Appendicitis: usefulness of US in diagnosis in a pediatric population.

One hundred eighty pediatric patients with suspected appendicitis were prospectively examined with graded compression ultrasonography (US) to assess the sensitivity, specificity, and accuracy of graded compression US in the diagnosis of appendicitis in children and to compare those results with results of clinical assessment in the diagnosis of this disorder. Patients were assigned to one of three groups prior to US based on the clinical level of confidence that appendicitis was present and on the planned management decision. Of 141 patients in the low- and intermediate-clinical risk categories, 20 (14%) had appendicitis: US had a sensitivity of 100%, specificity of 97%, and accuracy of 97% in these two groups. Of 39 patients in the high-clinical risk category, 32 (82%) had appendicitis: US had a sensitivity of 81%, specificity of 86%, and accuracy of 82%. Of 52 patients with surgically proved appendicitis, the initial management decision was to discharge to home or admit for observation and further testing in 18 (35%). Results at US were positive for appendicitis in all 18 patients in the latter two categories.     

Tumors of the pediatric chest

A wide spectrum of malignant and benign diseases can present as tumors involving the chest in children. The imaging evaluation of these children is initially directed by clinical presentation and usually begins with a chest radiograph. Further imaging with CT, MRI, or rarely ultrasonography may be performed to better detect, localize, or characterize the lesion(s). The differential diagnosis of these tumors is guided not only by tumor location and characterization, but also by patient age and clinical presentation. Familiarity with the clinical and radiographic aspects of these diseases will help the radiologist to continue to play a crucial role in the diagnosis and management of these children.     

Computer-aided diagnosis in chest radiography.

We have developed computer-aided diagnosis (CAD) schemes for the detection of lung nodules, interstitial lung diseases, interval changes, and asymmetric opacities, and also for the differential diagnosis of lung nodules and interstitial lung diseases on chest radiographs. Observer performance studies indicate clearly that radiologists' diagnostic accuracy was improved significantly when radiologists used a computer output in their interpretations of chest radiographs. In addition, the automated recognition methods for the patient and the projection view by use of chest radiographs were useful for integrating the chest CAD schemes into the picture-archiving and communication system (PACS).     

Soft-tissue venous malformations in pediatric and young adult patients: diagnosis with Doppler US.

PURPOSE: To describe the diagnostic features, appearance, and vascularization pattern of venous malformations (VMs) at Doppler ultrasonography (US). MATERIALS AND METHODS: Between February 1991 and May 1997, 51 soft-tissue VMs were studied with Doppler US in patients between 1 day and 21 years of age (mean age, 9 years). These VMs were located in the maxillofacial region (n = 19), trunk (n = 5), and upper (n = 10) and lower (n = 17) extremities. Twenty-three VMs had venographic confirmation, seven had only histologic confirmation, and 21 had both venographic and histologic confirmation. US was performed with 7.5- or 7-10-MHz linear transducers, a low pulse repetition frequency (mean, 1,680 Hz), and the lowest wall filter (25-50 Hz). RESULTS: At gray-scale US, VMs appeared as hypoechoic, heterogeneous lesions in 82% of cases. All lesions displayed compressibility. In eight lesions (16%), phleboliths were identified, thus confirming the diagnosis of VM. Analysis of vascular flow revealed monophasic, low-velocity flow in 40 VMs (78%), with an average flow velocity of 0.22 kHz. Biphasic flow was noted at the periphery of three lesions, which is indicative of a mixed capillary-venous malformation. The remaining eight lesions did not display any flow. CONCLUSION: In pediatric patients, Doppler US is a noninvasive, easily available, and rapid mode of investigation of vascular lesions and can help confirm the diagnosis of VM when it shows a characteristic flow pattern.     

Potential of ultrasound in the pediatric chest

Ultrasound (US) of chest, even with inherent limitations of the US beam and air, has been useful in many pediatric chest conditions. It has extended its role and is now widely used by many subspecialists in medicine. This review article will cover techniques, indications, and applications of chest US in neonates, infants and children, including also different common as well as some rare and modern aspects and applications, such as pleural effusion, pneumothorax, pulmonary lesions, mediastinum, diaphragm, and chest wall. Other related imaging modalities are also briefly discussed.     

Emergency radiology of the pediatric chest

This monograph will present an overview of pediatric emergency room chest radiology. Technique, interpretative approach, normal radiologic appearances, common normal variants, and unique features of the pediatric lung are discussed. The radiologic features of common pediatric chest emergencies (infection, airway foreign body, asthma, hydrocarbon aspiration, near-drowning pneumothorax, trauma, hemosiderosis and upper airway obstruction) are described and illustrated.     

Abnormalities of the chest wall in pediatric patients

A variety of focal processes and diffuse abnormalities are found predominantly in children. In addition, thoracic manifestations of trauma differ in children because of increased chest wall compliance. Familiarity with both these abnormalities as well as the common normal variations provides optimal imaging evaluation.     

Emergency pediatric chest radiology

Both traumatic and nontraumatic pediatric emergencies relating to the chest may be encountered in the emergency room, but nontraumatic problems probably are more common. This communication deals with the salient points used to identify and diagnose nontraumatic pediatric emergencies on initial radiographic studies.     

胸部病变的改良式动态增强CT扫描的应用

目的 :探讨改良式动态增强CT扫描对胸部病变诊断的价值。方法 :搜集连续胸部改良式CT增强扫描的病例 12 5例。所有病例在正位定位像上可发现明显的病变。全胸增强扫描前均在病灶中心层面平扫 1～ 3层 ,增强螺旋扫描后再在病灶相应层面加做延迟 2～ 5min的扫描。分析胸部病变改良式动态增强的CT诊断结果 ,与病检结果进行对照 ,以及改良式动态增强CT扫描对胸部病变诊断的价值。结果 :CT诊断的 12 5例病例 ,除 4例肺癌无法获得病检外 ,116例诊断正确 ,另 5例误诊。误诊主要在于病变自身特殊的病理结构所致 ,而与使用的这种增强扫描方法关系不大。结论 :胸部改良式动态增强CT扫描对胸部病变的正确诊断有很大帮助 ,具有实用价值     

Knowledge-based computer-assisted diagnosis of chest radiographs.

The computer can produce structured radiologic content which can potentially keep the radiologists current in radiology literature. As the radiologist continues to make observations and uses the available information, he has at his fingertips with the computer the current information to offer appropriate differential diagnosis and suggest appropriate patient follow up. The computer allows the radiologist to learn and grow rather than guess and hope.     

Intestinal anisakiasis: US in diagnosis.

Eighteen consecutive patients with intestinal anisakiasis were studied with high-resolution ultrasound (US) and barium studies. US showed markedly thickened bowel loops associated with luminal narrowing, swelling of Kerckring folds, and decreased peristalsis. A small amount of ascitic fluid around the bowel loops was found, and cytologic examinations of the ascites revealed a dense infiltration of eosinophils. Barium studies demonstrated segmental mucosal edema of the small intestine: The most common site was the distal ileum, and the mean length of the edematous lesion was 19 cm. All patients underwent treatment of symptoms without laparotomy, and their symptoms disappeared by the eighth day after onset. Patients with acute abdominal symptoms should be asked about the intake of raw or undercooked fish. If the above US features are found, the diagnosis of intestinal anisakiasis must be seriously considered to avoid unnecessary surgical treatment.     

Computed tomography in chest diseases

The evaluation of mediastinum, lngs, and chest wall diseases can simutaneously be accomplished by computed tomography (CT). A wide range of congenital, inflammatory and neoplastic disorders seen at our institution are presented to show the additional information available by CT as opposed to conventional films. CT has the advantage of being able to detect minor differences in attenuation and its noninvasive.     

Performance of chest ultrasound in pediatric pneumonia

ObjectiveThe objective of this study was to evaluate the performance of ultrasound in detecting lung consolidation in children suspected of pneumonia, in comparison to the current gold standard, chest X-rays.Materials and methodsFrom September 2013 to June 2014, a monocentric prospective study was performed on all children between 0 and 16 years-old, referred for chest X-ray for suspected pneumonia. Each child was examined by chest ultrasound by an examiner blinded to the chest X-ray. The presence or absence of areas of consolidation, their number and location were noted for each technique. The size of the consolidations identified only on ultrasound was compared with that of consolidations visible on both techniques.Results143 children (mean age 3 years; limits between 8 days and 14 years) were included. Ultrasound detected at least one area of consolidation in 44 out of 45 patients with positive X-rays. Of the 59 areas of consolidation on X-ray, ultrasound identified 54. In the 8 patients with negative X-ray, ultrasound revealed 17 areas of consolidation. The mean size of consolidations visible only on ultrasound was 9.4 mm; for consolidations visible on both techniques the mean size was 26 mm (p < 0.0001).The sensitivity and specificity of ultrasound were calculated at 98% and 92%. PPV and NPV were 85% and 99%, respectively.ConclusionChest ultrasound is a fast, non-ionizing and feasible technique. With its high negative predictive value, it can replace X-rays in order to exclude lung consolidation in children, thus reducing radiation exposure in this population.     

Extraneous adult fingers imaged on pediatric chest X-rays.

INTRODUCTION: The medical director of the pediatric intensive care unit (PICU) selected a collection of pediatric chest X-rays for a clinical audit. As an unrelated activity during the performance of this audit, the frequency of adult fingers visualized on the PICU chest X-rays was documented. METHODS: A clinical audit of 439 PICU chest X-rays was performed. The visualization of adult fingers on the radiographs was categorized into those fingers directly in the X-ray beam and those seen only in the partially coned area of the images. RESULTS: There were 43 instances (9.8%) in which adult fingers were directly exposed to the X-ray beam. Additionally, in 23 instances (5.2%), adult fingers were seen only in the partially coned area of the image. DISCUSSION: Professional standards of practice and radiation biology publications support the need to avoid occupational radiation exposure. Occupational health and safety and radiation safety regulations stipulate that operators of an X-ray emitting device, or technologists assisting in the operation of an X-ray emitting device, must distance themselves from the primary beam (minimum of 3 metres) during X-ray exposure. All attempts must be made not to expose other individuals during the acquisition of clinical images. These policies and practice standards must be reinforced to minimize the exposure of medical radiation technologists and other medical staff to radiation.     

Asbestos-related chest diseases: plain radiographic findings.

In summary, there are a wide range of pulmonary manifestations seen in asbestos-exposed individuals from pleural and parenchymal fibrosis to pleural and parenchymal malignancy. The chest roentgenogram has assumed an important role in the detection and surveillance of asbestos-related pleural and parenchymal changes.