Embolization for pediatric trauma.

BACKGROUND: The management of pediatric trauma with trans-arterial embolization is uncommon, even in level 1 trauma centers; hence, there is a dearth of literature on this subject compared to the adult experience. OBJECTIVE: To describe a single-center, level 1 trauma center experience with arterial embolization for pediatric trauma. MATERIALS AND METHODS: A retrospective review was performed to identify demographics, transfusion requirements, pre-procedure imaging, procedural details, adverse events, and arterial embolization outcomes over a 19-year period. Twenty children (age 4.5 months to 17 years, median 13.5 years; weight 3.6 to 108 kg, median 53 kg) were included. Technical success was defined as angiographic resolution of the bleeding-related abnormality on post-embolization angiography or successful empiric embolization in the absence of an angiographic finding. Clinical success was defined as not requiring additional intervention after embolization. RESULTS: Seventy-five percent (n=15/20) of patients required red blood cell transfusions prior to embolization with a mean volume replacement 64 ml/kg (range 12-166 ml/kg) and the median time from injury to intervention was 3 days (range 0-16 days). Technical success was achieved in 100% (20/20) of children while clinical success was achieved in 80% (n=16/20). For the 4 children (20%) with continued bleeding following initial embolization, 2 underwent repeat embolization, 1 underwent surgery, and 1 underwent repeat embolization and surgery. Mortality prior to discharge was 15% (n=3). A post-embolization mild adverse event included one groin hematoma, while a severe adverse event included one common iliac artery pseudoaneurysm requiring open surgical ligation. CONCLUSIONS: In this single-center experience, arterial embolization for hemorrhage control in children after trauma is feasible but can be challenging and the clinical failure rate of 20% in this series reflects this complexity. Standardization of pre-embolization trauma assessment parameters and embolic techniques may improve outcomes.

Imaging of Vesicoureteral Reflux: AJR Expert Panel Narrative Review.

Vesicoureteral reflux (VUR) is a common congenital anomaly of the urinary tract that can present with collecting system dilation or as a febrile infection. VUR can lead to permanent renal sequela requiring surgery but can also spontaneously resolve without complication. Therefore, it is important to recognize those patient populations who warrant imaging for screening, confirmation, or ongoing surveillance for VUR, while avoiding overdiagnosis. In the appropriate patient populations, an accurate diagnosis of VUR allows early treatment and prevention of pyelonephritis and scarring. Various imaging modalities are available to diagnose and grade VUR, including voiding cystourethrogram (VCUG), radionucleotide cystography (RNC), and contrast-enhanced voiding urosonography (ceVUS). The objective of this article is to summarize the current understanding of VUR diagnosis and management and to discuss these imaging modalities' strengths and pitfalls. Considerations include indications for VUR imaging, patient preparation, conduct of the examination, issues related to radiologic reporting, and cost-effectiveness. An emphasis is placed on ceVUS, which is the most recently introduced of the three imaging modalities and is receiving growing support among pediatric radiologists.

Ultrasound imaging of preterm brain injury: fundamentals and updates.

Neurosonography has become an essential tool for diagnosis and serial monitoring of preterm brain injury. Preterm infants are at significantly higher risk of hypoxic-ischemic injury, intraventricular hemorrhage, periventricular leukomalacia and post-hemorrhagic hydrocephalus. Neonatologists have become increasingly dependent on neurosonography to initiate medical and surgical interventions because it can be used at the bedside. While brain MRI is regarded as the gold standard for detecting preterm brain injury, neurosonography offers distinct advantages such as its cost-effectiveness, diagnostic utility and convenience. Neurosonographic signatures associated with poor long-term outcomes shape decisions regarding supportive care, medical or behavioral interventions, and family members' expectations. Within the last decade substantial progress has been made in neurosonography techniques, prompting an updated review of the topic. In addition to the up-to-date summary of neurosonography, this review discusses the potential roles of emerging neurosonography techniques that offer new functional insights into the brain, such as superb microvessel imaging, elastography, three-dimensional ventricular volume assessment, and contrast-enhanced US.

Mycotic Pulmonary Artery Aneurysm Mimicking a Rasmussen Aneurysm.

BACKGROUND: Mycotic aneurysms arising from the pulmonary arteries are rare; only a few cases have been reported. Staphylococcus and Streptococcus species are the most common causative pathogens. Mycotic aneurysms are seldom clinically apparent unless as a sequela of adverse procedural complications. They carry high morbidity and mortality if not treated expeditiously. CASE REPORT: We present the case of a 37-year-old male with bacteremia and bronchopneumonia associated with a pulmonary artery mycotic aneurysm. The case was confounded by clinical features mimicking a Rasmussen aneurysm. We discuss distinctive imaging features, disease mechanism, typical presentation, and management. CONCLUSION: While mycotic aneurysms are uncommon, certain clinical scenarios warrant consideration of the diagnosis, such as a history of intravenous drug use, bacterial endocarditis, and immunocompromise. Rapid identification is critical to prevent life-threatening complications such as vessel rupture. Computed tomography allows for an accurate and timely diagnosis, and interventional embolization is a fast, minimally invasive curative treatment. Given similar risk factors and presentation, a mycotic aneurysm can be indistinguishable from a Rasmussen aneurysm; therefore, appropriate precautions should be taken while adequate microbiologic assessment is performed.