Facial fractures in children: unique patterns of injury observed by computed tomography.

OBJECTIVE: To determine the patterns of facial fractures observed in pediatric patients after acute trauma. MATERIALS AND METHODS: The computed tomography studies of 338 patients (63% male, 37% female; 7 months to 18 years of age) performed after acute nonpenetrating facial trauma were retrospectively reviewed to evaluate for facial fractures and associated orbital hematomas or contiguous skull fractures. Fracture patterns were characterized as orbital roof, orbital floor, medial orbital wall, nasal bone, naso-orbital-ethmoid, zygomatic complex, isolated zygomatic arch, Le Fort type (I, II, or III), maxillary sagittal, alveolar ridge, or mandibular. The frequency of the various fracture types was determined. The correlation between fracture type and orbital hematomas or contiguous skull fractures was assessed (Kendall tau rank correlation). RESULTS: Computed tomography demonstrated facial fractures in 188 (54%) patients. The number and frequency of the fractures observed were as follows: orbital roof, 67 (36%); zygomatic complex, 38 (20%); naso-orbital-ethmoid, 30 (16%); orbital floor, 28 (15%); nasal bone, 25 (13%); mandibular, 24 (13%); medial orbital wall, 16 (9%); maxillary sagittal, 11 (6%); alveolar ridge, 8 (4%); isolated zygomatic arch, 3 (2%); Le Fort type I, 4 (2%); Le Fort type II, 4 (2%); and Le Fort type III, 0 (0%). Fifty children (27%) had multiple fractures. Orbital hematomas were seen in 28 patients (15%), and contiguous skull fractures were seen in 54 patients (29%). There was strong correlation between orbital hematomas and orbital roof fractures (0.62, P < 0.0001), orbital hematomas and naso-orbital-ethmoid fractures (0.18, P = 0.001), contiguous skull and orbital roof fractures (0.57, P < 0.0001), and contiguous skull and naso-orbital-ethmoid fractures (0.39, P < 0.0001). CONCLUSIONS: Fractures of the orbital roof are the most common facial fractures observed in pediatric patients after acute nonpenetrating trauma. Orbital roof and naso-orbital-ethmoid fractures are frequently associated with orbital hematomas and contiguous skull fractures.

Improved detection and characterization of adrenal disease with PET-CT.

Positron emission tomography (PET)-computed tomography (CT) combines complementary modalities, thereby providing useful structural and functional information for the detection and characterization of a variety of conditions affecting the adrenal gland. The coregistered information provided by PET-CT is often superior to that provided by CT or PET owing to a variety of pitfalls inherent in the use of either modality alone. In addition, PET-CT can prove invaluable in the differentiation between benign and malignant adrenal disease. However, this combined modality also has certain limitations. Benign entities such as lipid-poor adenomas may demonstrate increased uptake at 2-[fluorine 18]fluoro-2-deoxy-d-glucose PET while being indeterminate at standard CT. Moreover, the combined information from PET-CT will not always obviate additional studies or biopsy. Nevertheless, radiologists and nuclear physicians should be familiar with the common as well as the atypical manifestations of adrenal disease at PET and CT. They should also be meticulous in the performance and interpretation of PET-CT, which is crucial for optimal diagnosis and treatment.

Multidetector computed tomography of pediatric lateral condylar fractures.

OBJECTIVE: The objective of this study was to compare lateral condylar fracture characterization using radiographs and multidetector computed tomography (MDCT) of the elbow and to evaluate outcomes in a group of children managed based on MDCT findings. METHODS: Unenhanced MDCT of the elbow with sagittal and coronal reformations was prospectively performed without sedation in 10 children between 1 and 16 years of age with lateral condylar fractures identified on frontal and lateral radiographs of the elbow. Two blinded readers reviewed all radiographs and MDCT images independently and in consensus. For the radiographs and MDCT images, readers graded the displacement of the lateral condyle fracture fragment and classified the fractures according to the Milch classification. Articular and epiphyseal cartilage integrity was assessed on MDCT. Patients were managed based on the consensus interpretation of the MDCT study. The frequency of interobserver agreement, discordant grading of fracture displacement and fracture classification between radiographs and MDCT images, and altered management based on the MDCT findings were determined. RESULTS: Individual readers agreed on fracture displacement in 9 patients (90%) on radiographs and in all 10 patients (100%) on MDCT. Individual readers agreed on fracture classification in 4 patients (40%) on radiographs and in 9 patients (90%) on MDCT. In 4 patients (40%), grading of fracture displacement differed between the consensus interpretation of the radiographs and MDCT images. In 6 patients (60%), fracture classification differed between the consensus interpretation of the radiographs and MDCT images. All 3 patients with fracture displacement greater than 5 mm and 1 patient with fracture displacement between 2 and 5 mm demonstrated disruption of the articular and epiphyseal cartilage on MDCT. Two patients (20%) with fracture displacement near the surgical threshold of 2 mm had altered management based on the MDCT findings. All patients progressed to complete fracture healing, with no delayed displacement or other complications. CONCLUSIONS: Multidetector computed tomography is a highly reproducible means of characterizing pediatric lateral condylar fractures and frequently demonstrates disruption of the epiphyseal and articular cartilage in patients with fracture displacement greater than 2 mm. The findings of MDCT may lead to altered treatment in patients with fracture displacement near the surgical threshold of 2 mm.

16-MDCT of the posttraumatic pediatric elbow: optimum parameters and associated radiation dose.

OBJECTIVE: Our objective was to investigate a low-radiation-dose protocol for 16-MDCT of the posttraumatic pediatric elbow using z-axis automatic tube-current modulation, based on optimum scanning parameters determined in a porcine fracture model, and to report the radiation dose from this technique in nine children with acute elbow trauma. CONCLUSION: For the posttraumatic pediatric elbow, 16-MDCT using z-axis automatic tube-current modulation was optimal at 100 kVp with a noise index of 20 and a minimum amperage of 25 mA.

Multidetector computed tomography of fracture-separation of the distal humeral epiphysis.

A case of fracture-separation of the distal humeral epiphysis that was diagnosed using unenhanced multidetector computed tomography is reported. Fracture-separation of the distal humeral epiphysis is a rare injury of young children that is difficult to identify on routine radiographs and is frequently misdiagnosed at the time of initial evaluation.

Multidetector row CT in pediatric musculoskeletal imaging.

The proliferation of multidetector row CT (MDRCT) has had a significant effect on imaging of the musculoskeletal system. An increasing number of such examinations is being performed in children. We reviewed our experience using such examinations in children during a period of 20 months. In this review, we discuss MDRCT techniques and issues regarding the radiation dose of these examinations. We present the effect of newer scanning techniques and their incorporation into our scanning protocols.

CT of nontraumatic abdominal fluid collections after initial fluid resuscitation of patients with major burns.

OBJECTIVE: The purpose of this study was to describe the presence and CT distribution of nontraumatic fluid collections and edema in the abdomen and pelvis after initial fluid resuscitation of patients with major (>/==" BORDER="0"> 25% total body surface area) thermal burns. CONCLUSION: Awareness of the presence and expected CT distribution of nontraumatic fluid after initial fluid resuscitation in patients with major burns can assist the radiologist in differentiating such collections from those caused by mechanical trauma.

Internal hernia through a defect in the broad ligament: a rare cause of intestinal obstruction.

Internal hernias through the broad ligament are an extremely rare cause of intestinal obstruction. Clinical symptoms and imaging are often nonspecific, making preoperative diagnosis difficult. The authors report a case in which multidetector computed tomography proved useful in the preoperative diagnosis.