MR imaging of pentalogy of Cantrell variant with an intact diaphragm and pericardium.

We present a case of a neonate with the stigmata for pentalogy of Cantrell with the exception of diaphragmatic and pericardial defects. Diagnosing most of the anomalies in this rare syndrome can be accomplished using conventional modalities in radiology, but difficulties may arise determining diaphragmatic continuity. Accurate, early diagnosis of components of this syndrome is vital for surgical planning and assessing prognostic factors.

Langerhans' cell histiocytosis presenting with an intracranial epidural hematoma.

An 8-year-old boy developed vomiting and severe headache following minor head trauma. A CT scan of the head demonstrated a lytic lesion of the skull and adjacent epidural hematoma. Surgical evacuation and removal of the skull lesion and hematoma were carried out, and pathologic evaluation resulted in a diagnosis of Langerhans' cell histiocytosis (LCH). Epidural involvement of Langerhans' cell histiocytosis is very rare, and we report the first case of LCH presenting as an intracranial epidural hematoma.

Diffuse neonatal gastrointestinal hemangiomatosis: CT findings.

A 3-week-old boy presenting with a cutaneous hemangioma and gastrointestinal bleeding was found to have gastrointestinal hemangiomatosis involving the entire small bowel diagnosed by exploratory laparotomy. We present the striking, diffuse enhancement of the small bowel wall in this unusual disorder as demonstrated by dynamic contrast-enhanced computed tomography after the bowel was distended with non-radiopaque material.

Magnetic resonance imaging of a left circumflex aortic arch and aberrant right subclavian artery: the other vascular ring.

We present a case of a rare congenital cardiac anomaly. Magnetic resonance imaging accurately demonstrated a left circumflex aortic arch. This finding was not apparent on a prior conventional angiogram or echocardiography. Magnetic resonance imaging documentation of this anomaly is uncommon. Review of the embryonic development, clinical presentation of complete and incomplete vascular rings, and additional associated cardiac anomalies are discussed. This is one of only a few reported cases of a left circumflex aortic arch.

Diagnostic imaging of ventriculoperitoneal shunt malfunctions and complications.

Most pediatric patients with hydrocephalus are treated with ventriculoperitoneal (VP) shunt placement. However, shunt malfunction is common and is usually caused by mechanical failure. Shunt obstructions may be confirmed with radioisotope examination or with fluoroscopically guided injection of iodinated contrast material into the shunt reservoir. Disconnections or breaks are more readily detected at radiography in cases in which barium-impregnated shunt tubing was used. Migration and leakage may also occur. Cerebrospinal pseudocysts may be demonstrated with plain radiography and further evaluated with computed tomography (CT) and sonography. In increasing hydrocephalus, plain radiography may reveal sutural diastasis and increased cranial cavity size, and CT can be used to evaluate ventricle size. In cases of enlarging intracranial cysts, injection of iodinated contrast material followed by CT can help document a connection between the cyst and the ventricles. Ventriculitis and meningitis can be visualized at CT and magnetic resonance imaging as enhancement of the ventricular ependymal lining or cerebral cortical sulci. Other complications associated with VP shunts include surgery-related complications, shunt overdrainage and slit-ventricle syndrome, neoplastic metastasis, pleural effusion, and complications related to shunt variants. Imaging analysis is an essential adjunct to the clinical evaluation of patients with suspected VP shunt malfunctions or complications. Radiologists should be familiar with these potential problems and the diagnostic utility of various imaging modalities.

Pulmonary artery pseudoaneurysm after percutaneous transluminal angioplasty in a pediatric patient.

We report a case of a 4-year-old boy with tetralogy of Fallot, pulmonary atresia, and hypoplastic pulmonary arteries who presented with mild hemoptysis and upper respiratory infection 3 weeks following percutaneous transluminal angioplasty for pulmonary artery stenosis. While pneumonia was initially suggested on early plain radiographs of the chest, a large pseudoaneurysm of a right lower lobe pulmonary artery branch was subsequently diagnosed with CT and angiography.