Comparative effectiveness of imaging modalities for preoperative assessment of anorectal malformation in the pediatric population.

OBJECTIVE: The aim of this study was to compare the accuracy of MRI, colostography/fistulography, and X-ray imaging modalities for preoperative diagnosis of anorectal malformations (ARMs) in pediatric patients. METHODS: This retrospective analysis included a total of 84 pediatric patients with ARMs. Preoperative imaging findings were assessed by 2 radiologists and compared to surgical findings. RESULTS: MRI identified anomalies of the spine in 25 of 84 patients (29.8%), anomalies of the genital system in 7 of 84 patients (8.3%), anomalies of the urinary system in 22 of 84 patients (26.2%), and underdeveloped sphincter muscle complex in 34 of 84 patients (40.5%). In the 44 subjects receiving both MRI and X-ray, MRI was more sensitive in detecting anomalies of spine (18/44 vs. 8/44; P = 0.002), and both correctly identified the distal end of the rectum in 77.3% (34/44) of the cases. In the 24 subjects receiving both MRI and colostography/fistulography, MRI was more accurate in identifying Pena's classification (22/24 vs. 15/24; P = 0.039). Distal end of the rectum was correctly identified in 75.0% (18/24) and 58.3% (14/24) of the cases (P = 0.125). CONCLUSIONS: MRI could clearly reveal fistula anatomy and associated anomalies of ARMs and should be routinely used for preoperative evaluation of ARMs. TYPE OF STUDY: Study of diagnostic test. LEVEL OF EVIDENCE: Level II.

Transperineal ultrasound for assessment of fistulas and abscesses: a pictorial essay.

Perianal fistulas and abscesses may be cryptogenetic or associated with inflammatory bowel disease (IBD), specifically Crohn's disease. Proper identification and classification of these lesions are paramount for correct therapeutic management. Current diagnostic modalities include MRI (magnetic resonance imaging), EUS (endoscopic ultrasound), EUA (exam under anaesthesia) and recently, transperineal ultrasound (TPUS). The latter has been proposed as a noninvasive, easily available and cost-effective technique to diagnose, assess and follow up perianal disease particularly in IBD patients. This pictorial review focuses on the role of TPUS in clinical practice, highlighting the features of fistulas and abscesses.

Transesophageal three-dimensional echocardiographic assessment of left main coronary artery fistula.

We describe a patient with a left main coronary artery fistula with an opening at the superior vena cava-right atrial junction in whom three-dimensional transesophageal echocardiography permitted more accurate assessment of the shape and size of the communication site than two-dimensional transesophageal echocardiography.

Ultrasonic assessment of rhinostomy size following external dacryocystorhinostomy.

AIM: To assess the dimensions and patency of the surgical epithelial fistula after external dacryocystorhinostomy, using B mode ultrasonography to define the postoperative soft tissue anastomosis. METHODS: 12 patients undergoing 16 external dacryocystorhinostomies, with the creation of large osteotomies, were included in a prospective study. The horizontal and vertical dimensions of the bone ostium was recorded during surgery and compared with the ultrasonographic dimensions of the soft tissue anastomosis at 1 day, 2 weeks, and 6 months after surgery. Functional patency was confirmed with dye testing and irrigation. RESULTS: Compared with an osteotomy of between 100 and 380 mm2 (mean 235 mm2), the soft tissue anastomosis on the day after surgery was, in all cases, markedly smaller (72-252 mm2; mean 144 mm2, or 61% of the bone window). The soft tissue anastomosis decreased to between 8 and 208 mm2 (mean 98 mm2; 68% of immediate postoperative value) at 2 weeks and 3-208 mm2 (mean 71 mm2; 49% of immediate postoperative value) at 6 months. 14 of the 16 (88%) dacryocystorhinostomies were functional at the end of the study, the two failures being associated with marked contracture of the soft tissue anastomosis; the outcome of surgery correlated significantly with the area of the anastomosis at 2 weeks (chi 2 = 16.3; p < 0.01) and at 6 months (chi 2 = 16.0, p = 0.01). CONCLUSIONS: B mode ultrasonography provides a simple and effective method for assessing the size of the soft tissue anastomosis after external dacryocystorhinostomy and there is a significant reduction in size after surgery, to which the functional outcome of surgery appears related. As the initial soft tissue anastomosis cannot be larger than (and is, on average, about 60% of) the area of the osteotomy, this emphasises the paramount importance of a large rhinostomy to the success of lacrimal surgery.

Gonococcal endocarditis: assessment by transesophageal echocardiography.

Gonococcal endocarditis is a rare but aggressive infection that has an alarming rate of perivalvular abscess and mortality. We present a case of gonococcal endocarditis with intracardiac abscess and fistula diagnosed by transesophageal echocardiography. Given the often acute nature of gonococcal endocarditis and its propensity toward abscess formation, transesophageal echocardiography should be considered early in the course of this infection.

Radiologic assessment of the early postoperative total-laryngectomy patient.

Pharyngocutaneous fistula is a significant cause of postoperative morbidity following total laryngectomy. The records of 132 patients at the Johns Hopkins Hospital were reviewed retrospectively to determine the role of radiographic contrast studies in the early postoperative period after total laryngectomy. Radiographic studies were performed in 41 cases, of which 38 were cinepharyngoesophagograms. Fistulae occurred postoperatively in 28 patients (21%). In patients with no clinical signs or symptoms suggestive of an impending fistula (fever, wound erythema, wound swelling, or persistent elevated neck drain output), there is no need to perform a cinepharyngoesophagogram before starting oral alimentation. The presence of soft-tissue air in the neck seen on preliminary scout spot films, suggestive of an impending fistula seen in patients who also underwent a neck dissection, did not correlate with a clinical fistula if no extravasation of contrast was observed.

[The value of computerized tomography in the assessment of chronic osteomyelitis. A radiological, histological and clinical correlation study]. / Der Wert der Computertomographie bei der Abklärung der chronischen Osteomyelitis. Eine radiologische, histologische und klinische Korrelationsstudie.

Twenty-three consecutive CT examinations in cases of chronic osteomyelitis were analyzed and compared to conventional radiologic and surgical findings and histologic examinations of samples taken specifically for the purpose. CT is the most reliable method of detecting sequesters. A detailed structural analysis of the bone in regard to old bone portions and osteomyelitic osteoneogenesis is possible, but osteonecrosis cannot be detected with certainty. Abscesses and fistulae can be demonstrated with a high degree of reliability, using contrast medium if necessary. CT influences the authors' decisions concerning planned revisional surgery in chronic osteomyelitis cases more than any other examination method. It is used in all osteomyelitis diagnoses following removal of the metal.

Roentgenographic assessment of causes of cardiac pacemaker failure and complications.

Implantation of a permanent pacemaker to stimulate the heart is a well established procedure of great benefit. However, a malfunctioning pacemaker is a hazard to well-bing and to life. Once a pacemaker has been installed the physician's attention is directed not only to the patient's illness but also the unique complications of cardiac pacemakers. Roentgenograms are a valuable resource in the assessment of patients with pacemakers. It is essential that the radiologist thorougly understand the extent to which radiologic studies can depict the functioning of the complications associated with pacemakers. The roentgenographic assessment of the causes of pacemaker failure and the complications associated with permanent pacemakers are reviewed and the role of the roentgenogram is defined.