Transhepatic Catheterization Using Ultrasound-Guided Access

The efficacy and safety of ultrasound guidance to obtain transhepatic access for cardiac catheterization were investigated in this study. The transhepatic route for access to perform cardiac catheterization has become an acceptable alternative when conventional routes of access have failed. However, the use of ultrasound to guide transhepatic access has not been reported in the literature. We performed a retrospective chart review. Patient characteristics, indications for catheterization, procedures performed, and complications were recorded. All patients who underwent transhepatic cardiac catheterization at Duke University Medical Center were included in thids study. Eight patients underwent 12 catheterizations. The median age was 5.3 years (range, 9 months to 13 years) and median weight 18.7 kg (range, 7.1–44.8 kg). Seven catheterizations were diagnostic and 5 were interventional. There were no complications. Transhepatic access with ultrasound guidance is a safe and effective option for obtaining venous access for cardiac catheterization.     

Elevated renal rind.

We describe the findings from a group of five infants ranging in age from 3 weeks to 13 months who had shock of differing causes. In each case, sonographic evaluation of the abdomen revealed bilateral perirenal hyperechoic bands several millimeters thick, surrounding a thin, hypoechoic rim of fluid. The findings were identified during the acute phase of each child's illness and persisted after the patient's condition had clinically improved, eventually resolving in the three surviving children. We have dubbed this sign the "elevated renal rind." We believe that the changes are likely secondary to systemic inflammatory mediators and do not reflect localized intraabdominal disease.     

Recurrent thrombosis of the superior vena cava associated with activated protein C resistance: imaging findings

The purpose of this report is to describe imaging findings in activated protein C resistance, a hereditary cause of recurrent thrombosis. The case described was unusual in that a neonate was affected, whereas the vast majority of cases occur in adulthood. This entity is important to diagnose because of the recurrent nature of thromboses and the fact that relatives are often affected. Received: 30 October 1997 Accepted: 16 March 1998     

Data acquisition for pediatric CT angiography: problems and solutions

With appropriate attention to the technical aspects, excellent CT angiography can be obtained even in young infants. In this article, we will present the problems inherent with pediatric CT angiography and offer solutions that minimize or eliminate these difficulties. In addition, a literature review of specific pediatric applications is provided. Received: 4 February 2000/Accepted: 18 July 2000     

Patient safety in the pediatric emergency care setting

Patient safety is a priority for all health care professionals, including those who work in emergency care. Unique aspects of pediatric care may increase the risk of medical error and harm to patients, especially in the emergency care setting. Although errors can happen despite the best human efforts, given the right set of circumstances, health care professionals must work proactively to improve safety in the pediatric emergency care system. Specific recommendations to improve pediatric patient safety in the emergency department are provided in this policy statement.     

Imaging of pediatric mesenteric abnormalities

The relative paucity of mesenteric fat seen in the pediatric population can make detection and localization of processes in the mesentery difficult. This pictorial essay reviews pediatric mesenteric disorders and presents criteria that help localize processes to the mesentery. Disorders are categorized by specific patterns of involvement, which can readily be identified by imaging: developmental abnormalities of mesenteric rotation, diffuse mesenteric processes, focal mesenteric masses, and multifocal mesenteric masses. Received: 22 December 1998 Accepted: 5 March 1999