Curated and Annotated Dataset of Lung US Images in Zambian Children with Clinical Pneumonia

See also the commentary by Sitek in this issue. Supplemental material is available for this article.

Ultrasound evaluation of brain parenchyma in preterm infants with prenatal opioid exposure

OBJECTIVE

To evaluate whether preterm infants with prenatal opioid exposure had differences in brain size on head ultrasounds (HUS) in comparison to non-exposed infants.

STUDY DESIGN

Preterm infants ≤34 weeks with prenatal opioid exposure (n = 47) and matched non-exposed infants (n = 62) with early HUSs were examined. Fifteen brain measurements were made and linear regression models performed to evaluate differences.

RESULTS

Brain measurements were smaller in the right ventricular index [β = -0.18 mm (95% CI -0.32, -0.03]), left ventricular index [β = -0.04 mm (95% CI -0.08, -0.003)], left basal ganglia insula [β = -0.10 mm (95% CI -0.15, -0.04)], right basal ganglia insula [β = -0.08 mm (95% CI -0.14, -0.03)], corpus callosum fastigium length [β = -0.16 mm (95% CI -0.25, -0.06)], intracranial height index [β = -0.31 mm (95% CI -0.44, -0.18)], and transcerebellar measurements [β = -0.13 (95% CI -0.25, -0.02)] in the opioid-exposed group.

CONCLUSIONS

Preterm infants with prenatal opioid exposure have smaller brain sizes compared to non-exposed infants, potentially increasing their risk for neurodevelopmental abnormalities.

Normal variant residual germinal matrix in extremely premature infants: radiographic features and imaging pitfalls

BACKGROUND

As radiology volume from premature patients increases, previously undescribed imaging findings may be identified, posing diagnostic dilemma to the pediatric radiologist.

OBJECTIVE

The primary goal of our study is to characterize the previously undescribed imaging finding of subependymal echogenicity at the floor of the frontal horns, which we postulate represents normal variant embryologic remnant residual germinal matrix. Furthermore, we hope to equip the pediatric radiologist with diagnostic criteria to distinguish this normal variant from pathology.

MATERIALS AND METHODS

Retrospective review of neonates at our institution over a 10 year period was performed to identify extremely premature infants who received head ultrasounds during their hospital stay. Clinical data from EPIC was collected on these patients in addition to retrospective review of their head ultrasound images.

RESULTS

Literature review of neuroembryology and observed involution of the frontal horn subependymal echogenicity on sequential imaging inform our hypothesis that this imaging finding represents normal variant residual germinal matrix. Two-thirds of the 210 included extremely premature infants demonstrated this finding, which was frequently misinterpreted as grade 1 germinal matrix, intra-choroidal or intra-ventricular hemorrhage. Residual matrix was concomitantly present with additional pathology in 29.4% of the patients.

CONCLUSION

Previously undescribed subependymal echogenicity at the floor of the frontal horns is favored to represent normal variant embryologic remnant residual germinal matrix. Since this finding may be misinterpreted as germinal matrix, intra-choroidal or intra-ventricular hemorrhage, it is essential for the interpreting radiologist to be aware of this normal variant and not confuse it for pathology.

How Does Imaging of Congenital Zika Compare with Imaging of Other TORCH Infections?

The acronym TORCH is used to refer to congenital infections, such as toxoplasmosis, other infections (such as syphillis, varicella-zoster, and parvovirus B19), cytomegalovirus, and herpes simplex virus. The classic findings in patients with TORCH infections include rash in the mother during pregnancy and ocular findings in the newborn. Zika virus has emerged as an important worldwide congenital infection. It fits well with other congenital TORCH infections since there is a rash in the mother and there are commonly ocular abnormalities in the newborn. TORCH infections are recognized to have neurologic effects, such as ventriculomegaly, intraventricular adhesions, subependymal cysts, intracerebral calcifications, and microcephaly; however, the Zika virus is intensely neurotropic. Thus, it targets neural progenitor cells, leading to a more severe spectrum of central nervous system abnormalities than is typically seen in other TORCH infections, while relatively sparing the other organ systems. In this review, nonspecific findings of congenital infections initially will be described, then individual TORCH infections will be described and compared with the imaging findings associated with congenital Zika virus infection. For the radiologist, awareness of imaging features of common congenital infections may facilitate early diagnosis and may, at times, lead to prompt initiation of therapy. Online supplemental material is available for this article.

Expected Sonographic Appearance of the Spleen in Children and Young Adults With Sickle Cell Disease: An Update

OBJECTIVES

To update the imaging literature regarding spleen appearances in young patients with sickle cell disease (SCD).

METHODS

We conducted a retrospective study and included 112 patients age 0 to 21 years with SCD who had at least 1 abdominal sonogram at our institution between 1999 and 2011. Radiologic findings were compared between risk groups by χ(2) analysis. Findings were correlated with other imaging modalities when available.

RESULTS

In our cohort, 35.7% of patients had autosplenectomy, and 8.0% had undergone surgical splenectomy. Only 5.0% of individuals age 0 to 5 years had autosplenectomy. In those who had not undergone surgical splenectomy or autosplenectomy, 76.2% had echogenic spleens, heterogeneous-appearing spleens, or both, and patients with the homozygous sickle cell anemia (HbSS) genotype were more likely to have an abnormal spleen echo texture. Patients treated with transfusions had echogenic spleens and had a higher frequency of splenic regeneration nodules. Most patients (80%) with splenomegaly did not require surgical splenectomy after 5.7 years of follow-up.

CONCLUSIONS

Twenty years ago, children with HbSS SCD were expected to have autosplenectomy by age 5 years. There have been changes in the radiologic appearance of the spleen in patients with SDC, likely due to improved supportive care and the use of acute and chronic transfusion therapy. We found that autosplenectomy is rare by age 5 years, and during childhood and adolescence, the spleen typically appears echogenic, heterogeneous, or both, depending on disease severity.

Implications of radiologic-pathologic correlation for gallbladder disease in children and young adults with sickle cell disease

The purpose of this study is to describe gallbladder imaging findings in patients with sickle cell disease, and to determine how they correspond with occurrence of complications, need for cholecystectomy, and surgical pathology. This study is IRB approved and HIPAA compliant. Informed consent requirements were waived. We reviewed records of 77 children with sickle cell disease ages 0-18 years at the time of their first gallbladder imaging study. Demographics, hospital courses, and radiologic and pathologic reports were collected. Two pediatric radiologists independently and retrospectively reviewed the imaging studies. Statistical analysis was performed using kappa statistic, chi-squared test, and ANOVA F-test. Continuous variables were described with mean, median, variance, and range. Patients who underwent cholecystectomy (N = 25) were more likely than the patients who did not undergo cholecystectomy (N = 52) to have gallstones or sludge (100 versus 36.5 %, p = <0.0001) or other gallbladder or biliary abnormality (70.8 versus 1.9 %, p = <0.0001). Patients who did not undergo cholecystectomy more frequently had normal-appearing gallbladders and biliary tracts (63.5 versus 0 %, p = <0.0001). Ninety-two percent of patients with cholecystectomy had chronic cholecystitis on pathology, and 96 % had a complication, including chronic cholecystitis and sequelae of biliary obstruction. Young patients with sickle cell disease, cholelithiasis, and any other biliary imaging abnormality will almost certainly require cholecystectomy, and many will experience complications. The most common surgical pathologic diagnosis in this group is chronic cholecystitis, which has a variable radiologic appearance. Our findings support recommendations to perform elective cholecystectomy for children and young adults with sickle cell disease and cholelithiasis or gallbladder sludge.

Ultrasound-guided needle localization to aid foreign body removal in pediatric patients

Patients with podiatric foreign body injury commonly present to the emergency department. Often, the foreign object cannot be easily located or removed, and radiographs are frequently obtained to aid in localization. In cases requiring tissue dissection to remove the foreign bodies, accurate localization is required for safe removal of small and difficult to visualize bodies. We present 2 pediatric cases in which an ultrasound-guided needle localization technique was used to facilitate successful removal of small, difficult to visualize foreign bodies from the plantar foot. Ultrasound-guided needle localization reduced the required incision length and depth and helped to minimize the risk of damage to surrounding tissue.

Various Sonographic Appearances of the Hemorrhagic Corpus Luteum Cyst

Although hemorrhagic corpus luteum cysts are frequently seen during sonography of the female pelvis, their diagnosis is often challenging as a result of variations in size, thickness of the cyst wall, and internal echo pattern depending on the formation and lysis of the clot. There are cases in which hemoperitoneum is the most obvious finding. The differential diagnosis is extensive and includes ectopic pregnancy, adnexal torsion, neoplasm, and pelvic inflammatory disease. This review describes and illustrates the diverse appearances of the hemorrhagic corpus luteum, as well as other etiologies of adnexal pathology that can mimic the appearance of a hemorrhagic corpus luteum sonographically.

Ultrasound detection of first trimester malformations: a pictorial essay

Knowledge of normal and abnormal anatomy in the first trimester aids in early detection of anomalies and the avoidance of potential pitfalls.