Capitate and hamate fracture in a child: the value of MRI imaging

Carpal bone fractures in children are rare, and little is known about the appropriate tools to diagnose them, particularly in toddlers. We present a 2-year-old child with a capitate and hamate fracture. Based on our experiences with this case and on a review of the literature, we discuss the value of magnetic resonance imaging in carpal trauma in children

Ovarian germ cell tumors with rhabdomyosarcomatous components and later development of growing teratoma syndrome: a case report

<p>Abstract</p> <p>Introduction</p> <p>Development of a sarcomatous component in a germ cell tumor is an uncommon phenomenon. Most cases reported have a grim prognosis. Growing teratoma syndrome is also an uncommon phenomenon and occurs in approximately 2% to 7% of non seminomatous germ cell tumors and should be treated surgically.</p> <p>Case presentation</p> <p>We report the case of a 12-year-old Asian girl with an ovarian mixed germ cell tumor containing a rhabdomyosarcomatous component. She was treated with a germ cell tumor chemotherapy regimen and rhabdomyosarcoma-specific chemotherapy. Towards the end of her treatment, she developed a retroperitoneal mass that was increasing in size. It was completely resected, revealing a mature teratoma, consistent with growing teratoma syndrome. She is still in complete remission approximately three years after presentation.</p> <p>Conclusion</p> <p>The presence of rhabdomyosarcoma in a germ cell tumor should be treated by a combined chemotherapy regimen (for germ cell tumor and rhabdomyosarcoma). In addition, development of a mass during or after therapy with normal serum markers should raise the possibility of growing teratoma syndrome that should be treated surgically.</p

Pediatric imaging: Current and emerging techniques

Imaging has always been an important component of the clinical evaluation of pediatric patients. Rapid technological advances in imaging are making noninvasive evaluation of a wide range of pediatric diseases possible. Ultrasound and magnetic resonance imaging (MRI) are two imaging modalities that do not involve ionizing radiation and are preferred imaging modalities in the pediatric population. Computed tomography (CT) remains the imaging modality with the highest increase in utilization in children due to its widespread availability and rapid image acquisition. Emerging imaging applications to be discussed include MR urography, voiding urosonography with use of ultrasound contrast agents, CT dose reduction techniques, MR enterography for inflammatory bowel disease, and MR cine airway imaging

Pediatric imaging: Current and emerging techniques

Imaging has always been an important component of the clinical evaluation of pediatric patients. Rapid technological advances in imaging are making noninvasive evaluation of a wide range of pediatric diseases possible. Ultrasound and magnetic resonance imaging (MRI) are two imaging modalities that do not involve ionizing radiation and are preferred imaging modalities in the pediatric population. Computed tomography (CT) remains the imaging modality with the highest increase in utilization in children due to its widespread availability and rapid image acquisition. Emerging imaging applications to be discussed include MR urography, voiding urosonography with use of ultrasound contrast agents, CT dose reduction techniques, MR enterography for inflammatory bowel disease, and MR cine airway imaging

Fractures of the hands and feet in child abuse: imaging and pathologic features

PURPOSE: To determine the imaging and histopathologic appearance of fractures of the hands and feet in abused infants. MATERIALS AND METHODS: The imaging findings in 11 abused infants with fractures of the hands and feet were examined retrospectively. All 11 infants underwent skeletal surveys; five infants also underwent nuclear bone scanning. Postmortem radiographs of the specimen and histopathologic data were available in two infants. RESULTS: A total of 22 fractures were noted. Six infants had fractures of the hands: six metacarpal and nine proximal phalangeal fractures. Five infants had fractures of the feet: six metatarsal fractures and one proximal phalangeal fracture. Torus fractures predominated, and these patterns were confirmed at the histologic examinations. These morphologic features were consistent with a mechanism of forced hyperextension. Oblique views of the hands and follow-up skeletal surveys aided in detection of these injuries. Four of six metatarsal fractures involved the first ray. Seven patients had three or more additional fractures that involved the long bones of the upper and lower extremities, and seven patients had additional fractures of the ipsilateral extremity. CONCLUSION: Fractures of the hands and feet are subtle but important injuries in abused infants. Well-collimated, high-detail radiographs of the hands and feet should be included in the skeletal survey performed for suspected child abuse

Rib fractures in 31 abused infants: postmortem radiologic-histopathologic study

PURPOSE: To examine the morphologic alterations of fractures of the lateral and anterior rib arcs and costochondral junction (CCJ) to better understand the factors that influence radiographic visualization and to gain insight into the mechanism of injury in rib fractures of abused infants. MATERIALS AND METHODS: Thirty-one infants (average age, 3 months) who died with inflicted skeletal injuries were studied with high-detail, pre- or postmortem skeletal surveys, or both, and radiography of specimens, with histologic analysis. The distribution and number of fractures were determined for each technique, and dating was performed on the basis of radiographic and histologic criteria. The radiologic features were correlated with the pathologic findings in comparable histologic sections. RESULTS: Of 165 fractures, 84 (51%) involved the ribs. Only 30 rib fractures (36%) were visible with skeletal survey examination. Lateral and anterior arc fractures tended to impact along the inner cortex of the rib. CCJ fractures tended to involve the inner aspect of the osteochondral interface with an associated osseous fragment. CONCLUSION: Acute and healing rib fractures are common in infants who died with inflicted injury; detection is technique-dependent. Use of high-detail skeletal radiography to identify these injuries in live and deceased infants appears justified

Tailored low-dose fluoroscopic voiding cystourethrography for the reevaluation of vesicoureteral reflux in girls

OBJECTIVE. Radionuclide voiding cystography is generally advocated for the reevaluation of proved vesicoureteral reflux. The purpose of this study was to assess the efficacy of tailored low-dose fluoroscopic voiding cystourethrography for this purpose. SUBJECTS AND METHODS. Forty-five girls (2 years 9 months to 19 years 7 months old; mean, 7.4 years) who had proved reflux were examined with tailored low-dose voiding cystourethrography. The technique used a low-dose fluoroscopic system and a computer-based video frame grabber that produced frame-averaged digital video fluoroscopic hard copies. A tailored voiding cystourethrographic protocol was designed to minimize ovarian radiation dose. Digital images were compared with standard 105-mm spot films in a similar group of 25 children. RESULTS. The tailored low-dose fluoroscopic technique produced diagnostically adequate images in all patients that were comparable in quality to standard spot films. The ovarian dose was 1.7-5.2 mrad (0.017-0.052 mGy) with a mean of 2.9 mrad (0.029 mGy). This compared favorably with the lowest reported doses with the radionuclide technique. CONCLUSION. Tailored low-dose fluoroscopic voiding cystourethrography is an attractive and practical alternative to the radionuclide technique in girls with proved vesicoureteral reflux