Pediatric magnetic resonance angiography: to contrast or not to contrast.

Magnetic resonance (MR) angiography and MR venography imaging with contrast and non-contrast techniques are widely used for pediatric vascular imaging. However, as with any MRI examination, imaging the pediatric population can be challenging because of patient motion, which sometimes requires sedation. There are multiple benefits of non-contrast MR angiographic techniques, including the ability to repeat sequences if motion is present, the decreased need for sedation, and avoidance of potential risks associated with gadolinium administration and radiation exposure. Thus, MR angiography is an attractive alternative to CT or conventional catheter-based angiography in pediatric populations. Contrast-enhanced MR angiographic techniques have the advantage of increased signal to noise. Blood pool imaging allows long imaging times that result in high-spatial-resolution imaging, and thus high-quality diagnostic images. This article outlines the technique details, indications, benefits and downsides of non-contrast-enhanced and contrast-enhanced MR angiographic techniques to assist in protocol decision-making.

Anomalous aortic origin of the right coronary artery from the non-coronary sinus of Valsalva.

We report a rare case of anomalous aortic origin of the right coronary artery from the posterior/non-coronary sinus of Valsalva in a 9-year-old male diagnosed during the workup of premature ventricular contractions. The finding was initially noted on transthoracic echocardiogram and further confirmed with computed tomography. The anomalous coronary artery shows a wide ostium with no intramural or interarterial course.

Lipomatous Infiltration in Tuberous Sclerosis Complex - A Case Series and Literature Review.

Diffuse Lipomatosis is a dermatological lesion consisting of a poorly circumscribed, infiltrative overgrowth of mature adipose tissue that usually affects the trunk and the extremities. The lesions in the Tuberous Sclerosis Complex (TSC) are usually hamartomatous in nature, but lesions arising from adipocytes are rare. There are only three previous reports of association of TSC with diffuse lipomatosis. Herein we present a case series of diffuse lipomatosis in three subjects with TSC and proceed to review the literature for any other reported cases. On the basis of the three index cases and identification of three more cases in the literature, we believe that there is an association of diffuse lipomatosis with TSC that has not been appreciated until now. We believe that this association in some selected cases will serve to improve diagnosis, surveillance, and management..

Using liver elastography to diagnose sinusoidal obstruction syndrome in pediatric patients undergoing hematopoetic stem cell transplant.

Sinusoidal obstruction syndrome (SOS) is a potentially fatal complication of hematopoietic stem cell transplantation (HSCT). Traditional ultrasound (US) has poor sensitivity and specificity. US shear wave elastography (SWE) is a newer technology that measures liver stiffness. This is a single-institution, prospective cohort study evaluating SWE in patients younger than 21 years who received HSCT from December 2015 through June 2017. SOS was defined using the modified Seattle criteria. Subjects had US with SWE at three scheduled time points. t-tests were used to assess for difference between the groups and ROC curves were generated. Twenty-five patients were included. Five subjects developed SOS. At day +5 HSCT, SOS patients had SWE velocities that increased by 0.25 ± 0.21 m/s compared to 0.02 ± 0.18 in patients without SOS (p = 0.020). At day +14, SOS patients had SWE velocities that significantly increased by 0.91 m/s ± 1.14 m/s compared to 0.03 m/s ± 0.23 m/s in patients without SOS (p = 0.010). SWE SOS diagnosis occurred on average 9 and 11 days before clinical and conventional US diagnosis, respectively. Patients who develop SOS have increased liver stiffness compared to patients who do not develop SOS. SWE changes occur before other imaging and clinical findings of SOS.

An early abdominal wall ectopic pregnancy successfully treated with ultrasound guided intralesional methotrexate: a case report.

Background. The upper anterior abdominal wall is a very unusual location for an ectopic pregnancy making optimal management uncertain. Case. We report the case of a 26-year-old gravida 4, para 1, aborta 2 with a rising quantitative human chorionic gonadotropin level following a negative diagnostic laparoscopic examination. She was subsequently diagnosed with an abdominal wall ectopic pregnancy 2 cm inferior to the liver. A single percutaneous intralesional injection of methotrexate was successful after initial failure with systemic methotrexate. Conclusion. Systemic methotrexate is a logical first choice for management of a stable early abdominal wall pregnancy. Direct intralesional injection of methotrexate as the next treatment choice may avoid the morbidity linked with operative management.