CT of small-bowel obstruction in children: sensitivity and specificity.

UNLABELLED: OBJECTIVE.:The aim of this study was to determine the sensitivity, specificity, and accuracy of CT in the diagnosis of small-bowel obstruction in children. MATERIALS AND METHODS: The CT scans of 30 children with surgically proven small-bowel obstruction, 22 children with ileus, and 29 children who served as controls were retrospectively reviewed by two of four interpreters who were unaware of the children's final diagnoses. Causes of obstruction in the patients included 19 adhesions, six cases of volvulus, five intussusceptions, four strictures, and two cases each of internal hernia and abscess. Eight obstructions had multiple causes. The CT scans were evaluated for the presence of small-bowel obstruction using a scale with five degrees of confidence. In cases of discrepancy of more than one level of certainty, a third interpreter was consulted. Criteria for small-bowel obstruction included a discrepancy in caliber between the proximal dilated and the more distal small bowels or generalized small-bowel dilatation (>2.5 cm) in the presence of a collapsed colon. An interpreter's rating that an obstruction was either present or probable was considered a positive finding; a rating indicating that the interpreter was not sure whether an obstruction was present or believed that an obstruction was not probable or saw normal anatomic structures was considered a negative finding for small-bowel obstruction. The cause and level of obstruction also were recorded. RESULTS: There were 26 true-positive (87%) and four false-negative (13%) interpretations for small-bowel obstruction. Among the interpretations of scans of patients with ileus, 68% were true-negative and 32% were false-positive interpretations for small-bowel obstruction. Among the control group, there were no false-positive readings. Sensitivity of CT was 87%, specificity was 86%, and accuracy was 86%. In the scans of children 2 years and younger, CT had a sensitivity of 100% and specificity of 0%. Of the patients with surgically confirmed levels of obstruction, the correct level of obstruction was described by both interpreters in 12 (86%) of 14 scans. The causes of obstruction were correctly identified in 14 (47%) of 30 scans. CONCLUSION: CT is both sensitive and specific for use in diagnosing small-bowel obstruction in children, especially in children older than 2 years.

Neonatal fellowship. Neonatal pneumopericardium: successful treatment with nitrogen washout technique.

Pneumopericardium in the neonate is a rare event but is associated with significant morbidity and mortality. We describe a neonate with mild respiratory distress and cardiovascular compromise after delivery and resuscitation. A large isolated pneumopericardium was diagnosed. Treatment with an oxygen hood (FiO2 1.00) resulted in a complete resolution of the pneumopericardium within 12 hours.

New findings in short rib syndrome.

This white infant, born at 37 weeks of gestation, had a large cranium, bilateral anophthalmia, a midline cleft lip and palate, hypoplastic chest with short ribs, slightly protuberant abdomen, short limbs, bilateral single transverse palmar creases, a single umbilical artery, normal female external genitalia, normal (46 XY) chromosomes, and radiographic findings suggesting a short-rib (polydactyly) syndrome type IV (Beemer-Langer). Autopsy showed pulmonary hypoplasia, bilateral renal cystic dysplasia, intrahepatic bile duct cysts with periportal fibrosis, pancreatic cysts, absent internal genitalia, an atrophic optic chiasm, absent optic nerves, a single left anterior cerebral artery, polymicrogyria, and fusion of the frontal lobes, preoptic region, mammillary bodies, and thalami.

Usual and unusual radiologic manifestations of acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection in children.

AIDS is being recognized with ever-increasing frequency in children. This article includes a discussion of the common radiographic manifestations of AIDS as well as some rarely encountered problems. It is hoped that with heightened awareness of this spectrum of radiographic findings, radiologists may contribute to a prompt diagnosis of AIDS so that appropriate short-term therapy and counseling may be instituted.

Mesenteric vascular gas secondary to ischemic bowel in transmesenteric hernia.

A transmesenteric herniation of bowel with subsequent bowel ischemia in a thirteen-year-old boy is reported. Radiographic findings were that of abdominal mass and branching radiolucencies secondary to gas within the mesenteric vasculature. The unusual distribution of vascular gas (mesenteric rather than portal) is thought to be secondary to obstruction of mesenteric veins by strangulation.