Pediatric fibrous pseudotumor of the tunica vaginalis testis.

We describe a 16-year-old male with ultrasound evidence of a 1.3 cm right paratesticular nodule, which was managed by intraoperative frozen section and excisional biopsy. The pathologic findings were consistent with benign fibrous pseudotumor of the tunica vaginalis testis, which is a very rare lesion in the pediatric population. Consideration of fibrous pseudotumor in the differential diagnosis of pediatric paratesticular masses may help prevent unnecessarily aggressive therapy.

Metal Artifact Reduction: Added Value of Rapid-Kilovoltage-Switching Dual-Energy CT in Relation to Single-Energy CT in a Piglet Animal Model.

OBJECTIVE: The purpose of this article is to evaluate virtual monochromatic spectral imaging and metal artifact reduction software for reducing metal artifact and to compare it with conventional single-energy CT (SECT) in an animal model. MATERIALS AND METHODS: Postmortem juvenile (n = 5) and adult (n = 1) swine specimens were scanned with SECT followed by a dual-energy CT (DECT) pediatric protocol after the insertion of two rods into their paraspinal thoracolumbar regions. Virtual monochromatic spectral images were extrapolated from DECT images at five monoenergetic levels (64, 69, 75, 88, and 105 keV) with and without the use of metal artifact reduction software. Images were evaluated by a 5-point scoring system for the extent of metallic artifacts and image interpretability in soft-tissue and bone windows. The density in the most pronounced artifact was measured. CT dose index was recorded. RESULTS: In studies without metal artifact reduction software, higher energy reconstructions resulted in fewer artifacts and better image interpretability in both soft-tissue and bone windows (p < 0.0001). Artifact density decreased from -792 HU at 64 keV to -128 HU at 105 keV without the use of metal artifact reduction software. No difference was noted in attributes' scores or in artifact density in studies using metal artifact reduction software (p > 0.05). DECT studies showed lower scores compared with SECT with regard to all attributes. A new faint perimetallic hypodense halo was seen in all studies with metal artifact reduction software. The CT dose index of DECT was 1.18-3.56 times higher than that of SECT techniques. CONCLUSION: DECT at all energy levels with metal artifact reduction software and higher energy extrapolations without metal artifact reduction software reduced metallic artifact and enhanced image interpretability compared with SECT. Radiation dose with DECT could be significantly higher than SECT.

Nasogastric tubes and videofluoroscopic swallowing studies in children.

BACKGROUND: Videofluoroscopic swallowing study (VFSS) is considered to be the gold standard method in assessing the risk of aspiration. Not infrequently, children who undergo VFSS are on tube feeds. OBJECTIVE: To investigate the reliability of the findings of VFSS when a nasogastric tube is in place at the time of the study. MATERIALS AND METHODS: A retrospective review of VFSS covered a 6.5-year period. This review included only patients who had studies performed both with and without a nasogastric tube in place. Ninety-two studies (46 with and 46 without a nasogastric tube) were assessed in 46 children (30 boys, 16 girls) with a mean age of 6.7 months. The VFSS checklist of findings included weak sucking, incoordination, nasopharyngeal reflux, valecular and pyriform sinus pooling, penetration, aspiration and associated cough or respiratory compromise. We compared the occurrence rates of these events between studies with and without a nasogastric tube. RESULTS: No significant statistical difference was found in the occurrence of the different swallowing events during VFSS in the two groups. The presence of a nasogastric tube does not significantly alter the association of cough; however, it shows a moderately significant (P=0.06) higher incidence of clinical respiratory compromise if aspiration does occur (8.5% of aspiration events). CONCLUSION: The presence of a nasogastric tube does not alter the findings of VFSS; however, it might increase the incidence of respiratory compromise when aspiration is present.

Fluid levels in pediatric imaging: a pictorial review.

Fluid levels appearances are not uncommon findings in different diagnostic modalities including radiography, ultrasound, computed tomography, and magnetic resonance imaging. The significance of such signs varies according to the involved sites and the clinical settings. Familiarity with their imaging features and their diagnostic value as well as their clinical implication are of paramount importance for the radiologist and the clinician. We aim to review a spectrum of examples of fluid levels encountered with different modalities in paediatric imaging and discuss their appearances and clinical significances.