Interloop fluid in intussusception: what is its significance?

BACKGROUND: Sonography has been used to predict pneumatic reduction outcome in children with intussusception. OBJECTIVE: To assess the prognostic significance of fluid between the intussusceptum and intussuscepiens with respect to reduction outcome, lead point or necrosis. MATERIALS AND METHODS: Sonograms of children with a discharge diagnosis of intussusception from four institutions were reviewed for interloop fluid and correlated with results of pneumatic reduction and surgical/pathological findings when available. Maximal dimension of interloop fluid on a transverse image and fluid complexity were evaluated. RESULTS: Of 166 cases, 36 (21.7%) had interloop fluid. Pneumatic reduction was successful in 21 (58.3%) with fluid and 113 (87.6%) without. The average largest fluid dimension was 8.7 mm (range 5 mm-19 mm, median 8 mm) in cases with successful reduction and 12.8 mm (range 4 mm-26 mm, median 12.5 mm) in unsuccessful reduction (p < 0.05). Fluid dimension equal to or greater than 9 mm correlated with failed reduction (p < 0.0001;odds ratio 13:1). In 36 cases with interloop fluid that required surgery, there were four lead points and three necrosis. In cases without fluid with surgical reduction, there was one lead point and one necrosis. Interloop fluid correlated with lead point (p < 0.04) or necrosis (p < 0.03). Its significance increased with larger amounts of fluid (p < 0.0001). Patient age/fluid complexity did not correlate with reduction outcome (p = 0.9). CONCLUSION: Interloop fluid was associated with increased failure of pneumatic reduction and increased likelihood of lead point or necrosis, particularly when the maximum dimension exceeded 9 mm.

MRI and computed tomography of cardiac and pulmonary complications of tetralogy of fallot in adults.

Tetralogy of Fallot (TOF) represents the most common form of cyanotic congenital heart disease, accounting for 6.8% of all congenital heart disease. As surgical techniques and medical management of patients with TOF have improved, most affected patients are reaching adulthood. Though surgical outcomes are favorable (<2% early mortality rate), adults with TOF may experience complications from the long-term sequelae of congenital heart disease and complications related to treatment. We describe common and uncommon findings in adults with TOF, including pulmonary insufficiency, central and peripheral pulmonary artery stenosis and aneurysms, in addition to graft and shunt-related complications. Pulmonary function abnormalities and lung parenchymal imaging findings will be detailed. The diagnostic value of computed tomography and magnetic resonance imaging in adults with complications of TOF will be illustrated.