Terminal Ileitis Presenting With a Spontaneously Reduced Ileocolic Intussusception Diagnosed by Point-of-Care Ultrasonography.

Point-of-care ultrasound can be used in the initial workup of ileocolic (IC) intussusception. In general, these lesions require immediate attention and reduction to prevent ischemic bowel injury. We discuss the case of a 27-month-old boy whose IC intussusception was found to spontaneously reduce before a radiology performed ultrasound and the planned air enema reduction procedure. Radiology ultrasound revealed significant inflammatory changes of the terminal ileum. The incidence of spontaneous reduction of IC intussusception is not definitively known. It is important to be familiar with the possibility of spontaneous reduction as children are often referred to academic centers for radiological or surgical reduction. This may also impact the sensitivity of studies that evaluate test characteristics of point-of-care ultrasound compared with radiology performed ultrasound for the diagnosis of IC intussusception. We review the diagnostic technique for IC intussusception and the importance of a prereduction ultrasound immediately before image-guided pressure reduction attempt.

Intestinal blood flow by Doppler ultrasound: the impact of gestational age and time from first enteral feeding in preterm neonates.

OBJECTIVE: To explore whether superior mesenteric artery (SMA) peak systolic velocity (PSV) on Doppler ultrasound varies by gestational age (GA) and time from first enteral feeding and has an impact on feeding intolerance. DESIGN/METHODS: Preterm neonates were assigned to three GA groups at birth, group I: 31 to 356/7 weeks, group II: 27 to 306/7 weeks, and group III: ≤ 266/7 weeks. SMA PSV and clinical and feeding parameters were assessed before and after enteral feed, with the first enteral feed designated as time 1, time 2 = 1 to 4 days (after first feed), time 3= 5 to 7 days, time 4 = 8 to 14 days, and time 5 = 15 to 28. RESULTS: Forty-one patients completed the study (group I: n = 17, group II: n = 12, group III: n = 12). There was no significant difference in SMA PSV change after feeding between groups at the start of enteral feeding (p = 0.12). There were differences in change in SMA PSV after feeding at times 2, 3 and 5 (p = 0.003, p = 0.004, p = 0.009, respectively). Patients with feeding intolerance exhibited a smaller increase in SMA PSV after feeding. CONCLUSIONS: There were significant differences in PSV by GA group. SMA PSV change after feeding was lower in patients who had feeding intolerance compared with those who did not.

Pediatric ocular sonography.

Ultrasound is often used as an adjuvant in the workup of ocular pathology in children. It is particularly useful when ophthalmoscopic examination is limited, such as in the presence of extreme miosis or opaque ocular media. Other indications include assessment of a mass seen at ophthalmoscopy, elucidation of a mass underlying a retinal detachment, ocular trauma, and biometry. In this article, we review normal sonographic technique and ocular anatomy. The sonographic features of common pediatric ocular conditions are presented, with an emphasis on distinguishing features. Correlation, where pertinent, is made with other imaging modalities, such as computed tomography and magnetic resonance imaging. Ultrasound plays a critical role in the clinical diagnostic evaluation of globe pathology.

CT characteristics of lung nodules present at diagnosis of extrapulmonary malignancy in children.

OBJECTIVE: The purpose of this study was to evaluate the CT characteristics of lung nodules present at diagnosis of extrapulmonary malignancies in children. MATERIALS AND METHODS: We performed a retrospective analysis of CT images of children seen in our oncology service over a 6-year period. We included all children diagnosed with a non-CNS solid extrapulmonary malignancy or lymphoma who had also undergone chest CT at presentation. Images were reviewed for the presence of lung nodules; if present, the following nodular characteristics were recorded: sidedness, number, distribution, CT attenuation, shape, margins, calcification, and size. When available, pathology results were correlated with the nodules found on CT. RESULTS: One hundred eleven infants and children (age range, 14 days-17 years 10 months; median age, 11 years 8 months) had lung nodules on CT. The nodules showed a variety of patterns, but the most common findings were bilateral lung nodules (71 of 111 patients), between two and 10 in number (60 patients), peripheral distribution (98 patients), < or = 5 mm (48 patients), oval shape (45 patients), solid attenuation (74 patients), smoothly marginated (91 patients), and noncalcified (107 patients). Twenty-seven patients underwent biopsy. Seventeen biopsies showed benign lesions and nine, malignant lesions; the results for the remaining biopsy were inconclusive. In the subgroup of lung nodules that underwent biopsy, none of the CT characteristics was able to differentiate benignity from malignancy. CONCLUSION: Lung nodules in children with extrapulmonary malignancies showed a variety of patterns on CT. In the subgroup of lung nodules that underwent biopsy, none of the nodule features studied on CT reliably differentiated benignity from malignancy.

Do additional views improve the diagnostic performance of cervical spine radiography in pediatric trauma?

OBJECTIVE: The aims of this study were to measure the diagnostic performances of lateral views alone and multiple radiographic views of the cervical spine in comparison with MDCT scans in pediatric trauma and to determine whether evaluation of additional views, in relation to lateral views alone, improves the performance of radiography. MATERIALS AND METHODS: Retrospective analysis of cervical spine radiographs of 234 pediatric patients (age range, 3 months-17 years 11 months) who had been seen in our pediatric emergency department during the period of 2000-2005 for evaluation after acute trauma was performed. All patients underwent cervical spine MDCT examination at the same presentation. Radiographs were evaluated for the presence of fractures, subluxations, and dislocations. Radiographic abnormalities were correlated to findings on MDCT, which was used as the reference standard. RESULTS: Twenty-two patients had positive findings on CT: Atlantooccipital subluxation/dislocation was seen in one patient; C1 ring fracture, in three patients; C1-C2 rotatory subluxation, in one; C1-C2 subluxation/dislocation, in one; odontoid fracture, in two; vertebral body wedge fracture, in six; posterior arch fracture dislocation, in 10; and spinous process fracture, in none. The lateral view radiograph alone had 73% sensitivity (95% CI, 50-89%) and 92% specificity (95% CI, 87-95%) for cervical spine abnormalities compared with MDCT. The addition of other views did not change the sensitivity of radiography but rather marginally decreased its specificity to 91% (95% CI, 86-94%). CONCLUSION: Lateral view radiographs had a borderline acceptable sensitivity to cervical spine abnormalities in pediatric patients compared with MDCT. The addition of other radiographic views did not seem to improve the diagnostic performance of radiography.