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Shah MR, Levin TL, Blumer SL, Berdon WE, Jan DM, Yousefzadeh DK. Volvulus of the entire small bowel with normal bowel fixation simulating malrotation and midgut volvulus. Pediatr Radiol 2015. [PMID: 26209961 DOI: 10.1007/s00247-015-3430-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Midgut volvulus is a complication of malrotation of bowel and mesenteric malfixation. In contrast, primary volvulus of the small bowel is a distinctly different and rare entity characterized by torsion of the entire small bowel with normal mesenteric fixation. OBJECTIVE To present the clinical and imaging findings in four infants with primary small bowel volvulus and normal bowel fixation in order to improve awareness of this entity among clinicians and radiologists and to discuss the potential etiologies of this entity to distinguish it from other causes of small bowel volvulus. MATERIALS AND METHODS A retrospective review of imaging studies (two ultrasounds and four upper gastrointestinal series) in four infants (three full-term and one premature) from three institutions with surgically proven volvulus of the entire small bowel and normal bowel fixation were reviewed by three board-certified pediatric radiologists and correlated with clinical and surgical reports when available. RESULTS The infants presented during the first week to 6 months of life and were acutely ill. The upper gastrointestinal series showed complete duodenal obstruction with beaking in one and partial duodenal obstruction in three. All studies were interpreted as highly suspicious for malrotation and midgut volvulus. Emergent laparotomy demonstrated primary small bowel volvulus with normal mesenteric fixation in all infants. The base of the small bowel mesentery was described by the operating surgeon as smaller than normal in one infant (case 3). There was no mesenteric defect or other abnormality predisposing to volvulus in the other three. In both infants who had abdominal US, a retroperitoneal position of the third portion of the duodenum was demonstrated. All infants survived. One infant required resection of the necrotic small bowel and currently has short gut syndrome, one has malabsorption and two were lost to follow-up. CONCLUSION Primary small bowel volvulus with normal fixation is indistinguishable from malrotation with midgut volvulus in the acutely ill infant or child. Radiographic diagnosis can be difficult in patients with intermittent or incomplete small bowel volvulus without malrotation. In these patients, neither an upper gastrointestinal series demonstrating a normal position of the duodenojejunal junction nor the sonographic demonstration of a retromesenteric third portion of the duodenum excludes the diagnosis. In young infants, the clinical and imaging findings may mimic necrotizing enterocolitis. Sonography may be useful to evaluate the bowel for signs of bowel wall compromise or a whirlpool sign.
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Affiliation(s)
- Mansi R Shah
- Division of Pediatric Radiology, Department of Radiology, Children's Hospital of Montefiore Medical Center, 111 E. 210th St., Bronx, NY, 10467, USA
| | - Terry L Levin
- Division of Pediatric Radiology, Department of Radiology, Children's Hospital of Montefiore Medical Center, 111 E. 210th St., Bronx, NY, 10467, USA.
| | - Steven L Blumer
- Department of Medical Imaging, Nemours/AI duPont Hospital for Children, Wilmington, DE, USA
| | - Walter E Berdon
- Division of Pediatric Radiology, Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Dominique M Jan
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital of Montefiore Medical Center, Bronx, NY, USA
| | - David K Yousefzadeh
- Department of Radiology, University of Chicago Medical Center, Chicago, IL, USA
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Muensterer OJ, Berdon WE. From Vogt to Haight and Holt to now: the history of esophageal atresia over the last century. Pediatr Radiol 2015; 45:1230-5. [PMID: 25666441 DOI: 10.1007/s00247-015-3276-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 08/20/2014] [Accepted: 01/02/2015] [Indexed: 11/26/2022]
Abstract
Esophageal atresia was first classified by the Boston Children's Hospital radiologist Edward Vogt in 1929 and has been a major challenge in its characterization and management ever since. It defied all attempts at repair until University of Michigan thoracic surgeon Cameron Haight's first successful fistula ligation and primary esophageal anastomosis in 1941. Haight worked with the pediatric radiologist John Holt. This historical review describes advances in pre- and postnatal diagnosis.
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Affiliation(s)
- Oliver J Muensterer
- Department of Pediatric Surgery, University Medicine Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany,
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Levin TL, Mäkitie O, Berdon WE, Lachman RS. Shwachman-Bodian-Diamond syndrome: metaphyseal chondrodysplasia in children with pancreatic insufficiency and neutropenia. Pediatr Radiol 2015; 45:1066-71. [PMID: 25416932 DOI: 10.1007/s00247-014-3231-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 08/06/2014] [Accepted: 11/04/2014] [Indexed: 11/30/2022]
Abstract
Shwachman-Bodian-Diamond syndrome (OMIM 260400) was identified in 1964 by pediatricians Harry Shwachman, a leader in cystic fibrosis, and Louis K. Diamond, a hematologist, along with pediatrician and morbid anatomist Martin Bodian. Initially the syndrome's clinical presentation included exocrine pancreatic insufficiency (lipomatous replacement of the pancreas) and neutropenia. In 1967 skeletal changes of metaphyseal chondrodysplasia were also described, completing the triad of findings; these abnormalities are present in all affected children and should be viewed as an integral feature of the syndrome, also called Shwachman-Diamond syndrome.
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Affiliation(s)
- Terry L Levin
- Division of Pediatric Radiology, Department of Radiology, Montefiore Medical Center, 111 E. 210 St., Bronx, NY, 10467, USA,
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Stoelinga PJW, Berdon WE, Cohen MM. The extraordinary career of Professor Dr. Simon van Creveld. Am J Med Genet A 2014; 164A:2689-700. [PMID: 25269937 DOI: 10.1002/ajmg.a.36334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 10/03/2013] [Indexed: 11/06/2022]
Abstract
Simon van Creveld received both the MD and PhD degrees and had a multifaceted medical and scientific education at many hospitals and research institutes in the Netherlands, Germany, and the UK. He and his wife were the first to develop insulin for the Netherlands. His major interests were in hemophilia and hemorrhagic disorders, which accounted for 87 of his publications. In 1934, van Creveld demonstrated that a dispersed protein fraction obtained from serum could reduce the clotting time of hemophilic blood. His interest in glycogen storage disease resulted in van Creveld-von Gierke disease for which van Creveld contributed four published articles. The Ellis-van Creveld syndrome, also known as chondroectodermal dysplasia, was published in 1940 and became well known to medical geneticists. During the Nazi occupation of the Netherlands, van Creveld's professorship was taken away from him because he was Jewish. His visits to hospitals of concentration camps to treat babies and give pediatric advice while wearing a Jewish Yellow Star and interacting with SS Commandants in charge, and then leaving can only be described as amazing. After the war, his professorship was returned, and in the same year as his retirement, he established a large Hemophila Treatment and Research Center now known as the Van Creveld Clinic, which celebrated its 40th anniversary in 2005.
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Affiliation(s)
- Paul J W Stoelinga
- Department of Oral & Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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Starc MT, Berdon WE, Starc TJ. Undiagnosed primary tracheal stenosis in tetralogy of Fallot: complete rings with a low carina. Pediatr Radiol 2014; 44:362-3. [PMID: 24370795 DOI: 10.1007/s00247-013-2856-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 10/23/2013] [Accepted: 12/01/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Michael T Starc
- Department of Radiology, St. Luke's-Roosevelt Medical Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Zhong YM, Jaffe RB, Liu JF, Sun AM, Gao W, Wang Q, Zhu M, Qiu HS, Berdon WE. Multi-slice computed tomography assessment of bronchial compression with absent pulmonary valve. Pediatr Radiol 2014; 44:803-9. [PMID: 24706163 PMCID: PMC4061480 DOI: 10.1007/s00247-014-2898-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 12/12/2013] [Accepted: 01/23/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Absent pulmonary valve is a rare cardiovascular anomaly that can result in profound tracheobronchial compression. OBJECTIVE To demonstrate the advantage of multi-slice CT in diagnosing tracheobronchial compression, its severity as related to the adjacent dilated pulmonary arteries, and associated lung and cardiac lesions. MATERIALS AND METHODS We included children with absent pulmonary valve who were reviewed by multi-slice CT during a 17-year period. The number and locations of stenoses and lung lesions were noted and the severity of stenosis was categorized. The diameter of the pulmonary artery was measured and associated cardiac defects were demonstrated. RESULTS Thirty-one children (14 girls and 17 boys) were included. Of these, 29 had ventricular septal defect and 2 had an intact ventricular septum. Twenty-nine children (94%) had tracheobronchial compression, judged to be mild in nine children (31%), moderate in 10 (34%) and severe in 10 (34%). The different locations of the stenosis (carina, main bronchi, lobar and segmental bronchi) were observed. And the number and location of lung lesions demonstrated that the right middle and left upper and lower lobes were often affected. The diameter of the pulmonary artery in these children was well above normal published values, and Spearman rank correlation analysis showed a correlation between the size of the pulmonary artery and the severity of the tracheobronchial stenosis. Nineteen children (61%) underwent surgery and 4 of these children had a multi-slice CT post-operative follow-up study. CONCLUSION Absent pulmonary valve can cause significant morbidity and mortality in children. Multi-slice CT can accurately depict areas of tracheobronchial compression, associated lung lesions and cardiac defects, helping to direct the surgeon.
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Affiliation(s)
- Yu-Min Zhong
- Department of Radiology, Shanghai Children’s Medical Center and Shanghai Jiao Tong University Medical School, Shanghai, China
| | - Richard B. Jaffe
- Department of Medical Imaging, Primary Children’s Medical Center, Salt Lake City, UT USA
| | - Jin-Fen Liu
- Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, No.1678 Dong Fang Road, Shanghai, 200127 China
| | - Ai-Min Sun
- Department of Radiology, Shanghai Children’s Medical Center and Shanghai Jiao Tong University Medical School, Shanghai, China
| | - Wei Gao
- Department of Cardiology, Shanghai Children’s Medical Center and Shanghai Jiao Tong University Medical School, Shanghai, China
| | - Qian Wang
- Department of Radiology, Shanghai Children’s Medical Center and Shanghai Jiao Tong University Medical School, Shanghai, China
| | - Ming Zhu
- Department of Radiology, Shanghai Children’s Medical Center and Shanghai Jiao Tong University Medical School, Shanghai, China
| | - Hai-Sheng Qiu
- Department of Radiology, Shanghai Children’s Medical Center and Shanghai Jiao Tong University Medical School, Shanghai, China
| | - Walter E. Berdon
- Department of Radiology, Children’s Hospital of New York, New York, NY USA
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Marquardt ML, Done SL, Sandrock M, Berdon WE, Feldman KW. Copper deficiency presenting as metabolic bone disease in extremely low birth weight, short-gut infants. Pediatrics 2012; 130:e695-8. [PMID: 22869833 DOI: 10.1542/peds.2011-1295] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Copper deficiency can cause bone lesions in infants, which might be confused with child abuse. Two extremely low birth weight preterm infants had complicated medical courses requiring prolonged parenteral nutrition for short-gut syndrome, which led to the development of cholestasis. Both had spent their entire lives in the hospital. They had been on prolonged ventilator support for chronic lung disease. They developed signs of copper deficiency between 5 and 6 months of age, initially raising child abuse concerns. Musculoskeletal discomfort led to the recognition of radiographic findings of metabolic bone disease. Included were osteoporosis, metaphyseal changes, and physeal disruptions. Copper levels were low; both low copper parenteral nutrition and gut losses from refeeding diarrhea likely contributed to their deficiency. Therapeutic supplementation with copper corrected their deficits and clinical and radiologic findings. The information from these cases, in particular, their radiologic findings, indicate the need to monitor copper status in at-risk premature infants. These findings may aid prevention and earlier recognition of copper deficiency. Their specific radiologic and clinical findings should aid differentiation of such children from abused infants.
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Affiliation(s)
- Michelle L Marquardt
- Department of Pediatrics-Graduate Medical Education, Seattle Children’s Hospital, The University of Washington School of Medicine, Seattle, Washington, USA
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Muensterer OJ, Berdon WE, Lachman RS, Done SL. Pseudoachondroplasia and the seven Ovitz siblings who survived Auschwitz. Pediatr Radiol 2012; 42:475-80. [PMID: 22426567 DOI: 10.1007/s00247-012-2364-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Revised: 01/02/2012] [Accepted: 01/06/2012] [Indexed: 12/31/2022]
Abstract
This historical report focuses on the first clinical description of pseudoachondroplasia and its radiographic findings. Only half a century ago, pseudoachondroplasia was recognized as a genetic disorder with a distinct but variable phenotype of short stature, normal facial features, and progressive joint problems starting in adolescence. Radiologically, the disease is particularly intriguing because the patients appear normal at birth. The patients develop the typical gait disturbances when they begin to walk. Radiographs show the characteristic anterior tongue-shaped lumbar vertebral body changes that develop after the first year of life. This account presents the most well-known group of individuals affected by pseudoachondroplasia, the Ovitz family, who narrowly escaped death in the concentration camp of Auschwitz in 1944 because of SS physician Dr. Josef Mengele's fascination with dwarfs. It was not until 1995 that the underlying genetic defect in the COMP gene was identified on chromosome 19.
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Affiliation(s)
- Oliver J Muensterer
- Division of Pediatric Surgery, Department of Surgery, Komansky Center for Children's Health, Weill Cornell Medical College, New York Presbyterian, 525 E. 68th St., New York, NY 10065, USA.
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Berdon WE, Muensterer OJ, Zong YMM, Backer CL. The triad of bridging bronchus malformation associated with left pulmonary artery sling and narrowing of the airway: the legacy of Wells and Landing. Pediatr Radiol 2012; 42:215-9. [PMID: 22002862 DOI: 10.1007/s00247-011-2273-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 09/06/2011] [Accepted: 09/09/2011] [Indexed: 10/16/2022]
Abstract
Although noted in the 19th century, it was not until 1938 that Scheid published the combination of left pulmonary artery sling and narrowing of the airway due to annular tracheal cartilages. Unaware of these prior descriptions, and without a precise preoperative diagnosis, Willis Potts in Chicago performed the first successful sling repair in 1953. In 1976, Cohen and Landing described Scheid's combination of left pulmonary artery sling and stenosis caused by complete tracheal rings, and the term "ring-sling complex" was introduced by Berdon in 1984. Four years later, Wells and Landing noted characteristic tracheobronchial malformations associated with these lesions and proposed a classification that has been confirmed to be clinically relevant in recent cross-sectional imaging studies.
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Affiliation(s)
- Walter E Berdon
- Department of Radiology, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center, New York, NY, USA
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10
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Berdon WE, Feldman KW. A modest proposal: thoracic CT for rib fracture diagnosis in child abuse. Child Abuse Negl 2012; 36:200-201. [PMID: 22284740 DOI: 10.1016/j.chiabu.2011.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 07/18/2011] [Indexed: 05/31/2023]
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Hong TS, Reyes JA, Moineddin R, Chiasson DA, Berdon WE, Babyn PS. Value of postmortem thoracic CT over radiography in imaging of pediatric rib fractures. Pediatr Radiol 2011; 41:736-48. [PMID: 21264464 DOI: 10.1007/s00247-010-1953-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Revised: 10/22/2010] [Accepted: 11/11/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Studies have reported that thoracic CT may provide greater sensitivity compared with radiography in detection of pediatric rib fractures and fracture healing. The additional sensitivity afforded by thoracic CT may have medicolegal implications where abuse is suspected. OBJECTIVE To determine the additional value of postmortem thoracic CT compared with radiography in detecting pediatric rib fractures, and fracture healing, using autopsy findings as a gold standard. MATERIALS AND METHODS We retrospectively reviewed 56 coroner's cases with postmortem radiography and CT thoracic survey. All studies underwent primary interpretation by one or two radiologists. The study radiologist independently reviewed all images from 13 patients with positive findings on radiography, CT or autopsy. Sensitivity and specificity between observers and imaging modalities were compared. RESULTS Primary interpretation: Fractures were recognized on radiography in 5/12 patients who had fractures found at autopsy, and on CT in 8/12 patients. In total, 29% (24/83) of fractures were reported on radiography, and 51% (52/101) of fractures were reported on CT. Study radiologist: Fractures were recognized on radiography in 7/12 patients who had fractures found at autopsy, and on CT in 11/12 patients. In total, 46% (38/83) of fractures were reported on radiography, and 85% (86/101) of fractures were reported on CT. CONCLUSION Postmortem thoracic CT provides greater sensitivity than radiography in detecting pediatric rib fractures, most notably in anterior and posterior fractures. However, the degree of improvement in sensitivity provided by CT might depend on observer experience.
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Affiliation(s)
- Terence S Hong
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada
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Berdon WE, Lampl BS, Cornier AS, Ramirez N, Turnpenny PD, Vitale MG, Seimon LP, Cowles RA. Clinical and radiological distinction between spondylothoracic dysostosis (Lavy-Moseley syndrome) and spondylocostal dysostosis (Jarcho-Levin syndrome). Pediatr Radiol 2011; 41:384-8. [PMID: 21174082 DOI: 10.1007/s00247-010-1928-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 10/29/2010] [Accepted: 11/12/2010] [Indexed: 11/26/2022]
Abstract
In 1938, Saul Jarcho and Paul Levin from Johns Hopkins Hospital reported cases of thoracic insufficiency due to vertebral and rib anomalies. Nearly 30 years later, in 1966, Norman Lavy and associates from Indiana University reported a similar syndrome in a family from Puerto Rico. Lavy's description was followed by a report by John E. Moseley from New York City, where the name spondylothoracic dysplasia (dysostosis) was first used. For more than half a century, there has been confusion regarding the distinction between these two phenotypically similar syndromes that cause thoracic insufficiency. Spondylocostal dysostosis (SCD), or Jarcho-Levin syndrome, causes mild to moderate respiratory insufficiency, is panethnic and has been linked to genes such as DLL3, which is known to be associated with the Notch pathway. In contrast, spondylothoracic dysostosis (STD), or Lavy-Moseley syndrome, results in more severe respiratory compromise, is largely linked to Puerto Rican cohorts and is thought to be associated to the MESP2 gene, also a Notch pathway gene. Long-term studies of Puerto Rican cohorts with STD contradicts the previously held belief that individuals affected with STD have markedly diminished life expectancy with as many as 25% surviving into later childhood and adult life.
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Affiliation(s)
- Walter E Berdon
- Department of Radiology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York-Presbyterian, New York, NY, USA
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Gander JW, Kadenhe-Chiweshe A, Fisher JC, Lampl BS, Berdon WE, Stolar CJ, Zitsman JL. Hepatic pulmonary fusion in an infant with a right-sided congenital diaphragmatic hernia and contralateral mediastinal shift. J Pediatr Surg 2010; 45:265-8. [PMID: 20105618 PMCID: PMC4418537 DOI: 10.1016/j.jpedsurg.2009.10.090] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2009] [Revised: 10/27/2009] [Accepted: 10/28/2009] [Indexed: 11/29/2022]
Abstract
Hepatic pulmonary fusion is extremely rare with only 9 previous cases reported in the literature. In typical cases, the clinician should be alerted to the possibility of hepatic pulmonary fusion if the chest radiograph shows a large opacity on the right side without a contralateral mediastinal shift. The authors present a case of right-sided diaphragmatic hernia and hepatic pulmonary fusion with associated contralateral mediastinal shift discovered beyond the neonatal period. The 9 previous cases were retrospectively reviewed with special attention to mediastinal shift on preoperative chest radiograph, operative procedure, and mortality. Only one previous case demonstrated a contralateral mediastinal shift. The most common procedure performed was partial separation of the hepatic pulmonary fusion and approximation of the diaphragmatic defect. Four of the previous 9 patients died. In our case, reduction of bowel and approximation of the diaphragmatic defect around the fused liver and lung have been successful.
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Affiliation(s)
- Jeffrey W. Gander
- Division of Pediatric Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, Morgan Stanley Children’s Hospital of New York - Presbyterian, Columbia University Medical Center, New York, NY 10032
| | - Angela Kadenhe-Chiweshe
- Division of Pediatric Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, Morgan Stanley Children’s Hospital of New York - Presbyterian, Columbia University Medical Center, New York, NY 10032
| | - Jason C. Fisher
- Division of Pediatric Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, Morgan Stanley Children’s Hospital of New York - Presbyterian, Columbia University Medical Center, New York, NY 10032
| | - Brooke S. Lampl
- Division of Pediatric Radiology, Department of Radiology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children’s Hospital of New York - Presbyterian, Columbia University Medical Center, New York, NY 10032
| | - Walter E. Berdon
- Division of Pediatric Radiology, Department of Radiology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children’s Hospital of New York - Presbyterian, Columbia University Medical Center, New York, NY 10032
| | - Charles J. Stolar
- Division of Pediatric Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, Morgan Stanley Children’s Hospital of New York - Presbyterian, Columbia University Medical Center, New York, NY 10032
| | - Jeffrey L. Zitsman
- Division of Pediatric Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, Morgan Stanley Children’s Hospital of New York - Presbyterian, Columbia University Medical Center, New York, NY 10032,Corresponding Author. Please send all correspondence to: Jeffrey L. Zitsman, MD, Division of Pediatric Surgery, Children’s Hospital of New York-Presbyterian, 3959 Broadway, CHN 212, New York, NY 10032, Phone: 212-342-8585; Fax: 212-305-9270,
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Rothenberg AB, Berdon WE, D'Angio GJ, Yamashiro DJ, Cowles RA. The association between neuroblastoma and opsoclonus-myoclonus syndrome: a historical review. Pediatr Radiol 2009; 39:723-6. [PMID: 19430769 DOI: 10.1007/s00247-009-1282-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Revised: 02/10/2009] [Accepted: 04/07/2009] [Indexed: 11/30/2022]
Abstract
An association between neuroblastoma and opsoclonus-myoclonus syndrome (OMS) was described as early as 1927 within the first report on the transformation of malignant neuroblastoma to a benign ganglioneuroma. It was not recognized at that time nor was it appreciated in the subsequent follow-up report on the same patient in 1959. Myoclonic encephalopathy of infancy, an alternative name for OMS, was described by a pediatric neurologist in 1962; however, its connection to neuroblastoma was not known. It was only in 1968 that the association between these two conditions was first reported. The neuroblastoma tumors associated with OMS are almost all small, stage I-II with no associated MYCN amplification or metastases. OMS occurs in 2-3% of patients with neuroblastoma, but neuroblastoma is found in as many as 50% of children who present with OMS. Nearly 100% of the children with neuroblastoma associated with OMS survive, and this has led to speculation that the OMS is a result of an autoimmune process, not metastases. Affected children are treated with steroids, ACTH, or intravenous immunoglobulin, but many have persistent neurologic and developmental deficits. Using the original case reported in 1927, we summarize a century of literature in this review on OMS and its association with neuroblastoma.
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Abstract
Esophageal perforation is most commonly iatrogenic in origin with nasogastric tube insertion, stricture dilation, and endotracheal intubation, being the most frequent sources of the injury in infants and children. Clinical presentation depends on whether the cervical, thoracic, or abdominal esophagus is injured. Any patient complaining of chest pain after an upper endoscopy has esophageal perforation until proven otherwise. In infants and children, plain chest films and esophagography may assist in making the diagnosis. Hemodynamically stable patients with a contained perforation may be managed medically. Free perforation and hemodynamic lability mandates a more aggressive surgical approach for wide drainage of the mediastinum and pleural spaces. Exploration of the chest for attempted direct repair of the injury is now only rarely indicated. Mortality rates have been reported between 20 and 28% with delays in diagnosis and treatment appearing to be most strongly correlated with poor outcomes.
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Affiliation(s)
- Jeffrey W Gander
- Division of Pediatric Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons and Morgan Stanley Children's Hospital of New York-Presbyterian, New York, NY 10032, USA
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Lampl B, Levin TL, Berdon WE, Cowles RA. Malrotation and midgut volvulus: a historical review and current controversies in diagnosis and management. Pediatr Radiol 2009; 39:359-66. [PMID: 19241073 DOI: 10.1007/s00247-009-1168-y] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Revised: 12/09/2008] [Accepted: 01/14/2009] [Indexed: 01/27/2023]
Abstract
The complex and sometimes controversial subject of malrotation and midgut volvulus is reviewed commencing with the 19th-century Bohemian anatomist, Václav Treitz, who described the suspensory muscle anchoring of the duodenal-jejunal junction in the left upper quadrant, and continuing with William Ladd, the 20th-century American "father of pediatric surgery" who pioneered the surgical treatment of midgut volvulus. In this review, we present the interesting history of malrotation and discuss the current radiologic and surgical controversies surrounding its diagnosis and treatment. In the symptomatic patient with malrotation and possible midgut volvulus, prompt diagnosis is critical. The clinical examination and plain film are often confusing, and delayed diagnosis can lead to significant morbidity and death. Despite recent intense interest in the position of the mesenteric vessels on US and CT scans, the upper gastrointestinal series remains the fastest and most accurate method of demonstrating duodenal obstruction, the position of the ligament of Treitz, and, if the contrast agent is followed distally, cecal malposition. Controversy exists over the management of asymptomatic patients with malrotation in whom the diagnosis is made incidentally during evaluation for nonspecific complaints, prior to reflux surgery, and in those with heterotaxy syndromes.
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Affiliation(s)
- Brooke Lampl
- Department of Radiology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York-Presbyterian, New York, NY 10032, USA
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Plett SK, Berdon WE, Cowles RA, Oklu R, Campbell JB. Cushing proximal symphalangism and the NOG and GDF5 genes. Pediatr Radiol 2008; 38:209-15. [PMID: 17994231 DOI: 10.1007/s00247-007-0675-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Revised: 09/27/2007] [Accepted: 10/05/2007] [Indexed: 01/12/2023]
Abstract
Proximal symphalangism (SYM1) is an autosomal-dominant developmental disorder of joint fusion. This disorder is best known from famous historical descriptions of two large kindred: Cushing's description in 1916 of the "straight-fingered" Brown family of Virginia and Drinkwater's description in 1917 of the British Talbot family of noble blood, descended from the English war hero John Talbot, the first Earl of Shrewsbury (1388-1453). Recent genetic studies link this phenotype to expression of abnormal genes at future joint sites: too little expression of NOG, a growth antagonist, or overexpression of GDF5, a growth agonist, results in cartilage overgrowth and bony fusion. This review unites in depth the first historical accounts of SYM1 with a clinical description and reviews the current understanding of the molecular mechanism underlying what is likely the oldest dominant trait ever studied.
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Affiliation(s)
- Sara K Plett
- College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Rothenberg AB, Berdon WE, Woodard JC, Cowles RA. Hypervitaminosis A-induced premature closure of epiphyses (physeal obliteration) in humans and calves (hyena disease): a historical review of the human and veterinary literature. Pediatr Radiol 2007; 37:1264-7. [PMID: 17909784 DOI: 10.1007/s00247-007-0604-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Revised: 07/10/2007] [Accepted: 07/19/2007] [Indexed: 10/22/2022]
Abstract
Vitamin A toxicity in the infant, which now occurs rarely from dietary overdosage, was recognized in the 1940s as painful periostitis with rare progression to premature closure of the lower limb epiphyses. Decades later, most cases of vitamin A-induced premature epiphyseal closure (physeal obliteration) occur in pediatric dermatologic patients given vitamin A analogues. This phenomenon resembles a strange disease discovered in more recent years in calves with closed epiphyses of the hind limbs, known as hyena disease. This was a mystery until proved to be caused by vitamin A toxicity from enriched grain that causes the calves to have short hind limbs that resemble those of a hyena and gait disturbance. This historical review links the human and veterinary literature in terms of vitamin A-induced epiphyseal closure using a case report format of a 16-month-old human infant with closed knee epiphyses and gait disturbance that is reminiscent of hyena disease seen in calves.
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Affiliation(s)
- Alexis B Rothenberg
- Division of Pediatric Radiology, Department of Radiology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York-Presbyterian, New York, NY 10032, USA
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Rastogi S, Gupta A, Wung JT, Berdon WE. Treatment of giant pulmonary interstitial emphysema by ipsilateral bronchial occlusion with a Swan-Ganz catheter. Pediatr Radiol 2007; 37:1130-4. [PMID: 17882412 DOI: 10.1007/s00247-007-0597-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2007] [Revised: 06/12/2007] [Accepted: 07/13/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Unilateral giant pulmonary interstitial emphysema (PIE) can be seen as a complication of chronic ventilation in extremely low-birth-weight babies. Many can be managed by conventional pulmonary care which includes positioning, suctioning, chest physiotherapy, gentle conventional ventilation and high-frequency ventilation. Some may need invasive procedures such as lung puncture, pleurotomies and excisional surgery. This is the group in which single-lung ventilation may be beneficial and circumvent the need for an invasive procedure. OBJECTIVE We describe the technique of single-lung ventilation using a Swan-Ganz catheter to block the main stem bronchus on the diseased side in air-leak syndromes. MATERIALS AND METHODS A retrospective chart review was done on 17 newborns undergoing single-lung ventilation using this technique at the Children's Hospital of New York, Columbia University, from 1986 to 2000. RESULTS The technique was successful in the management of severe, neonatal unilateral lung disease not responsive to conventional modes of therapy in all but two neonates as seen by a significant improvement in pH and a decrease in PaCO(2) levels. In one neonate malpositioning of the Swan-Ganz catheter balloon could have contributed to the development of pneumothorax. CONCLUSION The described technique of single-lung ventilation provides a safe, minimally invasive and economically feasible method of management of unilateral giant PIE in newborns not responsive to conventional modes of therapy with minimal complications.
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Affiliation(s)
- Shantanu Rastogi
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of New York, College of Physicians & Surgeons, Columbia University, New York, NY, USA.
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Cowles RA, Berdon WE. Bland-White-Garland syndrome of anomalous left coronary artery arising from the pulmonary artery (ALCAPA): a historical review. Pediatr Radiol 2007; 37:890-5. [PMID: 17607572 DOI: 10.1007/s00247-007-0544-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2007] [Revised: 05/14/2007] [Accepted: 05/24/2007] [Indexed: 10/23/2022]
Abstract
The landmark 1933 case report from Massachusetts General Hospital by Bland, White and Garland (Am Heart J 8:787-801) described a 3-month-old child with progressive feeding problems, cardiomegaly on chest radiography, and EKG evidence of left ventricular damage. Of interest was the fact that the vigilant father of the infant was Aubrey Hampton, a radiologist and future chairman of radiology at Massachusetts General Hospital. At autopsy, the left coronary artery originated from the pulmonary artery rather than from the aorta. Effective treatment for this condition was not available until 1960 when Sabiston, Neill and Taussig showed that the blood flowed from the left coronary artery toward the pulmonary artery. The anomalous left coronary artery was ligated at its junction with the pulmonary artery and the child survived. This historical review of Bland-White-Garland syndrome, now known as anomalous left coronary artery arising from the pulmonary artery (ALCAPA), stresses the continued diagnostic significance of cardiomegaly on chest radiography and EKG changes suggesting left ventricular damage in 2- to 3-month-old infants with feeding intolerance or irritability. With a high index of suspicion, an echocardiogram can be obtained to confirm the diagnosis. Modern surgical methods involve left coronary artery translocation and afford excellent outcomes.
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Affiliation(s)
- Robert A Cowles
- Division of Pediatric Surgery,Columbia University College of Physicians and Surgeons, The Morgan Stanley Children's Hospital of New York-Presbyterian, 3959 Broadway, CHN 216B, New York, NY 10032, USA.
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Marcovici PA, Berdon WE, Liebling MS. Osteochondromas and growth retardation secondary to externally or internally administered radiation in childhood. Pediatr Radiol 2007; 37:301-4. [PMID: 17211603 DOI: 10.1007/s00247-006-0382-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Revised: 10/28/2006] [Accepted: 11/14/2006] [Indexed: 10/23/2022]
Abstract
For over five decades, osteochondromas (exostoses) and associated growth retardation have been known to be caused by radiation damage to the growing skeleton. Patients can be divided into three exposure groups. Group I received external beam radiation therapy primarily for the treatment of childhood cancers (typical dose 3,500 cGy), and 6-20% developed osteochondromas and growth retardation within the radiation portal. Group II consists of recently described patients who received total body irradiation in preparation for bone marrow transplant (typical dose: 800-1,200 cGy), and about 20% developed osteochondromas and growth retardation. Group III consists of 206 German children who in the 1940s and early 1950s received intravenous radioactive Peteosthor (Ra-224) to treat bone tuberculosis (estimated typical dose: 1,000-2,000 cGy), and 14% developed osteochondromas and growth retardation, among other benign and malignant sequelae. Combining these three exposure groups, osteochondromas and growth retardation develop in at least 6-20% of children who receive therapeutic radiation to their growing skeletons.
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Cowles RA, Schullinger JN, Berdon WE. Thomas Vincent Santulli: a central figure in the development of pediatric surgery in New York City. Surgery 2006; 140:113-7. [PMID: 16857449 DOI: 10.1016/j.surg.2006.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2005] [Revised: 12/22/2005] [Accepted: 01/13/2006] [Indexed: 10/24/2022]
Affiliation(s)
- Robert A Cowles
- Division of Pediatric Surgery, Columbia University College of Physicians and Surgeons, Columbia University Medical Center and Morgan Stanley Children's Hospital of New York, Presbyterian, USA.
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Cowles RA, Berdon WE, Holt PD, Buonomo C, Stolar CJ. Neonatal intestinal obstruction simulating meconium ileus in infants with long-segment intestinal aganglionosis: radiographic findings that prompt the need for rectal biopsy. Pediatr Radiol 2006; 36:133-7. [PMID: 16341713 DOI: 10.1007/s00247-005-0043-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2005] [Revised: 09/08/2005] [Accepted: 09/27/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND The initial clinical presentation and radiographic finding of microcolon in children with long-segment intestinal aganglionosis involving the entire colon, ileum and sometimes the jejunum can mimic meconium ileus. This makes the diagnosis difficult for the radiologist and surgeon. OBJECTIVE To document and describe the clinical and radiographic findings in children with long-segment intestinal aganglionosis who are initially thought to have meconium ileus. MATERIALS AND METHODS We reviewed the cases of six neonates with long-segment intestinal aganglionosis presenting as meconium ileus at our institutions between 1978 and 2002. We examined the clinical presentation and the radiographic, surgical, and pathologic findings. In addition, 17 cases from the literature were identified and are included in the discussion. RESULTS A total of 23 cases were reviewed. Right lower quadrant intraluminal calcifications were noted on abdominal radiographs in all six neonates of our series and were described in 13 of the 17 neonates reported in the literature. Similarly, a microcolon was present in five of the six neonates of our series and in 14 of 16 historical neonates (one not reported). CONCLUSION In a neonate with small-bowel obstruction and a microcolon, the presence of right lower quadrant intraluminal calcifications should raise the suspicion of long-segment intestinal aganglionosis even if the operative findings are typical of meconium ileus and a biopsy should be performed.
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Affiliation(s)
- Robert A Cowles
- Division of Pediatric Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University College of Physicians and Surgeons, 3959 Broadway, Rm. CHN216B, New York, NY 10032, USA.
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Taragin BH, Berdon WE, Printz B. MRI assessment of bronchial compression in absent pulmonary valve syndrome and review of the syndrome. Pediatr Radiol 2006; 36:71-5. [PMID: 16283289 DOI: 10.1007/s00247-005-0018-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2005] [Revised: 08/16/2005] [Accepted: 08/25/2005] [Indexed: 11/30/2022]
Abstract
Absent pulmonary valve syndrome (APVS) is a rare cardiac malformation with massive pulmonary insufficiency that presents with short-term and long-term respiratory problems secondary to severe bronchial compression from enlarged central and hilar pulmonary arteries. Association with chromosome 22.Q11 deletions and DiGeorge syndrome is common. This historical review illustrates the airway disease with emphasis on assessment of the bronchial compression in patients with persistent respiratory difficulties post-valvular repair. Cases that had MRI for cardiac assessment are used to illustrate the pattern of airway disease.
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Affiliation(s)
- Benjamin H Taragin
- Department of Radiology, Children's Hospital of New York, 3959 Broadway CHN-3, New York, NY 10032, USA.
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Walor DM, Berdon WE, Westra SJ. 'Hair-on-end' skull changes resembling thalassemia caused by marrow expansion in uncorrected complex cyanotic heart disease. Pediatr Radiol 2005; 35:698-701. [PMID: 15776229 DOI: 10.1007/s00247-005-1403-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2004] [Revised: 12/07/2004] [Accepted: 12/09/2004] [Indexed: 10/25/2022]
Abstract
"Hair-on-end" skull changes resembling thalassemia were rarely described in the 1950s and 1960s in children with cyanotic congenital heart diseases; these changes were described almost entirely in patients with tetralogy of Fallot or D-transposition of the great arteries. As these lesions have become correctable, the osseous changes, never common, seem now only to exist in a small number of patients with uncorrectable complex cyanotic congenital heart disease who survive in a chronic hypoxic state. We present two cases: a case of marked marrow expansion in the skull of a 5-year-old boy with uncorrectable cyanotic heart disease studied by CT, and a second case of an 8-year-old with tetralogy of Fallot and pulmonary atresia studied by plain skull radiographs. The true incidence of these findings is unknown.
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Affiliation(s)
- David M Walor
- Department of Radiology Children's Hospital of New York, Columbia University Medical Center, 3959 Broadway, New York, NY 10032, USA.
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Berdon WE, Baker DH. Azygos vein dilatation in acquired obstruction of the inferior vena cava (examples following calcified caval thrombosis and following mesocaval shunt for portal hypertension). Pediatr Radiol 2005; 2:221-4. [PMID: 15822886 DOI: 10.1007/bf00972693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Leonidas J, Berdon WE, Baker DH, Amoury R. Perforation of the gastrointestinal tract and pneumoperitoneum in newborns treated with continuous lung distending pressures. Pediatr Radiol 2005; 2:241-5. [PMID: 15822890 DOI: 10.1007/bf00972697] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Slovis TL, Berdon WE. Jack O. Haller, MD. Radiology 2004. [DOI: 10.1148/radiol.2333042550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Berdon WE, McManus C, Afzelius B. More on Kartagener's syndrome and the contributions of Afzelius and A.K. Siewert. Pediatr Radiol 2004; 34:585-6. [PMID: 15164138 DOI: 10.1007/s00247-004-1203-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2004] [Accepted: 03/29/2004] [Indexed: 10/26/2022]
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Holt PD, Arkovitz MS, Berdon WE, Stolar CJ. Newborns with diaphragmatic hernia: initial chest radiography does not have a role in predicting clinical outcome. Pediatr Radiol 2004; 34:462-4. [PMID: 15042331 DOI: 10.1007/s00247-004-1151-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2003] [Revised: 12/15/2003] [Accepted: 01/20/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND The management of life-threatening congenital diaphragmatic hernia (CDH) has undergone significant change over the last two decades. When CDH was felt to be a surgical emergency treated promptly after birth, survival rates of 50% were typical. Recent changes in medical management of these patients prior to surgery have had a dramatic influence on clinical outcome with survival rates over 80%. OBJECTIVE This study was performed to assess under the current 80% survival rates whether there is predictive value in the appearance of the initial chest radiograph and clinical outcome in patients with CDH. MATERIALS AND METHODS Initial chest radiographs on 56 newborns with CDH were retrospectively reviewed for percent aeration of ipsilateral lung, percent aeration of contralateral lung, percent mediastinal shift, and content of hernia and correlated with clinical outcome. RESULTS There was no significant relationship between radiographic analysis of the percent of ipsilateral lung aeration (P=0.43), contralateral aeration (P=0.52) mediastinal shift (P=0.18), or content of hernia and clinical outcome. All CDH lesions tend to "look the same" on radiographs, regardless of favorable or fatal outcome. CONCLUSION Chest radiography serves to confirm the diagnosis of CDH, but does not predict outcome.
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Affiliation(s)
- Peter D Holt
- Department of Radiology, Children's Hospital of New York-Presbyterian, 3959 Broadway, CHN 325, New York, NY 10032, USA
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Holt PD, Berdon WE, Marans Z, Griffiths S, Hsu D. Scimitar vein draining to the left atrium and a historical review of the scimitar syndrome. Pediatr Radiol 2004; 34:409-13. [PMID: 14872299 DOI: 10.1007/s00247-004-1149-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2003] [Revised: 12/29/2003] [Accepted: 01/08/2004] [Indexed: 10/26/2022]
Abstract
Scimitar vein draining to the left atrium is the rarest of the pulmonary venolobar anomalies with less than a dozen reported cases. A case is reported of a patient whose plain film radiographic findings showed a typical scimitar vein but whose echocardiography showed normal pulmonary venous drainage. Cardiac catheterization confirmed drainage of the scimitar vein to the left atrium and systemic arterial supply which was embolized. The case described is used to review the history of "scimitar syndrome" with reflections on the significant contributions of Halasz and colleagues, who in 1956 helped define the anatomy, and Neill and colleagues, who in 1960 described the familial occurrence and clinical spectrum of the condition.
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Affiliation(s)
- Peter D Holt
- Department of Radiology, Columbia University, College of Physicians and Surgeons, Children's Hospital of New York-Presbyterian, Babies Hospital 3N, 3959 Broadway, New York, NY 10032, USA
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Berdon WE, Willi U. Situs inversus, bronchiectasis, and sinusitis and its relation to immotile cilia: history of the diseases and their discoverers-Manes Kartagener and Bjorn Afzelius. Pediatr Radiol 2004; 34:38-42. [PMID: 14551758 DOI: 10.1007/s00247-003-1072-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2003] [Revised: 08/06/2003] [Accepted: 08/06/2003] [Indexed: 01/02/2023]
Abstract
The relationship of Kartagener's syndrome to immobile cilia syndrome is a fascinating merging of clinical observations and basic science in Zurich, Stockholm, and Toronto. In 1933, Manes Kartagener, a Zurich pulmonary physician, reported four patients with the triad of sinusitis, bronchiectasis, and situs inversus. In the following decades, he reviewed reports of hundreds of cases, but the fact that the male patients with the condition never had offspring eluded his notice. In the 1970s, Bjorn Afzelius, a Ph.D. ultrastructuralist from Stockholm, reported cilia immotility in infertile males, some of the cases occurring in families. Half of the cases had Kartagener's triad. The observation of Afzelius was soon applied to children by Jennifer Sturgess, a Ph.D. ultrastructuralist, and her medical colleagues in Toronto. With over 500 MEDLINE references since 1966 on Kartagener's and over 1,000 references on immotile cilia, the causes of the pulmonary infections have become clearer as the patients demonstrate impaired clearance of mucus with resultant sinus and bronchial disease. The cause of the situs inversus remains elusive to this day. It is appropriate to call the condition Kartagener-Afzelius syndrome.
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Affiliation(s)
- Walter E Berdon
- Department of Radiology, Children's Hospital of New York, 3959 Broadway, CHN 3-325, New York, NY 10032, USA.
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Haller JO, Berdon WE, Levin TL, Iyer KV. Tracheoesophageal fistula (H-type) in neonates with imperforate anus and the VATER association. Pediatr Radiol 2004; 34:83-5. [PMID: 14504842 DOI: 10.1007/s00247-003-1034-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2003] [Revised: 06/18/2003] [Accepted: 07/03/2003] [Indexed: 10/26/2022]
Abstract
We report three patients with imperforate anus and other stigmata of the VATER syndrome who were diagnosed as having tracheoesophageal (TE) fistula, H-type, with intact esophagus. The fistula was diagnosed in two of the three patients only after recurrent respiratory infections.
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Affiliation(s)
- Jack O Haller
- Department of Radiology, Beth Israel Medical Center, 16th Street and 1st Avenue, New York, NY 10004, USA.
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Milman E, Berdon WE, Garvin JH, Cairo MS, Bessmertny O, Ruzal-Shapiro C. Periostitis secondary to interleukin-11 (Oprelvekin, Neumega). Treatment for thrombocytopenia in pediatric patients. Pediatr Radiol 2003; 33:450-2. [PMID: 12728286 DOI: 10.1007/s00247-003-0893-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2002] [Accepted: 01/13/2003] [Indexed: 11/27/2022]
Abstract
Interleukin-11 (Oprelvekin, Neumega) is a newly introduced thrombopoietic growth factor that stimulates production, differentiation, and maturation of megakaryocytes and platelets. Reversible periostitis has been reported as the side effect of the drug in primates and in the phase I/II trials. We report our experience with 5 cases of periostitis, occurring in thrombocytopenic children with three non-malignant and two malignant conditions, out of 24 pediatric patients treated with IL-11 at 75 micro g/kg per day for a median of 17 days. The findings were noted in the clavicle or the proximal humerus. Two patients also had forearm and lower-extremity long-bone involvement. All patients had normal bones before IL-11 was given, changes occurred in both non-malignant and malignant diseases, and periostitis disappeared after use of the drug was discontinued. The distribution and appearance of the changes are similar to prostaglandin E1 and hypervitaminosis A. The changes are reversible after termination of treatment and are most noted in younger patients. The exact mechanism is not clear. The detection of periostitis makes it essential for the radiologists to inquire as to what medications patients are receiving. The pediatric doses (75 g/kg/d) are above those recommended for adult patients (50 g/kg/d) and this may account for the pediatric bone changes of periostitis.
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Affiliation(s)
- Edward Milman
- Department of Radiology, Division of Pediatric Radiology, Children's Hospital of New York-Presbyterian, 3959 Broadway, CHN 3-325, New York, NY 10032, USA
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Levin TL, Berdon WE, Cassell I, Blitman NM. Thoracolumbar fracture with listhesis--an uncommon manifestation of child abuse. Pediatr Radiol 2003; 33:305-10. [PMID: 12695862 DOI: 10.1007/s00247-002-0857-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2002] [Accepted: 10/31/2002] [Indexed: 11/26/2022]
Abstract
BACKGROUND Thoracolumbar fracture with listhesis (FL) is an uncommon manifestation of child abuse (increasingly known as nonaccidental trauma), with only six prior reports in the literature. OBJECTIVE This article seeks to call attention to FL of the thoracolumbar spine in abused children and infants. MATERIALS AND METHODS We reviewed plain films, CT and MR images in seven new cases of FL of the thoracolumbar spine in abused children ages 6 months to 7 years, two of whom became paraplegic from their injuries. RESULTS Findings varied from subtle listhesis of one vertebra on another to frank vertebral dislocation, most commonly at L1/2. Paravertebral calcification was present in all but one case. In two children, thoracolumbar FL was the only radiographic sign of abuse. CONCLUSION Radiographic findings of FL of the thoracolumbar spine may be subtle and may be erroneously interpreted as due to a congenital or neoplastic cause. While other signs of child abuse should be sought, spinal injury may be the sole sign of abuse. Recognition of this entity is important to pursue the diagnosis of abuse.
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Affiliation(s)
- Terry L Levin
- Department of Radiology, Montefiore Medical Center, 111 E 210th Street, Bronx, New York, NY 10467-2490, USA.
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Strouse PJ, Haller JO, Berdon WE, Rosovsky MA, Bellah RD, Barr M. Horseshoe adrenal gland in association with asplenia: presentation of six new cases and review of the literature. Pediatr Radiol 2002; 32:778-82. [PMID: 12389104 DOI: 10.1007/s00247-002-0773-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2001] [Accepted: 03/29/2002] [Indexed: 12/01/2022]
Abstract
BACKGROUND Asplenia syndrome is a form of heterotaxy characterized by bilateral right-sidedness. Congenital fusion of the adrenal glands ("horseshoe adrenal gland") is a less common feature of asplenia syndrome, most instances of which have been found at autopsy. PURPOSE To present clinical and imaging features of infants diagnosed with asplenia syndrome and horseshoe adrenal gland. MATERIALS AND METHODS Six infants with asplenia syndrome were identified as having a horseshoe adrenal gland. Medical records and imaging studies were reviewed to determine clinical presentation, associated anomalies, and outcome. The literature was reviewed for prior reports of horseshoe adrenal gland. RESULTS Horseshoe adrenal gland was identified in five infants by sonography and one by CT, the latter confirmed by autopsy. In all cases, the horseshoe adrenal gland was pre-aortic. Besides features of asplenia syndrome, one infant also had associated vertebral anomalies and bilateral renal agenesis. Including the current cases, of 65 reported cases of horseshoe adrenal gland 34 (52%) were associated with asplenia, 24 (37%) with neural tube defects, 19 (29%) with renal anomalies, and 2 (3%) with Cornelia de Lange syndrome. Horseshoe adrenal gland has not been reported with polysplenia syndrome. CONCLUSIONS Horseshoe adrenal gland is a less common manifestation of asplenia that may be demonstrated by imaging. Horseshoe adrenal gland may be a differentiating feature between asplenia and polysplenia.
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Affiliation(s)
- Peter J Strouse
- Section of Pediatric Radiology, CS Mott Children's Hospital, Room F3503, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0252, USA.
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Abstract
Neonatal tracheal injury/perforation is an uncommon complication of traumatic deliveries or endotracheal intubation. We present a case of neonatal tracheal injury following delivery at term that presented with subcutaneous emphysema and pneumomediastinum before any attempt at intubation. The clinical course, treatment, and outcome are described.
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Affiliation(s)
- Amer N Ammari
- Division of Neonatal Medicine, Department of Pediatrics, Columbia University, New York, NY 10032, USA
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Nickoloff EL, Berdon WE, Lu ZF, Ruzal-Shapiro CB, So JC, Dutta AK. Pediatric high KV/filtered airway radiographs: comparison of CR and film-screen systems. Pediatr Radiol 2002; 32:476-84. [PMID: 12107580 DOI: 10.1007/s00247-002-0689-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2001] [Accepted: 12/21/2001] [Indexed: 10/27/2022]
Abstract
The imaging of pediatric airways presents a challenge because of the superimposition of the airway over the bone of the spine on the AP view. In recent years, some radiology departments have replaced conventional X-ray films by computed radiography (CR). The effect of the various changes upon image quality and radiation doses has not been clearly demonstrated. The goal of this paper was to investigate and identify potential improvements and/or degradations to pediatric airways imaging from the application of new technology, in particular to high KV/filtered radiographs; a new filter was designed. Two modern film-screen combinations and a CR system were evaluated for a range of tube potentials from 60 to 140 kVp. The spatial resolutions were measured for different geometrical magnifications. Relative radiation doses were also determined. Clinical airway images of children taken with the different imaging methods were subjectively compared. Our study confirmed that the visualization of the pediatric airways is enhanced by using high X-ray tube potentials with proper X-ray beam filtration. For CR systems, the selection of the cassette size, cassette type, focal spot, and geometrical magnification impact upon the image quality. Despite the increased dynamic range and image processing advantage with CR systems, CR techniques need to be improved to be more comparable with high kVp filtered magnification radiographs using film screens and small X-ray tube focal spots. With appropriate X-ray beam filtration and high kVp's, CR image receptors can provide adequate image quality for pediatric airway imaging. However, the transition to digital radiography involves certain caveats. In general, radiation doses with CR systems are greater than typical doses with film-screen systems.
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Affiliation(s)
- Edward L Nickoloff
- Department of Radiology, Columbia University P&S and New York-Presbyterian Hospital, Milstein Hospital Building, Room 2-128, 177 Fort Washington Avenue, New York, NY 10032-3784, USA.
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Joshi A, Berdon WE, Brudnicki A, LeQuesne G, Ruzal-Shapiro C, Hayes C. Gastric thumbprinting: diffuse gastric wall mucosal and submucosal thickening in infants with ductal-dependent cyanotic congenital heart disease maintained on long-term prostaglandin therapy. Pediatr Radiol 2002; 32:405-8. [PMID: 12029339 DOI: 10.1007/s00247-002-0690-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2001] [Accepted: 12/20/2001] [Indexed: 11/28/2022]
Abstract
Seven infants with ductal dependent cyanotic congenital heart disease are reported. All were on prostaglandin E1 therapy to maintain ductus patency. All showed chest radiographic evidence of multiple masses indenting the stomach lumen (gastric thumbprinting). Other than feeding intolerance in two patients, the findings were incidental and disappeared with cessation of PGE1 therapy. "Gastric thumbprinting" appears to be a more common consequence of PGE1 therapy than actual obstructing antral masses (antral foveolar hyperplasia).
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Affiliation(s)
- Aparna Joshi
- Children's Hospital of Michigan, Department of Radiology, 3901 Beaubien Boulevard, Detroit, MI 48201, USA
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Gallagher MP, Schachner HC, Levine LS, Fisher DA, Berdon WE, Oberfield SE. Neonatal thyroid enlargement associated with propylthiouracil therapy of Graves' disease during pregnancy: a problem revisited. J Pediatr 2001; 139:896-900. [PMID: 11743522 DOI: 10.1067/mpd.2001.119447] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- M P Gallagher
- Department of Pediatrics, Columbia University, New York, NY, USA
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Haller JO, Berdon WE, Franke H. Sickle cell anemia: the legacy of the patient (Walter Clement Noel), the interne (Ernest Irons), and the attending physician (James Herrick) and the facts of its discovery. Pediatr Radiol 2001; 31:889-90. [PMID: 11727028 DOI: 10.1007/s002470100014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- J O Haller
- Department of Radiology, Beth Israel Medical Center, First Avenue and 16th Street, New York, NY 10003, USA
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Affiliation(s)
- W E Berdon
- Columbia Presbyterian Medical Center, Babies and Children's Hospital of New York, 3959 Broadway, New, York NY 10032, USA
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Brenner DJ, Elliston CD, Hall EJ, Berdon WE. Estimates of the cancer risks from pediatric CT radiation are not merely theoretical: comment on "point/counterpoint: in x-ray computed tomography, technique factors should be selected appropriate to patient size. against the proposition". Med Phys 2001; 28:2387-8. [PMID: 11764047 DOI: 10.1118/1.1415074] [Citation(s) in RCA: 115] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Comerci SC, Berdon WE, Ruzal-Shapiro C, Levin TL, Krongrad E, Bisset GS, Strife JL. Systemic arterial collateral esophageal indentations in pseudotruncus arteriosus. Pediatr Radiol 2001; 25:192-4. [PMID: 7644300 DOI: 10.1007/bf02021532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Barium esophagrams were obtained in two patients with respiratory problems whose underlying congenital heart disease was pseudotruncus arteriosus type I. The esophagrams revealed vascular indentations on the esophagus, one posteriorly, and the other anteriorly. Both types of indentations were secondary to aorto-pulmonary communicating arteries from the descending aorta.
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Affiliation(s)
- S C Comerci
- Department of Radiology, Columbia Presbyterian Medical Center, Babies & Children's Hospital, New York, NY 10032, USA
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Abstract
Pooling of blood in the spleen is a frequent occurrence in children with sickle cell diseases, particularly in the first few years of life, resulting in what is termed "splenic sequestration crisis." The spectrum of severity in this syndrome is wide, ranging from mild splenomegaly to massive enlargement, circulatory collapse, and even death. The diagnosis is usually clinical, based on the enlargement of the spleen with a drop in hemoglobin level by > 2 g/dl, and it is rare that imaging studies are ordered. However, in the patient who presents to the emergency department with non-specific findings of an acute abdomen, it is important to recognize the appearance of sequestration on imaging studies. We studied seven patients utilizing contrast-enhanced CT scans and found two distinct patterns--multiple, peripheral, non-enhancing low-density areas or large, diffuse areas of low density in the majority of the splenic tissue. Although radiological imaging is not always necessary to diagnose splenic sequestration, in those situations where this diagnosis is not immediately obvious, it makes an important clarifying contribution.
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Affiliation(s)
- S Sheth
- Division of Pediatric Hematology, Department of Pediatrics, Division of Hematology, College of Physicians and Surgeons of Columbia University, 622 West 168th Street, New York, NY 10032, USA.
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