Paul E. Berger

The role of computed tomography in the evaluation of blunt abdominal trauma in children

Computed tomography was used in the evaluation and follow-up of blunt intra-abdominal injuries in 46 children. The use of this modality resulted in a rapid and accurate diagnosis in the patients studied. Indications for CT scan examination included: a stable clinical state, symptoms and signs suggestive of intra-abdominal injury, hypotension responding to minimal fluid resuscitation, slowly declining hematocrit, hematuria, or suspicious radiographs. Patients with unstable vital signs were not considered candidates for CT scanning. The value of the protocol and CT scanning procedure itself was evident by the high yield of positive results (74% of the patients studied). Of the 12 children with urologic trauma, 2 had severe renal injuries that were not suspected by infusion i.v. pyelography and in one instance by arteriography. The magnitude and extent of perirenal hemorrhage was easily demonstrated. Thirteen patients had splenic lacerations, while 7 children had suspected hepatic injuries all accurately demonstrated by CT scans. Intra-peritoneal blood was easily detected. Two patients had pancreaticoduodenal injuries. Eleven of 12 renal injuries, 9 of 13 splenic lacerations, 5 of 7 hepatic injuries, and both pancreaticoduodenal injuries were successfully treated nonoperatively. The appropriateness of conservative management was substantiated by periodic follow-up examinations. This study demonstrated the improved sensitivity of CT scanning and ability to visualize intra- and retroperitoneal structures simultaneously when compared to more conventional methods of radiographic evaluation. The applications of CT scanning in the evaluation of the traumatized patient reduces the number of ancillary tests required for diagnosis, provides more accurate information regarding the extent and severity of the injury, and results in more appropriate decisions regarding the need for exploration versus nonoperative management. In addition, this modality offers an accurate method for long-term follow-up, allowing definitive recommendations concerning activities.

Computed tomography of tumors of the musculoskeletal system in children. Clinical applications.

Studies indicate that computed tomography (CT) has several important clinical applications in the evaluation of tumors of the musculoskeletal system. These include (a) diagnosis of lesions involving difficult areas such as the sacrum and ilium, (b) demonstration of soft-tissue components of bone tumors or primary soft-tissue masses, (c) assessment of bone-marrow involvement, and (d) follow-up after irradiation or chemotherapy. Several selected pediatric cases are described in detail.

Computed tomographic diagnosis of osteomyelitis.

Computed tomography (CT) was performed in conjunction with conventional radiography and radionuclide imaging in 22 children with known or suspected osteomyelitis. Preliminary findings suggest that when radionuclide scans are positive, CT can exclude or establish medullary involvement, differentiate between overlying soft-tissue and underlying bony abnormality, and clearly delineate the anatomy of the soft tissues.

Computed Tomography and Ultrasound in the Diagnosis and Management of Neuroblastoma

Gray-scale ultrasound and computed tomography were found to be diagnostically and clinically valuable in the study of 13 of 17 children with neuroblastoma. Use of ultrasound and computed tomography: (a) resulted in diagnoses not possible with conventional techniques, such as plain radiographs and excretory urograms; (b) defined more clearly the normal and pathologic anatomy in a three-dimensional perspective; (c) was an aid in evaluating extra-abdominal manifestations; and (d) permitted follow-up after surgery, radiation, and chemotherapy.

Fat thickness in the newborn infant of a diabetic mother

Normal standards for fat thickness as measured on chest radiographs of premature and term infants were determined. Infants of diabetic mothers and infants of gestational diabetic mothers have a greater amount of fat for gestational age than normal infants. The radiologist can suspect that the mother of an infant is diabetic from a chest radiograph of the infant by relating the fat thickness to dental and shoulder maturation. This may be particularly important in detecting gestational diabetes when the baby is normal in weight or premature.

Myelography in the evaluation of paravertebral mass lesions in infants and children.

The clinical, pathological, and radiological features in 21 pediatric patients with intraspinal extension may be present in the absence of either neurological symptoms or bony abnormalities. It is essential that myelography be performed prior to thoractomy or laparotomy in such cases.

The dorsum sellae in infancy and childhood

Evaluation of the dorsum sellae in infants and children is often difficult. Understanding its normal development and anatomy will help in the detection of pathologic states. The normal central concavity of the dorsum, normal pointing and tapering of the superior dorsum, variation in size and shape of the posterior clinoids, ossified dural bridging and a variable size of the dorsum occur at these ages. Changes associated with hydrocephalus, intrasellar and suprasellar tumours in the early stage may mimic variations of the norm. Multiple tomographic sections and projections of the sella and clinical correlation are essential.

Duration of Voluntary Apnea in Children

Results of breathholding were recorded in 50 children prior to excretory urography to help determine the optimal sectional imaging technique according to age and expected ability to suspend respiration during examination.

A simple technique for eliminating tracheal buckling on lateral neck roentgenograms

Brief, gentle extrinsic pressure on the trachea at the level of the cricothyroid membrane during lateral roentgenography of the neck is suggested as a safe, simple, and reliable means of evaluating the retrotracheal pre-cervical soft tissues in infants and children.