Posterior dislocation of sternoclavicular joint encroaching on ipsilateral vessels in 2 pediatric patients.

Dislocation of the sternoclavicular joint (DSCJ) with posterior displacement of the clavicle is uncommon in children. This can lead to ipsilateral compression of the great vessels. Diagnosis may not be apparent on routine radiographs. Axial computed tomographic (CT) scan is the imaging of choice for diagnosis. Reconstruction and 3-dimensional (3D) views on CT scan may be helpful to define the anatomy before surgical reduction. We present 2 patients who had traumatic posterior DSCJ with compromise to their vascular structures. Patient 1 was a 13-year-old boy with posterior DSCJ on his left side that was not apparent on x-ray and that was diagnosed to have encroachment of the medial end of the clavicle on the left brachiocephalic vein on CT scan. Reconstruction and 3D views on CT scan were helpful in defining the anatomy before surgical reduction. The patient underwent emergent open reduction and internal fixation with complete recovery.Patient 2 was a 14-year-old boy with posterior DSCJ on the right side that was apparent on x-ray and was evaluated to have encroachment of the medial end of the clavicle on the right innominate artery with an associated paratracheal hematoma on CT scan. Reconstruction and 3D views on CT scan were also helpful in defining the anatomy before surgical reduction. The patient underwent a successful closed reduction with complete recovery.

Prevalence of choroid plexus cysts in term and near-term infants with congenital heart disease.

OBJECTIVE: We retrospectively studied term and near-term infants to determine if there is an increased prevalence of choroid plexus cysts associated with congenital heart disease. MATERIALS AND METHODS: We reviewed 231 consecutive cranial ultrasound examinations from January 2005 through December 2008 on infants between 37-42 weeks of gestation (115 infants with and 116 without congenital heart disease). After exclusion for intracranial hemorrhage or anomalies excluding hydronephrosis, studies on 87 infants with and 99 without congenital heart disease were scored by a single pediatric radiologist blinded to clinical data for the presence of choroid plexus cysts. All studies used a multifrequency 6-8-MHz phased-array transducer. Results were analyzed using Pearson's chi-square test. RESULTS: Of 87 infants with congenital heart disease (53/87 [61%] cyanotic, 34/87 [39%] acyanotic), 26% (23/87) had choroid plexus cysts versus 12% (12/99) without heart disease (χ(2) = 4.48, p < 0.05). The rate of choroid plexus cysts in the cyanotic group (13/54 or 24%) and acyanotic group (10/33 or 30%) (χ(2) = 0.050, p > 0.05) were similar. Among 28 patients who underwent renal ultrasound, 50% (10/20) with congenital heart disease had choroid plexus cysts compared with 12.5% (1/8) of those without (χ(2) = 3.36, p < 0.10). CONCLUSION: We documented an increased prevalence of choroid plexus cysts in infants with congenital heart disease but no difference according to type. Our data revealed a possible association of choroid plexus cysts, hydronephrosis, and congenital heart disease. We suggest ultrasound evaluation of the kidneys and heart in infants with choroid plexus cysts.

Emergency MRI of acute pelvic pain: MR protocol with no oral contrast.

The aim of this study was to evaluate the efficacy of magnetic resonance (MR) without oral contrast in the assessment of suspected acute pathologies of the pelvis in pregnant and non-pregnant patients. Sixty-seven patients who had MR of the lower abdomen and pelvis for acute abdomen were included in the study. The MR examinations were evaluated for indication of the study, type of MR sequences, and sensitivity of MR in diagnosing the disease. T2 single shot fast spin echo (SS-FSE), T2 FSE, short tau inversion recovery, pre-gadolinium T1, and post-gadolinium T1 sequences were utilized. There were 30 pregnant and two postpartum women in the study group. Positive pelvic MR findings were seen in 73% (49/67). Final diagnoses were acute appendicitis (n = 12), ovarian torsion (n = 6), abscess (n = 3), tubo-ovarian abscess (n = 2), ovarian tumor (n = 2), degenerating fibroid (n = 3), and perianal fistula (n = 2). For acute appendicitis, sensitivity was 100% (12/12), and positive predictive value was 92% (12/13). Post-gadolinium T1-weighted sequences and T2 SS-FSE with FS were the sequences, which were most likely to best demonstrate the acute appendicitis. For ovarian torsion, the sensitivity was 86% (6/7), and positive predictive value was 100% (6/6). MR imaging is an efficacious means of diagnosing acute appendicitis, ovarian torsions, and other adnexal diseases in the acute setting. The four sequence protocol without oral contrast offers an excellent means of investigating the cause of acute lower abdominal and pelvic pain.

Computed tomography angiography and computed tomography perfusion in ischemic stroke: A step-by-step approach to image acquisition and three-dimensional postprocessing.

Recent technical advances in both image acquisition and postprocessing have enabled computed tomography angiography (CTA) with computed tomography perfusion to become front-line tools for acute stroke evaluation in many institutions. This article provides a step-by-step approach to utilizing these technologies, particularly in the rapid triage of appropriate stroke patients to reperfusion therapies. The specific contrast injection, image acquisition, and 3D postprocessing protocols for high-quality CTA, currently in use at our institution, are delineated. An important point of emphasis is how preliminary angiographic and cerebral perfusion observations can be made immediately at the scanner to expedite emergent therapy. Also explored is the manner in which a dedicated 3D lab can support a high clinical volume, including a large percentage of emergent studies. An accurate yet time-efficient approach for the neuroradiologist to integrate 3D interpretation with CTA source data review is offered. Several important imaging and interpretive pitfalls in stroke CTA are illustrated.