Pediatric Radiology

This case report demonstrates the course of herpes simplex virus cerebritis in a patient aged 7 years 2 months who presented with non-specific symptoms followed by an epileptic attack. Subcortical, bilateral opercular and bilateral thalamic lesions were detected, but the temporal and inferior frontal lobes were spared. The patient developed anarthria, impairment of mastication and swallowing consistent with operculum syndrome. Diagnosis was made by magnetic resonance imaging and elevation of oligoclonal antibodies specific to herpes simplex virus in cerebrospinal fluid after an unexpectedly negative polymerase chain reaction test.

Comparative radiologic/pathologic study of 45 newborns with primary and secondary pulmonary hypoplasia is presented and 43 cases were proven at autopsy. From 9 cases with primary pulmonary hypoplasia, 7 could be identified by 3 independent observers on chest radiographs. The roentgen criteria of primary pulmonary hypoplasia are evaluated and should serve in future to diagnose this condition clinically.

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.

This article highlights five important aspects of the clinical problem of evaluating young children who are suspected of having abusive head trauma: 1) the clinical questions to be addressed, 2) challenges when evaluating young children with suspected abuse, 3) key aspects of clinical practice and data collection, 4) a framework for decision-making and 5) key articles in the literature that can help inform a sound clinical decision about the likelihood of abuse.

The current practice of hip ultrasonography for developmental dysplasia of the hip (DDH) is based on more than three decades of experience. During this time, professional medical organizations in the United States have addressed both the clinical practice and imaging aspects of early detection of DDH. Current evidence-based clinical practice recommendations come from the American Academy of Pediatrics and the American Academy of Orthopaedic Surgeons. Consensus imaging recommendations come from the American Institute of Ultrasound in Medicine, the American College of Radiology, Society for Pediatric Radiology and the Society of Radiologists in Ultrasound. In this review the author compares and contrasts the current guidelines and offers additional practice tips for those providing comprehensive hip ultrasound services to infants.

Magnetic resonance imaging (MRI) has an established role in the accurate and non invasive assessment of airways compression by congenital vascular rings and pulmonary artery slings, making angiography of these lesions unnecessary [1, 2]. This role can be broadened to encompass other vascular compressive lesions, as in the two pediatric patients described here with aneurysmal pulmonary arteries of different etiology, one congenital and the other acquired.

MRI scans can be distressing for children and often require sedation. Educating children about what to expect reduces anxiety and increases likelihood of successful non-sedated MRI scans. Multimedia tools are a popular means of education. Animated video could provide a free, accessible method of preparing children for MRI scans. To evaluate a new animation video for preparing children for MRI, specifically for decreasing in-scanner motion and examination failure. We recruited 24 healthy children ages 5–11 years. Participants underwent pre- and post-viewing questionnaires and structured interviews. We then compared median Likert scale score changes between pre- and post-animation questions and analyzed the interview framework. Participants were filmed viewing the animation to calculate time spent looking at the screen to assess how well the video retained children’s attention. There were significant improvements in median scores regarding what to expect, checking for metal and keeping still. There were no significant changes in other knowledge-based topics. There were significant improvements in median scores for anxiety-based topics. On average, children watched the screen for 98.9% of the 174-s animation. The animation improved knowledge, reduced anxiety, retained attention and was enjoyed by participants. It can be accessed freely via the Internet to help prepare children ages 5–11 for having an MRI scan.