Characterization and quantification of fluid in the abdomen by ultrasound and magnetic resonance imaging in children with clinical suspicion of appendicitis.

PURPOSE: While regarded as a secondary sign of pediatric appendicitis, the frequency of physiologic intra-abdominal fluid in children with suspected but absent appendicitis is unknown. Ex vivo: to assess the validity of US/MRI measurements of free fluid. In vivo: in suspected pediatric appendicitis, to assess the amount of abdominal fluid by US and MRI, determine performance characteristics of US in fluid detection and identify fluid volume ranges in confirmed appendicitis. METHODS: Ex vivo: criterion validity of US and MRI for fluid volume measurements was tested using tissue-mimicking phantoms filled with different volumes of distilled water. In vivo: all participants from a previous prospective study of suspected appendicitis were evaluated by US; MRI was performed after equivocal USs. Qualitative and quantitative analyses of abdominal fluid and correlation of fluid presence with appendicitis were performed. RESULTS: Ex vivo: no difference was found between phantom-fluid amount and measured volume using the formula for volume of an ellipsoid for US (P=0.19) or MRI (P=0.08). In vivo: intra-abdominal fluid was present in 212/591 (35.9%) patients; 75/212 patients with fluid (35.4%) had appendicitis, 60 (28.3%) had alternate diagnoses, and 77 (36.3%) had physiologic fluid. Sensitivity and specificity of US for fluid detection were 84% (95% CI 71-93) and 65% (95% CI 52-77), respectively. In children with versus without appendicitis, the respective ranges of fluid volume were 0.7-1148.8 ml and 0.8-318 ml. CONCLUSION: The volume of an ellipsoid formula is a valid method for quantifying intra-abdominal fluid. The sole presence of intra-abdominal fluid on US does not support the diagnosis of pediatric appendicitis.

Extrapulmonary Tuberculosis: Pathophysiology and Imaging Findings.

Extrapulmonary tuberculosis (TB) represents approximately 15% of all TB infections. It is difficult to diagnose on the basis of imaging characteristics and clinical symptoms, and biopsy is required in many cases. Radiologists must be aware of the imaging findings of extrapulmonary TB to identify the condition in high-risk patients, even in the absence of active pulmonary infection. In extrapulmonary TB, the lymphatic system is most frequently affected. The presence of necrotic lymph nodes and other organ-specific imaging features increases the diagnostic probability of extrapulmonary TB. Disseminated infection and central nervous system involvement are the most frequent manifestations in immunosuppressed patients. Renal disease can occur in immunocompetent patients with very long latency periods between the primary pulmonary infection and genitourinary involvement. In several cases, gastrointestinal, solid-organ, and peritoneal TB show nonspecific imaging findings. Tuberculous spondylitis is the most frequent musculoskeletal manifestation. It is usually diagnosed late and affects multiple vertebral segments with extensive paraspinal abscess. Articular disease is the second most frequent musculoskeletal manifestation, and synovitis is its predominant imaging finding.©RSNA, 2019.

Anatomy and pathology of the nail and subungual space: Imaging evaluation of benign lesions.

The lesions of the ungual and subungual space include various etiologies, which may be similar in clinical presentation, almost always with nail deformity. Imaging evaluation is helpful in the characterization of these lesions, narrowing the differential diagnosis and leading to appropriate treatment. This review aims to outline the anatomy and terminology used to describe the alterations of the nail unit and the main imaging characteristics of some of the most common benign lesions of the nail.

Complejo linfangioleiomiomatosis-esclerosis tuberosa, ¿contraindicación para el trasplante pulmonar? Presentación de un caso / Lymphangioleiomyomatosis-Tuberous Sclerosis Complex. Contraindication For Lung Transplantation? A Case Report

El complejo linfangioleiomiomatosis (LAM)-esclerosis tuberosa (ET) es una enfermedad rara, con compromiso multisistémico que afecta principalmente pulmón y cerebro. Se presenta el caso de una paciente de 25 años con LAM pulmonar que ingresa a la institución para protocolo de trasplante pulmonar. Durante los estudios de extensión se documenta compromiso extrapulmonar sistémico del complejo LAM-ET. A partir de este caso, se realizó una revisión de la literatura de las manifestaciones radiológicas sistémicas de la enfermedad y las recomendaciones de diagnóstico y manejo de estos pacientes; en especial, las indicaciones y contraindicaciones del trasplante pulmonar.

The lymphangioleiomyomatosis (LAM) - Tuberous Sclerosis (TS) Complex is a rare disease with multisystem involvement affecting mainly lung and brain. We present the case of a 25-year-old female patient with pulmonary LAM. During the work-up studies for the lung transplantation protocol, the systemic extrapulmonary involvement of the LAM-TS complex is documented. From this case, a literature review of the systemic radiological manifestations of the disease and of the diagnosis and management recommendations of these patients was made. Special focus was made on the indications and contraindications of lung transplantation.

Biliary strictures complicating liver transplantation in pediatric patients: Experience in a South American transplant center.

OBJECTIVE: To describe the experience of percutaneous transhepatic cholangiography (PTC) with biliary dilatation and drainage after pediatric liver transplantation and to determine the long-term outcome of this procedure. METHODS: Retrospective study from 2001 to 2013. Follow-up after treatment was also undertaken. A survival analysis was performed in patients in whom the procedure and eventual removal of the catheter were successful. RESULTS: In all, 196 children received liver transplants; 40 of them (20 boys and 20 girls; median age of 4 years) were treated using PTC due to biliary complications. Sixty-one PTC procedures were performed in 40 liver transplant recipients. Technically successful PTC was achieved in 87.5% of the patients. The probability of a patient not developing unfavorable outcomes 1, 5, and 10 years after treatment was 88.9%, 83.0%, and 74.1%.

Neuroimaging evaluation in refractory epilepsy.

PURPOSE: To describe the application of neuroimaging analysis, compared to neuropsychological tests and video-electroencephalogram, for the evaluation of refractory epilepsy in a reference centre in Cali, Colombia. METHODS: Between March 2013 and November 2014, 29 patients, 19 men and 10 women, aged 9-65 years and with refractory epilepsy, were assessed by structural and functional magnetic resonance imaging while performing tasks related to language, verbal and non-verbal memory. Also, volumetric evaluation was performed. A 1.5 Tesla magnetic resonance imaging scanner was used in all cases. RESULTS: Neuroimaging evaluation identified 13 patients with mesial temporal sclerosis. The remaining patients were classified as: 10 patients with neoplastic masses, two patients with cortical atrophy, two patients with scarring lesions and two patients with non-structural aetiology. Among patients with mesial temporal sclerosis, comparison between techniques for lateralising the epileptogenic foci was made; the κ index between functional magnetic resonance imaging and hippocampi volumetry was κ=1.00, agreement between neuroimaging and video-electroencephalogram was good (κ=0.78) and comparison with a neuropsychological test was mild (κ=0.24). CONCLUSIONS: Neuroimaging studies allow the assessment of functional and structural damage related to epileptogenic lesions and foci, and are helpful to select surgical treatment, conduct intraoperative neuronavigation techniques, predict surgical deficits and evaluate patient recovery.