ABSTRACT
This review focuses on the detection of extracolonic findings at CT colonography (CTC). Since its introduction, it has been regarded as a promising alternative to conventional colonoscopy for the detection of colorectal polyps and cancers. Unlike conventional colonoscopy and barium enema, CTC allows evaluation not only of the colon but also visualization of the lung bases, the abdomen, and the pelvis. CTC is performed with thin sections (1-5 mm) and small intervals (0.5-2 mm), enabling superb image reconstruction. The ability to evaluate the extracolonic structures can present a clinical dilemma. On the one hand, CTC may incidentally demonstrate asymptomatic malignant diseases or other clinically important conditions, thus possibly reducing morbidity or mortality. On the other hand, CTC may reveal numerous findings of no clinical relevance; this could result in costly additional diagnostic examinations with an increase in morbidity and overall negative impact on patients' health. In this article, extracolonic findings at CTC will be reviewed and the potential benefits and disadvantages will be presented.
Subject(s)
Colonography, Computed Tomographic , Lung/diagnostic imaging , Pelvis/diagnostic imaging , Radiography, Abdominal , Colonography, Computed Tomographic/economics , Colonography, Computed Tomographic/methods , Colorectal Neoplasms/diagnostic imaging , Humans , Image Enhancement , Radiation DosageABSTRACT
UNLABELLED: Primary ciliary dyskinesia has been reported as a rare cause of respiratory distress during the neonatal period. This diagnosis is readily suspected in cases presenting with accompanying situs inversus. The aim of this study was to report on a pair of siblings with primary ciliary dyskinesia. The first case was an infant diagnosed with primary ciliary dyskinesia at the age of 14 d despite lack of situs inversus. The infant had presented with respiratory distress and atelectasis almost immediately after birth. The sibling, born one year later, presented with situs inversus, therefore allowing diagnosis of primary ciliary dyskinesia to be made immediately after birth. CONCLUSIONS: Diagnosis of primary ciliary dyskinesia should be considered in newborns presenting with respiratory distress or atelectasis. Early institution of an adequate treatment programme and follow-up may reduce or prevent further complications of the disease.
Subject(s)
Kartagener Syndrome/diagnosis , Respiratory Distress Syndrome, Newborn/diagnosis , Biopsy, Needle , Bronchoscopy/methods , Female , Follow-Up Studies , Humans , Infant, Newborn , Kartagener Syndrome/complications , Kartagener Syndrome/rehabilitation , Male , Microscopy, Electron , Nasal Mucosa/pathology , Physical Therapy Modalities/methods , Respiratory Distress Syndrome, Newborn/etiology , Respiratory Distress Syndrome, Newborn/therapy , Risk Assessment , Severity of Illness Index , Situs Inversus , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
This study compares the image accuracy of computerized tomography (CT) with that of plain film radiography (PFR) in analyzing the 3-dimensional shape of impacted teeth suspected of being malformed. Eighteen patients with 22 malformed teeth were studied by PFR and CT. Crown shape, root shape, crown/root relationship, and tooth inclination and structure were assessed by PFR and CT. CT was found to be superior to PFR in showing the multiplanar shape of tooth crown and root, crown/root relationship, and tooth inclination (P <.001). No difference was found in the representation of tooth structures. The findings demonstrate that CT imaging is useful to diagnose and plan treatment for patients with unerupted and malformed teeth.
Subject(s)
Tooth Abnormalities/diagnostic imaging , Tooth, Impacted/diagnostic imaging , Adolescent , Child , Female , Humans , Male , Radiography, Dental , Reproducibility of Results , Statistics, Nonparametric , Tomography, X-Ray Computed , Tooth Crown/abnormalities , Tooth Crown/diagnostic imaging , Tooth Root/abnormalities , Tooth Root/diagnostic imagingABSTRACT
BACKGROUND: Percutaneous image-guided needle biopsy in children has been slower to gain acceptance than in adults where it is regarded as the standard clinical practice in screening suspicious masses. OBJECTIVES: To report our experience with percutaneous image-guided needle biopsy in the pediatric population and assess its clinical use, efficacy and limitations. MATERIAL AND METHODS: Sixty-nine percutaneous image-guided needle biopsies were performed in 57 children. The age of the children ranged from 4 days to 14 years (mean 5.6 years). We used 16- to-20-gauge cutting-edge needles. Sixty-two biopsies were core-needle biopsies and 7 fine-needle aspiration biopsies. RESULTS: There were 50 malignant lesions, 10 benign lesions and 2 infectious lesions. In 55 (88.7 %) lesions the needle biopsy was diagnostic. In 7 (11.3 %) the biopsy was non-diagnostic and the diagnosis was made by surgery. Core-needle biopsy was diagnostic in 47 of 50 (94 %) of the malignant solid tumors. In 3 out of 5 children with lymphoma, an accurate diagnosis was obtained with needle aspiration. Seven children underwent a repeated core-needle biopsy, (5 for Wilms' tumor and 2 for neuroblastoma) that was diagnostic in all cases. All the biopsies were performed without complications. CONCLUSION: Percutaneous image-guided needle biopsy is a simple, minimally invasive, safe and accurate method for the evaluation of children with suspicious masses. These data suggest that image-guided needle biopsy is an excellent tool for diagnosing solid tumors in the pediatric population. Negative studies should be considered nondiagnostic and followed by excisional surgical biopsies when clinical suspicion of malignancy is high.
Subject(s)
Biopsy, Needle/methods , Infections/diagnosis , Neoplasms/diagnosis , Tomography, X-Ray Computed/methods , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Sensitivity and SpecificityABSTRACT
OBJECTIVE: To evaluate the clinical significance of low arterial oxygen tension-inspired oxygen concentration (PaO2-FIO2) ratio, as a measure of hypoxemia, in the early period after cardiac surgery with cardiopulmonary bypass (CPB); and to evaluate the preoperative, intraoperative, and postoperative factors contributing to the development of hypoxemia within the first 24 hours after cardiac surgery with CPB. DESIGN: Prospective observational study. SETTING: University hospital. PARTICIPANTS: Patients who underwent elective or emergency cardiac surgery with CPB (n = 466). INTERVENTIONS: Preoperative clinical and laboratory data were recorded, as were intraoperative and postoperative data regarding the PaO2-FIO2 ratio, fluid and drug therapy, and chest radiograph. Data analysis evaluated hypoxemia as depicted by the PaO2-FIO2 ratios at 1, 6, and 12 hours after surgery. Thereafter, the effect of the PaO2-FIO2 ratios on time to extubation, lung injury, and length of hospital stay was evaluated. The risk factors were analyzed in 3 separate periods: preoperative, intraoperative, and postoperative. Univariate and multivariate analyses were performed on each period separately. All data were analyzed in 2 consecutive steps: univariate analysis and multivariate analysis. MEASUREMENTS AND MAIN RESULTS: PaO2-FIO2 ratios after CPB were significantly lower compared with baseline values. Six patients (1.32%) met the clinical criteria compatible with acute lung injury. All 6 patients had prompt recovery. Significant risk factors for hypoxemia were age, obesity, reduced cardiac function, previous myocardial infarction, emergency surgery, baseline chest radiograph with alveolar edema, high creatinine level, prolonged CPB time, decreased baseline PaO2-FIO2, use of dopamine after discontinuation of CPB, coronary artery bypass grafting, use of left internal mammary artery, higher pump flow requirement during CPB, increased level of hemoglobin or total protein content, persistent hypothermia 2 and 6 hours after surgery, requirement for reexploration, event requiring reintubation, and chest radiograph with alveolar edema 1 hour after surgery. Six hours after surgery, a lower PaO2-FIO2 ratio correlated significantly with time to extubation and lung injury. CONCLUSIONS: This study shows that despite improvements in the technique of CPB, hypoxemia depicted by low PaO2-FIO2 ratios is common in patients after CPB. It is short lived, however, and has minimal effect on the postoperative clinical course of these patients.
Subject(s)
Cardiopulmonary Bypass/adverse effects , Hypoxia/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Hypoxia/etiology , Incidence , Length of Stay , Male , Middle Aged , Multivariate Analysis , Prospective Studies , Respiratory Distress Syndrome/etiology , Risk FactorsABSTRACT
BACKGROUND: The CT appearance of the normal and abnormal thymus and its age-related changes have been described. However, there is no information regarding the change in thymus CT attenuation values in children. OBJECTIVE: The aim of the present study was to evaluate the normal CT attenuation of the thymus in infants and children and discover when the decline begins. MATERIALS AND METHODS: CT attenuation values of the thymus were retrospectively evaluated in 152 children between ages of 1 day and up to 14 years. For each patient the mean value of the CT thymus attenuation was calculated and compared to CT attenuation of the chest wall and cardiac muscles. We also examined the correlation between thymic attenuation, gender, and disease. The statistical analysis used was multivariate linear regression. RESULTS: CT attenuation of the thymus declines with age, beginning only after the 1st year of life. The thymus is more hyperdense than the chest wall and cardiac muscles in infants less than 1 year. The thymus is denser in males than females. In malignant conditions, in infants less than 1 year, thymus CT attenuation is decreased. In older children thymus attenuation was similar to that for the chest wall and cardiac muscles. CONCLUSION: The decline in thymic CT attenuation with age is consistent with fatty infiltration of the gland. The measurements given in this report can serve as a basis for comparison to determine whether the thymus of a young child is normal or pathological.
Subject(s)
Thymus Gland/diagnostic imaging , Tomography, X-Ray Computed , Adolescent , Age Factors , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Kidney Neoplasms , Linear Models , Lung/diagnostic imaging , Lung Diseases/congenital , Lung Diseases/diagnostic imaging , Lung Injury , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/secondary , Male , Mediastinal Diseases/congenital , Mediastinal Diseases/diagnostic imaging , Retrospective Studies , Sex Factors , Wilms Tumor/diagnostic imaging , Wilms Tumor/secondaryABSTRACT
Microcephalic osteodysplastic primordial dwarfism is a rare disease characterized by unique clinical appearance and specific radiographic findings, and distinctive brain abnormalities. We describe the prenatal diagnosis of two siblings with microcephalic osteodysplastic primordial dwarfism types I/III at 23 and 26 weeks of gestation, respectively. Early detection by sequential antenatal sonographic evaluation is important for counselling families known to be at risk of this rare disease.
Subject(s)
Dwarfism/diagnostic imaging , Microcephaly/diagnostic imaging , Osteochondrodysplasias/diagnostic imaging , Ultrasonography, Prenatal , Abnormalities, Multiple , Abortion, Induced , Adult , Dwarfism/complications , Female , Fetal Growth Retardation/complications , Gestational Age , Humans , Male , Microcephaly/complications , Osteochondrodysplasias/complications , PregnancySubject(s)
Artifacts , Heart Failure/complications , Mitral Valve Insufficiency/complications , Vena Cava, Inferior/diagnostic imaging , Venous Thrombosis/diagnostic imaging , Abdominal Pain/etiology , Adult , Aged , Contrast Media , Diagnosis, Differential , Female , Heart Failure/diagnosis , Humans , Male , Tomography, X-Ray Computed/methods , Venous Thrombosis/complicationsABSTRACT
Herniation of a calcified intervertebral disk into the cervical and thoracic spine is a well-documented entity, but herniation of a calcified intervertebral disk into the lumbar spine presenting as acute scoliosis has not been previously reported.
Subject(s)
Calcinosis/diagnosis , Intervertebral Disc Displacement/diagnosis , Lumbar Vertebrae , Scoliosis/diagnosis , Acute Disease , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Biopsy, Needle , Calcinosis/complications , Calcinosis/drug therapy , Child , Diagnosis, Differential , Follow-Up Studies , Humans , Intervertebral Disc Displacement/complications , Intervertebral Disc Displacement/drug therapy , Magnetic Resonance Imaging , Male , Scoliosis/drug therapy , Scoliosis/etiologyABSTRACT
Thrombosis of the ovarian vein is a remarkable process occuring within a few days of labor in 1:500-1:2000 women. Its presentation is characterized by fever, abdominal pain and occasionally by a palpable abdominal mass that in earlier years sometimes lead to explorative laparotomy. With the advent of modern imaging techniques the diagnosis can be made relatively easily. The pathogenesis has been attributed to an infectious process expanding from the uterus to the right ovarian vein and stasis. A predisposition towards thrombosis has not been so far explored. In this study we retrospectively analysed the clinical features, diagnosis and treatment of 22 patients with objective documentation of post partum ovarian vein thrombosis (POVT) and assessed potential risk factors. In 11 of the 22 patients (50%) inherited prothrombotic risk factors were detected as follows: 4 were heterozygous for factor V G1691A, 2 had protein S deficiency, one had protein S deficiency and was heterozygous for factor V G1691A, and 4 were homozygous for MTHFR C677T. Eight of the 11 patients who bore a prothrombotic predisposition underwent cesarean section. Taken together, the data suggest that POVT may result from the combined effect of an infection, cesarean section and a prothrombotic tendency.
Subject(s)
Ovary/blood supply , Puerperal Disorders/etiology , Venous Thrombosis/etiology , Adult , Cesarean Section/adverse effects , Factor V/genetics , Female , Heterozygote , Homozygote , Humans , Infections/complications , Magnetic Resonance Imaging , Methylenetetrahydrofolate Reductase (NADPH2) , Oxidoreductases Acting on CH-NH Group Donors/genetics , Pregnancy , Protein S Deficiency/complications , Puerperal Disorders/complications , Puerperal Disorders/diagnosis , Retrospective Studies , Risk Factors , Tomography, X-Ray Computed , Uterine Diseases/complications , Venous Thrombosis/complications , Venous Thrombosis/diagnosisABSTRACT
A rare case of duodenal duplication cyst containing stones in a 17-year-old patient is presented. The cyst, acting as a leading point for duodeno-jejunal intussusception caused proximal small bowel obstruction and hyperbilirubinemia. Preoperative diagnosis was based on abdominal computerized tomography. At operation, the cyst wall was unroofed creating free drainage into the duodenal lumen without damaging the biliary and pancreatic ducts with resolution of symptoms.
Subject(s)
Cholestasis/etiology , Cysts/complications , Duodenal Diseases/etiology , Duodenum/abnormalities , Intussusception/etiology , Jejunal Diseases/etiology , Adolescent , Humans , MaleABSTRACT
Neurofibromatosis has been known to involve blood vessels throughout the body. Pulmonary involvement with interstitial fibrosing alveolitis has been described but no case of pulmonary vascular involvement has been reported to date. A 51 year old patient with cutaneous neurofibromatosis is described who presented with severe pulmonary hypertension and radiographic, scintigraphic, and angiographic evidence of chronic thromboembolic pulmonary hypertension. Severe intimal fibrosis consistent with vascular involvement with neurofibromatosis was found on endarterectomy with no evidence of pulmonary thromboembolism. Neurofibromatosis of pulmonary arteries should be considered as a possible cause of pulmonary hypertension.
Subject(s)
Hypertension, Pulmonary/etiology , Neurofibromatoses/complications , Pulmonary Embolism/etiology , Angiography , Fibrosis , Humans , Male , Middle Aged , Tomography, X-Ray ComputedABSTRACT
Primary pulmonary fibrosarcoma is a rare malignant tumor in childhood. In the absence of metastases, complete resection is curative. An 8-year-old boy suffered from unresolving pneumonia due to an obstructing lesion in the left main bronchus. Cytology of the bronchoalveolar lavage fluid and histology of bronchial biopsy revealed the diagnosis of pulmonary fibrosarcoma. The tumor did not respond to chemotherapy, and a total lobectomy with sleeve resection was performed with complete removal of the neoplasm. Two years after the operation the child has no evidence of disease.
Subject(s)
Bronchoscopy/methods , Fiber Optic Technology , Fibrosarcoma/diagnosis , Lung Neoplasms/diagnosis , Biopsy , Bronchoalveolar Lavage , Child , Fibrosarcoma/diagnostic imaging , Fibrosarcoma/surgery , Follow-Up Studies , Humans , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/surgery , Male , Optical Fibers , Pneumonectomy , Radiography, ThoracicABSTRACT
We report on a child with bifid femur, absent tibiae, hypoplastic hallux, bilateral club feet, congenital heart defects, and segmentation anomalies of the spine and ribs. Parents are consanguineous, from a region where other consanguineous families with similarly affected individuals have been reported. Clinical and genetic controversies of the tibial aplasia-ectrodactyly syndrome/Gollop-Wolfgang complex are discussed.
Subject(s)
Heart Defects, Congenital/genetics , Tibia/abnormalities , Femur/abnormalities , Femur/diagnostic imaging , Humans , Infant, Newborn , Male , Radiography , Tibia/diagnostic imagingABSTRACT
CT-guided excision of osteoid osteoma is a new surgical technique that enables accurate resection of the nidus during 1-day hospitalization. We present 5-year results in 42 patients (26 males and 16 females, mean age 18 years, range 3-46). In 40 out of 42, complaints disappeared immediately after the procedure. The recovery period was short and the return to normal activity was faster than in the open surgical approach. Complications were minimal and transient.
Subject(s)
Bone Neoplasms/surgery , Osteoma, Osteoid/diagnostic imaging , Osteoma, Osteoid/surgery , Adolescent , Adult , Bone Neoplasms/diagnostic imaging , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Monitoring, Intraoperative , Tomography, X-Ray Computed , Treatment OutcomeSubject(s)
Cutaneous Fistula/diagnostic imaging , Dental Fistula/diagnostic imaging , Software , Tomography, X-Ray Computed , Adult , Aged , Female , Humans , Image Processing, Computer-Assisted/methods , Mandible/diagnostic imaging , Mandibular Diseases/diagnostic imaging , Osteomyelitis/diagnostic imaging , Periapical Abscess/diagnostic imaging , Pericoronitis/diagnostic imaging , Radiographic Image Enhancement/methods , Radiography, Dental , Radiography, Panoramic/methods , Single-Blind Method , Tomography, X-Ray Computed/methods , Tooth, Impacted/diagnostic imagingABSTRACT
PURPOSE: This article proposes a hypothesis regarding the value of saving the fractured condyle and disc in their displaced position in ankylosis type III for optimal temporomandibular joint (TMJ) function and growth, and describes four cases treated in this manner. PATIENTS AND METHODS: Four patients (three females and one male, 9 to 48 years old) with TMJ ankylosis type III of 3 to 8 years' duration, a maximal mouth opening of 15 to 19 mm, and severely limited lateral and protrusive movements were treated. The ankylosed sites were resected, leaving the displaced condyle and disc in their medial position. RESULTS: Fifteen to 60 months after surgery, the patients had a maximal mouth opening of 44 to 50 mm, as well as better contralateral and protrusive movements. In addition, two young patients (9 and 11 years old) showed an improved facial symmetry. CONCLUSIONS: Treatment of patients with type III TMJ ankylosis should involve retention rather than removal of the displaced condyle and disc. The condyle and disc are left untouched in their precarious medial position so as to provide normal function and growth.
Subject(s)
Ankylosis/surgery , Mandibular Condyle/surgery , Temporomandibular Joint Disorders/surgery , Adult , Ankylosis/pathology , Arthrography/methods , Child , Facial Asymmetry/etiology , Facial Asymmetry/surgery , Female , Humans , Male , Mandibular Condyle/injuries , Mandibular Fractures/surgery , Middle Aged , Range of Motion, Articular , Temporomandibular Joint Disorders/complications , Temporomandibular Joint Disorders/pathologyABSTRACT
An adult patient with severe scoliosis secondary to familial dysautonomia developed dysphagia and recurrent aspirations. Various imaging studies showed a mechanical obstruction of the esophagus due to compression between the spine and the aorta. The patient underwent a gastrostomy and fundoplication, with a significant decrease in symptoms. The case demonstrates one of the possible long-term consequences of untreated scoliosis.