Computed tomography (CT) angiography in pre-embolization assessment of location of gastrointestinal bleeding in paediatric patient with granulomatosis with polyangiitis (Wegener's granulomatosis) : case report

Background: Acute gastrointestinal bleeding is an emergency with a high morbidity and mortality. Early diagnosis and appropriate intervention can be lifesaving and can prevent long-term complications. Case Report: In this case report, we discuss and illustrate the role of CT angiography in the evaluation of acute, active gastrointestinal haemorrhage and show its usefulness prior to embolization. We describe a 15-year-old girl with granulomatosis with polyangiitis, formerly known as Wegener's granulomatosis. Conclusions: An accurate pre-embolization assessment of bleeding with CT angiography shortens the total diagnostic time, which results in prompt and more effective endovascular treatment. We describe the clinical presentation of our patient and present diagnostic and interventional radiologic findings

Lower-dose CT urography (CTU) with iterative reconstruction technique in children : initial experience and examination protocol

Background: Conventional X-ray urography is one of the basic imaging techniques in urinary tract diseases in children. CT urography (CTU) employing standard Filtered Back Projection (FBP) reconstruction algorithms is connected with higher radiation dose. Advanced iterative reconstruction techniques enable lowering the radiation dose to the level comparable with conventional X-ray urography with better visualization of the urinary tract. Study protocol and indications for this modified technique should be discussed. Material and Methods: Introduction of iterative image reconstruction techniques allowed to significantly reduce the radiation dose delivered during examinations performed at our Department, including CT examinations of urinary tract in children. During the last two years, CT urography replaced conventional X-ray urography and became the basic imaging technique in our Department. We discuss the study protocol regarding pediatric CTU examinations. The main goal is to receive an optimal image quality at reduced radiation dose. Results: CTU examinations performed using the standard filtered back projection (FBP) reconstruction technique are associated with radiation doses about 1.5 times higher than those in conventional X-ray urography. Implementation of iterative reconstruction algorithms in advanced CT scanners allow to reduce the radiation dose to a level comparable or even lower than that in X-ray urography. In addition, urinary tract can be evaluated more precisely in multiplanar reformatted (MPR) and volume rendered (VR) images. Conclusions: 1. Advanced iterative reconstruction techniques allow to reduce radiation dose in CT examinations and to extend indications for CT urography in children. 2. Urinary tract can be evaluated more precisely in multiplanar reformatted and volume rendered images. 3. CTU may replace conventional X-ray urography in children

Zjawisko Tamm-Horsfalla u noworodków

Background: Tamm-Horsfall phenomenon is a transient hyperechogenicity of the renal pyramids during the first few days of life. The purpose of this study was to determine whether there is a correlation between the Tamm-Horsfall phenomenon and the pathology of pregnancy, the kind of delivery, or selected biochemical parameters of urine. Material/Methods: The study involved 153 neonates, divided into two groups based on pregnancy age. Group I consisted of 118 full term neonates born in the 37th - 42nd week of pregnancy, while Group II included 35 premature neonates born before the 37th week of pregnancy. Ultrasonograms of the kidneys were performed on the 1st and 3rd day of life, as well as examinations of urine protein, creatinine, uric acid and urea concentration. The Examinations were repeated in the 2nd month of life after making a diagnosis of Tamm-Hosfall phenomenon. Results: Tamm-Horsfall phenomenon was diagnosed in 32 eutrophic children (22.7% of the group). Among the term neonates, diagnoses of Tamm-Horsfall phenomenon were made in 24.6% of the children (29/118), as opposed to 8.6% (3/35) in the preterm group in. Pregnancy was terminated by caesarean section in 22 cases (68.7 % of all 32). 10 children (31.3 % of all 32) were born spontaneously (p=0.01). Significantly higher urine protein and creatinine concentrations were noted in this group only on the 3rd day of life. Children with Tamm-Horsfall phenomenon had greater body mass at birth (p=0.01) than the others. Repeated examinations of 23 children diagnosed with Tamm-Horsfall phenomenon performed in the 2nd month of life showed that this phenomenon had disappeared. Conclusions: Tamm-Horsfall phenomenon is observed more often in children delivered by caesarean section. Children diagnosed with Tamm-Horsfall phenomenon have higher urine levels of protein and creatinine on the 3rd day of life. Tamm-Horsfall phenomenon is observed more often in term, eutrophic children

Computed tomography urography with iterative reconstruction algorithm in congenital urinary tract abnormalities in children : association of radiation dose with image quality

Purpose: To assess the extent to which a radiation dose can be lowered without compromising image quality and diagnostic confidence in congenital urinary tract abnormalities in children by using a CT scanner with an iterative reconstruction algorithm. Material and methods: 120 CT urography image series were analysed retrospectively. Image series were divided into four study groups depending on effective radiation dose (group 1: 0.8-2 mSv; group 2: 2-4 mSv; group 3: 4-6 mSv; group 4: 6-11 mSv). Objective and subjective image quality were investigated. In objective analysis, measurements of attenuation and standard deviation (SD) in five regions of interest (ROIs) were performed in 109 excretory image series, and image noise was evaluated. In subjective analysis, two independent radiologists evaluated 138 kidney units for subjective image quality and diagnostic confidence. Results: There were no significant differences in image noise in objective evaluation between the following study groups: 2 vs. 3 and 3 vs. 4 in all ROIs (with the only exception in spleen SD measurement between study groups 2 vs. 3), while there was significantly more image noise in group 2 in comparison to group 4. For all other ROIs in all study groups, there was more image noise on lower dose images. There were no significant differences in pairwise comparisons between study groups in subjective image quality. Diagnostic confidence was not significantly different between all study groups. Conclusions: Low-dose CT urography can be a valuable method in congenital urinary tract abnormalities in children. Despite poorer image quality, diagnostic confidence is not significantly compromised in examinations performed with lower radiation doses

Injuries of diaphragm in children : diagnostic problems

Background: Nine children with blunt trauma were hospitalized in our hospital from September 2000 to July 2005. The group consisted of 7 boys and 2 girls from 2 to 15 years old. Material/Methods: The object of our article is to present problems in diagnosis of diaphragmatic injuries and compare the possibilities of diagnosis among different methods. We observed 3 children with trauma of diaphragm: in two of them the injury was on left side of diaphragm, and in one- on the right side. Results: Results of our examinations allowed us only to suspect a trauma of the right side of diaphragm, and in one patient correct diagnosis was established based on autopsy. The left side diaphragmatic injury was diagnosed by means of the CT abdominal scan after the extubations. Conclusions: Although various diagnostic methods were applied, diaphragmatic injuries constitute a serious problem in the diagnosis. Chest X-ray is still an important part of diagnosis in patients with diaphragmatic trauma

Zastosowanie midazolamu w zakładzie radiologii pediatrycznej : sedacja płytka przed diagnostycznymi badaniami obrazowymi

Background: The aims of the study were to evaluate the usefulness of midazolam administration for sedation prior to some diagnostic examinations in children and to present the requirements and rules for sedation in departments of pediatric radiology. Material/Methods: From Oct. 2001 to Aug. 2005, two hundred children were investigated after conscious sedation with midazolam. The examinations were: voiding cystourethrography (129), voiding sonocystography (64), barium enema (3), ultrasonography (1), urography (1), X-ray of facial bone (1), and brain CT (1). The children's age-range was 4 months to 13 years 9 months. The decision for sedation was based on conversation with the child and/or parents, their experience with previous examinations, emotional status of the child, and exclusion of contraindications (renal insufficiency, hepatic failure, respiratory/circulatory insufficiency, allergy to benzodiazepines in anamnesis). Midazolam was given orally in a dose of 0.5 mg/kg body weight, 15-20 minutes before examination (already at the department of pediatric radiology). The parents were informed of the possible side effects and what to do after the procedure. Results: All diagnostic procedures with conscious sedation were well tolerated by the children and accepted by the parents. The parents with experience from previous diagnostic procedures indicated that they would want their child to have midazolam again if the examination needed to be repeated. No significant complications were observed in the children receiving midazolam and few adverse effect on voiding during cystourethrography. In three children (2.5, 3, and 5 years old), paradoxical reactions occurred (psychomotor agitation) which disappeared spontaneously after some minutes and had no influence on the procedure. Conclusions: Application of midazolam for conscious sedation diminished anxiety and discomfort from diagnostic procedures and short anterograde amnesia protected the child's mind from painful experience. Conscious sedation should be widely used in children in whom exact psychological preparation is impossible, and anxiety before examination can make it difficult or inaccessible

Prenatalne podejrzenie - postnatalne rozpoznanie wady układu moczowego u dzieci

Background: Introduction of prenatal ultrasonography (USG) in fetus diagnostic caused early detection of congenital urinary tract abnormalities. Dilatation of renal pelvis, which is detected in ultrasonography from 16 week of gestational age is the most common abnormality in fetal urinary tract. The aim of the study was to assess the frequency of congenital abnormalities in urinary tract in children with prenatal suspicion of anomalies. Material/Methods: The retrospective study included 100 children with prenatal suspicion of congenital abnormalities in urinary tract. Changes in urinary tract were detected in ultrasonography between 18-41 (mean 32,6±5,6) week of gestational age. Unilateral dilatation of urinary tract was found in 57% fetuses, bilateral dilatation in 31%, others anomalies in 12% fetuses. Results: Ultrasonography of urinary tract was done in all children in 1-122 (mean 17,5±20,5) day of life, cystourethrography in 93% of children, renal dynamic scintygraphy in 52%, renal static scintygraphy in 16% and urography in 39% of children. Congenital urinary tract abnormalities were detected in 63% of children. Transient dilatation of renal pelvis was observed in 25% of children. We didn't find any abnormalities in 12% patients. The most common changes in urinary tract were: ureteropelvic junction obstruction (22%), vesicoureteral reflux (15%), ureterovesical junction obstruction (7%), posterior urethral valve (7%) and polycystic renal dysplasia (7%). 33% children were qualified for invasive treatment. Conclusions: 1. Prenatal and postnatal ultrasonography of urinary tract allows detecting congenital abnormalities of urinary tract early age of life. 2. High percentage of abnormalities in urinary tract detected in prenatal ultrasonography orders cooperation between neonatologist, urologist and nephrologist

Aktualne standardy badania USG jamy brzusznej u dzieci

Technological progress forces us to present after several years the updated standards in ultrasound examination of newborns, infants and older children. It should be emphasized that the examination of the youngest patients requires one to use high-class equipment. Lack of cooperation on the part of the child and imaging small structures constitute a huge challenge for the examiner. The work presents equipment requirements, the technology of examining the abdominal cavity in children and the manner of preparing the examination result. Moreover, modern expectations as regards ultrasound surgery equipment, where children are subject to examination have been presented. The minimum set of transducers the ultrasound apparatus should be equipped with has also been pointed out as well as the minimum requirements concerning image recording. Extending the scope of transducers over “minimum” significantly raises the imaging possibilities in pediatrics. Standard preparation of children for ultrasound has been discussed, taking into consideration the age of the patient and indications. It is essential to understand that it differs from standard preparation for examination in the case of adults. The technique of examining the abdominal cavity has been described, which enables the repeatability of examinations and ensuring making all the available structures visible. It proves imperative especially in the case of a large number of examinations. Attention should be paid particularly to the urinary system imaging – owing to the greatest incidence of congenital diseases in that system

Artefakt „zdwojonej aorty” w badaniu ultrasonograficznym – problem diagnostyczny

The double aorta artifact was described and studied thoroughly twenty-five years ago. Despite this, it is still not commonly known today and can cause diagnostic difficulty. Total aortic duplication can be considered an anatomic defect whilst partial duplication mimics aortic dissection. In the literature, this artifact has been compared with a very rare anomaly, i.e. the occurrence of two aortas in one patient. Currently, however, the differentiation of this artifact from abdominal aortic dissection seems to be of greater significance. The double aorta image occurs when ultrasound waves encounter prismatic fat tissue of the anterior abdominal wall. This artifact is more frequently observed in children and athletic young adults since the structure of this anatomic region in these individuals is conductive to the occurrence of this phenomenon. Moreover, it can be observed more often when curved transducers are used. Due to all these factors, an ultrasound beam undergoes greater refraction and make the artifact clearer. This phenomenon is usually easily recognizable and avoidable, but it sometimes might cause diagnostic difficulty. Obtaining an image of double abdominal vessels on ultrasound examination in transverse sections requires further inspection of the aorta in a different (sagittal) plane. This is not always possible due to poor patient preparation for scanning. Symmetrical flow on Doppler sonography is a typical feature of this artifact. Finally, magnetic resonance imaging or computed tomography can be considered to rule out a pathology.W  badaniu ultrasonograficznym, jak w  mało którym badaniu obrazowym, obserwuje się różnorodne artefakty. Od doświadczenia ultrasonografisty zależy ich rozpoznanie oraz prawidłowe zinterpretowanie obrazu. Artefaktami określamy echa, które nie odpowiadają żadnej strukturze anatomicznej. Powstają one na skutek założeń koniecznych do opracowania sygnału ultradźwiękowego, tj.: • prędkość ultradźwięków we wszystkich narządach i strukturach jest taka sama; • impulsy te rozchodzą się tylko w  jednym kierunku, wzdłuż prostej (nie ulegają załamaniu); • głowica wysyła ekstremalnie krótkie impulsy ultradźwiękowe;• nieznaczna część wiązki ultradźwiękowej zostaje odbita/ rozproszona na każdej powierzchni granicznej; • odbite ultradźwięki wracają do głowicy bez dalszych odbić (bezpośrednio). Natomiast zjawisko zdwojenia aorty powstaje, gdy nie zostały spełnione powyższe założenia. Kluczowe dla omawianego artefaktu są następujące fakty: • poszczególne tkanki przewodzą ultradźwięki z  różną prędkością; • impulsy wysłane przez głowicę oraz powracające echa ulegają załamaniu na granicy sąsiadujących tkanek (nie rozchodzą się wzdłuż jednej prostej)(1). Artykuł w wersji polskojęzycznej jest dostępny na stronie http://jultrason.pl/wydawnictwa/volume-17-no-6