocompromised children with hematological malignancies are at increased risk of developing potentially fatal pulmonary infections. Early detection and prompt treatment is critical to combat morbidity and mortality in these children. Twenty-six children with leukemia (age range: 5–13years) presenting with fever and neutropenia were included in this prospective study, which was approved by the institutional ethics committee. All patients underwent HRCT and MRI of the chest on the same day. The findings of HRCT and MRI were compared, with HRCT as the standard of reference. There was perfect agreement between MRI and CT examinations findings by kappa test (κ = 1). No significant difference was observed between the two modalities by the McNemar test (p > 0.05). Rapid lung MRI is technically feasible; has a high correlation, sensitivity and specificity to CT scan; and can emerge as the first line modality for the detection of pulmonary nodules in children with leukemia and persistent febrile neutropenia.

What all physicians should know about the potential radiation risk that computed tomography poses for paediatric patients.

The repeated use of CT imaging raises a childs radiation exposure, overall radiation accrual and future cancer risks. However, our review suggests that these risks can be considerably reduced by physicians, radiologists and academic bodies, through proper justification, optimisation and dose limitation.

CT virtual bronchoscopy: New non invasive tool in pediatric patients with foreign body aspiration

A 2-year-old girl presented with recurrent cough, wheese and breathing difficulty. Her imaging (CT and virtual bronchoscopy) revealed a foreign body in tracheobronchial tree, that was removed by rigid bronchoscopy.

Triangular Cord Sign in Biliary Atresia: Does It Have Prognostic and Medicolegal Significance?

Editor: We read with interest the article by Lee and colleagues (1) in the December 2011 issue of Radiology regarding the efficacy of ultrasonography (US)–guided percutaneous cholecystocholangiography for the early diagnosis and characterization of biliary atresia. We believe that the case illustrated in figure 3 of their article has additional importance. Although the triangular cord sign has been a highly specific US finding of extrahepatic biliary atresia (EHBA), its sensitivity has shown large variations in different studies (2). A recent study evaluated US findings in infants younger than 90 days old with conjugated hyperbilirubinemia (2). The authors reported a sensitivity of only 23.3% for the triangular cord sign in the diagnosis of biliary atresia. They suggested that one of the reasons for low sensitivity could be the young age of the patients “if the tissue interfaces responsible for producing the triangular cord sign evolve with the age of patients” and noted that “in the absence of data on serial sonographic findings in infants with EHBA, the exact impact of screening at a younger age cannot be predicted.” It is in this context that it is interesting to note that the patient illustrated in figure 3 of the article by Lee and colleagues was 22 days old at the time of initial US examination and developed a triangular cord sign at the follow-up examination performed 2 weeks later. The development of the triangular cord sign at a subsequent examination has possible clinical as well as medicolegal significance. Because the triangular cord sign is due to the presence of fibrosis (3), it is possible that patients with biliary atresia who have a positive triangular cord sign at abdominal US may have a poorer prognosis than those in whom the triangular cord sign is absent. Radiologists and clinicians screening babies at an earlier age should remain alert to the diagnosis of biliary atresia, even if the triangular cord sign is absent, and use percutaneous transhepatic cholecystography for early diagnosis. From a medicolegal viewpoint, absence of the triangular cord sign at US performed at a younger age should not be considered an error on the part of the radiologist; that is, if a radiologist performs a US examination in a young baby suspected of having EHBA and reports the triangular cord sign to be absent, the presence of the triangular cord sign at an examination performed after a few weeks to months should not lead to the conclusion that the triangular cord sign, and therefore the diagnosis of EHBA, was “missed” at the initial examination.

The diagnostic criteria for allergic bronchopulmonary aspergillosis in children with poorly controlled asthma need to be re‐evaluated

The aim of this study was to examine the association between allergic bronchopulmonary aspergillosis (ABPA) and poorly controlled asthma in children and appraise the diagnostic criteria.