Pediatric radiology
-
Pediatric radiology · Oct 1996
Fundamentals of transorbital sonographic evaluation of optic nerve sheath expansion under intracranial hypertension. I. Experimental study.
The optic nerve, ontogenetically part of the central nervous system, is surrounded by subarachnoidal cerebrospinal fluid (CSF) and dura mater. Because of the connection with the intracranial subarachnoidal space, CSF pressure variations influence the optic nerve sheath (ONS) diameter. Histologic studies revealed a segment of the optic nerve in which maximal diameter fluctuations could be expected, namely the bulging dura mater region approximately 3 mm behind the papilla. ⋯ Under clinical conditions, however, only axial sections can be obtained using anterior probe positions with transbulbar sound directions. Using such axial projections the 3 mm position proved reliably reproducible. The reduced resolution of the optic nerve itself, allowing it to be distinguished from its surrounding sheath, proved to be somewhat disadvantageous from this projection angle.
-
Pediatric radiology · Oct 1996
Fundamentals of transorbital sonographic evaluation of optic nerve sheath expansion under intracranial hypertension II. Patient study.
Up to now, the presence of elevated intracranial pressure (ICP) in acute neurological disorders is suspected by clinical and neuroimaging findings, but its verification depends on invasive techniques. Based on our experimental findings of rapid dilatation of human optic nerve sheaths (ONS), we investigated whether this phenomenon not only happens under chronic, but also under acute conditions of intracranial hypertension. Using optic nerve sonography the ONS was measured at 3 mm behind the papilla in axial transbulbar view. ⋯ Considering the error of measurement (0.35 mm), the ONSD is regarded as definitely enlarged when 5 mm is exceeded in children above age 4. In younger children, smaller ONSD have to be taken into consideration. We conclude that ultrasound studies of the optic nerve may contribute information about the acutely increased ICP in critically ill patients.
-
Two asymptomatic Turkish sibs are presented, a 4-year-old boy and his 7-year-old sister, with pulmonary alveolar microlithiasis (PAM) confirmed by transbronchial lung biopsy and bronchoalveolar lavage. Chest radiographs and high resolution CT demonstrated widespread intra-alveolar calcifications in both lungs. The lesions were sharply defined and less than 1 mm in diameter. ⋯ The more severe changes in the elder sib and the radiographic controls suggest that the pulmonary disease may be progressive in our patients. The described family of consanguineous, unaffected parents with two affected and one healthy child confirmed the autosomal recessive inheritance of PAM (McKusick 265100). In addition, the affected girl had autosomal recessive Waardenburg-anophthalmia syndrome (McKusick 206920), raising the question of whether this is a chance occurrence or possibly a contiguous gene syndrome.
-
Pediatric radiology · Jan 1996
Imaging gastrointestinal perforation in pediatric blunt abdominal trauma.
To assess the role of imaging, in particular CT, in the early detection of GI perforation. ⋯ Separating nondisrupting bowel injury from perforation is diagnostically difficult; however, CT remains a good modality for assessing GI perforation in pediatric blunt trauma, but it cannot replace diligent and repeated clinical evaluation of all potential perforation victims.
-
Pediatric radiology · Jan 1996
Safe use of power injectors with central and peripheral venous access devices for pediatric CT.
We report our experience in the safe use of power injectors with central and small-gauge peripheral venous access devices for intravenous administration of contrast agent to children undergoing computed tomography (CT) examinations. ⋯ In light of the low frequency of complications, power injectors and central venous access devices or small-gauge butterfly catheters are safe systems for delivery of intravenous contrast material to pediatric patients. We feel that our strict adherence to manufacturers' guidelines and previously reported techniques partially accounts for our success with these modes of delivery.