Identifying the Roadblocks to Successful Pediatric Imaging Without Sedation or Anesthesia

Background: Modern imaging modalities allow for assessment of a wide array of medical conditions. Because it is difficult for young children to remain still during lengthy imaging studies, there is a need for sedation and general anesthesia (GA). A growing literature, however, suggests that there may be deleterious neurocognitive effects of sedation/GA in young children. As such, it is in our patients’ best interest to critically evaluate the use of sedation/GA. Objective: To identify the roadblocks to obtaining clinical pediatric magnetic resonance imaging (MRI) exams without sedation/GA. Materials and Methods: Participants included 63 parents/guardians of 5- to 9-year-old patients who underwent outpatient MRI; 54% of the patients were sedated (n=34) and 46% not sedated (n=29). Parents and nonsedated patients completed surveys to gauge their respective knowledge, preferences, and preparation for the MRI exam. Results: The average scan duration was marginally significantly greater in sedated patients than nonsedated patients (p=0.06). Parents of sedated patients were significantly less likely to be interested in their child attempting a nonsedated scan (ppp=0.01) and practice in the mock scanner (p=0.01). Conclusion: The roadblocks to nonsedated pediatric imaging include extended scan duration, parental preference, parental anxiety, and patient anxiety. These roadblocks may be overcome by decreasing scan duration, increasing parental education, and increasing child preparation

Persistent Left Superior Vena Cava and Inferior Vena Cava Dual Drainage to Coronary Sinus: A Case Report.

Dilation of the coronary sinus is often a result of excessive volume overload from congenital anomalies of systemic venous return to the heart. These abnormalities are often discovered incidentally later in life when a patient requires cardiac imaging, cardiac catheterization, or thoracic surgery. The most common abnormality is a persistent left superior vena cava. Inferior vena cava malformation is less common, yet several different anomalies can arise. The presence of persistent left superior vena cava or inferior vena cava anomalies requires further evaluation to rule out congenital heart disease in infants. Knowledge of technically challenging systemic venous anatomy is beneficial prior to procedures necessitating central venous access such as a central line, cardiac catheterization, and intracardiac device implantation. We present an unusual case of persistent LSVC and IVC both draining directly into a severely dilated coronary sinus that was diagnosed by fetal echocardiogram and later confirmed postnatally by transthoracic echocardiogram and computed tomography angiography. To our knowledge this is the second reported case of IVC drainage into the CS and the first case that reports this as a prenatal diagnosis