Birth injuries to growth plates: A sheep in wolves' clothing.

Growth plate injuries (Salter-Harris type 1 or physeal fractures) of the long bones in the newborn are easily misdiagnosed as joint fractures with dislocations due to their nonossified epiphyses on plain radiographs. Diagnosis with musculoskeletal ultrasound (US) is advantageous due to its ability to visualize the nonossified epiphysis. We present two cases of humeral growth plate fractures in newborns, one at the shoulder (proximal humerus) and the other at the elbow (distal humerus). These cases emphasize the importance of quick and noninvasive diagnosis with US to avoid unnecessary intervention. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:511-514, 2017.

Pediatric nontraumatic myositis ossificans of the neck.

Nontraumatic myositis ossificans circumscripta (MOC) is a rarely reported benign heterotopic ossification characterized by the aberrant formation of bone in extraskeletal soft tissues. Although a history of trauma can be elicited in 75% of MOC patients, the etiology is unclear in patients without inciting injury. MOC is associated with young male athletes, and is most often localized to the muscle groups of the extremities. Rare cases have been reported in children and adolescents of nontraumatic MOC in the neck. We present a 15-year-old adolescent with a rapidly growing, painful neck mass without traumatic stimulus.

Waiting to exhale: salvaging the nondiagnostic CT pulmonary angiogram by using expiratory imaging to improve contrast dynamics.

We attempted to investigate whether computed tomography pulmonary angiography (CTPA) in the expiratory phase can improve contrast enhancement of the pulmonary arteries and mitigate the effect of inspiratory transient attenuation artifact, potentially salvaging nondiagnostic studies. Eighteen patients with indeterminate inspiratory CTPA, despite proper contrast bolus were studied. Patients were rescanned in expiration using the same contrast bolus and scanning parameters. The attenuation of each pulmonary arterial segment, superior and inferior vena cava, and atria and ventricles during the two phases of respiration was measured independently by three radiologists. All pulmonary segments were evaluated for filling defects during the two phases. In addition, the studies were graded for diagnostic quality of enhancement and probable impact on management. A statistically significant increase in pulmonary arterial enhancement was seen during expiration from the pulmonary trunk to the segmental pulmonary arteries (P < 0.001) and for the inferior vena cava, the right atrium, and the ventricle. The incidence of nondiagnostic inspiratory studies ranged from 89 to 100%, depending on the observer. All studies were upgraded to fully acceptable diagnostic quality with follow-up expiratory imaging (P < 0.0001). Expiratory phase imaging was observed to have diagnostic impact in 78 to 88% of cases, with overall good to moderate interobserver agreement. In one case, pulmonary embolism was detected on the expiratory scan, which was not seen on the inspiratory scan. Expiratory imaging for nondiagnostic CTPA improves pulmonary arterial enhancement and improves diagnostic quality of CTPA by eliminating transient attenuation artifact, thus facilitating more accurate diagnosis and providing earlier treatment of pulmonary embolism.