Faculty Bibliography

BACKGROUND: Shielding of the gonads is a dose-saving strategy in pediatric radiography and its use is the law in New York and the majority of other states. However, routine use of gonadal shields is controversial because of concerns that important diagnostic information can be obscured. OBJECTIVE: The purpose of this study was to assess the frequency and spatial distribution of key findings on portable neonatal abdominal radiographs. MATERIALS AND METHODS: We reviewed the 2,544 portable neonatal intensive care unit anteroposterior abdominal radiographs performed in 2010 at a university medical center, of which 962 were inadequately shielded. These 962 radiographs were reviewed by pairs of pediatric radiologists for the presence of findings in different regions, including bowel abnormalities, pneumatosis, free air, inguinal hernias, osseous abnormalities, and catheter/tube tips. RESULTS: The fewest pertinent findings were present below the level of the sacrosciatic notches (n = 181, 18.8%). Of the 853 abnormalities below the level of the iliac crests in our cohort, six were isolated to these regions, whereas others had concomitant abnormalities more superiorly. Of 35 radiographs with pneumatosis or suspected pneumatosis in the pelvis, 33 had pneumatosis in more superior regions. Suspected free air was never isolated to the pelvis. Osseous abnormalities were only present in the pelvis below the sacrosciatic notch, and 37.5% of lower extremity catheters terminated below the level of the sacrosciatic notches. CONCLUSION: Pertinent findings on neonatal intensive care unit abdominal radiographs are rarely isolated to the pelvic regions.

Purpose or Case Report: Distinguishing perforated from non-perforated appendicitis in children, a known limitation of ultrasound, may alter surgical management. We evaluated the diagnostic utility of select groups of sonographic findings for diagnosis of perforated appendicitis. Methods & Materials: With IRB approval, we retrospectively reviewed 116 abdominal ultrasound (US) exams obtained for evaluation of abdominal pain in children aged 2-18 years from 1/2008 to 9/2011 at a university hospital pediatric radiology department. The study group consisted of surgical and pathology proven acute appendicitis (n=51) and perforated appendicitis (n=22) US exams. Negative US exams for appendicitis (n=43) confirmed by follow up verbal communication comprised the control group. The de-identified US exams were independently reviewed on PACS workstations by four experienced pediatric radiologists blinded to diagnosis and clinical information. The radiologists recorded the presence of dilated bowel, right lower quadrant (RLQ) echogenic fat, increased hepatic periportal echogenicity, and intraperitoneal fluid, indicating quantity (number of abdominal quadrants) and quality of the fluid (simple or complex). Logistic regression for correlated data was used to evaluate the association of diagnosis with the presence versus absence of each US finding in addition to selected groups of US findings. Results: The select groups of findings included increased hepatic periportal echogenicity, echogenic fat, and complex fluid yielding a specificity of 95.0%for perforated appendicitis; increased hepatic periportal echogenicity and 2+ quadrants of fluid yielding a specificity of 96.1%; increased hepatic periportal echogenicity and dilated bowel with a specificity of 98.0%; and dilated bowel, echogenic fat and complex fluid with a specificity of 99.5%. The above constellations of sonographic findings yielded higher specificities than that of each of the following individual findings in isolation: presence of complex fluid (9!