Traumatic abdominal wall hernias in the pediatric population: a 13-year institutional review.

Background: Pediatric traumatic abdominal wall hernias are rare but potentially devastating injuries. Although classically considered to be caused by handlebar injuries from bicycle accidents, our anecdotal experience suggests pediatric traumatic abdominal wall hernias are far more likely to occur following road traffic accidents and have a high association with other significant intra-abdominal injuries.

Objective: The purpose of this study was to determine the frequency, mechanisms of injury, and associated injuries of traumatic abdominal wall hernias in the pediatric population.

Chest CT in the evaluation of child abuse - When is it useful?

Background: Indications for chest CT in evaluation of child abuse are unknown.

Objective: Determine which groups of children can best benefit from chest CT.

Participants And Setting: 10-year (1/2010 to 12/2019) retrospective study of children <3 years who had chest CT within 3 days of the initial skeletal survey.

Urinary excretion of low-osmolar contrast media during small-bowel follow-through studies in infants is not definitive evidence of bowel perforation.

Background: Presence of contrast agent in the urinary system in infants after small-bowel follow-through study with low-osmolar contrast media has been described as a sign of bowel perforation.

Objective: To evaluate how often the presence of contrast agent in the bladder after small-bowel follow-through is a reliable sign of bowel perforation or necrosis.

Materials And Methods: From the radiology information system, we retrieved imaging reports of infants evaluated with small-bowel follow-through and findings of contrast agent in the bladder.

Radiologists' Diagnostic Performance in Differentiation of Rickets and Classic Metaphyseal Lesions on Radiographs: A Multicenter Study.

Despite evidence supporting the specificity of classic metaphyseal lesions (CML) for the diagnosis of child abuse, some medicolegal practitioners claim that CML result from rickets rather than trauma. The purpose of this study was to evaluate radiologists' diagnostic performance in differentiating rickets and CML on radiographs. This retrospective seven-center study included children younger than 2 years who underwent knee radiography from January 2007 to December 2018 and who had either rickets (25-hydroxyvitamin D level < 20 ng/mL and abnormal knee radiographs) or knee CML and a diagnosis of child abuse from a child abuse pediatrician.

Accuracy of ultrasound in the diagnosis of classic metaphyseal lesions using radiographs as the gold standard.

Background: Diagnosis of classic metaphyseal lesions (CMLs) in children suspected for child abuse can be challenging. Ultrasound (US) can potentially help diagnose CMLs. However, its accuracy is unknown.

Ultrasound diagnosis of medial clavicular epiphysis avulsion fracture in a neonate.

Clavicle fractures are the most common bony injury that occurs during the delivery process. We present a case of medial clavicular physeal fracture mimicking sternoclavicular dislocation diagnosed by ultrasound (US) in a neonate. The infant presented to our clinic at 12 days old with improving left upper extremity pseudoparalysis and outside radiographs interpreted as left sternoclavicular dislocation.

Osteomyelitis of the ribs in children: a rare and potentially challenging diagnosis.

Background: Rib osteomyelitis is rare in children and can mimic other pathologies. Imaging has a major role in the diagnosing rib osteomyelitis.

Objective: To evaluate clinical presentation and imaging findings in children with rib osteomyelitis.

Compliance With Skeletal Surveys for Child Abuse in General Hospitals: A Statewide Quality Improvement Process.

The purpose of this study is to perform a statewide quality improvement process to improve compliance with the American College of Radiology (ACR) guidelines in performing skeletal surveys for suspected child abuse. We prospectively identified all outside hospital skeletal surveys for suspected child abuse in children younger than 3 years referred to our tertiary children's hospital in 2016-2017. We included a 3-month baseline and 21-month intervention period.

The added value of a second read by pediatric radiologists for outside skeletal surveys.

Background: Fractures are the second most common finding in non-accidental trauma after cutaneous signs. Interpreting skeletal surveys could be challenging as some fractures are subtle and due to anatomical variations that can mimic injuries.

Objective: To determine the effect of a second read by a pediatric radiologist of skeletal surveys for suspected non-accidental trauma initially read at referring hospitals by general radiologists.

Ultrasound diagnosis of tracheal cartilaginous sleeve in a patient with Pfeiffer syndrome.

There is an association between tracheal cartilaginous sleeve and syndromic craniosynostosis. We present a case of tracheal cartilaginous sleeve diagnosed by ultrasound (US) in a patient with Pfeiffer syndrome. The patient developed respiratory failure and was suspected at bronchoscopy to have tracheal cartilaginous sleeve.

Fishtail deformity of the distal humerus: association with osteochondritis dissecans of the capitellum.

Background: Fishtail deformity is a rare deformity of the humerus exhibiting concavity of the lateral trochlea, resulting in ulnotrochlear joint derangement. We wanted to share our experience that osteochondritis dissecans of the capitellum is a common associated complication.

Objective: To summarize imaging of fishtail deformity in children centered on complications of the radiocapitellar joint.

Prenatal and Postnatal Sonographic Confirmation of Congenital Absence of the Ductus Venosus in a Child with Noonan Syndrome.

The ductus venosus serves as an important vascular pathway for intrauterine circulation. This case presents a description of an absent ductus venosus in a female patient with Noonan syndrome, including both prenatal and postnatal imaging of the anomaly. In the setting of the anomalous vascular connection, the umbilical vein courses inferiorly to the iliac vein in parallel configuration with the umbilical artery.

Changes in femoral head size and growth rate in young children with severe developmental dysplasia of the hip.

Background: Developmental dysplasia of the hip (DDH) is known to result in smaller femoral head size in toddlers; however, alterations in femoral head size and growth have not been documented in infants.

Objective: To determine with ultrasound (US) whether femoral head size and growth are altered in infants (younger than 1 year of age) with severe DDH.

Materials And Methods: We identified all patients at our tertiary care children's hospital from 2002 to 2014 who underwent US for DDH.

JOURNAL CLUB: Can Coronal STIR Be Used as Screening for Acute Nontraumatic Hip Pain in Children?

Objective: The objective of this study is to evaluate whether coronal STIR MRI can be used as a screening test for nontraumatic acute hip pain in children.

Materials And Methods: From 2008 to 2012, we identified all patients younger than 18 years at our tertiary care facility who underwent pelvic MRI including coronal STIR for the following indications: acute hip pain, limping, or refusal to bear weight. Patients with a history of trauma were excluded.

Can ultrasound be used as the primary imaging in children with suspected Crohn disease?

Background: There is growing literature on the use of ultrasound (US) for evaluation of Crohn disease in adults, but few studies have been conducted on children. Several studies demonstrated high accuracy of US in the diagnosis of Crohn disease. Using US as the primary screening imaging modality for Crohn disease can reduce health care costs, the need for sedation and ionizing radiation exposure.

Double-read of skeletal surveys in suspected non-accidental trauma: what we learned.

Background: Missing a fracture in a child on skeletal surveys for suspected non-accidental trauma can have devastating results. Double-read has the potential to improve fracture detection. However the yield of double-read is unknown.

Multidetector CT diagnosis of massive hemobilia due to gallbladder polyposis in a child with metachromatic leukodystrophy.

Hemobilia secondary to gallbladder polyposis is rare in children but has been reported in a few children with metachromatic leukodystrophy. We present a case with preoperative multidetector computed tomography (MDCT) diagnosis of massive hemobilia caused by gallbladder polyposis in a patient with metachromatic leukodystrophy. Our report highlights the importance of both awareness of the association of gallbladder polyposis with other syndromes such as metachromatic leukodystrophy as well as the possibility of this entity presenting with life-threatening bleeding.

Optimization of hybrid iterative reconstruction level in pediatric body CT.

Objective: The objective of our study was to attempt to optimize the level of hybrid iterative reconstruction (HIR) in pediatric body CT.

Materials And Methods: One hundred consecutive chest or abdominal CT examinations were selected. For each examination, six series were obtained: one filtered back projection (FBP) and five HIR series (iDose(4)) levels 2-6.

Gastric pneumatosis secondary to pyloric stenosis.

Pneumatosis of the intestine is a concerning radiographic finding which may be indicative of intestinal ischemia or necrosis. Gastric pneumatosis is particularly rare, and in neonates, is usually associated with necrotizing enterocolitis. There are rare reports of gastric pneumatosis being associated with other non-ischemic etiologies.

Long bone fracture detection in suspected child abuse: contribution of lateral views.

Background: ACR guidelines for routine skeletal survey for child abuse recommend only AP radiographs of the long bones; however, many institutions add lateral radiographs.

Objectives: To evaluate whether adding lateral radiographs for long bones changes the frequency and confidence of fracture detection in skeletal survey radiographs for suspected abuse.

Materials And Methods: We identified 100 children younger than 2 years of age who underwent skeletal survey for child abuse; 56 with multiple long bone fractures, 22 with a single fracture and 22 with no fractures.