Coronary artery aneurysms due to Kawasaki disease: diagnosis with ultrafast CT.

Coronary artery aneurysms are the most serious complication of Kawasaki disease, and periodic screening examinations are necessary. Two-dimensional (2D) echocardiography represents the standard screening method; however, visualization of the distal coronary arteries is often limited. This report describes the complementary role of ultrafast computed tomography (CT) with 2D echocardiography in the evaluation of coronary artery aneurysms resulting from Kawasaki disease (mucocutaneous lymph node syndrome). Six pediatric patients with coronary aneurysms were examined with 2D echocardiography and ultrafast CT. Ten of 11 lesions were detected with ultrafast CT. The one missed coronary artery aneurysm was one of two contiguous aneurysms. Because of intersection thickness these two discrete aneurysms were interpreted as a solitary aneurysm. Ultrafast CT allowed detection of one aneurysm not initially visualized with echocardiography. In conclusion, ultrafast CT was found to be an effective complementary procedure with 2D echocardiography for noninvasively evaluating coronary artery aneurysms occurring as sequelae of Kawasaki disease.

Balloon dilatation of esophageal stenosis in children.

Balloon dilatation of benign esophageal strictures is an accepted mode of therapy in adults. This report describes balloon dilatation in 20 consecutive infants and children. The lesions treated include 11 strictures at surgical anastomotic sites, seven restrictive Nissen fundoplications, and three nonanastomotic esophageal strictures. One patient had two lesions. Most dilatations were performed on an outpatient basis without anesthesia. All strictures responded immediately to dilatation. In most cases, long-term resolution occurred after three or fewer procedures. A subgroup of patients was identified in which a prolonged course of treatment was needed. These included patients with long strictures due to esophageal atresia, patients with chronic severe esophagitis, and patients with strictures at the site of esophageal perforation. No significant complications were encountered. Balloon dilatation of esophageal stenosis in children is effective and safe and should be considered before other methods of treatment are used.

Deep venous thrombophlebitis: detection with 4-hour versus 24-hour platelet scintigraphy.

Thirty-one nonheparinized patients with suspected deep venous thrombophlebitis (DVT) underwent contrast venography and indium-111 platelet scintigraphy (In-111 PS). Venography permitted identification of acute DVT in 12 of 31 cases (39%). One additional patient was considered to have acute DVT despite nonconclusive venography results. In-111 PS results were positive at 4 hours in nine of 13 cases (69%) and at 24 hours in 12 of 13 cases (92%). Two of four patients with false-negative 4-hour In-111 PS studies had received warfarin. Thus, the sensitivity of 4-hour In-111 PS in patients not receiving anticoagulants was 82%. Venography results were negative for acute DVT in 18 cases, and 4-hour In-111 PS studies were negative or equivocal in each. In-111 PS is an alternative to contrast venography for detecting acute DVT. If 4-hour In-111 PS results are positive, anticoagulation can be initiated. Delayed images are necessary if the 4-hour images are negative or equivocal.

Cine CT of the mediastinum in pediatric patients.

Cine computed tomographic (CT) examinations of the mediastinum were performed in 83 pediatric patients. Lesions imaged include neoplastic, inflammatory, and vascular abnormalities. The 50-msec scan time of cine CT provides for superb depiction of the heart and airway, minimizes motion artifact, allows examinations to be done with little or no sedation, and permits optimal opacification of all vascular structures with as little as 0.5 mL of intravenously administered contrast medium per kg of body weight. Scanning time for an examination in which images in 20 sections are obtained is approximately 10 seconds. Radiation dose is significantly lower than that in comparable CT or plain radiographic studies. Preliminary experience shows cine CT to be an excellent imaging modality for the examination of the mediastinum in children.

Chronic airway obstruction in children: evaluation with cine-CT.

The radiographic diagnosis of airway lesions, especially laryngomalacia and tracheomalacia, often is imprecise. Endoscopy, which allows detailed examination of the upper airway, is an invasive procedure requiring sedation or anesthesia. A prospective study was undertaken to show the value of cine-CT (Imatron) scanning in diagnosing airway lesions in children. Eleven patients, aged 10 days to 4 years old, with a history of stridor were evaluated by both cine-CT and flexible fiberoptic endoscopy. Cine-CT studies of 12 children imaged for other reasons and without clinical evidence of airway disease served as controls to assess normal airway motion. Endoscopy identified 13 abnormalities, 11 of which were identified by cine-CT. Cine-CT has the capacity to image common causes of chronic stridor in children. It is rapid, noninvasive, and requires no sedation in most children. Although additional work is needed to clarify the role of cine-CT, this study suggests that cine-CT is a sensitive and specific imaging technique for evaluation of chronic stridor in infants and children.

Cine computed tomography for diagnosis of superior vena cava obstruction following the Mustard operation.

Superior vena caval obstruction is a well described complication following Mustard's repair for transposition of the great arteries. We report a case of a 6-year-old child with superior vena cava obstruction correctly diagnosed by Cine-CT. The advantages of imaging with Cine-CT for this complication are discussed.

Analysis of bowel perforation in necrotizing enterocolitis.

The most severe complication of necrotizing enterocolitis (NEC) is bowel perforation. Identification of neonates at high risk for perforation and optimization of radiologic imaging to identify bowel perforation are necessary to reduce the high mortality rate associated with this catastrophic event. One hundred and fifty-five cases of NEC were seen at our institution during a 5.5-year period. Nineteen (12%) progressed to perforation. A review of surgical findings, autopsy results and radiographs from these patients shows only 63% had radiographic evidence of free air in the peritoneal cavity at the time of perforation. Twenty-one percent had radiographic evidence of ascites but no pneumoperitoneum, and 16% had neither free air nor ascites. Thus purely radiographic criteria for bowel perforation in NEC are imprecise, and paracentesis is mandatory in NEC patients with ascites or clinical findings indicative of peritonitis. Timing of radiographic studies and site of bowel involvement are also important. Seventy-nine percent of perforations occurred by 30 h from confirmation of diagnosis (by clinical or radiographic criteria). Surgery or autopsy revealed involvement of the ileo-cecal region in 89% of cases with the actual site of perforation occurring in this area in 58% of patients.

Embolization therapy in the management of infantile hemangioma with Kasabach Merritt syndrome.

A case is presented in which a giant infantile hemangioma with thrombocytopenia is managed successfully by serial transcatheter embolization.

Intestinal motility disorders of infants and children: classification, clinical manifestations and roentgenology.

Diseases affecting intestinal motility in the pediatric age group are reviewed as to pathophysiology, clinical manifestations, and imaging investigation. Acute disease includes classical paralytic ileus (which has unique causes and manifestations in the infant) and acute regional bowel paralysis. Perinatal motility disorders consist of a group of related clinical syndromes which have in common functional intestinal obstruction. Chronic motility disorders are divided into those diseases in which the principal abnormality is in the bowel or those entities where the gut is affected as part of a generalized disease. Regional muscle disease includes Hirschsprung's disease and allied disorders. Some recognized causes of chronic functional obstruction of bowel include megacystis-microcolon-intestinal hypoperistalsis syndrome, rare enzymatic disorders, several discrete forms of chronic intestinal pseudoobstruction, as well as some less well-defined entities. Clinical and pathologic nature and methods of imaging investigation of these entities are considered.