Sadaf T. Bhutta

All-terrain vehicle injuries in children: injury patterns and prognostic implications

BackgroundAll-terrain vehicle (ATV) accidents are common in children. Our purpose was to identify imaging patterns associated with ATV injuries in children.Patients and methodsThe study group comprised 141 consecutive children admitted to a tertiary pediatric hospital following ATV accidents. Medical records were evaluated for demographics and patient outcome. All imaging studies were reviewed and abnormalities cataloged.ResultsExtremity fractures were the most common injuries in our study, occurring in 38% of patients. Lower extremity fractures were more common than upper extremity fractures. Partial foot amputation, an unusual injury, was present in three children. Torso injuries were present in 22% of the children. Pulmonary contusions, but not abdominal injuries, were significantly associated with long-term disability or death (p=0.01). Brain injuries occurred in 19% of the children and were significantly associated with death or long-term disability (p=<0.001). No association of brain injury and skull fracture was present.ConclusionsA wide variety of injuries were identified in children with ATV accidents. Partial foot amputation, an unusual injury, was identified in three children. Brain injuries and lung contusions detected by computed tomography were associated with long-term disability and death. Radiologists need to be aware of injuries associated with ATV accidents.

Evaluation and Management of Central Venous Access Complications

Venous access is 1 of the most common interventional procedures in the USA. Using image guidance in the last 2 decades, obtaining venous access has become increasingly routine, and the complications commonly associated with the procedure have significantly decreased. However, interventional radiologists still encounter both early and late complications routinely associated with both central and peripherally inserted access devices. This article discusses the most common and some unusual complications seen with the placement of these devices. We also briefly discuss the management of these complications.

A dual contrast injection technique for multidetector computed tomography angiography of Fontan procedures.

Extracardiac and lateral tunnel Fontan palliations result in caval venous return to the branch pulmonary arteries without prior blood mixing in the right atrium. Single contrast injection techniques result in suboptimal pulmonary computed tomography angiography since blood streaming results in asymmetric pulmonary flow of injected contrast. We used a dual injection technique––dorsal foot vein and upper extremity vein to achieve optimal simultaneous opacification of the inferior and superior venae cavae and branch pulmonary arteries. The resulting dataset allowed for excellent 3D volume renderings and multiplanar reformat images useful for stenosis, aneurysm, and metal stent evaluation.

Imaging findings in 512 children following all-terrain vehicle injuries.

BackgroundInjuries related to all-terrain vehicle (ATV) use by children have increased in recent years, and the pattern of these injuries is not well known among radiologists.ObjectiveOur purpose was to identify different radiologically diagnosed injuries in children suffering ATV-related trauma and determine associations among various injuries as well as between injuries and outcome.Materials and methodsThe study included 512 consecutive children suffering from ATV injuries treated at a tertiary care pediatric hospital. All imaging studies were reviewed and correlated with injury frequency and outcome using multivariate analysis.ResultsHead injuries occurred in 244 children (48%) and in five of six deaths. Calvarial skull fractures occurred in 104 children and were associated with brain, subdural and epidural injuries. Brain and orbit injuries were associated with long-term disability. A total of 227 extremity fractures were present in 172 children (34%). The femur was the most commonly fractured bone. Nine children had partial foot amputations. Multiorgan injuries occurred in nearly half of the 97 children with torso injuries. Determinants for long-term disability or death were head injuries (odds ratio 3.4) and extremity fractures (odds ratio 3.3).ConclusionHead and extremity injuries are the two most common injuries in children suffering ATV injuries and are associated with long-term disability. ATV use by children is dangerous and is a significant threat to child safety.

Management of complicated hemangiomas with vincristine/vinblastine: Quantitative response to therapy using MRI

PURPOSE To quantify the efficacy of vincristine and vinblastine in the treatment of complicated hemangiomas. DESIGN Retrospective review. METHODS Charts were reviewed to identify patients treated with vincristine or vinblastine for complicated hemangiomas from August 2002 to October 2007. Only patients who received both a pre and post-treatment magnetic resonance imaging (MRI) were considered. A database was created which includes patient gender, age at treatment initiation, rationale for treatment, hemangioma location, number of cycles of chemotherapy received, and complications of treatment. A single pediatric radiologist calculated lesion volumes from both pre and post-treatment MRI which were compared to quantify treatment response. RESULTS Seven patients (2 male, 5 female) met criteria. Mean age at treatment initiation was 20 weeks (median 14, range 5-60). Rationale for treatment included four patients (57%) with proptosis/orbital compromise and one patient each (14%) with heart failure, airway compression, and hemangiomatosis with rapid growth of multiple lesions. Patients received a mean of 2.86 cycles of chemotherapy (median 3, range 1-5). Twelve lesions were identified and analyzed for pre and post-treatment volume on MRI in the seven patients. Eleven of twelve (92%) lesions decreased in size after treatment. The mean volume ratio of hemangiomas at the conclusion of chemotherapy was 0.45 compared to pre-treatment size (median 0.18, range 0-2.19) Orbital compromise, airway compression, and cardiac failure either improved or resolved in all patients. Three complications of treatment were seen in seven patients (42%) including bacteremia with anemia, peripheral neuropathy and motor delay. All complications resolved after cessation of chemotherapy. CONCLUSIONS Treatment of complicated hemangiomas with vincristine or vinblastine can control growth and improve symptoms in the majority of patients. Treatment often requires multiple cycles of chemotherapy. Complications of treatment are common, but reversible.

A neonate with left pulmonary artery thrombosis and left lung hypoplasia: a case report

IntroductionSpontaneous intrauterine arterial thrombosis and congenital pulmonary hypoplasia are rare conditions and have not been reported to occur together. The literature rather includes two reports of babies with neonatal pulmonary artery occlusion and post-infarction cysts of the lungs.Case presentationWe report a case of a live Caucasian male newborn with left lung hypoplasia that occurred in association with left pulmonary artery thrombosis. Despite a critical neonatal course, including extracorporeal membrane oxygenation, this infant is alive and well at 18 months of age without any neurodevelopmental sequelae or reactive airway disease.ConclusionThis association suggests the possibility of an intrauterine vascular event between the fifth and eighth weeks of gestation during early pulmonary artery and lung development.

Establishment of a Simple and Inexpensive Remote Radiology Conference

t t p q m f P c c r V esidents’andfacultymembers’particpation ineducational conferences is reuired [1], but the delivery of quality onferences is a challenge in today’s acdemic environment. Didactic confernces are time and labor intensive, resients and faculty members are often ocated in multiple sites, and heavy linical workloads can preclude particiation [2,3]. Videoconferencing is a popular ay to transmit information to a disant site, but setup is expensive, and issatisfaction with quality has been eported [4]. A cost-effective alternaive is the Web conference. Real-time udio and video transmissions have ade Web conferencing possible, hile significant improvements in nformation technology and comunication bandwidth have faciliated the rapid development of reote conferencing capabilities [2,5]. Conference attendance in our raiology residency program suffered hen major construction projects ere under way on 2 of our 3 camuses. We sought an alternative that ould eliminate the travel burden. In haring our experience, we hope that ther medical education programs ill be able to implement similar ost-effective options using off-thehelf materials.