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1.
Int J Pediatr Otorhinolaryngol ; 97: 72-75, 2017 Jun.
Article in English | MEDLINE | ID: mdl-28483255

ABSTRACT

OBJECTIVES: To evaluate radiographic characteristics and to identify locations of cervicofacial lymphatic malformations in children based on known lymph node groupings. METHODS: Retrospective chart review of pediatric patients with cervicofacial lymphatic malformations who underwent imaging with magnetic resonance imaging (MRI), computed tomography (CT) or ultrasonography (US). Ninety charts were reviewed from November 2005 to June 2015. Demographic information and imaging characteristics were evaluated. RESULTS: Ninety children were included. The average age at presentation was 52 months (range, 1 day to 170 months). Imaging modalities were MRI in 73 (81%), CT in 7 (8%), US in 6 (7%), and multimodality imaging in 4 (4%) cases. Nearly half (49%) of lesions were found in the parotid and submandibular nodal group, 32% in the cervical group, and 19% in the midline face and oral cavity group. The lymphatic malformations were found on the left in 39 (43%) of cases, on the right in 30 (33%) of cases, and were bilateral in 21 (23%) cases. Nineteen (21%) lesions were macrocystic, twenty-two (24%) were microcystic, and forty-nine (49%) had mixed features. Mixed lesions were more likely to be extensive and involve multiple lymph node groups (P = 0.0005). Adjacent lymphadenopathy was present in 20 (22%) among all subjects, with an average size of 1.22 (± 1.92) cm in the short-axis. CONCLUSION: The results of this study demonstrate three lymph node groupings in which LM are commonly identified. The midline face and oral cavity lesions are predominantly microcystic, the parotid and submandibular lesions are predominately of mixed morphology, and the cervical lesions are predominately macrocystic and mixed. Further studies are needed to determine if such a classification system demonstrates clinically significant difference in disease progression and response to therapy.


Subject(s)
Face/pathology , Lymph Nodes/abnormalities , Lymphatic Abnormalities/diagnostic imaging , Neck/pathology , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Magnetic Resonance Imaging , Male , Retrospective Studies , Tomography, X-Ray Computed
2.
J Pediatr Orthop ; 34(1): 109-17, 2014 Jan.
Article in English | MEDLINE | ID: mdl-24322574

ABSTRACT

BACKGROUND: The diagnosis and management of vascular anomalies of the extremities can be challenging as these disorders are uncommon and may clinically overlap. The aim of this paper is to describe the clinical, radiologic, and histopathologic features of fibro-adipose vascular anomaly (FAVA), a previously unrecognized disorder of the limb. METHODS: The clinical, imaging, operative, and histopathologic data from patients with a unique intramuscular lesion of the extremities comprising dense fibrofatty tissue and slow-flow vascular malformations were retrospectively reviewed. RESULTS: Sixteen patients diagnosed with FAVA of the extremity (3 male and 13 female individuals) met the clinical, radiologic, and histopathologic inclusion criteria. The age at presentation ranged from the time of birth to 28 years. The locations of the lesions were: calf (n=10), forearm/wrist (n=3), and thigh (n=3). Fourteen patients presented with severe pain. Seven of the patients with calf lesions had limited ankle dorsiflexion. On imaging, the complex intramuscular lesions replaced muscle fibers with fibrofatty overgrowth and phlebectasia (dilation of the veins). The extrafascial component comprised fatty overgrowth, phlebectasia, and an occasional lymphatic malformation. The histopathologic features comprised dense fibrous tissue, fat, and lymphoplasmacytic aggregates within atrophied skeletal muscle. Adipose tissue also infiltrated skeletal muscle at the periphery of the lesion. There were large, irregular, and sometimes excessively muscularized venous channels and smaller, clustered channels. Other findings include organizing thrombi, a lymphatic component, and dense fibrous tissue-encircled nerves. CONCLUSIONS: The constellation of clinical, radiologic, and histopathologic features constitutes a distinct entity comprising fibrofatty infiltration of muscle, unusual phlebectasia with pain, and contracture of the affected extremity. The clinical and radiologic findings permit the diagnosis of FAVA with major therapeutic implications. LEVEL OF EVIDENCE: Level III.


Subject(s)
Muscle, Skeletal/pathology , Peripheral Vascular Diseases/congenital , Peripheral Vascular Diseases/diagnosis , Vascular Malformations/diagnosis , Adipose Tissue/blood supply , Adipose Tissue/pathology , Adolescent , Adult , Child , Child, Preschool , Cohort Studies , Female , Follow-Up Studies , Humans , Lower Extremity/blood supply , Lower Extremity/diagnostic imaging , Lower Extremity/pathology , Magnetic Resonance Angiography , Male , Muscle, Skeletal/blood supply , Muscle, Skeletal/diagnostic imaging , Peripheral Vascular Diseases/pathology , Radiography , Retrospective Studies , Risk Assessment , Severity of Illness Index , Time Factors , Treatment Outcome , Upper Extremity/blood supply , Upper Extremity/diagnostic imaging , Upper Extremity/pathology , Vascular Malformations/surgery , Young Adult
3.
J Vasc Interv Radiol ; 22(9): 1300-5, 2011 Sep.
Article in English | MEDLINE | ID: mdl-21715187

ABSTRACT

PURPOSE: To review an initial experience studying the lymphatic system using direct injection of ethiodized oil contrast medium into lymph nodes (ie, intranodal lymphangiography) in children with chylous disorders. MATERIALS AND METHODS: Children with chylous disorders who underwent intranodal lymphangiography were included in this retrospective study. Under general anesthesia, ultrasonography was used to guide the placement of a small-bore (22-25-gauge) needle into an inguinal lymph node. Ethiodized oil contrast medium was very slowly injected into the node. Opacification of the lymphatic system was documented with fluoroscopic and digital substraction imaging and videofluoroscopic clips. RESULTS: Five children (age range, 6 wk to 17 y) with chylous vaginorrhea (n = 1), postoperative chylothorax (n = 2), or spontaneous chylothorax (n = 2) underwent intranodal lymphangiography. The amount of ethiodized oil injected was 0.5-4.5 mL. Intranodal lymphangiography was successfully completed in four patients. One procedure was terminated because of patient motion and extravasation of contrast medium. Lymphangiographic findings included a spectrum of lymphatic channel disorders including incompetence, obstruction, collateralization, chylous reflux, and chylous leak. There were no complications. CONCLUSIONS: The simplified technique of injecting contrast medium into a lymph node to opacify the lymphatic system in children can be an alternative to the more elaborate conventional lymphangiography.


Subject(s)
Chylothorax/diagnostic imaging , Lymph Nodes/diagnostic imaging , Lymphatic Diseases/diagnostic imaging , Lymphography/methods , Adolescent , Anesthesia, General , Boston , Child , Child, Preschool , Contrast Media , Ethiodized Oil , Feasibility Studies , Female , Fluoroscopy , Humans , Infant , Male , Pilot Projects , Predictive Value of Tests , Radiographic Image Enhancement , Radiography, Interventional , Retrospective Studies
4.
AJR Am J Roentgenol ; 196(6): W823-30, 2011 Jun.
Article in English | MEDLINE | ID: mdl-21606276

ABSTRACT

OBJECTIVE: The objective of our study was to determine the rate of pulmonary embolism (PE) on pulmonary CT angiography (CTA) in children and adolescents visiting adult-centered community hospitals. We also investigated alternative diagnoses that may account for presenting symptoms. MATERIALS AND METHODS: We identified consecutive children and adolescents (age ≤ 19 years) who underwent pulmonary CTA during a 12- and 24-month period, respectively, at two community hospitals. Staff radiologists' clinical interpretations of pulmonary CTA studies were compared with interpretations performed by a blinded, subspecialty-trained thoracic radiologist, with a third tie-breaking interpretation performed in cases of discrepancy. A systematic review of pulmonary CTA studies for possible alternative diagnoses was completed. Diagnostic rates of PE on pulmonary CTA studies in adults at these hospitals were also reviewed for comparison. RESULTS: The study population consisted of 130 individuals (32 boys and 98 girls; median age, 18 years; age range, 11-19 years) who underwent 137 examinations, 11 as inpatients and 126 as outpatients. CTA studies were positive for PE in six patients (4.6%). CTA showed an important alternative diagnosis, such as pulmonary consolidation, in 27 patients (21%). By comparison, pulmonary CTA studies in adults at these two hospitals yielded a 16% positive rate for PE. CONCLUSION: The prevalence of PE in young ambulatory patients with clinically suspected PE at adult-centered community hospitals is substantially lower than in adults. Alternative diagnoses, such as pulmonary consolidation and pneumothorax, are discovered more frequently than PE on pulmonary CTA studies. Pulmonary CTA should be used with discretion in adolescents, especially when radiography may provide the necessary diagnosis.


Subject(s)
Hospitals, Community , Pulmonary Embolism/diagnostic imaging , Tomography, X-Ray Computed , Adolescent , Child , Female , Humans , Male , Ohio/epidemiology , Prevalence , Pulmonary Embolism/epidemiology , Young Adult
5.
Pediatr Radiol ; 41(7): 867-74, 2011 Jul.
Article in English | MEDLINE | ID: mdl-21301826

ABSTRACT

BACKGROUND: Use of medical imaging is under scrutiny because of rising costs and radiation exposure. We compare imaging utilization and costs across pediatric hospitals to determine their variability and potential determinants. MATERIALS AND METHODS: Data were extracted from the Pediatric Health Information System (PHIS) database for all inpatient encounters from 40 U.S. children's hospitals. Imaging utilization and costs were compared by insurance type, geographical region, hospital size, severity of illness, length of stay and type of imaging, all among specific diagnoses. RESULTS: The hospital with the highest utilization performed more than twice as many imaging studies per patient as the hospital with the lowest utilization. Similarly, imaging costs ranged from $154 to $671/patient. Median imaging-utilization rate was 1.7 exams/patient on the ward and increased significantly in the PICU (11.8 exams/patient) and in the NICU (17.7 exams per patient, (P < 0.001). Considerable variability in imaging utilization persisted despite adjustment for case mix index (CMI, range in variation 16.6-25%). We found a significant correlation between imaging utilization and both CMI and length of stay, P < 0.0001). However, only 36% of the variation in imaging utilization could be explained by CMI. CONCLUSION: Diagnostic imaging utilization and costs vary widely in pediatric hospitals.


Subject(s)
Diagnostic Imaging/statistics & numerical data , Hospitals, Pediatric/statistics & numerical data , Databases, Factual , Diagnostic Imaging/economics , Humans , Insurance, Health/statistics & numerical data , Length of Stay/statistics & numerical data , Linear Models , Severity of Illness Index , United States
6.
Pediatr Radiol ; 40(4): 488-90, 2010 Apr.
Article in English | MEDLINE | ID: mdl-20225109

ABSTRACT

This article discusses challenges in becoming a pediatric radiologist and contains words of advice from two young pediatric radiologists. Discussions include fellowship challenges and adjustment to being a new attending, including balancing work and life and difficult cases.


Subject(s)
Job Description , Pediatrics , Radiology , Workload , United States , Workforce
7.
J Am Coll Radiol ; 6(9): 635-42, 2009 Sep.
Article in English | MEDLINE | ID: mdl-19720359

ABSTRACT

PURPOSE: Persistent workforce shortages exist in some radiology subspecialties. Residents' motivations for selecting particular fellowships, as well as their perceptions of the subspecialty fields, heavily influence the supply of new radiologists to these areas. The authors investigated the factors residents consider most important in subspecialty choice, fellowship choice patterns between 1999 and 2008, and changes that might attract residents to one particular shortage field: pediatric radiology. MATERIALS AND METHODS: An online questionnaire was developed and sent to 1,000 radiology trainees in the United States using contact information from the ACR's national resident database. Anonymized responses were evaluated using analysis of variance and logistic regression models. RESULTS: Leading factors for fellowship selection were "area of strong personal interest," "advanced/multimodality imaging," and "intellectual challenge." Compensation ranked low, 13th among 20 factors. Large shifts in subspecialty preference were seen between 1999 and 2008. Those with a pediatric radiology preference ranked "physician-physician interaction," "physician-patient contact," and "altruism" higher than respondents selecting other subspecialties. Respondents believed that pediatric radiologists make less money than other subspecialists ($325,000 vs $385,000 per year). There was no association between choosing pediatric radiology and gender, age, research plans, or parental status. CONCLUSIONS: Multiple factors account for subspecialty selection among residents, and it is useful to understand these factors when attempting to recruit residents to specific subspecialties. To ease the workforce shortage in pediatric radiology, advanced and varied imaging modalities, numerous job opportunities, and well-paid private practice positions should be emphasized to residents.


Subject(s)
Career Choice , Internship and Residency/statistics & numerical data , Pediatrics/statistics & numerical data , Radiology/statistics & numerical data , Decision Making , United States , Workforce
8.
Am J Orthod Dentofacial Orthop ; 122(3): 274-6, 2002 Sep.
Article in English | MEDLINE | ID: mdl-12226608

ABSTRACT

The purpose of this study was to measure the shear bond strength of stainless steel brackets bonded to enamel in vitro with a recently developed self-etching primer (Transbond Plus Self Etching Primer, 3M Unitek, Monrovia, Calif). Forty-eight extracted human teeth were obtained and randomly divided into 4 groups of 12: (1) control group with a conventional etchant and separate primer, (2) experimental group with the self-etching primer, left for 15 seconds before bonding, (3) same as group 2, but with the primer left for 2 minutes before bonding, (4) same as group 2, but with the primer left for 10 minutes before bonding. For each group, stainless steel brackets were mounted onto the prepared enamel, stored for 24 hours at 37 degrees C, and tested in a testing machine with a crosshead speed of 1 mm/min. There was no significant difference in the bond strength between the 4 groups as determined by analysis of variance (ANOVA) (P <.05). Under the conditions of these experiments, a 10-minute delay in bonding after application of the self-etching primer might not be deleterious to adhesion.


Subject(s)
Dental Bonding , Dental Enamel/ultrastructure , Orthodontic Brackets , Resin Cements/chemistry , Stainless Steel/chemistry , Acid Etching, Dental , Adhesiveness , Adhesives/chemistry , Analysis of Variance , Dental Stress Analysis/instrumentation , Humans , Hydrogen-Ion Concentration , Stress, Mechanical , Temperature , Time Factors
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