Nucharin Supakul

Distal Humeral Epiphyseal Separation in Young Children: An Often-Missed Fracture—Radiographic Signs and Ultrasound Confirmatory Diagnosis

OBJECTIVE. Distal humeral epiphyseal separation is rare and often misdiagnosed. The purpose of this study was to summarize an experience with radiography and ultrasound of distal humeral epiphyseal separation. MATERIALS AND METHODS. The records of all children younger than 36 months with the diagnosis of distal humeral epiphyseal separation from 2006 to 2013 were identified. Medical and imaging records were reviewed for diagnosis with radiography and ultrasound, cause, treatment, and follow-up. The initial diagnosis, relation of the radius and ulna to the distal humerus, presence of other fractures, and signs of elbow effusion were evaluated. RESULTS. Sixteen patients (10 boys, six girls; mean age, 8.6 months) were evaluated for distal humeral epiphyseal separation. All patients had elbow radiographs. Fifteen (94%) patients had medial and six (38%) had posterior displacement of the radius and ulna. The diagnosis was missed on radiographs of nine (56%) patients. Ultrasound was performed for 12 patients and showed distal humeral epiphyseal separation in all. In 10 (63%) patients, one or more additional humeral fractures were found: bucket-handle fractures in five patients and condylar avulsion fracture in six patients. In the six (38%) patients younger than 1 month, distal humeral epiphyseal separation was secondary to birth trauma. In 4 of the 10 (40%) older patients, nonaccidental trauma was diagnosed. All patients underwent follow-up with a pediatric orthopedist and had full range of motion. Two patients had mild varus deformities. CONCLUSION. The diagnosis of distal humeral epiphyseal separation is often missed on radiographs. Radiologists should be aware that posteromedial displacement of the radius and ulna in young children is highly suggestive of distal humeral epiphyseal separation and that the diagnosis can be confirmed with ultrasound.

Ultrasound of the Pediatric Chest—The Ins and Outs

Chest radiograph is the primary imaging modality for evaluation of chest pathology and computed tomography scan is typically performed when there is a need for better characterization of the pathology or for surgical planning. Ultrasound (US) is mainly used for the evaluation of pleural effusion. However, US can be used in the evaluation of other pathologies, some of which are occult on chest radiographs. In children, the immature cartilaginous sternum can also serve as an acoustic window for the evaluation of the mediastinum. US of the chest has various advantages including the use of nonionizing radiation, portability, and real-time guidance for interventional procedure. In this review, we discuss the use of US in evaluation of the chest wall, pleural space, lung parenchyma, mediastinum, and diaphragm in children.

Ectopic external auditory canal and ossicular formation in the oculo-auriculo-vertebral spectrum

Ear abnormalities in oculo-auricular-vertebral spectrum commonly present with varying degrees of external and middle ear atresias, usually in the expected locations of the temporal bone and associated soft tissues, without ectopia of the external auditory canal. We present the unique imaging of a 4-year-old girl with right hemifacial microsomia and ectopic location of an atretic external auditory canal, terminating in a hypoplastic temporomandibular joint containing bony structures with the appearance of auditory ossicles. This finding suggests an early embryological dysfunction involving Meckel’s cartilage of the first branchial arch.