ABSTRACT
BACKGROUND: Catheter removal is essential for treating catheter-related bloodstream infection (CRBSI); however, clinicians are sometimes hesitant to remove catheters in pediatric patients due to the difficulty of securing vascular access. Confirming the diagnosis of CRBSI is important to justify catheter removal. The purpose of this study was to describe the sonographic findings of CRBSI. MATERIALS AND METHODS: We included patients with a central venous catheter (CVC) or peripherally inserted central catheter (PICC) who had a positive blood culture and underwent ultrasound. The patients were classified as with or without CRBSI. Sonographic findings, such as the presence/absence of thrombus, venous wall thickening, hyperechogenicity, and fluid collection around the vein were compared using Fisher's exact test. RESULTS: Of the 58 patients, 38 (66%) were diagnosed with CRBSI. The presence of thrombus (19/38 vs 3/20, P = .011); and hyperechogenicity around the vein (14/38 vs 2/20, P = .035) differed significantly, but There was no significant difference in the presence of venous wall thickening (10/38 vs 1/20, P = .077), and fluid collection around the vein (5/38 vs 0/20, P = .153), did not differ significantly in patients with and without CRBSI, respectively. One-third of patients with CRBSI, including 11 (42.3%) patients with CVC, and 2 (16.7%) patients with PICC, did not have abnormal sonographic findings. CONCLUSION: Ultrasound findings are useful for diagnosing CRBSI. However, the sensitivity of sonographic findings is low and abnormal sonographic findings are sometimes absent in children with CRBSI; therefore, physicians should not rule out CRBSI based on normal sonographic findings, especially in patients a CVC and a positive blood culture.
Subject(s)
Bacteremia , Catheter-Related Infections , Catheterization, Central Venous , Central Venous Catheters , Thrombosis , Humans , Child , Catheterization, Central Venous/adverse effects , Bacteremia/diagnostic imaging , Catheter-Related Infections/diagnostic imaging , Central Venous Catheters/adverse effectsABSTRACT
OBJECTIVES: Extrapulmonary sequestration (EPS) within the diaphragm (ID-EPS) is rare and requires additional procedures such as incision or detachment of the diaphragm from the lesion for diagnosis. This study aimed to describe the imaging findings and evaluate the diagnostic accuracy of ultrasonography and computed tomography (CT) for ID-EPS. MATERIAL AND METHODS: Split diaphragm sign, shape of lesion edge, drainage vein into intra-abdomen on ultrasound and CT, and lesion characteristics on ultrasound were compared between patients with ID-EPS and with above-diaphragm EPS (AD-EPS) using Fisher's exact test. RESULTS: Three and nine patients were diagnosed with ID-EPS and AD-EPS, respectively. Significant differences were observed between the two groups in the split diaphragm sign on ultrasound (presence/absence in patients with ID-EPS vs AD-EPS, 2/1 vs 0/9, P = .046), shape of lesion edge on ultrasound/CT (round/beak in patients with ID-EPS vs AD-EPS, 3/0 vs 0/9, P = .005 on both CT and ultrasound), lesion characteristics on ultrasound (presence/absence of cystic area within lesion in patients with ID-EPS vs AD-EPS, 0/3 vs 7/2, P = .046), and the drainage vein into the abdomen on CT (presence/absence in patients with ID-EPS vs AD-EPS; 2/1 vs 0/9, P = .046). No drainage veins were visualized in the abdomen on ultrasonography and no significant differences in the presence/absence of the split-diagram sign on CT (presence/absence in patients with ID-EPS vs AD-EPS and ID-EPS; 0/3 vs 0/9, P > .999; 1/2 vs 0/9, P = .250) were observed between the two groups. CONCLUSION: A combination of postnatal ultrasonography and CT was useful in predicting EPS located within the diaphragm.
Subject(s)
Bronchopulmonary Sequestration , Diaphragm , Tomography, X-Ray Computed , Ultrasonography , Humans , Pilot Projects , Female , Male , Diaphragm/diagnostic imaging , Ultrasonography/methods , Tomography, X-Ray Computed/methods , Reproducibility of Results , Bronchopulmonary Sequestration/diagnostic imaging , Adult , Middle Aged , Sensitivity and Specificity , Retrospective Studies , Aged , AdolescentABSTRACT
OBJECTIVES: To demonstrate the usefulness of ultrasonography for differentiating soft tissue infections with or without osteomyelitis in pediatric patients who underwent ultrasonography and subsequent magnetic resonance imaging (MRI). METHODS: Twenty-three patients were classified into 2 groups: 12 patients with and 11 patients without osteomyelitis based on MRI. Osteomyelitis using ultrasound is characterized by the presence of bone cortex irregularity and/or subperiosteal abscess formation. The diagnostic performance of ultrasonography for detecting osteomyelitis and subperiosteal abscess formation was compared with that of MRI. Diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were calculated with 95% confidence intervals (CIs). RESULTS: Of 12 osteomyelitis cases, 11 had abnormal bone marrow enhancement (one residual case did not undergo contrast enhancement study) and 5 had subperiosteal abscesses. The diagnostic accuracy of ultrasonography for osteomyelitis was 82.6% (number of correct diagnosis of osteomyelitis/total number = 19/23; 95% CI, 61.2-95.0) and for detecting periosteal abscess was 95.7% (number of correct diagnosis of periosteal abscess/total number = 22/23; 95% CI, 78.1-99.9), respectively. The sensitivity and specificity of ultrasonography for detecting osteomyelitis were 66.7% (95% CI, 34.9-90.1) and 100% (95% CI, 71.5-100), respectively. The sensitivity and specificity of ultrasonography for detecting periosteal abscess were 80% (95% CI, 28.4-99.5), and 100% (95% CI, 81.5-100), respectively. One-third of osteomyelitis cases could not be detected using ultrasonography. CONCLUSIONS: Ultrasonography may be useful for diagnosing osteomyelitis in pediatric patients; however, the technique appears limited by low sensitivity. However, it is more accurate for diagnosis of periosteal abscess in these patients.
Subject(s)
Osteomyelitis , Sensitivity and Specificity , Soft Tissue Infections , Ultrasonography , Humans , Osteomyelitis/diagnostic imaging , Male , Female , Pilot Projects , Child , Ultrasonography/methods , Child, Preschool , Reproducibility of Results , Soft Tissue Infections/diagnostic imaging , Infant , Adolescent , Magnetic Resonance Imaging/methods , Diagnosis, DifferentialABSTRACT
OBJECTIVES: Cervical chondrocutaneous branchial remnants (CCBRs) and dermal lesions, such as epidermoid cysts or brachial anomalies, including lateral cervical cysts/sinuses or dermal sinuses of anterior chest lesions, are usually located at the lower neck at the anterior or posterior border of the sternocleidomastoid muscle (SCM). We aimed to demonstrate the usefulness of ultrasonography in the differential diagnosis and evaluation of CCBRs. METHODS: We evaluated 22 lesions of 20 pediatric patients, classified into CCBR and dermal lesion groups. We used Fisher's exact test to evaluate differences between these groups in terms of lesion shape (low-echoic mass- or tubular-like), whether the lesion was adjacent to/in contact with the SCM or not, and the presence or absence of a concave SCM caused by the lesion. RESULTS: Of the 22 lesions, 8 were CCBRs, and 14 were dermal lesions. We found a significant difference in the presence/absence of adjacency to or contact with the SCM (presence/absence of adjacency to or contact with the SCM in CCBRs vs that in dermal lesions: 6/2 vs 1/13, P = .002) and presence/absence of lesion-induced concavity of the SCM (presence/absence of lesion-induced concavity of the SCM in CCBRs vs that in dermal lesions: 3/5 vs 0/14, P = .036). The lesion shape (low-echoic mass-like/tubular-like lesions) did not significantly differ between the two study groups (low-echoic mass-like/tubular-like lesions in CCBRs vs that in dermal lesions: 5/3 vs 11/6, P = .624). CONCLUSIONS: CCBRs have a strong association with the SCM. These sonographic findings may be useful in the differential diagnosis of dermal cervical lesions.
Subject(s)
Cartilage , Epidermal Cyst , Child , Humans , Pilot Projects , Cartilage/abnormalities , Cartilage/pathology , Branchial Region/abnormalities , Branchial Region/pathology , Neck/pathologyABSTRACT
OBJECTIVES: To assess the usefulness of ultrasonography in the diagnosis and evaluation of extraocular intra-orbital lesions in pediatric patients. METHODS: Twenty-three pediatric patients with intra-orbital lesions who underwent both ultrasound and computed tomography/magnetic resonance imaging (CT/MRI) were included. The following parameters were evaluated using ultrasound: 1) lesion detection rate (presence or absence of lesions), 2) lesion characteristics, 3) lesion location (extraconal or intraconal), and 4) the lesion longest linear dimensions, and these were compared using Fisher's exact test and Mann-Whitney U test. RESULTS: Two lesions could not be detected using ultrasound; in the other 21 cases, the lesion characteristics diagnosed by ultrasound were correct. Diagnostic accuracy of detection and characteristics assessment using ultrasound were 91.3% and 91.3%, respectively. The lesion location was not significantly different between the two groups (intraconal/extraconal in those detected using ultrasound versus those in the absence on ultrasound = 7/14 versus 0/2, P > .999); however, in two cases that were not detected on ultrasound, the lesions were located at extraconal. Lesions that were small in longest linear dimensions on CT/MRI were not detected using ultrasound (the longest linear dimensions in lesions detected using ultrasound versus that in the absence of ultrasound: 29.5 ± 8.2 [range, 13-46] versus 10 and 11 mm, P = .043). CONCLUSIONS: Ultrasonography proved to be useful for visualizing and evaluating intra-orbital lesions except for lesions that were relatively small in size. Therefore, although ultrasound could not detect lesions located behind bone and bone invasion, it could be used for diagnosing and selecting treatment strategies for intra-orbital lesions.
Subject(s)
Orbital Neoplasms , Humans , Child , Orbital Neoplasms/diagnosis , Orbital Neoplasms/pathology , Retrospective Studies , Magnetic Resonance Imaging/methods , Tomography, X-Ray Computed , UltrasonographyABSTRACT
Urethral lesions in pediatric patients can be visualized using ultrasonography. Therefore, sonographers and physicians should be familiar with the technique.
Subject(s)
Ultrasonography , Urethra , Humans , Urethra/diagnostic imaging , Ultrasonography/methods , Child , Male , Urethral Diseases/diagnostic imaging , Child, Preschool , InfantABSTRACT
INTRODUCTION: Renal abscesses are rare in pediatric populations. We aimed to highlight the differences in the computed tomography (CT) imaging characteristics of renal abscesses in patients with and without vesicoureteral reflux (VUR). MATERIALS AND METHODS: Thirteen children with renal abscesses were included and categorized into those with and without VUR. Blood and urine culture results were recorded as positive or negative. Imaging characteristics were recorded: with/without subcapsular fluid collection, with/without upper/lower pole involvement, and with single/multiple lesions in kidneys. Fisher's exact test was used for intergroup comparisons of the rate of positive pathogens and imaging characteristics. RESULTS: Nine patients had VUR (45.9%). Blood and urine culture were positive in two (15.4%) and seven cases (53.8%), respectively. There was no significant difference in the rate of pathogen-positive blood and urine cultures (blood culture positive/negative status with VUR vs. that without VUR = 2/7 vs. 0/4, p > 0.999, urine culture positive/negative status with VUR vs. that without VUR = 4/5 vs. 3/1, p = 0.559). The two groups differed significantly regarding subcapsular fluid collection presence (with/without subcapsular fluid collection with VUR vs. that without VUR = 9/0 vs 1/3, p = 0.014). There was no significant difference in upper/lower pole involvement (with/without involving upper/lower pole with VUR vs. that without VUR = 8/1 vs 2/2, p = 0.203). Patients with VUR were non-significantly more likely to have multiple lesions compared to those without VUR. CONCLUSIONS: VUR was associated with subcapsular fluid collection and possibly with multiple lesions, indicating the need for prompt detection of and specific treatment for VUR in cases with these findings.
Subject(s)
Abscess , Kidney Diseases , Vesico-Ureteral Reflux , Abscess/diagnosis , Abscess/etiology , Kidney Diseases/diagnosis , Kidney Diseases/etiology , Vesico-Ureteral Reflux/complications , Humans , Male , Female , Infant , Child, Preschool , Child , Tomography, X-RayABSTRACT
BACKGROUND: No previous research papers have reported a comparative survey of local radiologic diagnoses and central review in children with hepatoblastoma. OBJECTIVE: To evaluate the utility of central review of children with hepatoblastoma enrolled in a clinical trial. MATERIALS AND METHODS: The study included 91 children enrolled in a clinical trial conducted by the Japanese Study Group for Pediatric Liver Tumor. We compared the results of the initial pre-treatment extent of tumor (PRETEXT) disease staging performed at local sites with the results obtained on central review to determine the concurrence rates for tumor staging and additional criteria. RESULTS: The concurrence rate for PRETEXT staging was 70%. As the stage increased, the concurrence rate decreased. Using additional criteria, central review identified 143 lesions (157.1%), about 1.8 times higher than the number identified for the local site diagnoses. The additional criterion found most often on central review was "multifocal lesion" (n=19). The concurrence rate for lung metastases was high. However, our central review found many false-positive assertions of hepatic vein lesions, portal vein invasion and extrahepatic lesions among the local site diagnoses. CONCLUSION: In a clinical trial of hepatoblastoma, central review provided a more precise diagnosis than local site diagnoses with respect to severe PRETEXT stages III and IV cases and other cases including hepatic and portal vein invasion. The central review process appears to be effective and essential for improving the quality of clinical trials.
Subject(s)
Hepatoblastoma , Liver Neoplasms , Lung Neoplasms , Child , Humans , Infant , Hepatoblastoma/pathology , Liver Neoplasms/pathology , Neoplasm Staging , Treatment OutcomeABSTRACT
OBJECTIVES: To demonstrate the association between the dynamic movements of hyperechoic foci in portal venous gas (PVG) and patients'/sonographic outcomes after congenital heart disease or cardiac events. METHODS: Thirty-one pediatric patients requiring management of congenital heart diseases or cardiac events who had PVG on ultrasound were included in this retrospective study. The patient outcome was prognosis: dead or alive. The sonographic outcome was recovery from PVG, measured as days from PVG detection to when it diminished on ultrasound. The following sonographic findings of hyperechoic foci in PVG were compared between patients: detection within the mesenteric vein, having to-and-fro movements within the intrahepatic portal vein, distribution (left segment or both left and right segments) and shape (line or punctate) in the liver, and detection within the portal and hepatic veins. Comparisons were made using Fisher's exact/Mann-Whitney U test. RESULTS: Four patients died without having recovered from PVG. A significant difference was observed in terms of the to-and-fro movement (with/without to-and-fro movement in dead vs. alive patients: 3/1 vs. 1/26, respectively; P = 0.003). Furthermore, a significant difference in sonographic outcomes was observed regarding patients with/without hyperechoic foci within the mesenteric vein (days with vs. without this finding: 2.0 ± 1.24(1-5) vs.1 ± 0(1), respectively; P = 0.011). CONCLUSIONS: In our small limited cohort, when PVG was visualized on ultrasound, close evaluation of the dynamic movement of hyperechoic foci, especially their to-and-fro movement within the intrahepatic portal vein and detection of hyperechoic foci within the mesenteric vein, were useful in predicting patients' outcomes and the time to PVG diminishment.
Subject(s)
Cardiovascular Diseases , Portal Vein , Humans , Child , Portal Vein/diagnostic imaging , Retrospective Studies , Liver , AbdomenABSTRACT
Rhabdomyosarcoma developing in deep locations, such as the genitourinary tract, and perianal and perineal regions, symptoms may be obscure. Dermal rhabdomyosarcoma metastases may be first symptom of that and those arise in the subcutaneous fat tissue, presenting as a high echoic area surrounded by a low echoic area, accompanied by a high echoic peripheral area. These sonographic findings might indicate an aggressive malignant disease, and that would be useful to differentiate from other dermal lesions.
Subject(s)
Rhabdomyosarcoma , Humans , Rhabdomyosarcoma/diagnostic imaging , Rhabdomyosarcoma/pathology , Diagnosis, DifferentialABSTRACT
OBJECTIVES: To describe the incidence and diagnostic performance of ultrasound for perianal abscess or fistula-in-ano in pediatric patients with perianal inflammation. METHODS: We included 45 patients with perianal inflammation who underwent ultrasonography. To demonstrate the diagnostic performance of ultrasound for fistula-in-ano, a definite diagnosis of perianal abscess, and fistula-in-ano was determined as that proven through magnetic resonance imaging (MRI) or computed tomography (CT). The absence or presence of perianal abscess and fistula-in-ano on ultrasonography was recorded. RESULTS: Among the 45 patients, on ultrasound, perianal abscess and fistula-in-ano were detected in 22 (48.9%) and 30 (68.2%) patients, respectively. Nine patients had MRI or CT and a definite diagnosis of perianal abscess or fistula-in-ano; accuracy, negative predictive value, and positive predictive value of ultrasound for perianal abscess were 77.8% (7/9; 95% confidence interval [CI]: 40.0%-97.1%), 66.7% (2/3; 95% CI: 9.4%-99.2%), 83.3% (5/6; 95% CI: 35.9%-99.6%), and those of fistula-in-ano were 100% (9/9; 95% CI: 66.4%-100%), 100% (8/8; 95% CI: 63.1%-100%), and 100% (1/1; 95% CI: 2.5%-100%), respectively. CONCLUSIONS: Perianal abscess and fistula-in-ano were detected by ultrasound in half of the patients with perianal inflammation. Accordingly, ultrasound has an acceptable diagnostic performance for perianal abscess and fistula-in-ano.
Subject(s)
Anus Diseases , Rectal Fistula , Humans , Child , Abscess/diagnostic imaging , Incidence , Anus Diseases/diagnostic imaging , Anus Diseases/epidemiology , Anus Diseases/complications , Rectal Fistula/diagnostic imaging , Rectal Fistula/epidemiology , Ultrasonography/adverse effectsABSTRACT
OBJECTIVE: Direct ultrasound imaging findings alone have low sensitivity for diagnosing duodenal (65%) and gastric ulcers (40%). This retrospective study evaluated the efficiency of ultrasound in detecting gastric/duodenal ulcers in pediatric patients through direct and indirect findings. METHODS: We evaluated 244 children who underwent ultrasound and subsequent endoscopy within 4 weeks for direct and indirect imaging findings indicative of gastric/duodenal ulcers. Positive direct imaging findings revealed gastric or duodenal wall thickness >8 or 5 mm, respectively, and indirect findings revealed inflammatory changes, hyperechogenicity, and presence of lymph node around ulcers. Correspondingly, we calculated the sensitivity and specificity for diagnosing gastric/duodenal ulcers and used the Fisher's exact and Mann-Whitney U tests to compare the frequency of findings and gastroduodenal wall thicknesses in pediatric patients with gastric/duodenal ulcers. RESULTS: Overall, 6 and 24 were diagnosed with gastric and duodenal ulcers, respectively. The sensitivities of direct and indirect findings were 60.0% (18/30) and 80.0% (24/30), respectively; the corresponding specificities were 98.1% (210/214) and 97.2% (208/214). The frequency of direct and indirect sonographic findings differed significantly between patients with gastric or duodenal ulcers (18/30 versus 24/30, P = .002). Gastric and duodenal wall thicknesses were greater in patients with gastric (6.6 ± 2.6 mm versus 3.6 ± 1.4 mm; P = .003) or duodenal ulcer (5.0 ± 1.4 mm versus 2.2 ± 1.0 mm; P <.0001), respectively, than in those without. CONCLUSIONS: The frequency of indirect finding was greater than that of direct finding in pediatric patients with gastric/duodenal ulcers. Therefore, sonographers should carefully evaluate indirect findings around the stomach or duodenum.
Subject(s)
Duodenal Ulcer , Child , Duodenal Ulcer/diagnostic imaging , Endoscopy, Gastrointestinal , Humans , Retrospective Studies , UltrasonographyABSTRACT
BACKGROUND: To demonstrate the association between pediatric outcomes and tracer hepatic uptake as a marker of systemic circulation in lymphoscintigraphy. METHODS: We included 31 initial lymphoscintigraphic studies. We compared the presence or absence of hepatic uptake between deceased and survived patients in both early and delayed images using Fisher's exact test. Kaplan-Meier survival analysis was performed based on imaging results, and these curves were compared using the log-rank test. The primary endpoint was death and the survival period was defined from the day of examination to the day of the last visit or death. RESULTS: Of 31 patients, six died. Hepatic uptake was significantly different in both early and delayed images (early images, died [with/without visualization] vs. survived [with/without visualization], 0/6 vs. 13/12, P = 0.028; delayed images, died [with/without visualization] vs. survived [with/without visualization], 2/4 vs. 22/3, P = 0.014) between deceased and survived patients. Survival periods were significantly different between the two groups with and without hepatic uptake in early and delayed images (with/without visualization in early imags = 1,177.1 ± 773.8 days/426.7 ± 419.8 days, P = 0.008 and with/without visualization in delayed images = 821.3 ± 738.0 days/467.4 ± 452.4 days, P = 0.003). CONCLUSIONS: Visualization of hepatic uptake in both early and delayed lymphoscintigraphy is associated with patient outcomes. Hepatic uptake could represent tracer inflow into the systemic circulation, indicating preservation of the connection between the lymphatic system and the systemic circulation. Physicians should evaluate these findings carefully on lymphoscintigraphy.
Subject(s)
Lymphatic System , Lymphoscintigraphy , Child , Humans , Lymph Nodes , Lymphoscintigraphy/methodsABSTRACT
BACKGROUND: To determine the incidence and risk factors for late severe intestinal complications after surgical repair for intra-abdominal congenital intestinal atresia/stenosis. METHODS: We included 51 patients who underwent surgical repair for congenital intestinal atresia/stenosis. Late severe intestinal complications included adhesive ileus, incisional hernia, or volvulus. Whether surgical intervention was urgent or not was recorded. The location of the atresia/stenosis was classified into two groups: atresia/stenosis located at the oral or anal side from the Treitz ligament. The type of atresia/stenosis was classified as low-risk types (type I, mucosal web/II, fibrous cord/IIIa, mesenteric gap defect) and high-risk types (IIIb, apple peel/IV, multiple atresia). We compared the incidence of late intestinal complications between the location of intestinal atresia/stenosis at the oral and anal side of Treitz ligament, and between low- and high-risk types of atresia/stenosis using Fisher's exact test. RESULTS: Eight (15.7%) had late intestinal complications, all of which occurred in patients with intestinal atresia/stenosis located on the anal side of the ligament of Treitz. Urgent surgical intervention was needed in four cases. There was a significant difference in the location of atresia/stenosis (with vs. without late intestinal complications at oral/anal side of the Treitz ligament: 0/8 vs. 24/19; P = 0.005) and the type of intestinal atresia/stenosis (with vs. without that accompanying low-/high-risk type: 5/3 vs. 41/2; P = 0.023). CONCLUSIONS: Physicians should consider the presence of intestinal complications that require surgical intervention in patients undergoing surgical reconstruction for jejunal and ileal atresia/stenosis with abdominal symptoms.
Subject(s)
Intestinal Atresia , Intestinal Obstruction , Constriction, Pathologic , Humans , Incidence , Intestinal Atresia/epidemiology , Intestinal Atresia/surgery , Intestinal Obstruction/etiology , Jejunum/abnormalities , Jejunum/surgeryABSTRACT
PURPOSE: The incidence of lithium button battery ingestion has been increasing recently, which results in severe complications. We aimed to demonstrate the association between the corrosion of lithium button batteries in the esophagus on radiographs and their complications. METHODS: The nine pediatric patients included in this study were classified into two groups based on the presence of severe complications. The presence and degree of corrosion on plain radiographs were evaluated. The degree of corrosion was classified into the following three grades; none: 0%; moderate: 1-50%; severe: 51-100%. Fisher's exact test was used for statistical analyses. RESULTS: Of the nine patients, five showed complications. The number of patients who had grade none, moderate, and severe degrees of corrosion was three, four, and two, respectively. The incidence of severe complications differed significantly between the incidence of lithium button batteries' contour (without vs. with severe complications [presence/absence of corrosion] = 1/3 vs. 5/0, respectively; P = 0.0476). In cases with "none" degree of corrosion, all three cases had no complication, and in cases with a "severe" degree of corrosion, all two cases had complications. CONCLUSION: The cases with the presence of corrosion of lithium button batteries had a higher tendency to have severe complications. Therefore, physicians should anticipate the presence of severe complications in pediatric patients with corrosion more than those without corrosion.
Subject(s)
Foreign Bodies , Lithium , Child , Corrosion , Electric Power Supplies/adverse effects , Esophagus/diagnostic imaging , Foreign Bodies/complications , Foreign Bodies/diagnostic imaging , HumansABSTRACT
BACKGROUND: Postoperative diaphragmatic paralysis is an unavoidable complication of cardiovascular surgery. Although diaphragmatic plication, as a surgical treatment, can be performed, spontaneous recovery is possible. We aimed to identify differences in fluorographic findings of diaphragmatic paralysis between pediatric patients with and without spontaneous recovery within 1 year of intrathoracic surgery. METHODS: Ten children, who had been followed-up for at least 1 year post-surgery and who had not received diaphragmatic plication were included and classified into those with or without spontaneous recovery. The presence or absence of the paradoxical movement of the diaphragm and mediastinum was evaluated based on fluorographic findings. Fisher's exact test was used to compare the presence or absence of paradoxical movement between the groups. RESULTS: Eight patients experienced spontaneous recovery. The mean ± standard deviation time to spontaneous recovery was 150 ± 114 days (range, 18-338 days). In the spontaneous recovery group, no patient had paradoxical movement of the mediastinum, and a significant between-group difference was observed in the presence of the paradoxical movement of the mediastinum (present/absent in patients with vs. without spontaneous recovery: 0/8 vs. 2/0, P = 0.02). There was no significant between-group difference in paradoxical movement of the diaphragm (present/absent in patients with vs. without spontaneous recovery: 1/7 vs. 2/0, P = 0.07). Pediatric patients without paradoxical movement of the mediastinum spontaneously recovered within 1 year of intrathoracic surgery. CONCLUSIONS: Pediatric patients without paradoxical movement of the mediastinum, based on fluorography findings, spontaneously recovered within 1 year of surgery. The timing of spontaneous recovery varied between cases.
Subject(s)
Respiratory Paralysis , Child , Diaphragm/diagnostic imaging , Humans , Respiratory Paralysis/diagnostic imaging , Respiratory Paralysis/etiology , Retrospective StudiesABSTRACT
PURPOSE: In neonates, pyriform sinus fistulas and lymphangiomas require different early treatment, such as surgical resection or sclerosing therapy, respectively. We aimed to evaluate the use of sonographic findings for differentiating between pyriform sinus fistulas and lymphangiomas in neonates with a lateral cervical cystic mass. METHODS: Sixteen cases diagnosed with pyriform sinus fistulas (n = 7) or lymphangiomas (n = 9) were included. Sonographic findings, including fistulas from the pyriform sinus, air-containing cysts, abnormal thyroid parenchyma echogenicity, internal septae within the cyst and spread to the opposite cervical site, were compared between neonates with pyriform sinus fistulas and those with lymphangiomas. Fisher's exact was used for statistical comparisons. RESULTS: A significant difference was observed between cases with and without air-containing cysts (present/absent in neonate with pyriform sinus fistula vs lymphangioma: 5/2 vs. 0/9; p = 0.005), abnormal thyroid parenchyma echogenicity (present/absent: 4/3 vs. 0/9; p = 0.019), and internal septae within the cysts (present/absent: 2/7 vs. 9/9; p = 0.005). No significant differences were observed between cases with or without a fistula from the pyriform sinus (present/absent: 2/5 vs. 9/0; p = 0.175) and spread to the opposite cervical site (present/absent: 4/3 vs. 4/5; p = 0.500). CONCLUSIONS: Ultrasound can differentiate pyriform sinus fistulas from lymphangiomas in neonates. In our small cohort, if they exhibited the respective sonographic findings; fistula from pyriform sinus, air-containing cysts or abnormal thyroid parenchyma echogenicity, patients were diagnosed as cases of pyriform sinus fistula. These diagnoses are critical for pediatric surgeons or otolaryngologists in surgical planning.
Subject(s)
Fistula/diagnostic imaging , Head and Neck Neoplasms/diagnostic imaging , Lymphangioma, Cystic/diagnostic imaging , Neck/diagnostic imaging , Pyriform Sinus/diagnostic imaging , Ultrasonography/methods , Diagnosis, Differential , Female , Humans , Infant, Newborn , Male , Retrospective StudiesABSTRACT
PURPOSE: Manual detorsion can be performed for testicular torsion before scrotal exploration. Using sonographic findings, this study investigated the need for additional treatments after manual detorsion for testicular torsion. METHODS: This study evaluated 13 retrospective cases of testicular torsion subjected to manual detorsion. Manual detorsion was classified as failure or success based on residual spermatic cord twist. The following sonographic findings of the affected testis were compared using the Fisher exact test: whirlpool sign, horizontal or altered lie, and hypoperfusion. RESULTS: Manual detorsion failed in five patients. There was a significant difference in the incidence of the whirlpool sign between the two groups (present/absent sign in the failure vs. success groups: 4/1 vs. 0/8, p = 0.007). Horizontal or altered lie and hypoperfusion in the affected testis were not significantly different between groups (5/0 vs. 3/4, p = 0.07, one case excluded, and 5/0 vs. 4/4, p = 0.10, respectively). CONCLUSIONS: Ultrasound findings after manual detorsion, particularly, the whirlpool sign, were useful for planning subsequent treatment such as additional manual detorsion or surgical intervention. The testicular axis and the perfusion of the twisted testis may not recover to normal after successful manual detorsion, but if they recover, this procedure could be judged a success.
Subject(s)
Spermatic Cord Torsion , Humans , Male , Retrospective Studies , Spermatic Cord Torsion/diagnostic imaging , Spermatic Cord Torsion/therapy , Testis/diagnostic imaging , UltrasonographyABSTRACT
BACKGROUND: Although complications associated with pazopanib, a multitarget tyrosine kinase inhibitor, are known, periosteal reaction as a side effect has never been reported. OBSERVATION: We present a case involving a male pediatric patient with desmoid tumors treated for 6 months with pazopanib who presented with pain and periosteal reaction in the ilium and scapula. Three months after termination of pazopanib therapy, the periosteal reaction in the scapula resolved and that in the ilium improved. CONCLUSION: Children receiving pazopanib presenting with focal pain should be examined for the periosteal reaction; this knowledge may facilitate correct diagnosis of symptoms as a drug-associated finding.
Subject(s)
Adenomatous Polyposis Coli/drug therapy , Angiogenesis Inhibitors/adverse effects , Ilium/pathology , Periosteum/pathology , Pyrimidines/adverse effects , Scapula/pathology , Sulfonamides/adverse effects , Adenomatous Polyposis Coli/pathology , Adolescent , Humans , Ilium/drug effects , Indazoles , Male , Periosteum/drug effects , Prognosis , Scapula/drug effectsABSTRACT
OBJECTIVES: Early diagnosis and prompt surgical intervention are important to prevent intestinal necrosis in patients with volvulus. The purpose of this study was to determine which ultrasound (US) findings may predict bowel ischemic changes in pediatric patients with intestinal volvulus. METHODS: Thirty-one pediatric patients with surgically proven intestinal volvulus were retrospectively reviewed. We compared the demographics and US findings (eg, superior mesenteric artery collapse, ascites, echogenic ascites, and degree of intestinal twist) between patients with and without bowel ischemic changes during surgery. Data are presented as median and range. The Fisher exact test, Mann-Whitney U test, and Wilcoxon signed rank sum test were used for statistical analyses. RESULTS: Eleven patients had bowel ischemic changes. Significant differences existed between patients with and without ischemic changes for age (2 days [range, 0-137 days] versus 6.5 days [range, 2-1618 days]; P = .02), superior mesenteric artery collapse (present/absent, 10/1 versus 9/11 patients; P = .02), the presence of ascites (present/absent, 8/3 versus 6/14 patients; P = .03), and intestinal twist degree on US imaging (540° [range, 180°-720°] versus 360° [range, 180°-720°]; P = .02). The groups did not significantly differ for sex, the time from the US examination to the operation, or echogenic ascites. The intestinal twist degree insignificantly differed between US and surgical findings (360° [range, 180°-720°] versus 360° [range, 0°-1080°]; P = .36). CONCLUSIONS: The presence of superior mesenteric artery collapse, ascites, and a large intestinal twist on US imaging were significant predictors of intestinal ischemic changes. Pediatric surgeons should perform prompt surgical interventions in cases of volvulus with these US findings.