The role of 3D computed tomography (CT) imaging in the diagnosis of foreign body aspiration in children.

OBJECTIVE: The aim of this study was to improve the understanding of FBA in children and to decrease the rate of misdiagnosis, missed diagnosis and morbidity. PATIENTS AND METHODS: We analyzed the clinical features and the three-dimensional reconstructed CT images of 590 children with foreign body aspiration (FBA) in the Xuzhou area of the Jiangsu province. RESULTS: CT imaging revealed common complications of FBA including emphysema (n = 379), pneumonia (n = 174), and atelectasis (n = 26). The remaining 120 patients had no visible complications on the three-dimensional reconstructed CT images. Serious complications including pneumothorax, pneumomediastinum, subcutaneous emphysema, pneumatorrhachis could also be observed. The types of foreign bodies were diverse: the most common were peanuts and sunflower seeds. The diagnostic accuracy of the three-dimensional CT imaging was high, with a sensitivity and specificity of 99.83% and 99.89%, respectively. CONCLUSIONS: 3D CT imaging is an accurate, non-invasive technique to evaluate children with suspected FBA that can help decrease the rate of misdiagnosis and eliminate a delay in treatment for this potentially life-threatening condition.

Magnetic resonance venography in the diagnosis of inferior vena cava obstruction in Budd-Chiari syndrome.

OBJECTIVE: To evaluate the informativeness of magnetic resonance venography (MRV) in the diagnosis of different types of inferior vena cava (IVC) obstruction. PATIENTS AND METHODS: 56 patients with IVC obstruction underwent MRV scans. These scans were evaluated for morphology of the obstruction and compared with digital subtraction angiography (DSA) images. RESULTS: Using DSA, we determined that 47 patients had complete obstruction and 9 had partial obstruction. MRV scans revealed 6 cases of partial obstruction. Using MRV, we determined the morphology of the proximal and distal ends of the complete obstructions in the IVC. We classified our observations into cone, plateau, and irregular subtypes. Both DSA and MRV scans were compared to assess the consistency between two methods. MRV demonstrated high sensitivity (100%) for diagnosing a complete obstruction of the IVC, and its specificity was 66.7%. The positive and negative predictive values of MRV were 94% and 100%, respectively. CONCLUSIONS: MRV imaging is a valuable alternative to DSA for detection of obstructions in the IVC in Budd-Chiari syndrome, particularly in the distal end, which could expedite the decision making for interventional treatment programmes. However, MRV imaging is less suitable for observing the morphology of the proximal ends of obstructions due to the limitations of the scanning plane and the influence of pseudo shadows.