RESUMO
A 17-year-old patient presented, after a motor vehicle collision, with right hip pain and unusual radiographs of the chest and pelvis. Multiple radiopacities obscured detail. These partly obscured and distracted attention from a right acetabular fracture. The etiology was persistent perflubron 9 years after partial liquid ventilation for acute respiratory distress syndrome. Persistence of perflubron beyond 138 days has not been previously reported. We review the imaging appearance of perflubron and the mechanism likely related to its distribution and persistence in this case, and emphasize the importance of obtaining clinical history and avoiding distraction when faced with unusual radiographic findings.
Assuntos
Meios de Contraste/farmacologia , Fluorocarbonos/farmacologia , Ventilação Líquida/efeitos adversos , Mediastino/diagnóstico por imagem , Espaço Retroperitoneal/diagnóstico por imagem , Adolescente , Feminino , Humanos , Hidrocarbonetos Bromados , Radiografia , Síndrome do Desconforto Respiratório/terapiaAssuntos
Malformações Arteriovenosas/classificação , Neoplasias dos Genitais Masculinos/classificação , Neoplasias dos Genitais Masculinos/diagnóstico , Hemangioma Cavernoso/classificação , Hemangioma Cavernoso/diagnóstico , Cordão Espermático/diagnóstico por imagem , Criança , Diagnóstico Diferencial , Neoplasias dos Genitais Masculinos/cirurgia , Hemangioma Cavernoso/cirurgia , Humanos , Masculino , Orquiectomia/métodos , Radiografia , Cordão Espermático/cirurgia , UltrassonografiaRESUMO
OBJECTIVE: To a) describe superior mesenteric artery resistive index, as an estimate of perfusion, before and after modified Norwood; and b) assess incidence of diastolic flow reversal in the superior mesenteric artery before and after modified Norwood. DESIGN: Prospective observational trial. SETTING: Children's hospital pediatric intensive care unit. PATIENTS: Ten newborns with hypoplastic left heart syndrome. INTERVENTIONS: Ultrasound documentation of superior mesenteric artery diastolic flow direction and measurement of superior mesenteric artery resistive index 24-48 hrs before and 24-48 hrs after modified Norwood. MEASUREMENTS AND MAIN RESULTS: Seven males and three females were enrolled. There was no change between the superior mesenteric artery resistive index pre- vs. postoperatively-0.99 (95% confidence interval, 0.85, 1.12) vs. 1.07 (95% confidence interval, 1.0, 1.15) (p = .13). Incidence of retrograde diastolic blood flow in the superior mesenteric artery was not different pre- vs. postoperatively (70% vs. 50%, p = .41). No patients developed necrotizing enterocolitis and all survived to hospital discharge. CONCLUSIONS: Ultrasound measurements in neonates with hypoplastic left heart syndrome suggest that superior mesenteric artery perfusion, as measured by resistive index, is impaired. Superior mesenteric artery diastolic flow reversal is common before and immediately after modified Norwood.
Assuntos
Síndrome do Coração Esquerdo Hipoplásico/fisiopatologia , Síndrome do Coração Esquerdo Hipoplásico/cirurgia , Artéria Mesentérica Superior/fisiopatologia , Circulação Esplâncnica , Enterocolite Necrosante/fisiopatologia , Enterocolite Necrosante/prevenção & controle , Feminino , Humanos , Síndrome do Coração Esquerdo Hipoplásico/diagnóstico por imagem , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Assistência Perioperatória , Estudos Prospectivos , Ultrassonografia Doppler , Resistência VascularRESUMO
Ultrasound is exquisitely sensitive for the identification of portal vein pneumatosis, which in neonates is commonly caused by necrotizing enterocolitis. We describe the ultrasound finding of systemic arterial pneumatosis in a case of necrotizing enterocolitis associated with congenital heart disease. A combination of a patent ductus venosus and an extracardiac right-to-left shunt via the great vessels through a patent ductus arteriosus provided a pathway for the pneumatosis from the portal vein to the abdominal aorta.
Assuntos
Permeabilidade do Canal Arterial/diagnóstico por imagem , Enterocolite Necrosante/diagnóstico por imagem , Pneumatose Cistoide Intestinal/diagnóstico por imagem , Anormalidades Múltiplas/diagnóstico por imagem , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/fisiopatologia , Terapia Combinada , Permeabilidade do Canal Arterial/complicações , Permeabilidade do Canal Arterial/terapia , Enterocolite Necrosante/complicações , Enterocolite Necrosante/terapia , Seguimentos , Humanos , Recém-Nascido , Masculino , Pneumatose Cistoide Intestinal/complicações , Pneumatose Cistoide Intestinal/terapia , Veia Porta/diagnóstico por imagem , Veia Porta/fisiopatologia , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento , Ultrassonografia DopplerRESUMO
Nuclear medicine bone scan is an essential diagnostic imaging tool both for the diagnosis and staging of bone tumors and in the follow-up of these patients. It is very important that we be able to discriminate between normal variants, changes related to altered physical stress, and recurrent disease in order to interpret the bone scan meaningfully. We wish to report the appearance of the isotope bone scan, technetium 99m-labeled methylene diphosphonate ((99m)Tc-MDP), associated with an auto-transplanted osteoarticular plug (epiphyseal transplant) performed following limb amputation. This reconstructive surgery can give a potentially misleading appearance on the nuclear medicine bone scan if one is unfamiliar with this surgical technique.
Assuntos
Amputação Cirúrgica , Osso e Ossos/diagnóstico por imagem , Epífises/transplante , Adolescente , Feminino , Humanos , Perna (Membro) , Cintilografia , Compostos Radiofarmacêuticos , Medronato de Tecnécio Tc 99m , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Transplante AutólogoRESUMO
Thoracic outlet syndrome (TOS) is rare in childhood. In adults, TOS results in compression of the neurovascular bundle (branches of the brachial plexus and the subclavian artery), but more than 95% of cases present solely with neurologic compression. We present a case of TOS in a very young child and describe the rare finding of subclavian artery compression and post-stenotic aneurysm. The clinical features, imaging workup, and surgical findings are discussed. The combination of three-dimensional MR angiography and CT was of great value in diagnosis and surgical planning.
