M I Boechat

Pulmonary emboli following therapeutic embolization of cerebral arteriovenous malformations in children

Background. Reports of the complicating side effect of pulmonary embolism (PE) following endovascular therapy of cerebral arteriovenous malformations (AVM) in children have been limited in number. Details of its occurrence are yet to be fully elucidated.¶Objective. The hypothesis is that inadvertent pulmonary migration of embolic material is common and may go unrecognized.¶Materials and methods. Forty-seven patients (ages 1 day to 16 years and 11 months) underwent embolization of a cerebral AVM with at least one material (cyanoacrylate, platinum coils, detachable balloons, polyvinyl alcohol particles). The medical records and chest radiographs were reviewed retrospectively. Chest radiographs were available in 34 patients. The radiographs were analyzed for the presence or absence of foreign material in the lungs.¶Results. The chest radiographs in 12 patients (35 %) showed pulmonary deposits of embolic material; cyanoacrylate in 10 patients and platinum coils in 2. Two of the patients with cyanoacrylate deposits in the lungs developed respiratory distress that required endotracheal intubation. The patients gradually improved after a time period of 7–10 days with conservative treatment.¶Conclusion. PE is not an uncommon complication in children undergoing embolization of brain AVM. Although usually asymptomatic, PE may cause severe symptoms.

MR imaging of bone marrow in children.

The magnetic resonance (MR) images of the knees and hips of children with systemic diseases involving bone marrow were correlated with their marrow histology and compared with the images of asymptomatic normal children. In normal children the intensity of the MR signal from the bone marrow of the knees and hips was uniform throughout the metaphyses and diaphyses. In contradistinction the MR signal was uniformly diminished for the hypercellular marrow of patients with sickle cell anemia, was similar to normal for the hypocellular hyperfatty marrow of untreated aplastic anemia, and was nonuniform and patchy for leukemic marrow.

Normal US appearance of ovaries and uterus in four patients with Turner's syndrome and 45,X karyotype

Pelvic ultrasonographic (US) studies of four patients (ages 11–19 years) with Turners syndrome, 45,X karyotype, and normal ovarian function were reviewed. All four had persistent menses, spontaneous breast development, and normal follicular stimulant hormone (FSH) serum concentrations. The US studies depicted normal postpubertal uterus and normal-sized ovaries with follicles. In three patients, ovaries were seen bilaterally, while in one only one gonad was identified. Radiologists should be aware that patients with Turners syndrome, even with a single X chromosome, may occasionally have normal genital development.

Congenital bladder rupture and urine ascites secondary to a sacrococcygeal teratoma.

A case of congenital bladder rupture with urine ascites and bilateral hydronephrosis secondary to a sacrococcygeal teratoma obstructing the bladder outlet is presented. As no evidence of pulmonary hypoplasia and renal dysplasia was present, with rapid recovery of renal function after decompressive surgery, the infravesical obstruction probably occurred late in the fetal period. The bladder rupture resulting in internal decompression may have constituted an additional protective mechanism for the preservation of renal function.

Outcomes of bladder neck closure for intractable urinary incontinence in patients with neurogenic bladders

OBJECTIVE Recent reports of outcomes of bladder neck closure for neurogenic urinary incontinence reveal poor initial continence and high vesicourethral fistula rates. We evaluated a large series of patients who underwent complete transection and closure of the bladder neck with modified abdominal stoma creation. MATERIALS AND METHODS The medical records of 52 consecutive patients (23 males and 29 females) undergoing bladder neck closure by a single surgeon between July 1996 and January 2003 were reviewed. Mean follow up was 20 months (range 2-68 months) and mean age was 13.9 years (range 1.5-58 years). Forty-two patients (81%) underwent concomitant bladder augmentation. Catheterizable stomas included 46 appendicovesicostomies (88%) and six Monti tubes (12%). Of the 52 patients, 22 were confined to wheelchairs (42%), and the majority of patients had spinal cord pathology (40/52, 77%). Mean preoperative vesical leak point pressure was 25 cm/H(2)O (range 4-69 cm/H(2)O). RESULTS Complete postoperative urinary continence was achieved in 44 patients (88%) after one procedure. Of the six patients who were incontinent (12%), one had a vesicourethral fistula (2%) and five had incontinence at the urinary diversion stoma (10%). Twelve of 50 patients had urinary stomal stenosis (24%), with six requiring urgent evaluation (12%) and six requiring surgical revision (12%). Postoperative urinary continence was unknown in two patients due to inadequate follow-up data. CONCLUSIONS Our findings suggest that bladder neck closure is a safe and effective method of achieving urinary continence in children with neurogenic voiding dysfunction. While there are risks of stomal stenosis and fistula formation, modifications in surgical technique may reduce them to acceptable levels.

Effect of data compression on diagnostic accuracy in digital hand and chest radiography

Image compression is essential to handle a large volume of digital images including CT, MR, CR, and digitized films in a digital radiology operation. The full-frame bit allocation using the cosine transform technique developed during the last few years has been proven to be an excellent irreversible image compression method. This paper describes the effect of using the hardware compression module on diagnostic accuracy in hand radiographs with subperiosteal resorption and chest radiographs with interstitial disease. Receiver operating characteristic analysis using 71 hand radiographs and 52 chest radiographs with five observers each demonstrates that there is no statistical significant difference in diagnostic accuracy between the original films and the compressed images with a compression ratio as high as 20:1.

Clinical utilization of grayscale workstations

The factors influencing the image fidelity of gray-scale monitors and how they are determined through both physical and psycho-physical measurements are discussed. Estimation techniques for the amount of image data to be displayed, both the daily digital image data volume and the estimation of the number of gray-scale display stations required, are also examined. Gray-scale display station hardware and software designs are presented. It is pointed out that exceptional attention must be paid to the details of workstation design, as this is the sole interface of the radiologist to the resources of the digital image management network.<<ETX>>

World Federation of Pediatric Imaging (WFPI) volunteer outreach through tele-reading: the pilot project in South Africa.

BackgroundShortages in radiology services are estimated to affect 3.5–4.7 billion people worldwide. Teleradiology is a potential means of alleviating this shortage.ObjectiveThis paper examines the practicality and sustainability of a pilot pediatric teleradiology project at the Khayelitsha District Hospital in sub-Saharan Africa. We analyze how this World Federation of Pediatric Imaging (WFPI) program fares against the global challenges described in the current literature facing these practice types.Materials and methodsA teleradiology pilot was developed to provide coverage to the Khayelitsha District Hospital after the district pediatrician requested assistance in interpreting radiographs. This program utilized a network of WFPI volunteer pediatric radiologists, direct JPEG conversion of digital radiographic images, and an e-mail delivery system of images, referral requests and teleradiology opinion. Data were collected retrospectively from referral cards and JPEG images of radiographs, as well as from the volunteer officer database.ResultsA total of 555 referral cards and 1,106 radiographs were submitted for teleradiology opinion during the course of this pilot program; 74.6% of requests for image interpretation were chest radiographs and 14.2% of those were for the evaluation of tuberculosis. There were 40 volunteer teleradiologists from 17 countries; all spoke English, and 14 were bilingual (8 fluent in Spanish, 5 in Portuguese, and 1 in Italian).ConclusionTeleradiology is a viable option to alleviate radiologist shortages in underserved areas, but there are many challenges to designing an adequate teleradiology system. The WFPI pilot teleradiology program can be considered a successful one.

Gas gangrene: An unusual cause of graft failure in an orthotopic pediatric liver transplant

Gas gangrene of the liver is a very unusual cause of graft failure, and gas gangrene caused byEnterobacter cloacae is also exceedingly rare. Although Clostridial infection could not be excluded in this case, the literature and our case show thatEnterobacter cloacae can be present in gas gangrene tissue whether or not it is the only infecting organism.

Osteochondral Lesions in Pediatric and Adolescent Patients

Osteochondral lesions are acquired, potentially reversible injuries of the subchondral bone with or without associated articular cartilage involvement. Injury results in delamination and potential sequestration of the affected bone. Although an association with mechanical and traumatic factors has been established, the etiology remains poorly understood. These lesions commonly occur in the knee; articular surfaces of the elbow, ankle, hip, and shoulder are also affected. Osteochondral lesions are relatively common in children and adolescents, and the incidence is increasing. Prognosis of these lesions depends on stability, location, and size of the lesion.Imaging has an essential role in the diagnosis, staging, and management of osteochondral lesions. Many of these lesions are first diagnosed by plain film. MRI adds value by identifying unstable lesions that require surgical intervention. This review focuses on the clinical and imaging features of osteochondral lesions of the knee, elbow, and ankle. Imaging criteria for staging and management are also reviewed.