Pneumatosis intestinalis in two infants with rotavirus gastroenteritis.

Pneumatosis intestinalis is uncommon in children other than in the premature infant with necrotizing enterocolitis (NEC). We recently observed pneumatosis intestinalis in two infants with rotavirus gastroenteritis. Both children prior to the onset of acute vomiting and diarrhea were healthy and thriving with no evidence of any underlying illness. The disease and the pneumatosis intestinalis observed in the infants presented in this paper responded well to supportive and conservative medical management. The association of pneumatosis intestinalis in otherwise healthy children with acute rotavirus gastroenteritis has not been previously described.

Tracheobronchial calcification: an observation in three children after mitral valve replacement and warfarin sodium therapy.

Tracheal calcification in children may be congenital or acquired. The authors describe three children in whom tracheal or tracheobronchial calcification was noted on radiographs after prosthetic mitral valve replacement and after long periods of warfarin sodium therapy. Laryngeal and tracheal calcification has been known to occur in warfarin embryopathy. This suggests that possibility of warfarin sodium as an etiologic factor in the development of the tracheal or tracheobronchial calcification in these children. However, further investigation is necessary.

Subacute necrotizing encephalomyelopathy (Leigh disease): CT and MRI appearances.

Subacute necrotizing encephalomyelopathy (SNE) is a genetic disorder of pyruvate metabolism. Until recently the diagnosis of SNE could only be made at autopsy. However, an antemortem diagnosis can now be suggested by the correlation of clinical and laboratory data with computed tomography (CT) and/or magnetic resonance imaging (MRI). Five children with clinical and laboratory data suggesting the diagnosis of Leigh disease were evaluated by CT and MR. MR was found to be more sensitive than CT in the detection of areas of necrosis in the brain of the five children we studied. The absence of focal lesions detected by either modality in one of our patients did not exclude the diagnosis of SNE since focal lesions were present at autopsy one month following CT and MR.

Atypical radionuclide scan appearance in cellulitis due to group A streptococcus.

The scintigraphic manifestations of cellulitis consist of a diffuse increase in activity in the affected soft tissues without a focal increase in activity in the bone. The radionuclide images in two children with Group A streptococcal cellulitis were atypical, as no increased activity was noted in the soft tissues. The false-negative radionuclide images in these children is attributed to the marked amount of edema present at the sites of infection.

Recent advances in pediatric nuclear medicine.

The applications of nuclear medicine in pediatrics have grown parallel with the development of higher resolution complementary imaging modalities such as computed tomography, ultrasound, digital angiography, and magnetic resonance. The purpose of this article is to present clinically significant advances in pediatric nuclear imaging, with emphasis on newer techniques less often associated with pediatric patients.

Effect of oxygen on right ventricular performance evaluated by radionuclide angiography in two young patients with chronic lung disease.

Pulmonary hypertension is a relatively common complication of chronic lung disease in children that can cause diminished right ventricular performance (RVP) and, eventually, cor pulmonale and heart failure. Since oxygen may decrease pulmonary artery pressure in these patients, we questioned whether RVP would also improve concomitantly. We evaluated the effect of oxygen on RVP in two young hypoxemic patients by radionuclide angiography. A child with bronchopulmonary dysplasia and cor pulmonale who was not clinically in heart failure had acutely better RVP while breathing oxygen and a further improvement after continuous oxygen therapy for 1 year. In a young adult with cystic fibrosis who was suspected of being in heart failure RVP acutely improved when the FIO2 was increased. We conclude that oxygen may improve RVP in hypoxemic patients and speculate that the observation of such improvement may be valuable for the early detection of patients who can benefit from long-term oxygen therapy.

The wide spectrum of renal osteodystrophy in children.

When chronic renal failure was a routinely fatal condition little attention needed to be paid to the recognition and management of the associated bone disease. The improved medical and surgical management have prolonged the lives of children with chronic renal disease, but in so doing it has also changed the nature of their biochemical environment. These two factors contribute to an increase in the spectrum of abnormalities we see in the bones of children with renal failure, some of which are still unexplained. It has become even more important for the radiologist to recognize subtle as well as overt alterations in the bony architecture because these will influence the clinical management. This is especially true in children because of the severe growth impairment as well as the bony deformities that result from long-standing renal disease.

Distinguishing cardiac from pulmonary problems in the neonate.

Congenital heart disease is one of the most significant maladies affecting infants and young children. In most instances a congenital heart defect in the neonate is readily appreciated clinically. But in one group of infants, it may not be clear clinically whether pulmonary disease or cardiac disease is the major cause of the infant's distress. The radiologist is frequently called upon to make this distinction. The purpose of this paper is to present a plain film approach to the diagnosis of congenital heart disease in the neonate which may be of assistance in distinguishing cardiac from pulmonary problems.

Congenital middle-ear deafness: CT study.

Computed tomography (CT) was used to study 25 patients with congenital conductive hearing loss and normal external auditory canals. Deformities were subdivided according to ossicular, fenestral, and cholesteatomatous origin. Isolated ossicular deformities were found in 14 patients (five bilateral), cholesteatoma in eight, oval-window nondevelopment (with ossicular deformity) in one, and normal studies in two (congenital stapes fixation at the level of the annular ligament). Ossicular deformities may be subdivided into incudostapedial disconnections into incudostapedial disconnections (most common), malleoincudal fixations, and stapes fixations. Most are due to developmental anomaly of the first or second branchial arch. The stapes has a dual origin (second arch and otic capsule). A cholesteatoma is defined as congenital only if there is no history of otitis and the tympanic membrane is intact. In this series, six were in the middle ear proper, and two were within the attic beyond otoscopic view. Their CT appearance, with one exception, was essentially identical to that of acquired lesions.

"Communicating" bronchopulmonary foregut malformations.

The clinical, radiologic, and pathologic features of four children with uncommon variations of congenital bronchopulmonary foregut malformations are presented. In each case, the malformation included a persistent communication between lung tissue and the gastrointestinal tract. One case, in which an esophageal bronchus was associated with esophageal atresia and tracheoesophageal fistula, is considered extremely unusual. The embryogenesis of these communicating bronchopulmonary foregut malformations is outlined, and the key radiologic features are discussed.

Digital subtraction angiography and its application in children.

The authors explain the basic principles of this exciting new modality and focus on the special considerations of its use in children, its clinical applications, digital subtraction and radiation exposure, and digital fluorography and radiography.

Renal masses in children. An integrated imaging approach to diagnosis.

In view of the continuing technologic advancements in the development and availability of diagnostic imaging modalities, it is appropriate to assess periodically the currently accepted approaches to the evaluation of renal masses in children. The roles, advantages, and disadvantages of plain film, intravenous urography, ultrasonography, radionuclide scintigraphy, computed tomography, angiography, and magnetic resonance imaging in the approach to the evaluation of renal masses in children are discussed. An integrated imaging approach that provides the most accurate and necessary information for diagnosis and treatment is recommended.

CT of the pediatric chest.

The use of CT in the pediatric age group has been steadily increasing since the introduction of the newer generations of scanners with improved resolution and faster scan times. Though the clinical impact of CT of the chest has been less dramatic than that of the head and abdomen, the role of CT is rapidly evolving. CT of the chest has proven to be of great value in the evaluation of the mediastinum and in the detection of metastatic disease. The role of CT of the chest is expanding and further applications are to be expected.

Digital subtraction angiography in pediatric cerebrovascular occlusive disease.

While conventional angiography has been used to demonstrate cerebrovascular occlusive disease in the past, digital subtraction angiography (DSA) is capable of showing progressive vascular involvement with ease, simplicity, and extremely low morbidity, making it particularly well suited for children and outpatients either alone or coordinated with computed tomography. The authors discuss the usefulness and advantages of DSA as demonstrated in 7 infants and children with hemiplegia, 4 of whom had sickle-cell disease.

Obstruction of the airway by the aorta: an observation in infants with congenital heart disease.

Obstruction of the airway by a dilated aorta was observed in four infants who had complex congenital heart defects as follows: two infants had a tetralogy of Fallot and pulmonary atresia; one infant had a truncus arteriosus type 1 and small branched pulmonary arteries; and one infant had a dextroversion of the heart with a right aortic arch, single atrium, single ventricle, transposition of the great vessels, and severe subpulmonic obstruction. In addition to the extrinsic compression of the airway by the large aorta, intrinsic anomalies of the trachea and at times the main bronchi were observed at autopsy in three of the four infants. The compression of the trachea is readily apparent on lateral radiographs of the chest.

Sternal infarction in sickle-cell anemia: concise communication.

Bone scintigraphy in six children with sickle-cell anemia has demonstrated infarction of bony segments of the sternum. Anterior oblique views of the thorax provided best visualization of the infarcts which were seen as areas of decreased bone tracer accumulation.

Dilatation of the descending aorta: a radiologic and echocardiographic diagnostic sign in arteriovenous malformations in neonates and young infants.

Eleven infants with arteriovenous malformations were admitted to St. Christopher's Hospital for Children between 1970 and 1978. Dilatation of the descending aorta was seen in the chest roentgenogram in 8 of the 11 patients. Echocardiography used in the two most recent cases revealed approximation of the descending aorta to the posterior left atrial and left ventricular wall in association with generalized cardiomegaly. The most frequently reported radiologic findings in infants with arteriovenous malformations are cardiomegaly, increased pulmonary vasculature and a widened superior mediastinum. These findings can accompany other congenital malformations of the heart, but the radiographic and echocardiographic findings of a dilated descending aorta appear to be more specifically associated with arteriovenous malformations in the neonate and infant.