ABSTRACT
We report the case of an infant boy born at 39 weeks and 5 days who presented a cleft lip and palate. During the assessment to detect associated malformations, cardiac auscultation revealed a systolic heart murmur. Echocardiography and subsequent thoracic computed tomography angiography identified an aneurysm of the ductus arteriosus. Ductus arteriosus aneurysm, a complicated form of patent ductus arteriosus, may not be as rare as once considered. A clear majority of ductus arteriosus aneurysms are asymptomatic and physiologically resolve after birth. Nevertheless, severe complications can occur, primarily during the postnatal period.
Subject(s)
Aneurysm/diagnostic imaging , Ductus Arteriosus/diagnostic imaging , Asymptomatic Diseases , Computed Tomography Angiography , Ductus Arteriosus, Patent/diagnostic imaging , Echocardiography , Humans , Infant, Newborn , MaleABSTRACT
Bone and joint pain are common causes of pediatric consultation for a variety of etiologies. The causes are mostly traumatic or infectious or have an inflammatory origin. Acute leukemia (AL) can sometimes begin with osteoarticular signs and radiological investigations such as magnetic resonance imaging (MRI) can help guide the diagnosis. We report on two cases of pediatric AL revealed by osteoarticular signs, with MRI helpful in the diagnostic procedure. In these children, the first signs were recurrent joint pain, with no blood count anomalies. There was a delay between the onset of arthralgia and diagnosis due to atypical presentation of the disease. MRI guided the investigations to the diagnosis of AL. The persistence of pain or inflammation must lead to considering a bone MRI and a complete blood count must be repeated in case of persistent inflammatory bone pain to avoid a missed diagnosis of blood disease.
Subject(s)
Bone and Bones/diagnostic imaging , Magnetic Resonance Imaging , Precursor Cell Lymphoblastic Leukemia-Lymphoma/diagnosis , Child , Child, Preschool , Female , Fractures, Spontaneous/diagnostic imaging , HumansABSTRACT
OBJECTIVE: MR imaging using diffusion-weighted (DW) images and delayed gadolinium-enhanced T1-weighted images is evolving into an alternative to second look surgery in detection of recurrent cholesteatomas. The aim of this study was to retrospectively compare the DW images, the post-gadolinium T1-weighted images and the combination of both methods in this indication. PATIENTS AND METHODS: We retrospectively evaluated the MR examination of 39 patients clinically suspected for a recurrent cholesteatoma. Patients in the study underwent DW sequences, delayed gadolinium enhanced T1-weighted sequences as well as standard uninjected protocol using T1 and T2 sequences. Three blinded radiologists evaluated three data sets: a set of post-gadolinium T1-weighted images, a set of DW images and a set of the combination of both methods. The interobserver agreement was evaluated and the diagnostic accuracy of each method was described by sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). The performances of the three techniques were also evaluated using ROC curves, from which the AUC were compared. Results were compared with surgical results or a two-year follow-up. RESULTS: The overall sensitivity and specificity were respectively 63% and 71% for the post-gadolinium T1-weighted images, 88% and 75% for the DW images and 84% and 75% for the combined images. The PPV and NPV were respectively 89% and 33% for the post-gadolinium T1-weighted images, 93% and 62% for the DW images and 93% and 55% for the combined images. The sensitivity and the NPV were significantly different between the three methods (P<0.0001 and P=0.027). There was no statistically significant difference in specificity or PPV between the three methods (P=0.931 and P=0.650). The diagnostic accuracy evaluated with the AUC showed no statistically significant difference between the DW images and the combined images (P=0.433). CONCLUSION: MR imaging reliably identifies those patients suspected for recurrent cholesteatoma who require a surgical second look by using DW MR imaging. The combination with delayed gadolinium enhanced T1-weighted sequences does not significantly increase the diagnostic accuracy of the examination.