The radiolucent wooden foreign body.

Wooden foreign bodies in the extremities are frequently not suspected at initial presentation. Most often, these foreign bodies are not visualized radiographically. Xeroradiography, ultrasound, computed tomography, and MRI have been described as useful adjuncts in foreign body detection and localization. In our case, a truly radiolucent wooden foreign body was well visualized on plain radiographs. The atypical appearance resulted in misinterpretation, and proper diagnosis and treatment were delayed.

Comparison of iohexol with barium in gastrointestinal studies of infants and children.

This study evaluates iohexol as a contrast agent in the gastrointestinal tract in children. In the first part of the study, iohexol in concentrations of 180 and 300 mg l/ml was compared in double-blind manner with barium. Sixty-four patients were studied. No significant difference in changes of blood pressure and pulse rate was found between the three groups of patients studied. Diarrhea was significantly more common in the children receiving iohexol than in children receiving barium. The diarrhea was not due to previously identified high-risk factors in the children, nor was it due to concurrent medication. When image quality was assessed in each anatomic region of the gastrointestinal tract, fewer nondiagnostic ratings occurred with barium than with iohexol. With barium, fewer ratings of poor mucosal coating and slightly fewer ratings of suboptimal contrast density occurred. The second part of the study was an open evaluation of iohexol 180 mg l/ml in 18 patients in whom barium was clinically contraindicated. Three of 53 assessments were nondiagnostic. Mucosal coating was poor in 6%, and contrast density was suboptimal in 8% of patients. The results of this study indicate that barium is the preferred contrast agent for routine evaluation of the gastrointestinal tract in children. Good-quality images can be obtained, however, with iohexol in concentrations of 180 or 300 mg l/ml, and iohexol is an excellent contrast agent for evaluation of the gastrointestinal tract in those patients in whom barium is relatively or absolutely contraindicated.

Update on pediatric chest imaging.

Even in the high-technology medical imaging arena, the decision of how to first image pediatric chest disease is quite simple: by plain chest radiograph, including frontal and lateral views. The diagnosis can often be made or suggested on the basis of these films or with other basic imaging procedures, such as fluoroscopy or esophagram. From this point onward the decision how to proceed with further imaging such as ultrasound, computed tomography, nuclear medicine imaging, or magnetic resonance imaging, will depend on the probability of gaining further helpful information. Beginning with a concise differential diagnosis allows one to proceed in a logical manner through the diagnostic work-up in a time-effective and cost-effective manner. One must keep in mind that in some cases the diagnosis cannot be made radiologically and must be left to the pathologist. In these cases the work-up should end when no further progress is possible toward making the diagnosis. In the pediatric age group, one should always strive to limit the amount of unnecessary radiation exposure.

Recognition of renal osteodystrophy on bone imaging.

Renal osteodystrophy, a frequent complication of chronic renal failure, can be recognized and the diagnosis suggested with a fairly high degree of confidence on bone imaging, if one is familiar with common scintigraphic findings. This case report illustrates some of those findings.