Sarah J. Menashe

Ultrasound-guided joint injections for MR arthrography in pediatric patients: how we do it

In children, MR arthrography is typically performed using fluoroscopic guidance. This article explores the role of US-guided joint injections as an alternative for MR arthrography in children, discussing its advantages and disadvantages compared to standard methods. We describe techniques for performing US-guided injection of the shoulder, elbow, hip, knee, ankle and posterior subtalar joints, highlighting pertinent anatomy, routes of access and unique considerations for this modality in children. Written descriptions, images and links to video clips are used to illustrate proper arthrographic technique. We conclude that US provides effective guidance for intra-articular injection prior to MR arthrography, with the advantages of improved visualization of internal structures, reduced radiation exposure, convenience of performing the procedure portably and ease of performance. Although this paper does not address therapeutic steroid injections, these techniques could easily be translated for such purposes. We propose US guidance as a viable alternative to fluoroscopic technique for arthrography in children.

Brachial Plexus Birth Palsy: Multimodality Imaging of Spine and Shoulder Abnormalities in Children

OBJECTIVE. The purpose of this article is to provide a comprehensive overview of the imaging of brachial plexus palsy, including both pathologic conditions of the spine and shoulder and clinical background and management. CONCLUSION. Brachial plexus birth palsy can result in permanent disability and limb deformity. Identifying the lesion type and associated sequelae is important in clinical management aimed at optimizing outcome. The imaging algorithms used are guided by clinical presentation and are designed to assess the extent of injury to guide possible surgical intervention.

Pediatric Spinal Neoplasia: A Practical Imaging Overview of Intramedullary, Intradural, and Osseous Tumors

Imaging of the pediatric spine can be a daunting task for pediatric radiologists, neuroradiologists, and musculoskeletal imagers alike. This is in large part consequent to multiple differential considerations that are frequently specific to this patient population. Though a definitive diagnosis is not always possible through imaging, determining an appropriate anatomical compartment facilitates a more focused differential list, and therefore provides value to the treating providers. This is typically achieved with magnetic resonance imaging and computed tomography. The purpose of this paper is to equip the radiologist with a useful approach to the imaging of, and creating a practical differential for tumors of the pediatric spine. This includes intramedullary, intradural, and osseous pathology. We focus on the most commonly encountered lesions in each of the above compartments. We discuss less common lesions where appropriate owing to their incidence in the adult spine or pediatric extraspinal locations, and are often included in imaging reports or tumor board discussions. As such, this review offers the radiologist a reasonable and reproducible framework for imaging and diagnosing the vast majority of lesions encountered in the pediatric spine.

Glenohumeral Dysplasia Following Neonatal Brachial Plexus Palsy: Presentation and Predictive Features During Infancy

PURPOSE To evaluate the presence and degree of glenohumeral dysplasia (GHD) in infants undergoing surgical exploration for neonatal brachial plexus palsy (NBPP) and to identify potential predictive factors of early maladaptive shoulder morphology. METHODS We included all consecutive patients with NBPP who underwent surgical exploration of their brachial plexus and who had a preoperative magnetic resonance imaging scan at our institution over a 3-year period. Demographic, therapy, and surgical data were collected. Imaging was reviewed for glenoid morphology, glenoid version, percent humeral head anterior to the scapula, and alpha angle. RESULTS Of 116 infants who presented to our institution during this 3-year period, 19 (16%) underwent surgical exploration and were included in the study. Median age at the time of the scan was 16 weeks (interquartile range, 14-46 weeks). Fourteen of 19 (74%) had GHD of Waters class 2 or increased malformation. Babies who had more severe palsies underwent earlier surgery and had less severe GHD at the time of surgery than did those with less severe palsies who had surgery later. Less severe GHD was associated with more severe palsies, as indicated by Narakas classification and number of root avulsions. Active external rotation was almost universally absent whereas other shoulder movements were present to varying degrees. More severe GHD was associated with greater total shoulder active range of motion and greater pectoralis major muscle mass. CONCLUSIONS Glenohumeral dysplasia occurs often and early in NBPP and may occur in the absence of restricted range of motion. Predictors include increasing age and factors related to muscular imbalance. As such, GHD likely affects the functional outcome that may be achieved with reinnervation, and early screening may improve outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.

Novel Ingested Foreign Bodies—A Fidget Spinner Case Report

Novel Ingested Foreign Bodies— A Fidget Spinner Case Report A woman in her late teens with a complex mental health history including depression and eating disorder was found to have severe neck pain and vomiting after reporting ingestion of a fidget spinner toy broken into 3 pieces. Surgical treatment was required for removal. We review this case and use it to highlight important features in the diagnosis and treatment of ingested foreign bodies. To our knowledge, this is the first case report describing ingestion of a fidget spinner toy and subsequent complications. A common cause of emergency evaluations, foreign bodies are frequently benign and often pass without incident. However, some features should raise suspicion for potential problems. Magnets can cause obstruction, ulceration, and perforation owing to their propensity to attract across bowel loops and electrochemical burns can develop quickly with modern small batteries.1 Large objects (commonly defined as those greater than 20-25 mm) can obstruct or become impacted.2-4 Sharp or pointed objects can lead to perforation from ingestion or removal.

Pediatric Chest Radiographs: Common and Less Common Errors

OBJECTIVE Radiographic imaging of the pediatric chest presents several unique challenges and nuances, stemming from congenital variants and pathologic processes specific to this population. Errors in interpretation may lead to inappropriate further imaging, incurring additional radiation exposure and cost, as well as psychologic effects on the patients and their families. CONCLUSION Here, we aim to highlight some common and less common pitfalls in pediatric chest radiography, as well as some tools for avoiding potential mistakes.

Establishment of normative values for the fetal posterior fossa by magnetic resonance imaging.

Suspected Dandy‐Walker continuum anomalies constitute a significant percentage of prenatal cases evaluated by magnetic resonance imaging (MRI). To unify the description of posterior fossa malformations, we sought to establish objective measurements for the posterior fossa in normal fetuses between 18 and 37 weeks gestation.

The central nervous system manifestations of localized craniofacial scleroderma: a study of 10 cases and literature review

BackgroundLocalized craniofacial scleroderma is a rare pediatric disease that involves a spectrum of discoloration, fibrosis and hemiatrophy of the face and scalp. Children with localized craniofacial scleroderma may have neurological symptoms, and in this context often undergo diagnostic imaging of the brain.ObjectiveTo catalogue neuroimaging abnormalities in patients with localized craniofacial scleroderma treated at our institution, review their clinical courses and compare this data with prior studies.Materials and methodsFollowing Institutional Review Board approval, an imaging database search identified 10 patients with localized craniofacial scleroderma and neuroimaging abnormalities treated at our institution. Neuroimaging exams and the electronic medical record were reviewed for each case.ResultsThe most common indications for neuroimaging were headache or seizure (80% of cases). The most common neuroimaging abnormalities were T2-hyperintense, subcortical white matter lesions ipsilateral to the cutaneous lesion (90% of cases) on magnetic resonance imaging (MRI). Calcifications or blood products (50%), cysts (40%) and abnormal enhancement (20%) were also observed. A positron emission tomography (PET) scan obtained for a single case demonstrated diminished 18F-fluorodeoxyglucose (FDG) avidity corresponding to the dominant focus of signal abnormality on MRI. Progressive neuroimaging abnormalities were present in 30% of cases. There was no consistent relationship between changes in neurological symptoms following treatment and neuroimaging findings.ConclusionOur results are similar to previously published data. In the absence of new or worsening neurological symptoms, the role of neuroimaging for follow-up of localized craniofacial scleroderma is unclear. Knowledge of intracranial neuroimaging abnormalities that are commonly associated with localized craniofacial scleroderma helps to distinguish these lesions from others that have similar appearance.

Pediatric Abdominal Radiographs: Common and Less Common Errors

OBJECTIVE Interpretation of abdominal radiographs of children benefits from a firm knowledge of the congenital anomalies and pathologies unique to this patient population, leveraged by a systematic approach. Interpretive errors place the patients and their families at risk for a delay in diagnosis, unnecessary additional imaging, a potential increase in the radiation burden, and possible psychologic trauma. CONCLUSION In this article, we describe the common and uncommon potential pitfalls in pediatric abdominal radiography, using several of our own interpretive errors as a framework while providing teaching points to help avoid these mistakes.