Pediatric radiology
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Pediatric radiology · Jul 2015
Imaging of the elbow in children with wrist fracture: an unnecessary source of radiation and use of resources?
Anecdotally accepted practice for evaluation of children with clinically suspected or radiographically proven wrist fracture in many urgent care and primary care settings is concurrent imaging of the forearm and elbow, despite the lack of evidence to support additional images. These additional radiographs may be an unnecessary source of radiation and use of health care resources. ⋯ Although elbow fractures occasionally complicate distal forearm fractures in children, our findings indicate that a careful physical evaluation of the elbow is sufficient to guide further radiographic investigation. Routine radiographs of both the wrist and elbow in children with distal forearm fracture appear to be unnecessary when an appropriate physical examination is performed.
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Pediatric radiology · Jul 2015
CT of the chest in suspected child abuse using submillisievert radiation dose.
The cornerstone of child abuse imaging is the skeletal survey, but initial imaging with radiographs may not demonstrate acute and non-displaced fractures, especially those involving the ribs. Given the high mortality of undiagnosed non-accidental trauma, timely diagnosis is crucial. CT is more sensitive in assessing rib fractures; however the effective radiation dose of a standard chest CT is high. ⋯ The average effective dose for a four-view chest radiograph across the four children was 0.29 mSv and the average effective dose for the chest CT was 0.56 mSv. Therefore the effective dose of a chest CT is on average less than twice that of a four-view chest radiograph. Our protocol thus shows that a reduced-dose chest CT may be useful in the evaluation of high specificity fractures of non-accidental trauma when the four-view chest radiographs are negative.
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Pediatric radiology · Jul 2015
Optimal insertion lengths of right and left internal jugular central venous catheters in children.
Knowledge of the optimal lengths for central venous catheterization prior to the procedure may lessen the need for repositioning and prevent vascular complications. ⋯ The optimal insertion lengths (cm) suggested by our data are, for the right internal jugular vein 0.034 × height (cm) + 3.173, and for the left 0.072 × height (cm) + 2.113.
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Pediatric radiology · Jul 2015
Umbilical venous catheter malposition and errors in interpretation in newborns with Bochdalek hernia.
Neonates with congenital diaphragmatic hernia (CDH) often require placement of lines and tubes for supportive therapy. The resulting altered anatomy can result in diagnostic errors when interpreting the location of support lines and tubes such as UVCs (umbilical venous catheters). ⋯ The location of an UVC in an infant with Bochdalek hernia can pose a diagnostic challenge because of the altered anatomy and change in the expected course of the catheter. Familiarity with the altered anatomy and vigilance of the various abnormal locations in which UVCs can be placed can help optimize management for the child and reduce morbidity and mortality.
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Pediatric radiology · Jul 2015
Metaphyseal osteomyelitis in children: how often does MRI-documented joint effusion or epiphyseal extension of edema indicate coexisting septic arthritis?
Joint effusions identified by MRI may accompany osteomyelitis and determining whether the joint effusion is septic or reactive has important implications on patient care. ⋯ Patients with joint effusions identified by MRI, in the setting of metaphyseal osteomyelitis, should be presumed to have septic arthritis until proven otherwise. Epiphyseal extension of edema, perisynovial edema and epiphyseal non-enhancement in the setting of metaphyseal osteomyelitis are not helpful predictors in differentiating reactive and pyogenic joint effusions. Osteomyelitis at a site with an intra-articular metaphyses, however, is more likely to have concurrent septic arthritis.