ABSTRACT
A 17-year-old patient presented, after a motor vehicle collision, with right hip pain and unusual radiographs of the chest and pelvis. Multiple radiopacities obscured detail. These partly obscured and distracted attention from a right acetabular fracture. The etiology was persistent perflubron 9 years after partial liquid ventilation for acute respiratory distress syndrome. Persistence of perflubron beyond 138 days has not been previously reported. We review the imaging appearance of perflubron and the mechanism likely related to its distribution and persistence in this case, and emphasize the importance of obtaining clinical history and avoiding distraction when faced with unusual radiographic findings.
Subject(s)
Contrast Media/pharmacology , Fluorocarbons/pharmacology , Liquid Ventilation/adverse effects , Mediastinum/diagnostic imaging , Retroperitoneal Space/diagnostic imaging , Adolescent , Female , Humans , Hydrocarbons, Brominated , Radiography , Respiratory Distress Syndrome/therapySubject(s)
Arteriovenous Malformations/classification , Genital Neoplasms, Male/classification , Genital Neoplasms, Male/diagnosis , Hemangioma, Cavernous/classification , Hemangioma, Cavernous/diagnosis , Spermatic Cord/diagnostic imaging , Child , Diagnosis, Differential , Genital Neoplasms, Male/surgery , Hemangioma, Cavernous/surgery , Humans , Male , Orchiectomy/methods , Radiography , Spermatic Cord/surgery , UltrasonographyABSTRACT
OBJECTIVE: To a) describe superior mesenteric artery resistive index, as an estimate of perfusion, before and after modified Norwood; and b) assess incidence of diastolic flow reversal in the superior mesenteric artery before and after modified Norwood. DESIGN: Prospective observational trial. SETTING: Children's hospital pediatric intensive care unit. PATIENTS: Ten newborns with hypoplastic left heart syndrome. INTERVENTIONS: Ultrasound documentation of superior mesenteric artery diastolic flow direction and measurement of superior mesenteric artery resistive index 24-48 hrs before and 24-48 hrs after modified Norwood. MEASUREMENTS AND MAIN RESULTS: Seven males and three females were enrolled. There was no change between the superior mesenteric artery resistive index pre- vs. postoperatively-0.99 (95% confidence interval, 0.85, 1.12) vs. 1.07 (95% confidence interval, 1.0, 1.15) (p = .13). Incidence of retrograde diastolic blood flow in the superior mesenteric artery was not different pre- vs. postoperatively (70% vs. 50%, p = .41). No patients developed necrotizing enterocolitis and all survived to hospital discharge. CONCLUSIONS: Ultrasound measurements in neonates with hypoplastic left heart syndrome suggest that superior mesenteric artery perfusion, as measured by resistive index, is impaired. Superior mesenteric artery diastolic flow reversal is common before and immediately after modified Norwood.
Subject(s)
Hypoplastic Left Heart Syndrome/physiopathology , Hypoplastic Left Heart Syndrome/surgery , Mesenteric Artery, Superior/physiopathology , Splanchnic Circulation , Enterocolitis, Necrotizing/physiopathology , Enterocolitis, Necrotizing/prevention & control , Female , Humans , Hypoplastic Left Heart Syndrome/diagnostic imaging , Infant, Newborn , Intensive Care Units, Neonatal , Male , Mesenteric Artery, Superior/diagnostic imaging , Perioperative Care , Prospective Studies , Ultrasonography, Doppler , Vascular ResistanceABSTRACT
Ultrasound is exquisitely sensitive for the identification of portal vein pneumatosis, which in neonates is commonly caused by necrotizing enterocolitis. We describe the ultrasound finding of systemic arterial pneumatosis in a case of necrotizing enterocolitis associated with congenital heart disease. A combination of a patent ductus venosus and an extracardiac right-to-left shunt via the great vessels through a patent ductus arteriosus provided a pathway for the pneumatosis from the portal vein to the abdominal aorta.
Subject(s)
Ductus Arteriosus, Patent/diagnostic imaging , Enterocolitis, Necrotizing/diagnostic imaging , Pneumatosis Cystoides Intestinalis/diagnostic imaging , Abnormalities, Multiple/diagnostic imaging , Aorta, Abdominal/diagnostic imaging , Aorta, Abdominal/physiopathology , Combined Modality Therapy , Ductus Arteriosus, Patent/complications , Ductus Arteriosus, Patent/therapy , Enterocolitis, Necrotizing/complications , Enterocolitis, Necrotizing/therapy , Follow-Up Studies , Humans , Infant, Newborn , Male , Pneumatosis Cystoides Intestinalis/complications , Pneumatosis Cystoides Intestinalis/therapy , Portal Vein/diagnostic imaging , Portal Vein/physiopathology , Risk Assessment , Severity of Illness Index , Treatment Outcome , Ultrasonography, DopplerSubject(s)
Rectum/diagnostic imaging , Barium Sulfate , Constipation/diagnostic imaging , Contrast Media , Female , Humans , Infant , Muscle Contraction , RadiographyABSTRACT
Nuclear medicine bone scan is an essential diagnostic imaging tool both for the diagnosis and staging of bone tumors and in the follow-up of these patients. It is very important that we be able to discriminate between normal variants, changes related to altered physical stress, and recurrent disease in order to interpret the bone scan meaningfully. We wish to report the appearance of the isotope bone scan, technetium 99m-labeled methylene diphosphonate ((99m)Tc-MDP), associated with an auto-transplanted osteoarticular plug (epiphyseal transplant) performed following limb amputation. This reconstructive surgery can give a potentially misleading appearance on the nuclear medicine bone scan if one is unfamiliar with this surgical technique.
Subject(s)
Amputation, Surgical , Bone and Bones/diagnostic imaging , Epiphyses/transplantation , Adolescent , Female , Humans , Leg , Radionuclide Imaging , Radiopharmaceuticals , Technetium Tc 99m Medronate , Tibia/diagnostic imaging , Tibia/surgery , Transplantation, AutologousABSTRACT
Thoracic outlet syndrome (TOS) is rare in childhood. In adults, TOS results in compression of the neurovascular bundle (branches of the brachial plexus and the subclavian artery), but more than 95% of cases present solely with neurologic compression. We present a case of TOS in a very young child and describe the rare finding of subclavian artery compression and post-stenotic aneurysm. The clinical features, imaging workup, and surgical findings are discussed. The combination of three-dimensional MR angiography and CT was of great value in diagnosis and surgical planning.
