Melissa R. Spevak

MR imaging of benign fatty tumors in children: report of four cases and review of the literature

This study correlates the magnetic resonance imaging characteristics with the pathologic findings in rare benign fatty soft tissue tumors in four children. A review of the literature is presented. Two cases of infiltrating lipoma displayed bright signal on both T1- and T2-weighted images, similar to that observed in subcutaneous fat. Histological study revealed extensive muscle infiltration by mature fat, with some areas of total fatty replacement. The case of facial lipomatosis revealed an extensive process of fatty invasion of adjacent soft tissue and osseous deformity by mass effect of the tumor. This lesion was bright on T1- and T2-weighted images. Histopathologic examination showed widespread invasion of squamous mucosa and skeletal muscle. The single case of lipoblastoma involved the presacral region and right buttock. This lesion, although bright on both T1 and T2 weighting, was relatively hypointense to subcutaneous fat on T1. Microscopic examination revealed a well-encapsulated fatty mass made up of cells ranging from lipoblasts to mature lipocytes. In childhood, when fatty lesions are almost always benign, a morphologic characterization by magnetic resonance may be sufficient basis on which to make critical therapeutic judgements.

Distal humeral physeal injuries in child abuse: MR imaging and ultrasonography findings

Distal humeral physeal injuries, in particular, fracture-separation of the distal humeral epiphysis, can be seen in abused infants. Detection of physeal injury in an infant or toddler may indicate the possibility of unsuspected abuse, particularly when an appropriate history explaining the circumstance of the fracture is lacking. In addition, the extent of injury can be difficult to characterize on plain radiographs. Ultrasonography (US) and MR imaging (MRI) may be of value in diagnosis and may obviate the need for intraoperative arthrography. We present MRI findings in three abused children with distal humeral physeal injuries. Sonographic correlation is alos presented in one case.

Soft tissue swelling and acute skull fractures.

To determine whether soft tissue swelling, as identified by computed tomography, invariably accompanies acute calvarial fracture, the computed tomography scans of 35 children aged 3 months to 8 years with acute skull fractures were evaluated. Bone window settings revealed at least 4 mm of soft tissue swelling in all instances. We conclude that a skull fracture without overlying soft tissue swelling demonstrable by computed tomography is probably inconsistent with an acute injury.

The Tailored Low Dose Fluoroscopic Voiding Cystogram for Familial Reflux Screening

PURPOSE Radionuclide voiding cystography is generally advocated as a screening study to detect familial reflux. We assessed the efficacy of tailored low dose fluoroscopic voiding cystography for this purpose. MATERIALS AND METHODS We evaluated 10 boys and 10 girls 9 months to 10 years old (mean age 5 years) who were siblings of patients known to have reflux. The technique used a low dose fluoroscopic system. A tailored voiding cystographic protocol was designed to minimize gonadal radiation dose. RESULTS Absence of reflux was confirmed in 10 patients. Mean fluoroscopy time was 19 seconds (range 14 to 22), resulting in mean gonadal radiation exposure of less than 1.5 mrad., which is comparable to the lowest reported doses with the radionuclide technique. After reflux was demonstrated in 10 patients the study was immediately converted to a standard fluoroscopic imaging technique to define lower tract anatomy and quantitate reflux, avoiding a second study. CONCLUSIONS Tailored low dose fluoroscopic voiding cystography appears to be a practical approach for the assessment of familial reflux.

Detection of rib fractures in an abused infant using digital radiography: A laboratory study

Abstract Purpose. To assess the diagnostic performance of digital radiography using charge-coupled device (CCD) technology in the detection of rib fracture in infant abuse. Materials and methods. Four fractured posterior rib arcs and eight normal ribs removed at autopsy from a 10-month-old abused infant were radiographed using a CCD prototype, four clinical film-screen systems, and direct-exposure film. Each rib was viewed with these six systems in nine different projections. The resultant 648 images were assessed for probability of fracture (0–100%) by four pediatric radiologists. The calculated area under the resultant ROC curves (Az) for the CCD was compared with those obtained with direct-exposure, high-detail, medium and fast film-screen radiographic systems. Results. The mean Az for the CCD (0.937) fell within the range of the high-detail systems (0.934–0.940) and was significantly higher (p<0.05) than the medium and fast system (0.861 and 0.858, respectively). Despite a lower spatial resolution than direct-exposure film (7 line pairs per millimeter vs. >20 line pairs per millimeter) the CCD performance was comparable (Az=0.944 vs. 0.937). The similar performance can be explained by the higher contrast resolution of the digital technology. Conclusion. This study indicates that in the ex vivo setting, digital radiology can perform comparably to high-detail film-screen imaging. The findings suggest that digital radiography has the potential to replace film-screen imaging in the evaluation of inflicted skeletal injury in infants.

Novel Contrast-Enhanced Ultrasound Evaluation in Neonatal Hypoxic Ischemic Injury: Clinical Application and Future Directions

Sensitive, specific, and safe bedside evaluation of brain perfusion is key to the early diagnosis, treatment, and improved survival of neonates with hypoxic ischemic injury. Contrast‐enhanced ultrasound (US) imaging is a novel imaging technique in which intravenously injected gas‐filled microbubbles generate enhanced US echoes from an acoustic impedance mismatch. This article describes contrast‐enhanced US imaging in 2 neonates with hypoxic ischemic injury and future directions on developing quantitative contrast‐enhanced US techniques for improved characterization of perfusion abnormalities. The importance of studying the temporal evolution of brain perfusion in neonatal hypoxic ischemic injury is also highlighted.

Imaging of Neonatal Child Abuse with an Emphasis on Abusive Head Trauma

Child abuse and neglect is a serious clinical and socioeconomic problem that is sometimes underestimated. One of the most devastating forms is abusive head trauma. This review addresses the radiological workup in cases of suspected child abuse. The use of all modalities, and their advantages and disadvantages, is discussed. A special section is devoted to the radiological report in cases of child abuse, as a clinical record and a legal document.

Ultrasonography of the adolescent female pelvis.

Ultrasound of the adolescent female pelvis is the imaging method of choice for most medical problems presenting with symptoms and signs referable to this area. Recognizing the transition from child to mature female and its manifestations are crucial in directing the workup and interpreting the sonographic findings. A description of the normal anatomy and physiology of the pelvic organs is followed by a discussion of the clinical and imaging findings in primary and secondary amenorrhea, pelvic pain, and pelvic masses.

Localized pneumothorax with lobar collapse and diffuse obstructive airway disease.

Localized pneumothorax adjacent to a collapsed lobe has been reported in children with bronchial obstruction. We present our findings in seven children with a similar phenomenon occurring in association with diffuse obstructive airway disease. The children, aged from 3 weeks to 17 years, were admitted for diffuse obstructive airway disease and, subsequently, developed lobar collapse with adjacent localized pneumothorax. In five of the seven patients there was a paradoxical shift of the mediastinum toward the side of the pneumothorax. In six cases, the pneumothorax resolved spontaneously with lobar reexpansion. A conservative treatment approach to patients with this constellation of radiographic findings appears justified.