Horner's syndrome secondary to asymptomatic pneumothorax in an adolescent.

Horner's syndrome is uncommon in the paediatric population, but is seen more in infancy, and most cases are either congenital or related to birth trauma, head and neck tumours or thoracic surgery. We report an unusual cause of Horner's syndrome in a healthy adolescent boy secondary to a large, spontaneous, but asymptomatic, primary pneumothorax.

Does intravenous glucagon improve common bile duct visualisation during magnetic resonance cholangiopancreatography? Results in 42 patients.

INTRODUCTION: Magnetic resonance cholangiopancreatography (MRCP) has been demonstrated as a reliable, non-invasive means of biliary tract imaging among patients with suspected choledocholithiasis. The aim of this study was to establish the impact of intravenous glucagon administration (IVGA) upon visualisation of the common bile duct (CBD) and ampulla of Vater during MRCP. MATERIALS AND METHODS: Forty-two consecutive, non-diabetic subjects with a working diagnosis of symptomatic choledocholithiasis were scanned, pre- and post-IVGA using the half-Fourier, single shot, turbo-spin-echo (HASTE) sequence. Maximum intensity projections (optimised for the extra-hepatic biliary tree and ampulla of Vater) were reviewed blindly by three consultant radiologists. The CBD images were graded (0-3) according to the length of duct seen. The ampullary images were graded according to whether to it was visualised clearly (1), or not (0). RESULTS: Following IVGA the CBD was visualised at grade 3 (75-100% of length seen) in 14 additional patients compared with images prior to IVGA. Furthermore, ampullary visualisation was considered diagnostic in 18 additional patients post-IVGA. No glucagon-associated adverse effects were observed. CONCLUSION: These results demonstrate that IVGA improved visualisation of the CBD and ampulla of Vater during magnetic resonance cholangiopanctreatography. This may reduce the requirement for repeat investigation or recourse to invasive diagnostic procedures (e.g. endoscopic retrograde cholangiopancreatography (ERCP)).

The use of contrast-enhanced power Doppler ultrasound in the diagnosis and follow-up of inflammatory abdominal masses associated with Crohn's disease.

1. Contrast-enhanced power Doppler ultrasound has a high sensitivity and specificity in the detection and evaluation of inflammatory abdominal masses associated with Crohn's disease. 2. The spatial resolution and sensitivity of this technique allows the detection of small inflammatory abdominal masses of 1 cm or above. 3. The absence of any associated X-ray radiation allows repeated examinations to be undertaken. This facilitates assessment of disease progression and response to treatment 4. The early detection of the complications of Crohn's disease may facilitate treatment by medical means rather than necessitating surgical intervention. Clinical and biochemical assessment of the complications of Crohn's disease such as abscess, stricture and fistula formation is extremely difficult. Radiological imaging is therefore widely utilized. This includes barium studies, ultrasound, computed tomography and nuclear medicine techniques. Contrast-enhanced power Doppler ultrasound has high sensitivity and specificity in the detection and evaluation of inflammatory abdominal masses associated with Crohn's disease, and compares favourably with computed tomography. The spatial resolution and sensitivity of contrast-enhanced power Doppler ultrasound enables the detection of small inflammatory abdominal masses. The absence of radiation dose to the patient allows multiple and serial examinations to be undertaken. This facilitates assessment of disease progression and response to treatment. The early detection of the extra-mural complications of Crohn's disease and the close monitoring of response to medical treatment may obviate the need for surgical intervention.