The continuous lure of pediatric radiology.

Pediatric radiology is an immensely rewarding career choice. Eight pediatric radiologists, enthusiastic for their profession, were asked six questions about their career choice. Their responses illustrate the common virtues of pediatric radiology and also demonstrate the diverse paths and activities that pediatric radiologists take and pursue.

Pediatric musculoskeletal ultrasound.

The expanding applications of musculoskeletal ultrasound include many examinations that are new to pediatric radiologists but are well known to our adult colleagues. In this review we present an introduction and guide to some of these entities for pediatric radiologists making inroads into the world of musculoskeletal ultrasound.

The current role of diagnostic imaging in the preoperative workup for refractory neonatal brachial plexus palsy.

Introduction: Despite recent improvements in perinatal care, the incidence of neonatal brachial plexus palsy (NBPP) remains relatively common. CT myelography is currently considered to be the optimal imaging modality for evaluating nerve root integrity. Recent improvements in MRI techniques have made it an attractive alternative to evaluate nerve root avulsions (preganglionic injuries).

Utility of ultrasound in noninvasive preoperative workup of neonatal brachial plexus palsy.

Background: Ultrasound has been utilized in the evaluation of compressive and traumatic peripheral nerve pathology.

Objective: To determine whether US can provide comprehensive evaluation of the post-ganglionic brachial plexus in the setting of neonatal brachial plexus palsy and whether this information can be used to guide preoperative nerve reconstruction strategies.

Materials And Methods: In this retrospective cohort study, preoperative brachial plexus ultrasonography was performed in 52 children with neonatal brachial plexus palsy who were being considered for surgery.

Prospective cohort study of ultrasound-ultrasound and ultrasound-MR enterography agreement in the evaluation of pediatric small bowel Crohn disease.

Background: There is a paucity of published literature describing ultrasound (US)-US and US-MR enterography (MRE) inter-radiologist agreement in pediatric small bowel Crohn disease.

Objective: To prospectively assess US-US and US-MRE inter-radiologist agreement in pediatric small bowel Crohn disease.

Materials And Methods: Institutional Review Board approval and informed consent/assent were obtained for this HIPAA-compliant prospective cohort study of children with newly diagnosed distal small bowel Crohn disease (July 2012 to December 2014).

Antenatal Magnesium and Cerebral Palsy in Preterm Infants.

Objective: To evaluate the relationship of maternal antenatal magnesium sulfate (MgSO4) with neonatal cranial ultrasound abnormalities and cerebral palsy (CP).

Study Design: In a randomized trial of MgSO4 or placebo in women at high risk of preterm delivery, up to 3 cranial ultrasounds were obtained in the neonatal period. Images were reviewed by at least 2 pediatric radiologists masked to treatment and other clinical conditions.

Pediatric MR Urography: Indications, Techniques, and Approach to Review.

Magnetic resonance (MR) urography is a valuable imaging modality for assessing disorders of the pediatric urinary tract. It allows comprehensive evaluation of the kidneys and urinary tract in children by providing both morphologic and functional information without exposing the child to ionizing radiation. Pediatric MR urography can be used to thoroughly evaluate renal and urinary tract abnormalities that are difficult to identify or fully characterize with other imaging techniques, and it has the potential to allow earlier diagnosis while decreasing the number of imaging studies performed.

Prevalence of Posterior Shoulder Subluxation in Children With Neonatal Brachial Plexus Palsy After Early Full Passive Range of Motion Exercises.

Background: Children with neonatal brachial plexus palsy (NBPP) are often prescribed shoulder range of motion (ROM) exercises; however, the extent and timing of exercise implementation remains controversial in the context of shoulder joint integrity. The association of ROM exercises to delayed posterior shoulder subluxation (PSS) is unknown.

Objective: To determine prevalence of PSS in children with NBPP who began full passive ROM exercises before 6 months of age, and characteristics associated with development or absence of PSS in children.

Can Shear-Wave Elastography be Used to Discriminate Obstructive Hydronephrosis from Nonobstructive Hydronephrosis in Children?

Purpose: To determine if ultrasonographic (US) renal shear-wave speed (SWS) measurements obtained either before or after intravenous diuretic administration can be used to discriminate obstructive hydronephrosis from unobstructive hydronephrosis in children, with diuretic renal scintigraphy as the reference standard.

Materials And Methods: Institutional review board approval and parental informed consent were obtained for this HIPAA-compliant prospective cross-sectional blind comparison with a reference standard. Between November 2012 and September 2014, 37 children (mean age, 4.

Pediatric Small Bowel Crohn Disease: Correlation of US and MR Enterography.

Small bowel Crohn disease is commonly diagnosed during the pediatric period, and recent investigations show that its incidence is increasing in this age group. Diagnosis and follow-up of this condition are commonly based on a combination of patient history and physical examination, disease activity surveys, laboratory assessment, and endoscopy with biopsy, but imaging also plays a central role. Ultrasonography (US) is an underutilized well-tolerated imaging modality for screening and follow-up of small bowel Crohn disease in children and adolescents.

Spine ultrasound imaging in the newborn.

Ultrasound of the spine in the neonate is widely used as the initial modality to evaluate spinal canal anatomy, anatomical variants, and congenital malformations. The spinal canal and its contents are best visualized in the newborn and young infant owing to incomplete ossification of the posterior vertebral elements.

Ultrasonography for neonatal brachial plexus palsy.

Ultrasonography has previously been reported for use in the evaluation of compressive or traumatic peripheral nerve pathology and for its utility in preoperative mapping. However, these studies were not performed in infants, and they were not focused on the brachial plexus. The authors report a case in which ultrasonography was used to improve operative management of neonatal brachial plexus palsy (NBPP).

National ultrasound curriculum for medical students.

Ultrasound (US) is an extremely useful diagnostic imaging modality because of its real-time capability, noninvasiveness, portability, and relatively low cost. It carries none of the potential risks of ionizing radiation exposure or intravenous contrast administration. For these reasons, numerous medical specialties now rely on US not only for diagnosis and guidance for procedures, but also as an extension of the physical examination.

Serial ultrasound evaluation of pediatric trigger thumb.

Background: The etiology of pediatric trigger thumb is unknown, although ultrasound in adults has shown thickening of the A1 pulley leading to constriction of the flexor pollicis longus (FPL) tendon. The purpose of this study is to characterize the underlying cause of the pediatric trigger thumb and factors responsible for resolution utilizing sonography.

Methods: A prospective analysis of children with trigger thumbs was conducted from May 2008 through June 2010.

Biliary duplication cyst with heterotopic gastric mucosa resulting in obstruction of the biliary system: a case report.

Biliary tract duplication cysts with heterotopic gastric mucosa are rare congenital anomalies, with our case representing only the fourth reported case in the literature. An 8-year-old girl with several months of abdominal pain was found to have a complex cystic mass communicating with the biliary system via the common hepatic duct. Intraoperatively, inflammation caused by the cystic mass was found to have resulted in a Mirizzi-like syndrome, with a nearly complete obstruction at the confluence of the left and right hepatic ducts.

Hemangiomas and vascular malformations of the head and neck: a simplified approach.

This article is a review of vascular tumors and malformations that occur in infancy and childhood. It discusses anomalies of arterial, venous, capillary, lymphatic, and mixed vascular endothelium in terms of their varying forms, clinical course, imaging characteristics, complications, and treatment. The comparative utility of various imaging modalities is simplified.

Sonographic twinkling artifact for renal calculus detection: correlation with CT.

Purpose: To retrospectively correlate sonographic color Doppler twinkling artifact within the kidneys with unenhanced computed tomography (CT) in the detection of nephrolithiasis.

Materials And Methods: Institutional review board approval was obtained for this retrospective HIPAA-complaint investigation, and the informed consent requirement was waived. Sonographic imaging reports describing the presence of renal twinkling artifact between January 2008 and September 2009 were identified.

MRI of congenital urethroperineal fistula.

We present the MRI features of a congenital urethroperineal fistula diagnosed in a 12-year-old boy being evaluated after a single urinary tract infection. This diagnosis was initially suggested by voiding cystourethrogram and confirmed by MRI. Imaging revealed an abnormal fluid-filled tract arising from the posterior urethra and tracking to the perineal skin surface that increased in size during micturition.

Breast fibroadenomas in the pediatric population: common and uncommon sonographic findings.

Background: Sonography is usually requested to evaluate palpable pediatric breast lumps, and solid masses are almost always fibroadenomas. Lack of familiarity with the findings of fibroadenomas can lead to diagnostic uncertainty and sometimes unnecessary biopsy and excision. We sought to review the spectrum of sonographic findings in our cases of pathology proven pediatric fibroadenomas.