CT and ultrasound imaging of retropharyngeal abscesses in children.

PURPOSE: To show the role of ultrasound (US) in distinguishing retropharyngeal abscess from adenitis in children. METHODS: Eleven infants and children had clinical symptoms suggestive of retropharyngeal infection. Radiographic evaluation included, lateral neck radiography (11/11), contrast-enhanced neck CT (10/11), contrast-enhanced neck MR (1/11), and real time US (11/11) patients. US was used to characterize masses as solid (adenitis) or complex (abscess) and for guiding intraoperative aspiration and drainage. RESULTS: Contrast CT and MR showed findings suspicious for abscess in all 11 cases. Only three children had surgically drainable abscesses. CT numbers within inflammatory masses did not distinguish adenitis from abscess. US was able to correctly diagnose abscess or adenitis in each case. CONCLUSION: Lateral neck radiography and contrast CT identify and localize retropharyngeal inflammatory masses in children. US, but not CT, distinguishes between adenitis and abscess and aids in intraoperative aspiration and drainage.

Infantile hepatic hemangioma: Doppler US.

The duplex Doppler ultrasound (US) characteristics of 13 infantile hepatic hemangiomas were reviewed to assess the utility of these characteristics in diagnosis and follow-up. Clinical correlation was available for all children, with a histologic diagnosis established in three. A variety of tumoral flow patterns were demonstrated, including arterial and venous signals with high-frequency shifts, arteries with little systolic-diastolic flow variation, and low-frequency arterial and venous signals. Follow-up studies in 12 infants documented slower flow within the tumors; one child underwent immediate surgery without follow-up examination. The Doppler US characteristics of infantile liver hemangiomas are variable and overlap with those described in the literature for malignant tumors. Doppler US is most useful in follow-up by allowing monitoring of changes in flow within tumors after therapeutic embolization or conservative management.

High resolution ultrasound with Doppler: a diagnostic adjunct in orbital and ocular lesions in children.

Twenty-six infants and children with orbital and ocular pathology were examined with ultrasound (US) utilizing real-time imaging and Duplex Pulsed Doppler evaluation. Twenty-two of these patients underwent concurrent orbital computed tomography (CT) and two had magnetic resonance imaging (MRI). Orbital and periorbital lesions included hemangioma, dermoid, lymphangioma, rhabdomyosarcoma, encephalocoele and abscess. Ocular lesions included infection, trauma, retinal detachment, retinoblastoma, Coat's disease, and persistent hyperplastic primary vitreous. High resolution US with Doppler provided unique diagnostic information in patients with penetrating ocular trauma, orbital and periorbital masses, and intraocular structural abnormalities. High resolution US examination of the eye and periorbital tissues is readily performed using widely available equipment and often delineates subtle structural abnormalities not shown by CT or MRI.

Abscess of the iliopsoas muscle diagnosed by magnetic resonance imaging and ultrasonography.

We have reported a case of abscess of the iliopsoas muscle, in which a limp and hip pain pointed toward pathology of the hip. The diagnosis in such cases may be difficult unless there is close attention to the clinical history and a good physical examination is obtained. One ultrasonographic examination of the hip in such a patient, subtle differences between the iliopsoas muscles should alert the radiologist to examine the psoas muscle. Ultrasonography is instrumental in demonstrating the solid or cystic nature of the iliopsoas mass, while MRI depicts the extent and proximity of adjacent organs. Once an iliopsoas abscess is diagnosed, treatment includes parenteral antibiotics and drainage.

The changing epidemiology of tuberculosis and other mycobacterial infections in the United States: implications for the radiologist.

Diseases consequent to infection with mycobacterial organisms, such as Mycobacterium tuberculosis and other mycobacterial species, remain a significant health problem in the United States. Over the past decade several new factors have amplified this problem, the most significant of which is the ongoing epidemic of infection with the human immunodeficiency virus. This review will discuss the changing epidemiology of mycobacterial disease and emphasize the significance of these changes to the radiologist.

Ultrasound in advanced pediatric osteomyelitis. A report of 5 cases.

The use and reporting of ultrasound for the evaluation of pediatric osteomyelitis is minimal. However, ultrasound is noninvasive and does not employ ionizing radiation, and it is less expensive than other methods available. Consequently, its application, if contributory, would be desirable in evaluating pediatric osteomyelitis. We examined five patients ranging from 2-weeks to ten-years-old with ultrasound after bony abnormalities were found on plain film. In all cases ultrasound was valuable in assessing the type and location of abnormality (4 cases of osteomyelitis, 1 case of discitis), but unhelpful in determining the age of disease.

Screening spinal ultrasound in newborns with neural tube defects.

Twenty-six newborns with spina bifida had complete spinal ultrasound (US) prior to initial surgical repair of the neural tube defects. Associated anomalies were found on screening US in seven infants and included diastematomyelia (two cases), hydromyelia (two cases), and dural fat deposits (three cases). Initial surgical therapy was altered in one infant with diastematomyelia. Four closed simple meningoceles showed no internal neural elements on US and none were found at surgery.

Brain death in infants: evaluation with Doppler US.

In a preliminary study, nine infants with a clinically determined diagnosis of brain death were examined with duplex pulsed Doppler ultrasonography (US) through the anterior fontanelle. Flow velocity measurements were made in the intracranial internal carotid artery and anterior cerebral artery. Resistive index (RI) was calculated in each patient and used as an indicator of diastolic flow. Eight of nine infants showed markedly elevated RI (100%-191%) with reversal of diastolic flow. One infant had low RI (42%-58%) with preserved systolic and diastolic flow until death. The authors believe that the elevation of RI with diastolic flow reversal seen in these patients is a reflection of increased intracranial pressure and is a sign of poor prognosis when present on serial examinations. Cranial duplex pulsed Doppler US is a useful, noninvasive tool in the diagnosis of brain death in infants but must be carefully correlated with clinical examination and other diagnostic tests.

Duplex pulsed Doppler US versus intracranial pressure in the neonate: clinical and experimental studies.

This study was conducted to determine if the resistive index (RI) could be used for the examination and follow-up of neonates with increased intracranial pressure. First, in a laboratory model with four mongrel dogs, RI was found to correlate linearly with cerebral perfusion pressure. Second, RI was studied in 57 healthy neonates and 285 neonates with abnormal clinical or head ultrasound findings. Average RI for healthy newborns was 75 +/- 10 and was inversely related to gestational age. RI in newborns with abnormal findings was uniformly elevated, but these values varied considerably and were not statistically different from normal values. Third, the RI was found to decrease significantly after patent ductus arteriosus ligation, tapping of subdural effusions, ventricular tapping (later cerebrospinal fluid shunting led to a further drop in RI), and ventriculoperitoneal shunting. Elevated RI indicates possible intra- or extracranial abnormality affecting cerebral blood flow. Doppler RI is valuable in following up neonates with abnormal or unstable conditions and in assessing the effectiveness of therapies to improve cerebral perfusion.

Extracardiac chest ultrasonography in infants and children: radiographic and clinical implications.

Extracardiac chest ultrasonography was performed in 51 children for characterization and localization of pleural disease (29 children), for evaluation of chest and mediastinal masses (12), and for determining the cause of unilateral chest radiographic opacification (10). Ultrasonography clearly differentiated drainable fluid from pleural thickening, accurately characterized chest and mediastinal masses, guided aspiration and drainage procedures, and allowed rapid diagnosis of causes of unilateral opaque hemithorax.

Intussusception: clinical and radiographic factors influencing reducibility.

Hydrostatic reduction of intussusception by barium or air enema has been widely accepted. The five-year experience with this procedure at two children's hospitals is reviewed and the results compared to previous studies. Various clinical and radiographic factors are evaluated in relation to the reduction rate. The findings show that the more distal the intussusception is encountered, the lower the rate of reduction. However, 25% are reduced within the rectum with no evidence of increased complications. Small bowel obstruction and prolonged duration of signs and symptoms decreased the rate of reduction statistically but there is no significant increase in complication rate in those attempted, contrary to a previous report. The cresent sign (dissection sign) and age of the patient are not significant factors in reduction as reported by other studies.

Median cleft of the upper lip associated with lipomas of the central nervous system and cutaneous polyps.

An unusual combination of three rare developmental anomalies, ie, complete median cleft lip, cutaneous polyps, and midline lipomas of the central nervous system, was discovered in a male newborn. Inguinal hernia, cryptorchidism, and clinodactyly of the fifth fingers were other features. His mother was found to have clinodactyly, antimongoloid slant to her palpebral fissures, and computed tomography (CT) scan evidence of asymptomatic hydrocephaly. Family history and clinical investigations did not reveal any clues to etiology. This combination of findings may represent a new syndrome or another expression of frontonasal dysplasia.

Serendipitous diagnosis of childhood xanthogranulomatous pyelonephritis in a child with osteomyelitis.

Xanthogranulomatous pyelonephritis (XGP), a rare chronic renal infection in children, usually presents as high fever, pyuria and an abdominal mass. This child with clinical and radiologic evidence of osteomyelitis was not suspected of renal disease until a non-functioning kidney was discovered during a bone scan. The pathologic proven diagnosis of XGP could have been made by correlative imaging using renal ultrasound, a renal scan and a gallium scan. Computed tomography and voiding cystourethrography provided additional information as to the nature and extent of the disease process.

Posterior urethral valves: an update and review.

Here, in a comprehensive review of an important pediatric problem, the authors discuss the embryology, the clinical and radiological features, the complications and the management of posterior urethral valves.

"Communicating" bronchopulmonary foregut malformations.

The clinical, radiologic, and pathologic features of four children with uncommon variations of congenital bronchopulmonary foregut malformations are presented. In each case, the malformation included a persistent communication between lung tissue and the gastrointestinal tract. One case, in which an esophageal bronchus was associated with esophageal atresia and tracheoesophageal fistula, is considered extremely unusual. The embryogenesis of these communicating bronchopulmonary foregut malformations is outlined, and the key radiologic features are discussed.