Assessment of the American College of Radiology Thyroid Imaging Reporting and Data System for Thyroid Nodule Malignancy Risk Stratification in a Pediatric Population.

OBJECTIVE: The purpose of this study is to assess the diagnostic performance of the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TIRADS) for malignancy risk in pediatric thyroid nodules. MATERIALS AND METHODS: Two radiologists reviewed ultrasound images of 74 tissue-proven thyroid nodules in 62 children. Points were given for individual features and then added to determine the ACR TI-RADS category, ranging from 1 (benign) to 5 (high suspicion). Kappa coefficients were generated to assess intra- and interobserver agreement. Generalized linear mixed-effects models were used to estimate the odds of malignancy with construction of a supplementary ROC curve. RESULTS: Fifty-four nodules were benign and 20 were malignant, with a median ACR TI-RADS category of 4 (interquartile range, 4-5). Nineteen of 20 (95.0%) malignant nodules were rated as TI-RADS category 4 or 5. There was substantial intraobserver agreement (κ = 0.69-0.77; p < 0.001) and moderate interobserver agreement (κ = 0.37; p = 0.002) for TIRADS category. Univariable analysis showed that, with every 1-unit increase of TI-RADS category, the likelihood of malignancy increased 2.63 times (95% CI, 1.08-6.41; p = 0.03). After adjusting for nodule size, TI-RADS category remained marginally associated with malignancy (adjusted odds ratio, 2.27; 95% CI, 0.93-5.54; p = 0.07). The AUC was 0.75 (95% CI, 0.64-0.86). An optimal cut point of TI-RADS category 5 was selected, with TI-RADS category 5 nodules 10.44 times (95% CI, 2.71-40.21; p < 0.0001) more likely than categories 1-4 nodules to be malignant. CONCLUSION: ACR TI-RADS discriminates well between malignant and benign nodules in a pediatric population, particularly at TI-RADS category 5.

Atypically presenting kaposiform hemangioendothelioma of the knee: ultrasound findings.

Kaposiform hemangioendothelioma (KHE) is a rare vascular tumor of early childhood and infancy. Kasabach-Merritt phenomenon, a common complication of KHE, is characterized by life-threatening thrombocytopenia, hemolytic anemia, and consumption coagulopathy. There may be atypical cases that do not present with Kasabach-Merritt phenomenon and do have atypical imaging findings. Knowledge of atypical imaging features may assist radiologists in identifying KHE. In this report, we present a 4-year-old case of KHE with atypical ultrasound findings.

Avulsion fractures of the pediatric knee.

Although avulsion fractures of the pediatric knee are uncommon, they are important injuries to recognize because they are frequently associated with adjacent soft-tissue and osteocartilaginous abnormalities. Related injuries, which include entrapment of soft-tissue structures, intra-articular fracture extension, and intra-articular loose bodies, can complicate or alter therapy. The most commonly affected soft-tissue structures include the cruciate ligaments, collateral ligaments and supporting tendons, and extensor mechanism and retinacula. The purpose of this pictorial essay is to review avulsion fractures of the pediatric knee and to highlight associated injuries.

Protecting military convoys in Iraq: an examination of battle injuries sustained by a mechanized battalion during Operation Iraqi Freedom II.

Improvised explosive devices and mines pose a formidable threat to military convoys traveling in Iraq. This study evaluated battle injuries sustained by a mechanized battalion operating against this threat. The objective was to gain insight into injury profiles and prevention. In the period examined, 32 attacks injured 120 Marines, causing 188 injuries. Upper extremity and head injuries (70%) were common, whereas lower extremity injuries (11%) were rare (as expected, given the threat and the body areas exposed). Shoulder and axilla protectors may be beneficial, but lower arm and hand injuries remain difficult to combat. Ear injury was the most common single injury type (23%). Combat earplugs may reduce ear blast injuries. Eye injuries were uncommon (0.5%), likely because of ballistic eye protection. Injury to the torso (11%) was generally mild, because of body armor vests. The majority of wounds were minor, allowing > 80% of the injured Marines to return to duty.