Radiographics : a review publication of the Radiological Society of North America, Inc
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Case Reports
Complications of laparoscopic cholecystectomy and their interventional radiologic management.
Cholelithiasis and cholecystitis are encountered throughout the world and are responsible for the majority of cholecystectomies performed. Treatment has traditionally consisted of open cholecystectomy, but laparoscopic cholecystectomy is currently a popular alternative. ⋯ The literature suggests that the total complication rate for the laparoscopic procedure compares favorably with that of the open procedure, but this may apply only to surgeons who have accomplished numerous laparoscopic procedures and not to those who have just completed a training course and are performing their first few procedures. With the growing success of the laparoscopic procedure, it is essential that the radiologist be knowledgeable about the radiographic manifestations and interventional radiologic management of potential complications, since the radiologist can significantly affect patient care.
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Upper airway obstruction in infants and children is a common and distressing problem because of the relatively narrow diameter of the airway in early life. Although ultrasound, computed tomography, and magnetic resonance imaging have become increasingly popular modalities for use in many pediatric diseases, plain radiography and fluoroscopy, with attention to technique, collimation, and patient position, continue to be the mainstays for the evaluation of stridor in children. ⋯ Plain radiographic and fluoroscopic findings from over 100 cases of infants and children with this condition were reviewed to determine how frequently the specific diagnosis was confirmed with these studies. In the vast majority of cases, plain radiography and fluoroscopy suffice.
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Langerhans cell histiocytosis (LCH), previously called histiocytosis X, refers to a spectrum of disease characterized by idiopathic proliferation of histiocytes producing focal or systemic manifestations. Causes and pathogenesis remain unclear. However, recent studies suggest abnormal immune regulation as an important factor. ⋯ Radiographic appearance of osseous LCH depends on site of involvement and phase of the disease. Early lesions appear aggressive with poorly defined margins and lamellated periosteal reaction. Late lesions appear well defined and may show sclerotic margins and expanded remodeled appearance.
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Orbital abnormalities encountered in the pediatric population differ substantially from those found in adult patients. Retinoblastoma, the most serious intraocular tumor, is often difficult to diagnose, but use of computed tomography (CT) (which reveals the characteristic focal calcification) and magnetic resonance (MR) imaging allows this tumor to be differentiated from pseudogliomas, such as Coats disease, and retrolental fibroplasia. ⋯ Both modalities allow the differentiation of rhabdomyosarcoma from dermoid, cavernous hemangioma, and lymphangioma and provide helpful information for the diagnosis of many other tumors. Since CT and MR imaging have widely expanded the capabilities of orbital imaging, it is more important than ever before for radiologists to understand pediatric orbital disease.