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1.
Nadja Kadom Zarir Khademian Gilbert Vezina Eglal Shalaby-Rana Amy Rice Tanya Hinds 《Pediatric radiology》2014,44(7):839-848
Background
In the evaluation of children younger than 3 years with intracranial hemorrhage it can be difficult to determine whether the cause of hemorrhage was traumatic, and if so, whether abusive head trauma (AHT) is a possibility. Cervical spine MRI is not a routine part of the nationally recommended imaging workup for children with suspected abusive head trauma. There is increasing evidence that spinal injuries are found at autopsy or MRI in abused children. However the prevalence of cervical spine injuries in children evaluated for abusive head trauma is unknown. We sought to determine both the incidence and the spectrum of cervical spine and brain injuries in children being evaluated for possible abusive head trauma. We also examined the relationship between cervical and brain MRI findings and selected study outcome categories.Materials and methods
This study is a 3-year retrospective review of children evaluated for abusive head trauma. Inclusion criteria were: children with head trauma seen at our institution between 2008 and 2010, age younger than 36 months, availability of diagnostic-quality brain and cervical spine MRI, and child abuse team involvement because abusive head trauma was a possibility. A child abuse pediatrician and pediatric radiologists, all with board certification, were involved in data collection, image interpretation and data analysis. Statistical analysis was performed using Stata v12.1.Results
The study included 74 children (43 boys, 31 girls) with a mean age of 164 days (range, 20–679 days). Study outcomes were categorized as: n?=?26 children with accidental head trauma, n?=?38 with abusive head trauma (n?=?18 presumptive AHT, n?=?20 suspicious for AHT), and n?=?10 with undefined head trauma. We found cervical spine injuries in 27/74 (36%) children. Most cervical spine injuries were ligamentous injuries. One child had intrathecal spinal blood and two had spinal cord edema; all three of these children had ligamentous injury. MRI signs of cervical injury did not show a statistically significant relationship with a study outcome of abusive head trauma or help discriminate between accidental and abusive head trauma. Of the 30 children with supratentorial brain injury, 16 (53%) had a bilateral hypoxic–ischemic pattern. There was a statistically significant relationship between bilateral hypoxic–ischemic brain injury pattern and abusive head trauma (P?<?0.05). In addition, the majority (81%) of children with bilateral hypoxic–ischemic brain injuries had cervical injuries.Conclusion
Although detection of cervical spine injuries by MRI does not discriminate between accidental and abusive head trauma, it can help to distinguish a traumatic from non-traumatic intracranial subdural hemorrhage. Cervical MRI should be considered in children with acute intracranial bleeds and otherwise non-contributory history, physical examination and ophthalmological findings. There is a statistically significant relationship between diffuse hypoxic–ischemic brain injury patterns and abusive head trauma. The high incidence of cervical injuries in children with hypoxic–ischemic injuries suggests a causal relationship. Overall, increased utilization of brain and spine MRI in children being evaluated for abusive head trauma can be helpful. 相似文献2.
Ignasi Barber Jeannette M. Perez-Rossello Celeste R. Wilson Michelle V. Silvera Paul K. Kleinman 《Pediatric radiology》2013,43(11):1507-1515
Background
Spinal fractures are uncommon manifestations of child abuse and elimination of the lateral views of the spine from the initial skeletal survey protocol has been recommended.Objective
To establish the prevalence of spinal fractures detected on skeletal surveys performed for suspected child abuse and their association with intracranial injury (ICI).Materials and methods
The ACR standardized skeletal surveys and neuroimaging studies of 751 children (ages 0–4 years) were reviewed. A positive skeletal survey was defined as having one or more clinically unsuspected fractures.Results
Fourteen children had a total of 22 definite spinal fractures. This constituted 1.9% (14/751) of the total cohort, and 9.7% (14/145) of children with a positive skeletal survey. Advanced imaging confirmed the fractures in 13 of the 14 children and demonstrated 12 additional spinal fractures. In five cases, spinal fractures were the only positive skeletal findings. In 71% (10/14) of the children, the spinal fractures were accompanied by ICI. Children with spinal fractures were at significantly greater risk for ICI than those without spinal injury (P?<?0.05).Conclusion
Spinal fractures are not rare in children with positive skeletal surveys performed for suspected abuse and they may be the only indication of skeletal trauma. There is an association between spinal fractures and ICI. 相似文献3.
4.
R. Schumacher B. Navarro-Crummenauer Dr. M. Stenzel 《Monatsschrift für Kinderheilkunde》2012,160(1):55-61
Background
The quality of radiological primary diagnostics in suspected child abuse was assessedPatients and methods
All radiological documents in cases of suspected child abuse from July 2007 to October 2009 were subjected to an independent second analysis by 2 pediatric radiologists concerning image quality, completeness according to present guidelines and diagnosis.Results
A total of 28 cases, aged between 6 weeks and 2 years (mean 5.8 months, median 3.5 months, 11 females and 17 males) from clinics in Rhineland-Palatinate (n=25) and Hesse (n=3) were included.Conclusion
There is an obvious deficit in the radiologic diagnostics of fractures in children. Urgent attention has to be paid to this matter. 相似文献5.
6.
Objective
To assess the proportion and pattern of extracardiac birth defects in children with congenital heart defects referred to a tertiary care institute.Methods
Cross-sectional observational study from January 2010 to June 2011.Results
Out of 560 children with congenital heart defects, 98 (17.5%) had extracardiac birth defects. Fifty-six had multiple congenital defects; 36 were syndromic cases and 6 had laterality defects. A total of 386 extracardiac birth defects (103 major and 283 minor) were documented, with craniofacial and skeletal birth defects being the commonest.Conclusion
Extracardiac birth defects are common in children with congenital heart defects. 相似文献7.
Background
The radiologic evaluation of Hirschsprung disease is well described in the literature. However, there is a paucity of literature describing the appearance of the neo-rectum and colon after repair, specifically describing findings in patients with poor functional outcome, which would suggest the need for reoperation.Objective
We describe findings on contrast enema and correlate them with surgical findings at reoperation in children with poor functional outcome after primary repair for Hirschsprung disease who suffer from bowel dysfunction that can manifest with either soiling or obstructive symptoms such as enterocolitis.Materials and methods
Children were identified from our colorectal surgery database. At the time of abstract submission, 35 children had contrast enemas prior to reoperation. Additional children continue to present for evaluation. The majority of children included in the study had their primary repair performed elsewhere. The initial procedures included: Duhamel (n?=?11), Soave (n?=?20) or Swenson (n?=?3). One child had undergone a primary Soave repair and subsequently had a Swenson-type reoperation but continued to have a poor outcome. One child’s initial surgical repair could not be determined. Images were reviewed by a staff pediatric radiologist and a pediatric radiology fellow.Results
Findings encountered on contrast enema in these children include a distal narrowed segment due to stricture or aganglionic/transitional zone segment (8), dilated/hypomotile distal segment (7), thickened presacral space due to compressing Soave cuff (11), dilated Duhamel pouch (8), active enterocolitis (3) and partially obstructing twist of the pull-through segment (1).Conclusion
Multiple anatomical and pathological complications exist that can lead to bowel dysfunction in children after repair of Hirschsprung disease. Little recent literature exists regarding the radiographic findings in children. We had the opportunity to review a substantial series of these children, describe the contrast enema findings in these difficult cases and correlate them with operative findings. Radiologic evaluation is key to assessing such patients; it defines the potential anatomical problem with the pull-through and facilitates surgical planning. 相似文献8.
Surendra Narayanam Ted Gerstle Joao Amaral Philip John Dimitri Parra Michael Temple Bairbre Connolly 《Pediatric radiology》2013,43(9):1144-1151
Background
Analysis of small pulmonary nodules in children poses an important diagnostic and therapeutic challenge for clinicians.Objective
To review our experience of lung tattooing with immediate video-assisted thoracoscopic resection (IVATR) performed as a single procedure in a hybrid room for technical difficulties, complications and diagnostic yield of the procedure.Material and methods
Retrospective analysis of 31 children (16 boys, 15 girls) who underwent lung tattooing of various lesions from January 2001 to July 2011. Data were collected from the Interventional Radiology database, Electronic Patient Chart (EPC) and PACS.Results
A total of 34 lesions were treated in 31 children. Tattooing was performed on lung lesions with median size 3 mm and median depth 2 mm from pleura. Technical success was 91.1% and diagnostic yield was 100%. In seven children, it was combined with other interventional radiologic procedures. The median procedure time for lung tattooing and IVATR was 197 min.Conclusion
Lung tattooing with IVATR as a single procedure in a hybrid room is safe and effective in children with several inherent advantages, including avoiding the need to move the child from the interventional radiology suite to the operating room. 相似文献9.
Sanjay P. Prabhu Alice W. Newton Jeannette M. Perez-Rossello Paul K. Kleinman 《Pediatric radiology》2013,43(5):575-581
Background
The value of 3-D skull models in evaluation of young children with suspected child abuse is not known.Objective
The purpose of this study was to assess the value of 3-D skull models as a problem-solving tool in children younger than 2 years.Materials and methods
We performed a retrospective study on 73 children (ages 0–24 months) seen by a child protection team (CPT) who were undergoing head CT between August 2007 and July 2009.Results
Of the 73 children, volume-rendered 3-D models were obtained in 26 (35.6%). Three-dimensional models changed initial CT interpretation in nine instances (34.6%). Findings thought to be fractures were confirmed as normal variants in four children. Depressed fractures were correctly shown to be ping-pong fractures in two cases. In one case, an uncertain finding was confirmed as a fracture, and an additional contralateral fracture was identified in one child. A fracture seen on skull radiographs but not seen on axial CT images was identified on the 3-D model in one case. Changes in interpretation led to modification in management in five children.Conclusion
Use of 3-D skull models can be a problem-solving tool when there is discordance among the CT reading, subsequent radiographic investigations and clinical evaluation. 相似文献10.
Ah Young Lee Sung Ho Jang Eunsil Lee Sang Ho Ahn Hee Kyung Cho Hae Min Jo Su Min Son 《Pediatric radiology》2013,43(5):612-619
Background
Widespread white matter (WM) pathology in preterm children has been proposed.Objective
The purpose of this study was to investigate maturational differences of WM between preterm infants with thinning of the corpus callosum and full-term infants.Materials and methods
A total of 18 preterm children and 18 full-term children were divided into three subgroups according to the corrected age at the time of diffusion tensor imaging scanning. Tract-based spatial statistics was used for assessing differences in fractional anisotropy (FA) between preterm and full-term children, and between each age-related subgroup in preterm and in full-term children.Results
In the preterm group, FA values of overall WM showed an increase with age. This trend indicates that WM maturation is a gradual occurrence during a child’s first 2 years. In the full-term group, most WM structures had reached maturation at around 1 year of age; however, centrum semiovale level showed sustained maturation during the first 2 years.Conclusion
Results of our study demonstrate radiologic maturational differences of WM and provide evidence of the need for therapeutic intervention within 2 years of birth to prevent specific functional impairment and to improve clinical outcome in preterm children. 相似文献11.
Hadeel M. Seif El Dien Reem I. Esmail Rania E. Magdy Hala M. Lotfy 《Pediatric radiology》2013,43(9):1159-1165
Background
Current thalassemia major treatment includes blood transfusion and iron chelation, which is associated with growth disturbances and radiographic changes in the long bone metaphyses.Objective
To explore and discuss the spectrum of deferoxamine-induced bone-dysplasia-like changes in children with thalassemia major in Egypt.Materials and methods
We studied 59 Egyptian children with thalassemia major and generalized arthralgia. All started deferoxamine treatment at 3 years of age. We conducted skeletal survey and MRI of both knees in radiographically positive children. Each child’s age, serum ferritin, age of onset and duration of therapy were compared with the radiologic findings.Results
Twenty-two (37.3%) children had variable degrees of skeletal dysplasia-like changes similar to those described with deferoxamine intake, mostly around the knees. Mild dysplasia-like changes were seen in 4 (18%) children; moderate changes were seen in 11 (50%) children and severe changes were seen in 7 (31.8%) children. No statistically significant relationships were detected between bone changes and the children’s age, age of starting deferoxamine, duration of therapy, or serum ferritin level.Conclusion
A wider spectrum of deferoxamine-induced bone-dysplasia-like changes was recognized despite delayed onset and small doses of therapy. These changes should be considered as a possible cause of arthropathy in children with thalassemia major, especially symptomatic children. 相似文献12.
Cleveland RH Gordon LB Kleinman ME Miller DT Gordon CM Snyder BD Nazarian A Giobbie-Hurder A Neuberg D Kieran MW 《Pediatric radiology》2012,42(9):1089-1098
Background
Progeria is a rare segmental premature aging disease with significant skeletal abnormalities. Defining the full scope of radiologic abnormalities requires examination of a large proportion of the world’s progeria population (estimated at 1 in 4 million). There has been no comprehensive prospective study describing the skeletal abnormalities associated with progeria.Objective
To define characteristic radiographic features of this syndrome.Materials and methods
Thirty-nine children with classic progeria, ages 2–17?years, from 29 countries were studied at a single site. Comprehensive radiographic imaging studies were performed.Results
Sample included 23 girls and 16 boys—the largest number of patients with progeria evaluated prospectively to date. Eight new and two little known progeria-associated radiologic findings were identified (frequencies of 3–36%). Additionally, 23 commonly reported findings were evaluated. Of these, 2 were not encountered and 21 were present and ranked according to their frequency. Nine abnormalities were associated with increasing patient age (P?=?0.02–0.0001).Conclusion
This study considerably expands the radiographic morphological spectrum of progeria. A better understanding of the radiologic abnormalities associated with progeria and improved understanding of the biology of progerin (the molecule responsible for this disease), will improve our ability to treat the spectrum of bony abnormalities. 相似文献13.
Aim
To identify the risk factors for scholastic backwardness in children.Participants
Children in the 6–12 year age group attending regular schools and referred to the child guidance clinic for scholastic backwardness.Setting
Tertiary care hospital in South India.Methods
Participants were compared with an age-and sexmatched group of children with good academic performance, to ascertain risk factors for scholastic backwardness.Results
There were 75 boys and 35 girls in the study group. Among them 30 (27%) children had mental retardation, 39 (36%) had borderline intelligence and 12 (11%) had microcephaly. Undernutrition was noted in 36 (33%) children and 31 (28%) had stunted growth. 28 (26%) children had a history of chronic medical problems like epilepsy, bronchial asthma and congenital heart diseases. Visual, hearing and speech defects were present in 6 (6%), 5 (5%) and 12 (11%) children, respectively. Statistically significant differences were noted in the educational level and employment status of parents of children with scholastic backwardness and those with good academic performance.Conclusion
Social and family factors have a significant influence on the academic functioning of children. 相似文献14.
Arabinda K. Choudhary Ramsay Ishak Thomas T. Zacharia Mark S. Dias 《Pediatric radiology》2014,44(9):1130-1140
Background
Spinal imaging has been a neglected part of abusive head trauma (AHT) imaging. As most of the radiographs and CT spine are negative in AHT in infants, the cervical spine is assumed to be normal. There is increasing evidence in the role of injury to brainstem and cervical cord in the pathogenesis of AHT. In addition, in courts of law, there is fierce debate about AHT, its mimics and other disparate nontraumatic diagnoses explaining the neuroradiological and skeletal findings. However, this discussion ignores the evidence and significance of spinal injury. We sought to study the cervical spine in an AHT cohort to understand the true prevalence of spinal injuries in AHT and contrast it with cohorts of accidental and nontraumatic groups to give the clinicians a robust diagnostic tool in evaluating AHT.Objective
The purpose of this study is to compare the relative incidence of spinal ligamentous and soft-tissue abnormalities on spinal MRI among three groups of children ages <48 months: 1) those with AHT, 2) those with accidental trauma, and 3) those with nontraumatic conditions.Materials and methods
This comparative study included 183 children who underwent spine MRI: 67 with AHT, 46 with accidental trauma and a clinical suspicion of spinal injury, and 70 with nontraumatic conditions. Clinical and radiographic findings were collected in all cases and were analyzed retrospectively to identify MRI evidence of traumatic spinal injuries. The incidence of spinal injuries among the three groups was compared. The incidence of spinal ligamentous injuries was calculated for those with and without radiographic evidence of hypoxic-ischemic encephalopathy. All comparisons were performed using Fisher exact test with P?Results Cervical spine ligamentous injuries (predominantly the nuchal, atlanto-occipital and atlanto-axial ligaments) were present in 78% of the AHT group, 46% of the accidental trauma group and 1% of the nontraumatic group; all of these differences were statistically significant. Among the AHT group, ligamentous injuries were statistically correlated with evidence of brain ischemia.Conclusion
Injury to the cervical spinal posterior ligamentous complex is common in AHT and even more prevalent than in clinically symptomatic traumatic cases. The high correlation between the radiographic findings of occipitocervical ligamentous injuries and hypoxic-ischemic brain injury is consistent with an interpretation that transient upper occipitocervical spinal cord injury in AHT leads to disordered breathing and results in hypoxic-ischemic encephalopathy. We recommend imaging the entire spine in AHT to properly identify and classify these injuries. 相似文献15.
16.
Lauren P. Golding Michael J. Walsh Thomas E. Sumner Thomas A. Nakagawa 《Pediatric radiology》2013,43(8):937-940
Background
Tracheobronchial calcifications are considered a rare radiologic finding in children. Our clinical experience indicates that this finding is not infrequently seen among children with prosthetic heart valves who have been treated with warfarin sodium.Objective
We hypothesized that calcifications of the tracheobronchial tree are more common than previously reported in this patient population.Materials and methods
We reviewed the medical records and imaging studies of children who underwent cardiac valve replacement at our institution to estimate the prevalence.Results
Tracheobronchial calcifications were identified on chest radiographs in 6 out of 17 children (35%), indicating that this imaging finding might be frequently overlooked.Conclusion
All children positive for tracheobronchial calcifications had been anticoagulated with warfarin sodium between the time of surgery and development of positive imaging findings. Our findings suggest that tracheobronchial calcifications are not uncommon in children treated with warfarin. Further investigation is necessary to determine wether there is a cause–effect relationship in these children. 相似文献17.
Background
Diagnostic findings of the skin, especially hematoma, belong to the cardinal symptoms of physical child abuse and can be found in almost 90% of all affected children.Case and discussion
We present the case of a 10-year-old girl showing vasculitic hematoma on both ventral upper arms. This case shows the importance of a thorough patient history, differentiated diagnostic considerations, and the relevance of laboratory testing in order to exclude coagulation disturbances and other pathologic alterations. 相似文献18.
Review shows that Icelandic society is taking firmer steps to tackle the diverse forms of child abuse and neglect that its children are exposed to 
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下载免费PDF全文 《Acta paediatrica (Oslo, Norway : 1992)》2018,107(9):1500-1511
Aim
This review examined and summarised the research published on child abuse in Iceland, which was mainly in the country's native language, to make the findings more accessible to English speakers. It specifically focused on child rearing and the physical, emotional and sexual abuse, neglect and intrafamilial conflicts suffered by children at the hands of their parents and other carers.Method
The review drew on published research, books and reports and compared the findings with Nordic research and global estimates of child abuse.Results
Qualitative and quantitative research revealed that the prevalence of different forms of child abuse, child neglect and intra‐familial conflicts in Iceland was similar to, or higher than, global and Nordic estimates. Younger respondents reported less physical abuse than older respondents, but higher levels of emotional abuse. Legislation, greater awareness, public debates and research on child abuse in Iceland have contributed to the growing recognition of the negative consequences of child abuse and strengthened support for prevention strategies.Conclusion
Icelandic children have reportedly experienced diverse forms of child abuse and neglect from their parents and other carers. Diverse initiatives have been put in place that underline the urgent need to tackle such behaviour.19.
Kristin Garton Crichton Jennifer N. Cooper Peter C. Minneci Jonathan I. Groner Jonathan D. Thackeray Katherine J. Deans 《Pediatric surgery international》2016,32(8):815-818
Purpose
Recognition of physical child abuse is imperative for ensuring children’s safety. Screening tools (ST) may increase identification of physical abuse; however, the extent of their use is unknown. This study assessed use of STs for physical abuse in children’s hospitals and determined attitudes regarding STs.Methods
A web-based survey was sent to child abuse program contacts at 103 children’s hospitals. The survey assessed institutional use of a ST for physical abuse and characteristics of the ST used. Respondents were asked to identify benefits and liabilities of STs used or barriers to ST use.Results
Seventy-two respondents (70 %) completed the survey; most (64 %) were child abuse pediatricians. Nine (13 %) respondents reported using a ST for physical abuse; STs varied in length, population, administration, and outcomes of a positive screen. Most respondents (86 %) using a ST felt that it increased detection of abuse. Barriers noted included lack of time for development and provider completion of a ST.Conclusions
While few respondents endorsed use of a ST for physical abuse, most believed that it increased detection of abuse. Future research should focus on development of a brief, uniform ST for physical abuse which may increase detection in at-risk children.20.
