Clinical imaging
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This is a retrospective study of the computed tomography (CT) examinations and medical records of 243 consecutive pediatric patients sent for CT studies after blunt abdominal trauma. The purpose of the study was to determine the frequency and significance of periportal tracking identified by CT, and correlate this finding with liver enzyme levels and liver injury. Periportal tracking (PPT) was divided into four grades (0-3) depending upon the distribution of decreased attenuation adjacent to the portal vessels. ⋯ Sixteen children with grade 3 PPT and no liver injury had significantly elevated liver enzymes as compared to children with combined 0-2 grade PPT. Eleven of the 20 children with grade 3 PPT had no other CT evidence of intraabdominal injury and none of these patients developed intraabdominal hemorrhage. Thus, grade 3 periportal tracking as an isolated abnormality did not indicate a clinically significant liver injury in any patient.
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Thirty-three patients were examined by color-coded Doppler ultrasound of the thoracoaxillary region or upper arm to review the utility of the method in this local area. The subclavian artery and vein were identified in all but one patient, in whom the subclavian vein was occluded and collateral vessels had developed. Masses and foreign bodies were easily distinguished from vascular abnormalities. ⋯ Carotid subclavian grafts were noted and evaluated appropriately in two patients. Color-coded sonography offered advantages in speed of localization of vessels and visual assessment of vessel location, direction of flow, turbulence, relationship to adjacent soft tissues, and detection of collateralization. Foreign body detection was not enhanced by color coding.