Imaging assessment of renal injuries in children and adolescents: CT or ultrasound?

BACKGROUND: Since the introduction of the ALARA ("as low as reasonably achievable") concept, ultrasound (US) has been progressively advocated for paediatric diagnostic imaging. This study aimed to analyse the role and accuracy of US in paediatric renal trauma. METHODS: From 1999 to 2009, the tertiary-care-hospital database was retrospectively evaluated for renal trauma with regards to aetiology, type of injury, diagnostics, management and outcome. RESULTS: Forty-seven patients (29 males, 18 females; median age=14years, range 1-17 years) were identified. US was initially applied in 45 patients with correct results in 86.6%. Computed tomography (CT) was performed in 16 patients in the acute trauma setting - complementary to US in 14 cases, with a diagnostic accuracy of 93%. Most renal injuries were grade I° (n=30), followed by grade III° (n=8), IV° (n=5), and II°/V° (n=2 each). All patients were initially managed conservatively and followed by US. Clinical deterioration necessitated surgery in four patients (2 nephrectomies, 1 partial nephrectomy, 1 urinoma drainage). The outcome was generally favourable with a renal preservation rate of 95%. CONCLUSION: With respect to the ALARA principle, US can be safely and reliably applied as the first-line diagnostic imaging technique and for follow-up for suspected traumatic paediatric renal injuries.

Three-dimensional ultrasonography-based virtual cystoscopy of the pediatric urinary bladder: a preliminary report on feasibility and potential value.

OBJECTIVE: The purpose of this study was to validate the feasibility and potential of 3-dimensional ultrasonography (3DUS)-based virtual cystoscopy in the pediatric urinary bladder. METHODS: Twenty patients (age range, newborn-14 years) underwent urinary tract ultrasonography and 3DUS of the urinary bladder. From this data set, virtual cystoscopy was reconstructed for visualization of the inner bladder surface. Three-dimensional ultrasonography was compared with 2-dimensional ultrasonographic (2DUS) findings, voiding cystourethrography (VCUG) results, and reports from cystoscopy or surgery when available. RESULTS: Three-dimensional ultrasonography was feasible in all patients. Data quality was sufficient for virtual cystoscopy without major motion artifacts. The 3DUS results matched all other findings; particularly, 3DUS superiorly visualized the ureteral ostium and the bladder neck configuration; in 5 patients, 3DUS depicted pathologically shaped ostia not detected by 2DUS. This correlated with the presence of vesicoureteral reflux on VCUG. Performing virtual cystoscopy added 1 minute to the investigation time (range, 0.5-2 minutes) and 3 minutes for postprocessing and viewing (range, 2-5 minutes). CONCLUSIONS: Three-dimensional ultrasonography-based virtual cystoscopy is feasible in the pediatric urinary bladder without sedation. It reveals surface information not accessible by 2DUS, improving detection of pathologic conditions such as atypically shaped ureteral ostia. Three-dimensional ultrasonography-based cystoscopy may become a valuable adjunct to 2DUS of the pediatric urinary tract, improving selection criteria for further imaging such as VCUG, and potentially may help reduce the need for endoscopic cystoscopy. However, these preliminary results still have to be confirmed in prospective studies with larger patient numbers.

Subsequent displacement of initially nondisplaced and minimally displaced fractures of the lateral humeral condyle in children.

BACKGROUND: Although conservative treatment is a well-established method for treating nondisplaced and minimally displaced (< or =2 mm) fractures of the lateral humeral condyle in children, there is still great uncertainty concerning the rate and time course of subsequent displacement. Therefore, the appropriate frequency of radiographic follow-up remains unclear. The aim of the study was to determine the rate of subsequent displacement after conservative treatment of nondisplaced and minimally displaced fractures of the lateral humeral condyle in children. METHODS: A retrospective analysis of 51 consecutive patients with nondisplaced and minimally displaced fractures of the lateral humeral condyle was performed. RESULTS: Five fractures (9.8%) displaced within 5 days while immobilized and were safely detected by a follow-up radiograph within 1 week after trauma. Additional follow-up radiographs between the first and third weeks did not show relevant alterations in the fracture gap. Mean time of cast immobilization was 22 days, with a range of 17 to 34 days. No pseudarthrosis occurred. CONCLUSION: Fractures with less than or equal to 2 mm of displacement can probably be primarily treated safely by cast immobilization. Anteroposterior and lateral radiographs out of plaster between the fourth and sixth days are necessary to diagnose subsequent displacement of unstable fractures, whereas further "late" displacement did not occur.