Imaging of cavitary necrosis in complicated childhood pneumonia

Abstract.: The aim of this study was to illustrate the chest radiographs (CR) and CT imaging features and sequential findings of cavitary necrosis in complicated childhood pneumonia. Among 30 children admitted in the Pediatric Intensive Care Unit for persistent or progressive pneumonia, respiratory distress or sepsis despite adequate antibiotic therapy, a study group of 9 children (5 girls and 4 boys; mean age 4years) who had the radiographic features and CT criteria for cavitary necrosis complicated pneumonia was identified. The pathogens identified were Streptococcus pneumoniae (n=4), Aspergillus (n=2), Legionella (n=1), and Staphylococcus aureus (n=1). Sequential CR and CT scans were retrospectively reviewed. Follow-up CR and CT were evaluated for persistent abnormalities. Chest radiographs showed consolidations in 8 of the 9 patients. On CT examination, cavitary necrosis was localized to 1 lobe in 2 patients and 7 patients showed multilobar or bilateral areas of cavitary necrosis. In 3 patients of 9, the cavitary necrosis was initially shown on CT and visualization by CR was delayed by a time span varying from 5 to 9days. In all patients with cavities, a mean number of five cavities were seen on antero-posterior CR, contrasting with the multiple cavities seen on CT. Parapneumonic effusions were shown by CR in 3 patients and in 5 patients by CT. Bronchopleural fistulae were demonstrated by CT alone (n=3). No purulent pericarditis was demonstrated. The CT scan displayed persistent residual pneumatoceles of the left lower lobe in 2 patients. Computed tomography is able to define a more specific pattern of abnormalities than conventional CR in children with necrotizing pneumonia and allows an earlier diagnosis of this rapidly progressing condition. Lung necrosis and cavitation may also be associated with Aspergillus or Legionella pneumonia in the pediatric populatio

A forensic case of hydranencephaly in a preterm neonate fully documented by postmortem imaging techniques.

The authors present a medico-legal autopsy case of hydranencephaly in a male preterm newborn, fully documented by postmortem unenhanced and enhanced imaging techniques (postmortem computed tomography and postmortem magnetic resonance imaging). Hydranencephaly is a congenital anomaly of the central nervous system, consisting in almost complete absence of the cerebral hemispheres and replacement of the cerebral parenchyma by cerebrospinal fluid, rarely encountered in forensic medical practice. A premature baby was born during the supposed 22nd and 24th week of pregnancy in the context of a denial of pregnancy without any follow-up. The newborn died a few hours after birth and medico-legal investigations were requested to determine the cause of death and exclude the intervention of a third person in the lethal process. The external examination revealed neither traumatic nor malformative lesions. Postmortem imaging investigations were typical of hydranencephaly, and conventional medico-legal autopsy, neuropathological examination, and histological examination confirmed a massive necrotic-haemorrhagic hydranencephaly. This case represents in itself an association of out-of-the-ordinary elements making it worthy of interest. Postmortem unenhanced and enhanced imaging techniques (computed tomography and magnetic resonance imaging) were performed as complementary examination to conventional medico-legal investigations.Postmortem angiography of a preterm newborn is possible with catheterization of the umbilical blood vessels.Hydranencephaly is a congenital anomaly of the central nervous system, consisting in almost complete absence of the cerebral hemispheres and replacement of the brain by cerebrospinal fluid, for which several aetiologies have been postulated

Congenital disorder of glycosylation type Id (CDG Id): phenotypic, biochemical and molecular characterization of a new patient

Summary: Congenital disorders of glycosylation (CDG) are a family of multisystem inherited disorders caused by defects in the biosynthesis of N- or O-glycans. Among the many different subtypes of CDG, the defect of a mannosyltransferase encoded by the human ALG3 gene (chromosome 3q27) is known to cause CDG Id. Six patients with CDG Id have been described in the literature so far. We further delineate the clinical, biochemical, neuroradiological and molecular features of CDG Id by reporting an additional patient bearing a novel missense mutation in the ALG3 gene. All patients with CDG Id display a slowly progressive encephalopathy with microcephaly, severe psychomotor retardation and epileptic seizures. They also share some typical dysmorphic features but they do not present the multisystem involvement observed in other CDG syndromes or any biological marker abnormalities. Unusually marked osteopenia is a feature in some patients and may remain undiagnosed until revealed by pathological fractures. Serum transferrin screening for CDG should be extended to all patients with encephalopathy of unknown origin, even in the absence of multisystem involvemen

The material role of digital media in connecting with, within, and beyond museums

The connective potentials of digital media have been positioned as a key part of a contemporary museum visitor experience. Using a sociology of translation, we construct a network of visitor experiences using data from a digital media engagement project at a large and multi-sited museum in the United Kingdom. These experiences relate to (dis)connections with the museum, museum objects, and other visitors. Through this analysis we disclose the often contradictory roles of the non-human, including and going beyond the digital, as contributors to the success and failure of attempts to change museum visitor experiences through engagement activities rooted in narratives of participation and connectivity

Punishment in the Frame: Rethinking the History and Sociology of Art

Images of punishment have featured prominently in Western art and this article explores what might be learnt from studying such pictures of suffering. It seeks to develop an approach to the visual that avoids both the essentialism of art history and the reductionism of sociology by offering a rethinking of the relationships between the two. It begins by setting out the current state of the sociology of art, before discussing ‘new’ art histories that are inspired by social analysis. It then concentrates on how images of punishment have featured in Western art. This substantive material provides a rich resource to understand the force of representation and offers an opportunity to develop an aesthetic sociology that avoids some of the problems identified in the article. The approach developed in the second part is one that seeks to elaborate an aesthetic sociology that combines a historical sensitivity to images with the analytical concerns of social science. It strives to extend the art historian Michael Baxandall’s writings toward more sociological interpretations of visual analysis

Exploring contemporary patterns of cultural consumption : offline and online film watching in the UK

This paper focuses on patterns of film consumption within cultural consumption more broadly to assess trends in consumerism such as eclectic consumption, individualised consumption and omnivorous/univorous consumption and whether economic background and status feature in shaping cultural consumption. We focus on film because it is widely consumed, online and offline, and has many genres that vary in terms of perceived artistic and entertainment value. In broad terms, film is differentiated between mainstream commercially driven film such as Hollywood blockbusters, middlebrow ‘feel good’ movies and independent arthouse and foreign language film. Our empirical statistical analysis shows that film consumers watch a wide range of genres. However, films deemed to hold artistic value such as arthouse and foreign language feature as part of broad and wide-ranging pattern of consumption of film that attracts its own dedicated consumers. Though we found that social and economic factors remain predictors of cultural consumption the overall picture is more complex than a simple direct correspondence and perceptions of other cultural forms also play a role. Those likely to consume arthouse and foreign language film consume other film genres and other cultural forms genres and those who ‘prefer’ arthouse and foreign language film have slightly more constrained socio-economic characteristics. Overall, we find that economic and cultural factors such income, education, and wider consumption of culture are significant in patterns of film consumption

Virtual Touch (TM) Quantification to Diagnose and Monitor Liver Fibrosis in Hepatitis B and Hepatitis C: A NICE Medical Technology Guidance

King’s Technology Evaluation Centre is funded by NICE to act as an External Assessment Centre for the Medical Technologies Evaluation Programme. The NHS has a financial interest in the guidance issued by NICE as a result of this work and two authors are NHS employees (Prof. Keevil and Dr. Lewis

Contribution of magnetic resonance imaging to the prenatal diagnosis of common congenital vascular anomalies.

Screening ultrasound (US) has increased the detection of congenital vascular anomalies in utero. Complementary magnetic resonance imaging (MRI) may improve the diagnosis, but its real utility is still not well established. We aimed to describe the imaging findings on prenatal US and MRI of the most frequent congenital vascular anomalies (lymphatic malformations and congenital hemangiomas) to assess the accuracy of prenatal US and MRI exams for diagnosis and to evaluate the relevance of the additional information obtained by complementary fetal MRI. All confirmed postnatal congenital vascular anomalies detected in the last 10 years at 3 university hospitals were retrospectively identified. The prenatal diagnosis was compared with the final diagnosis for both methods and the clinical relevance of additional MRI information was evaluated. A second MRI in advanced pregnancy was performed in fetuses with lesions in a sensitive anatomical location and the clinical relevance of the additional information was evaluated. Twenty-four cases were included in the study, 20 lymphatic malformations and 4 hemangiomas. MRI slightly improved the diagnosis of lymphatic malformation, 85% vs. 80% at US, especially for abdominal lesions. Both methods had a low identification rate (25%) for tumors. MRI performed late in five fetuses with lymphatic malformation allowed optimized management at birth. MRI improves the diagnosis of congenital lymphatic malformations whereas hemangiomas remain difficult to identify in utero. The main role of MRI is to provide high-defined anatomical data to guide management at birth

Magnetic resonance imaging of fetal pelvic cysts.

The detection of fetal anomalies has improved in the last years as a result of the generalization of ultrasound pregnancy screening exams. The presence of a cystic imaging in the fetal pelvis is a relatively common finding, which can correspond to a real congenital cystic lesion or result from the anomalous liquid accumulation in a whole pelvic organ, mainly the urinary bladder, the uterus, or the vagina. In selected cases with poor prognosis and/or inconclusive echographic findings, magnetic resonance may bring additional information in terms of the characterization, anatomical location, and real extension of the pathology. This pictorial essay describes the normal pelvic fetal anatomy, as well as the most common pelvic cysts. It also describes the causes of an anomalous distension of the whole pelvic organs detected in utero, with emphasis on prenatal magnetic resonance imaging exams. Moreover, it proposes practical teaching points to reduce the differential diagnosis of these lesions based on the sex of the fetus, the division of the pelvis in anatomical spaces, and the imaging findings of the pathology. Finally, it discusses the real utility of complementary MRI

Spontaneous thrombosis of hepatic aneurysms in an infant with Wiskott-Aldrich syndrome

Vasculitides and aneurysm formation are well-known complications in Wiskott-Aldrich syndrome (WAS), most often appearing later in life, usually in second decade. The authors report the case of a 5-month-old boy with a genetically and phenotypically severe Wiskott-Aldrich syndrome and sequential formation and spontaneous thrombosis of hepatic aneurysms. This case demonstrates that aneurysm formation may develop early in the course of severe WAS phenotypes. Because of the progressive nature of these manifestations, surgical or interventional procedures are not advisable. Early allogeneic hematopoietic stem cell transplantation (HSCT) should be considered before the manifestation of irreversible organ damage