Mauro Oddone

Multi-modality evaluation of the abnormalities of the aortic arches in children: techniques and imaging spectrum with emphasis on MRI.

The failure of embryonic vascular arches to fuse and regress in the usual manner during the formation of the aortic arch, pulmonary arteries and ductus arteriosus can cause a wide spectrum of vascular congenital abnormalities of the aortic arch and its branches. These abnormal vascular structures may cause variable compression of the trachea and/or oesophagus with symptoms ranging from none to severe stridor, dyspnoea, dysphagia and cyanosis. Diagnosis and possible treatment of affected patients require multiple imaging modalities. In the majority of cases, the underlying malformation can be detected by chest radiography and barium oesophagography, visualizing the location of the aortic arch and the presence of anomalous compressions of the trachea and/or oesophagus. However, in most cases the exact configuration of the vascular abnormality cannot be fully defined with conventional radiology alone. MRI is fundamental for evaluation of the thoracic vessels. Not only is it non-invasive, but it can also provide large-field-of-view images in any number of planes with three-dimensional reconstruction, adding valuable information about exact vascular configuration, tracheobronchial compression and brachiocephalic vessel branching. The aim of this review is to describe the imaging findings in children affected with special emphasis on MRI.

MRI road-map of normal age-related bone marrow. II: Thorax, pelvis and extremities

We retrospectively reviewed T1-weighted MR images of 381 patients aged from 7 days to 24 years to evaluated the bone marrow change in thoracic wall and shoulder, pelvis and proximal femur and upper and lower extremities. The patients included in the study were without history of bone marrow disease. A grade of from 1 to 4 was assigned to the marrow signal intensity of the examined anatomic segments. The signal intensity of all anatomic segments was as low as or lower than that of muscle in all patients younger than 2 months, reflecting underlying hematopoietic marrow. The first segments to become hyperintense were the epiphyseal/round bone ossification centers, followed by the phalanges, diaphysis, flat bones and metaphysis. Marrow signal intensity increased in all regions with age. While in the epiphysis, round bones and diaphysis bone marrow shows a diffuse and homogeneous increased signal intensity with age, in the sternum ribs, scapulae, posterior ilium and metaphysis varying percentages of intermediate signal intensity are maintained. An orderly progression of red to yellow marrow was established.

Diagnosis of neonatal hemochromatosis with MR imaging and duplex Doppler sonography

Abstract. Neonatal hemochromatosis is a rare congenital disorder which affects both fetuses and newborns. It is characterized by hepatocellular failure, often appearing on the first day of life in the form of coagulopathy, hypoalbuminemia, hypoglycemia, and jaundice. Most of the affected infants die early in life, and definitive diagnosis has often been made only by post-mortem evaluation. With the help of MRI, plus increasing awareness of the disorder, diagnosis is now often made early, even in utero. Duplex Doppler sonography does not provide information on siderosis but shows abnormalities in the liver or blood-flow patterns associated with liver disease.

Testicular microlithiasis: US findings in six pediatric cases and literature review.

Abstract. The aim of this article is to report on six pediatric cases of testicular microlithiasis (TM) and to review literature reports, in order to schedule US and/or other control examinations, particularly when concomitant focal or diffuse alterations of the testicular parenchymal structure are present, considering the possible association of TM with testicular tumors. Six patients (age range 4–12 years) underwent US examination for scrotal trauma (two cases) unilateral cryptorchidism (one case) follow-up after orchidopexy for bilateral cryptorchidism (one case), and varicocele (two cases). Five examinations were performed with high-frequency probes (10/13 MHz) and seven with 5/7.5-MHz frequency transducers. Follow-up US examinations were performed at different times depending on initial clinical indications, presence of underlying disease, and initial US findings. Two of the six patients underwent three US examinations, two patients underwent two US examinations, and the remaining two patients underwent only one US examination. The patients underwent a total of 12 US examinations. Microliths were bilateral in four patients and unilateral in two patients. In these two latter cases, the contralateral testis was, in one case, cryptorchid and could not be evaluated by US; in the other case it was small and hyperechogenic with orchidopexy sequelae. In three cases microliths were distributed throughout the testis. In the remaining three cases they were present in limited areas of parenchyma. As to the importance of microliths, it was defined as mild in three cases and moderate/severe in three cases. Intratubular testicular microlithiasis is a well-proved histological finding (biopsy or autopsy). More recent is the US demonstration of TM with consequent definition of its pattern: usually bilateral hyperechogenic multiple small foci without acoustic shadows with complete or partial extension to the parenchyma. Testicular microlithiasis is a rare finding. Moreover, the pediatric cases reported in the literature are very few. However, the use of high-frequency US transducers (10–13 MHz) has recently allowed an easier demonstration of this disease also in children. Of particular interest is the study of the still-debated association of microliths with other diseases such as neoplasms. Some aspects need further investigation, namely the real incidence of microliths in the healthy population, the incidence of tumors in patients with microliths, the differences between adults and children, and the different types of follow-up at different ages. In pediatric age, if TM represents an isolated sign, patients need non-invasive US follow-up until adult age. Only if TM is in association with focal lesions of testis parenchyma is it mandatory to perform biopsy or surgical treatment.

Catheter Lock and Systemic Infusion of Linezolid for Treatment of Persistent Broviac Catheter-Related Staphylococcal Bacteremia

The treatment of persistently positive blood cultures in the setting of indwelling central venous catheter (CVC)-related bacteremia may represent a difficult task when CVC removal is not feasible. In this setting, antibiotic lock has been demonstrated to be an effective option, both as a first-line

Gastric duplication cyst: appearance on prenatal US and MRI

M. Lituania Department of Obstetrics and Gynaecology, Giannina Gaslini Hospital for Sick Children, Genoa, Italy Gastric duplication cyst (GDC) is a rare malformation of the gastrointestinal tract. Only seven cases detected by prenatal US have been described to date [1]. Routine US of a 29-year-old gravida at 24 weeks’ gestation detected an 8-mm cyst adjacent to the fetal stomach (Fig. 1). A presumptive diagnosis of GDC was made. However, the rarity and uncertainty of the prenatal US findings prompted us to undertake prenatal MRI to define better the cyst origin and relationship with adjacent organs. Turbo spinecho express T2-weighted sequences were used and showed a round, well-circumscribed, hyperintense 1-cm mass below the diaphragm and adherent to the gastro-oesophageal junction. The other abdominal organs appeared to be normal (Fig. 2). On day 10, after delivery at term, the baby underwent laparotomy. A GDC connected to the cardia was resected. To the best of our knowledge, this is the first prenatal MRI detection of GDC. In our case, prenatal MRI confirmed the presumptive US diagnosis, providing additional information on the malformation site and the nature and relationship with other organs, thus contributing to treatment planning.