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Birch AA, Spalluto LB, Chatterjee T, Nguyen CN, Lightfoote JB, Morgan GN, Bradshaw ML, Bates SA, Spottswood SE. Historically Black Schools of Medicine Radiology Residency Programs: Contributions and Lessons Learned. Acad Radiol 2021; 28:922-929. [PMID: 33896717 DOI: 10.1016/j.acra.2021.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/28/2021] [Accepted: 03/19/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Black radiologists remain significantly underrepresented in the radiology workforce, despite a 1973 plea by Black radiologists of the National Medical Association to increase training programs for minority radiologists. OBJECTIVE The authors provide a qualitative narrative that highlights the radiology residency programs of three historically Black schools of medicine (HBSOM) in the U.S., their contributions, and lessons learned from their closure. METHODS Data from public repositories, interviews, and conversations were conflated to chronicle significant events and establish a timeline during these residency programs' existence. RESULTS Radiology residencies at Howard University School of Medicine (1945), Meharry Medical College (1949), and Charles R. Drew University of Medicine and Science (1972) were established to train Black doctors to treat communities of color. These programs provided care to underserved and under-resourced areas of the country, where inequitable health care fueled a legacy of poor health outcomes. These radiology residency programs collapsed under the weight of suboptimal funding, strapped capital budgets, attrition of faculty, a declining hospital patient census, and failure to maintain other residency specialty programs.` CONCLUSION: Understanding the history and impact of these programs, and of their closure, can be leveraged to develop strategies to increase the representation of racial and ethnic minorities in radiology. Possible reinstatement, with appropriate allocation of resources and creation of intentional policies to ensure sustained success, merits further investigation and may be a pathway to achieve optimal representation.
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Affiliation(s)
- Andrea A Birch
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Lucy B Spalluto
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Johnson B Lightfoote
- Department of Diagnostic Radiology, Pomona Valley Hospital Medical Center, Pomona, California
| | - Gail N Morgan
- Formerly, Department of Diagnostic Radiology, Virginia Mason Medical Center, Seattle, Washington. Retired, Atlanta, Georgia
| | - Marques L Bradshaw
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sandra A Bates
- Formerly, Department of Diagnostic Radiology, VA Tennessee Valley Healthcare System (Alvin C. York Campus) Murfreesboro, Tennessee. Retired, Nashville, Tennessee
| | - Stephanie E Spottswood
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
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Kwatra NS, Shalaby-Rana E, Andrich MP, Tsai J, Rice AL, Ghelani SJ, Spottswood SE, Majd M. Gastric emptying of milk in infants and children up to 5 years of age: normative data and influencing factors. Pediatr Radiol 2020; 50:689-697. [PMID: 31993707 DOI: 10.1007/s00247-020-04614-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 07/05/2019] [Revised: 10/28/2019] [Accepted: 01/09/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Gastric emptying scintigraphy is widely used in infants and children, but there is a lack of age-specific normative data. OBJECTIVE The objectives of this retrospective study were: 1) to establish a range of gastric emptying of milk or formula as a surrogate for normal gastric emptying in infants and young children ≤5 years of age, and 2) to investigate the effects of patient age, feeding volume, feeding route and gastroesophageal reflux on gastric emptying. MATERIALS AND METHODS The reports of 5,136 gastric emptying studies of children ≤5 years of age performed at Children's National Medical Center from January 1990 to August 2012 were reviewed. Demographic data, 1-h and 3-h gastric emptying values and gastroesophageal reflux status of all patients were stored in a database. Using stringent inclusion and exclusion criteria, the studies of patients as similar to healthy children as possible were selected for this study. RESULTS The study group included 2,273 children (57% male) ages 0-59 months (median: 4.6 months). The median 1-h gastric emptying was 43% (interquartile range [IQR] 34-54%). The median 3-h gastric emptying was 91% (IQR 79-98%). Sixty-one percent of patients with 1-h gastric emptying value of <50% had 3-h gastric emptying ≥80%. Gastric emptying was significantly faster in children ≤6 months as compared with all older age groups. In each age group, the median gastric emptying decreased with increasing feeding volume. Gastric emptying was significantly faster in patients fed via combined nasogastric tube and oral routes as compared with those fed exclusively orally. There was no significant difference in gastric emptying of children with and without gastroesophageal reflux. CONCLUSION Although there are statistically significant differences in gastric emptying based on age, volume and route of feeding, the data suggest that overall normal liquid gastric emptying in infants and children ≤5 years of age is ≥80% at 3 h. One-hour emptying measurements are not reliable for detecting delayed gastric emptying.
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Affiliation(s)
- Neha S Kwatra
- Department of Radiology, Boston Children's Hospital, Boston, MA, USA
| | - Eglal Shalaby-Rana
- Division of Diagnostic Imaging and Radiology, Children's National Medical Center, 111 Michigan Ave., N.W., Washington, DC, 20010, USA
| | - Mary P Andrich
- Division of Diagnostic Imaging and Radiology, Children's National Medical Center, 111 Michigan Ave., N.W., Washington, DC, 20010, USA
| | - Jason Tsai
- Department of Radiology, Good Samaritan Hospital Medical Center, West Islip, NY, USA
| | - Amy L Rice
- Independent consultant (biostatistics), Chevy Chase, MD, USA
| | - Sunil J Ghelani
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Stephanie E Spottswood
- Department of Radiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Massoud Majd
- Division of Diagnostic Imaging and Radiology, Children's National Medical Center, 111 Michigan Ave., N.W., Washington, DC, 20010, USA. .,Radiology and Pediatrics, The George Washington University, Washington, DC, USA.
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Spottswood SE, Spalluto LB, Washington ER, Donnelly EF, Birch AA, Bradshaw ML, Omary RA. Design, Implementation, and Evaluation of a Diversity Program for Radiology. J Am Coll Radiol 2019; 16:983-991. [PMID: 30745038 DOI: 10.1016/j.jacr.2018.12.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [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: 08/20/2018] [Revised: 11/26/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
RATIONALE AND OBJECTIVES Diagnostic radiology training programs are less diverse than graduating US medical school classes and the patient populations they serve. Inclusion of physicians who are underrepresented minorities in medicine (URMM) can strengthen the profession and help to meet the needs of an increasingly diverse population. Our Department of Radiology developed and implemented a plan to increase the number of URMMs in our residency applicant pool and residency training program. MATERIALS AND METHODS We designed a recruitment strategy to diversify the radiology residency applicant pool. This included website development, advertising, early exposure opportunities, travel to predominantly minority institutions and national meetings, and mentoring URMM medical students. We implemented parallel activities to increase the number of URMMs in our residency program. These included holistic screening tools for residency application review, a diverse residency recruitment committee, a welcome environment for visiting candidates, and "Second Look Weekend" visits for talented candidates. Primary outcomes measured include change in percentages of URMM applicants in our applicant pool and URMM residents in our residency program. RESULTS The percentage of URMM radiology residency applicants increased from 7.5% (42 of 556) of the total applicant pool in the 2012 to 2013 recruitment year to 12.6% (98 of 777) in the 2017 to 2018 recruitment year (P = .001). URMM radiology residency representation increased from 0% (0 of 32) in the 2013 to 2014 academic year to 20% (6 of 30) in the 2018 to 2019 academic year (P = .01). CONCLUSION An intentional, strategic diversity program can diversify an institution's residency applicant pool and increase representation of URMMs in a diagnostic radiology residency program.
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Affiliation(s)
- Stephanie E Spottswood
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Lucy B Spalluto
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee; Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee
| | - Eleby R Washington
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Edwin F Donnelly
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Andrea A Birch
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marques L Bradshaw
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee; Veterans Health Administration-Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Reed A Omary
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
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Spalluto LB, Spottswood SE, Deitte LA, Chern A, Dewey CM. A Leadership Intervention to Further the Training of Female Faculty (LIFT-OFF) in Radiology. Acad Radiol 2017; 24:709-716. [PMID: 28526513 DOI: 10.1016/j.acra.2016.12.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/14/2016] [Accepted: 12/14/2016] [Indexed: 11/16/2022]
Abstract
RATIONALE AND OBJECTIVES Women are under-represented in the field of radiology, occupy a minority of leadership positions, and, at our institution, have not achieved the same level of academic success as their male counterparts. Consequently, the authors designed, implemented, and evaluated the Leadership Intervention to Further the Training of Female Faculty (LIFT-OFF) program to (1) improve access to opportunities for women's faculty development and advancement, and (2) improve clarification of expectations about the role and path of advancement. MATERIALS AND METHODS LIFT-OFF was developed based on the results of a needs assessment survey. The results generated 14 priority topics, which served as the basis for educational modules conducted by expert speakers. Module effectiveness was assessed with pre- and postsurveys to elicit participant knowledge about the targeted subject matter. A formative program evaluation was performed at the completion of year 1 of 2 to assess outcomes and impacts to date. RESULTS Seventeen of 55 (31%) educational module post-survey questions demonstrated a statistically significant (P < 0.05) increase in "yes" responses, indicating an improved understanding of targeted information. At year 1, 75% of the participants indicated that the program improved access to faculty development opportunities and 62% reported improved access to career advancement opportunities. Satisfaction with pace of professional advancement increased from 25% to 46% for junior women faculty (P = 0.046). CONCLUSIONS Faculty development programs such as LIFT-OFF can provide career development opportunities and executive skills necessary for women to achieve academic career success and assume leadership positions.
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Affiliation(s)
- Lucy B Spalluto
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, 1161 21st Ave. South, Nashville, TN 37232.
| | - Stephanie E Spottswood
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, 1161 21st Ave. South, Nashville, TN 37232
| | - Lori A Deitte
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, 1161 21st Ave. South, Nashville, TN 37232
| | - Alexander Chern
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Charlene M Dewey
- Department of Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
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Spalluto LB, Spottswood SE. A Female Faculty Development Program for Radiology. J Am Coll Radiol 2016; 13:716-8. [DOI: 10.1016/j.jacr.2015.12.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 12/05/2015] [Indexed: 11/26/2022]
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Ellis WD, Spottswood SE, Lovejoy SA. A rare accessory muscle in the hand--the flexor digitorum superficialis indicis. Pediatr Radiol 2016; 46:293-5. [PMID: 26416178 DOI: 10.1007/s00247-015-3461-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 02/17/2015] [Revised: 07/23/2015] [Accepted: 08/28/2015] [Indexed: 12/19/2022]
Abstract
Accessory muscles are easily overlooked during imaging evaluation. Although usually discovered incidentally, they are occasionally symptomatic. With increasing utilization of cross-sectional imaging, the radiologist should be prepared to readily identify these anomalous muscles. It is particularly important to distinguish these anatomical variants from soft-tissue tumors prior to invasive intervention, reserving biopsy and surgery for children who are symptomatic. This report discusses a case of a flexor digitorum superficialis indicis muscle, an extremely rare but well-described accessory muscle, presenting as a painful mass in a 15-year-old girl. The report includes the clinical presentation, radiologic findings, and the significance to management.
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Affiliation(s)
- Wendy D Ellis
- Department of Radiology and Radiologic Sciences, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Ste. 1415, Nashville, TN, 37232-9700, USA. .,Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
| | - Stephanie E Spottswood
- Department of Radiology and Radiologic Sciences, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Ste. 1415, Nashville, TN, 37232-9700, USA
| | - Steven A Lovejoy
- Department of Orthopaedics and Rehabilitation, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
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Ayres KL, Spottswood SE, Delbeke D, Price R, Hodges PK, Wang L, Martin WH. Dose Optimization of the Administered Activity in Pediatric Bone Scintigraphy: Validation of the North American Consensus Guidelines. J Nucl Med 2015. [PMID: 26205299 DOI: 10.2967/jnumed.115.156141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED The 2010 North American Consensus Guidelines (NACG) for pediatric administered doses and the European Association of Nuclear Medicine (EANM) Dosage Card guidelines recommend lower activities than those administered at our institution. We compared the quality of the lower-activity images with the higher-activity images to determine whether the reduction in counts affects overall image quality. METHODS Twenty patients presenting to our pediatric radiology department for bone scintigraphy were evaluated. Their mean weight was 20 kg. The patients were referred for oncologic (n = 10), infectious/inflammatory (n = 5), and pain (n = 5) evaluation. Dynamic anterior and posterior images were acquired for 5 min for each patient. Data were subsampled to represent different administered activities corresponding to the activities recommended by the NACG and the EANM Dosage Card. Images were evaluated twice, first for diagnostic quality and then for acceptability for daily clinical use. RESULTS There was no statistically significant difference in the diagnostic quality of the images from any of the 3 protocols. Pathologic uptake was correctly identified independent of the administered activity, although there was a single false-positive result for an EANM image. When images were subjectively evaluated as acceptable for daily clinical use, there was a slight preference for the higher-activity images over the NACG (P = 0.04). CONCLUSION The recommended administered activities of the NACG produce images of diagnostic quality while reducing patient radiation exposure.
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Affiliation(s)
- Karen L Ayres
- Department of Radiology and Radiologic Sciences, Vanderbilt Children's Hospital/Vanderbilt University Hospital, Nashville, Tennessee
| | - Stephanie E Spottswood
- Department of Radiology and Radiologic Sciences, Vanderbilt Children's Hospital/Vanderbilt University Hospital, Nashville, Tennessee
| | - Dominique Delbeke
- Department of Radiology and Radiologic Sciences, Vanderbilt Children's Hospital/Vanderbilt University Hospital, Nashville, Tennessee
| | - Ronald Price
- Department of Radiology and Radiologic Sciences, Vanderbilt Children's Hospital/Vanderbilt University Hospital, Nashville, Tennessee
| | - Pamela K Hodges
- Department of Radiology and Radiologic Sciences, Vanderbilt Children's Hospital/Vanderbilt University Hospital, Nashville, Tennessee
| | - Li Wang
- Department of Radiology and Radiologic Sciences, Vanderbilt Children's Hospital/Vanderbilt University Hospital, Nashville, Tennessee
| | - William H Martin
- Department of Radiology and Radiologic Sciences, Vanderbilt Children's Hospital/Vanderbilt University Hospital, Nashville, Tennessee
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Spottswood SE, Pfluger T, Bartold SP, Brandon D, Burchell N, Delbeke D, Fink-Bennett DM, Hodges PK, Jolles PR, Lassmann M, Maurer AH, Seabold JE, Stabin MG, Treves ST, Vlajkovic M. SNMMI and EANM practice guideline for meckel diverticulum scintigraphy 2.0. J Nucl Med Technol 2014. [PMID: 24948825 DOI: 10.2967/jmnt.113.136242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
| | | | | | | | - Nanci Burchell
- Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | | | | | | | | | | | - Alan H Maurer
- Temple University Hospital, Philadelphia, Pennsylvania
| | | | | | - S Ted Treves
- Harvard Medical School, Boston, Massachusetts; and
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Spottswood SE, Pfluger T, Bartold SP, Brandon D, Burchell N, Delbeke D, Fink-Bennett DM, Hodges PK, Jolles PR, Lassmann M, Maurer AH, Seabold JE, Stabin MG, Treves ST, Vlajkovic M. SNMMI and EANM practice guideline for meckel diverticulum scintigraphy 2.0. J Nucl Med Technol 2014; 42:163-9. [PMID: 24948825 DOI: 10.2967/jnmt.113.136242] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | | | | | - Nanci Burchell
- Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | | | | | | | | | | | - Alan H Maurer
- Temple University Hospital, Philadelphia, Pennsylvania
| | | | | | - S Ted Treves
- Harvard Medical School, Boston, Massachusetts; and
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Marshall AP, Spottswood SE, Grau AM, Jackson GP. Juvenile fibroadenoma and granular cell tumor of the breast in an adolescent. J Pediatr Surg 2012; 47:1930-3. [PMID: 23084210 DOI: 10.1016/j.jpedsurg.2012.07.050] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 07/30/2012] [Accepted: 07/30/2012] [Indexed: 12/27/2022]
Abstract
We describe a case of a 15-year-old girl who presented with 2 painful masses in her right breast. Ultrasound confirmed the presence of 2 lesions, both of which appeared noncharacteristic for fibroadenomas. Both lesions were surgically resected. One was found to be a fibroadenoma and the other a granular cell tumor, both benign upon further histologic evaluation. Breast masses are rare in the pediatric population. The finding of a concurrent fibroadenoma and granular cell tumor is unique and has not been previously reported. Granular cell tumors of the breast are relatively uncommon. Often, they are mistaken for a breast malignancy. The concerning clinical and radiographic findings in this patient warranted operative excision.
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Affiliation(s)
- Andre P Marshall
- Department of Surgery, Vanderbilt University Medical Center, D-4314 MCN 2730, Nashville, TN 37232-2730, USA.
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Affiliation(s)
- Bradley P Thomas
- Department of Radiology and Radiological Sciences, Monroe Carrell Jr. Children's Hospital, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
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Mody RN, Stokes LS, Bream PR, Spottswood SE. Removal of a Günther Tulip retrievable inferior vena cava filter after 147 days in a pediatric patient. Pediatr Radiol 2006; 36:440-4. [PMID: 16532347 DOI: 10.1007/s00247-005-0101-2] [Citation(s) in RCA: 6] [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: 09/09/2005] [Revised: 11/21/2005] [Accepted: 12/12/2005] [Indexed: 10/24/2022]
Abstract
A Günther Tulip retrievable inferior vena cava filter was placed in a 9-year-old boy with T-cell ALL who had both iliofemoral deep vein thrombosis (DVT) and acute intracranial hemorrhage. The filter was removed 147 days after placement, when the patient was no longer at increased risk for DVT or pulmonary embolus. Removal of the filter did not compromise flow through the vena cava.
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Affiliation(s)
- Rekha N Mody
- Department of Radiology, Vanderbilt University Medical Center, 1161 21st Ave. S., Nashville, TN 37232, USA.
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Affiliation(s)
- S E Spottswood
- Department of Radiology, Virginia Commonwealth University Health System, Richmond, Virginia 23507, USA.
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Spottswood SE, Allison KZ, Lopatina OA, Sethi NN, Narla LD, Lowry PA, Nettleman MD. The clinical significance of lung hypoexpansion in acute childhood asthma. Pediatr Radiol 2004; 34:322-5. [PMID: 14767624 DOI: 10.1007/s00247-003-1083-6] [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: 01/10/2003] [Revised: 04/19/2003] [Accepted: 09/13/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Many children experiencing acute asthmatic episodes have chest radiographs, which may show lung hyperinflation, hypoinflation, or normal inflation. Lung hypoinflation may be a sign of respiratory fatigue and poor prognosis. OBJECTIVE To compare the clinical course in children with asthma according to the degree of lung inflation on chest radiographs. PATIENTS AND METHODS We conducted a retrospective study during a 24-month period (from July 1999 to July 2001) of children aged 0-17 years, who presented to a pediatric emergency department or outpatient clinic with an asthma exacerbation. Chest radiographs obtained at presentation were reviewed independently by three pediatric radiologists who were blinded to the admission status of the patient. The correlation between hypoinflation and hospital admission was assessed in three age groups: 0-2 years, 3-5 years, and 6-17 years. RESULTS. Hypoinflation on chest radiographs was significantly correlated with hospital admission for children aged 6-17 years (odds ratio 16.00, 95% confidence interval 1.89-135.43). The inter-reader agreement for interpretation of these radiographs was strong, with a kappa score of 0.76. Hypoinflation was not correlated with admission in younger children. CONCLUSION Lung hypoinflation is associated with a greater likelihood of hospital admission in children aged 6 years or older. Therefore, hypoinflation was a poor prognostic sign and may warrant more aggressive therapy.
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Affiliation(s)
- Stephanie E Spottswood
- Department of Radiology, Medical College of Virginia, Virginia Commonwealth University Health System, Box 980615, Richmond, VA 23298-0615, USA.
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Abstract
Myositis ossificans (MO) refers to non-neoplastic heterotopic soft tissue ossification that can have several aetiologies. Broadly it can be classified into three categories based on aetiology [1]. MO traumatica, the most common form occurs secondary to acute or chronic trauma. MO can also be associated with neurological disorders and in rare cases is congenital. The latter (progressive MO) is a genetic disorder in which congenital osseous abnormalities are associated with progressive soft tissue calcification. Despite an increased tendency to soft tissue bleeds, MO has been rarely reported in haemophilia. We treated three adolescents with haemophilia and MO of varying degrees of severity and outcome.
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Affiliation(s)
- G V Massey
- Department of Pediatrics, Virginia Commonwealth University, Medical College of Virginia, Richmond, Virginia, USA.
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Lopatina OA, Berry TT, Spottswood SE. Giant prostatic utricle (utriculus masculinis): diagnostic imaging and surgical implications. Pediatr Radiol 2004; 34:156-9. [PMID: 12961046 DOI: 10.1007/s00247-003-1048-9] [Citation(s) in RCA: 13] [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: 06/18/2003] [Revised: 07/08/2003] [Accepted: 07/24/2003] [Indexed: 10/26/2022]
Abstract
The prostatic utricle is an embryological remnant of the Mullerian duct system. It is often revealed incidentally on voiding cystourethrography in young males undergoing evaluation for possible vesicoureteral reflux. We present the case of a very large prostatic utricle found incidentally on ultrasound evaluation in a 4-year-old boy with a history of recurrent urinary tract infections.
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Affiliation(s)
- O A Lopatina
- Medical College of Virginia, Richmond, Virginia, USA
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Abstract
This article reviews the literature and describes a methodologic approach to the diagnosis of hypertension in the young infant. The numerous etiologies of hypertension have been discussed and normative blood pressure data for neonates and infants have been provided. Techniques for accurate blood pressure measurement in the intensive care setting and for routine outpatient settings, are discussed. The lengthy discussion of radiologic approach to imaging can be summarized with the following suggested algorithm. Initial screening should be performed with gray-scale sonography, to identify renal parenchymal or collecting system abnormalities, including mass lesions and congenital anomalies. Further imaging with color and duplex Doppler sonography detects renal arterial or aortic thrombosis, and alterations in the arterial waveform caused by intrinsic or extrinsic renal artery narrowing. The major limitation of Doppler sonography is the recognition that disease in accessory renal arteries or in small segmental intrarenal arteries may frequently be undetected. Functional imaging with ACEI renography should follow renal sonography to detect hemodynamically significant renovascular disease (with a sensitivity and specificity of approximately 90%); intravenous enalaprilat is the preferred ACEI. Angiography should be reserved for older children in whom interventional percutaneous angioplasty may be more feasible. A young infant with hypertension caused by renal artery stenosis should be controlled medically until he or she is large enough to undergo angiography and angioplasty successfully. CT angiography and MR angiography, although promising in the adult population, may not adequately resolve the small intrarenal vessels, which are frequently the culprit in renovascular hypertension of infancy.
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Affiliation(s)
- Christopher G Roth
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, 88 East Newton Street, Boston, MA 02118, USA
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Abstract
Care of individuals with renal failure continues to impose a tremendous burden on our national health care budget. Chronic renal failure is the final common denominator of a multiplicity of pathologic processes, some of which progress silently over years. Of these, obstructive uropathy is a prominent cause of kidney failure, accounting for 16.5% of all pediatric renal transplants in 1997. The pathophysiology of obstructive uropathy is reviewed as the basis for a differential diagnosis. In view of the significant role played by obstructive uropathy in the development of renal failure, early and definitive treatment of this clinical entity is imperative.
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Affiliation(s)
- Karl S Roth
- Department of Pediatrics, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond 23229, USA
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Affiliation(s)
- S E Spottswood
- Department of Radiology, Division of Nuclear Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia 23298-0615, USA.
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Affiliation(s)
- S E Spottswood
- Department of Radiology, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia, USA.
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Abstract
Enteric duplication cysts are infrequently located in the retroperitoneum. Such cysts are typically spherical or ovoid. We report a retroperitoneal duplication cyst with extension across the abdominal midline in a previously unreported dumbbell configuration. This is the third reported case of prenatally detected retroperitoneal enteric duplication cyst.
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Affiliation(s)
- D A May
- Department of Radiology, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298-0615, USA.
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23
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Affiliation(s)
- L L Everett
- Department of Anesthesiology, University of Washington and Children's Hospital and Regional Medical Center, Seattle, USA.
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24
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Affiliation(s)
- S E Spottswood
- Department of Radiology, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298-0615, USA
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25
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Abstract
Gastric duplication cysts are uncommon congenital anomalies, and examples imaged with scintigraphy are rarely reported in the literature. The authors report an infant with duplication of the stomach, which was extensively evaluated using scintigraphy, ultrasound, computed tomography, and upper gastrointestinal series. The role of multimodality imaging is discussed, and correlative surgical and histologic findings are presented.
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Affiliation(s)
- J R Dittrich
- Department of Radiology, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298, USA
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26
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Abstract
Ultrasonography is useful in the evaluation of enteric duplication cysts in infants. Typically, there is an anechoic fluid-filled lumen with a double-layered surrounding wall. This case report documents an additional sonographic finding which has not been recorded: peristaltic contractions of the cyst wall. This provides a real-time observation which is specific in the pre-operative diagnosis of neonatal cystic abdominal masses.
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Affiliation(s)
- S E Spottswood
- Department of Radiology, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298
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27
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Abstract
A previously healthy young child presented with a large pericardial effusion and cardiac tamponade. The chest radiography was key to the recognition of the pericardial effusion. Cytologic examination of the pericardial fluid ultimately established the diagnosis of acute monoblastic leukemia in the absence of associated clinical or laboratory findings. The pericardial fluid was vital for leukemic cell classification because the bone marrow has hypocellular and non-diagnostic. This presentation of acute monoblastic leukemia is very rare, and in the three previously reported pediatric cases has been associated either with peripheral blasts or a history of preleukemia. When the cardiac configuration suggests pericardial effusion in a previously healthy young child, the diagnosis of new onset leukemia should be considered.
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Affiliation(s)
- S E Spottswood
- Department of Radiology, Children's Medical Center, Medical College of Virginia, Virginia Commonwealth University, Richmond
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28
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Stiles RG, Spottswood SE, Jolgren DL, Stewart JR, DeVito DP, Schwartz HS. An unusual appearance of an aneurysmal bone cyst of the thoracic spine. J Spinal Disord 1991; 4:104-9. [PMID: 1807524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Aneurysmal bone cysts (ABCs) have been reported in essentially every bone of the human skeleton. This case report documents a very unusual clinical appearance for this entity: a superior mediastinal mass. Also, the patient underwent multiple imaging studies that demonstrated both common (absence of septations) and unusual (extensive involvement of vertebral body with little involvement of posterior elements) characteristics of ABCs.
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Affiliation(s)
- R G Stiles
- Department of Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-2675
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