Background . To analyze the spectrum of clinical features, management and outcome of children with documented spontaneous reduction of intussusception (SROI). Materials and methods. Review of records of 50 children (33 boys, 17 girls; age range 11 days–15 years; mean age 4 years) with documented SROI, in whom intussusception was initially diagnosed by sonography (US) in 44, air enema in 2, and computed tomography in 4, in the 6-year period 1992–1998. Results . Symptoms suggestive of intussusception were present in 21 (3 of whom had Henoch-Schönlein purpura and 4 had previous ileocolic intussusception reduced by air enema). Intussusception was an incidental finding in the other 29, in 28 of whom the finding was in the small bowel. Intussusception was limited to the small bowel in 43 and was ileocolic in 7. SROI was usually documented on US. Laparotomy performed in only 4 showed no evidence of intussusception or pathologic lead point. Outcome in all patients was favorable. Conclusions . SROI may present in symptomatic or asymptomatic children and occurs more commonly than previously reported. These intussusceptions are usually short-segment, small-bowel intussusceptions with no recognizable lead point. In asymptomatic patients, conservative observation is warranted. Intervention should be dictated by the clinical findings in symptomatic patients.

Objective. This study was conducted to determine the reliability of detecting features and making diagnoses of lower respiratory infections from chest radiograms in young infants.Methods. Forty chest radiograms of infants younger than 6 months of age admitted with lower respiratory tract infection to a tertiary care pediatric hospital were independently reviewed on two separate occasions by three pediatric radiologists blinded to the patients' clinical diagnoses, For each radiograph the radiologists noted whether a feature was present, absent or equivocal on a standardized form, The features examined were hyperinflation, peribronchial thickening, perihilar linear opacities, atelectasis and consolidation, On the same form each radiologist indicated whether the radiograph was normal or showed airways and/or airspace disease, Within and between observer agreement were calculated by the average weighted kappa statistic.Results. Within observer agreement for the radiologic features of hyperinflation, peribronchial wall thickening, perihilar linear opacities, atelectasis and consolidation were 0.85, 0.76, 0.87, 0.86 and 0.91, respectively, The between observer kappa results for these features were 0.83, 0.55, 0.82, 0.78 and 0.79, respectively, The within and between observer kappa statistics for interpretation of the radiographic features were best for airspace disease (within, 0.92; between, 0.91), and lower for normal (within, 0.80; between, 0.66) radiogram and for airways disease (within, 0.68; between, 0.48), The presence of consolidation was highly correlated with a diagnosis of airspace disease by all three radiologists.Conclusions. Clinicians basing the diagnosis of lower respiratory infections in young infants on radiographic diagnosis should be aware that there is variation in intraobserver and interobserver agreement among radiologists on the radiographic features used for diagnosis, There is also variation in how specific radiologic features are used in interpreting the radiogram, However, the cardinal finding of consolidation for the diagnosis of pneumonia appears to be highly reliable.

Two cases of congenital tracheal stenosis were managed conservatively despite mild to moderate initial respiratory symptomatology in infancy. Serial CT examinations were performed on each child, with tracheal dimensions and cross-sectional areas measured in the region of stenosis at each CT examination. The examinations document increases in tracheal cross-sectional area in the region of stenosis over time, confirming tracheal cartilage growth. We present these data to dispel the hypothesis that tracheal growth does not occur in complete-ring tracheal stenosis. The selection of cases for surgical repair must be considered with the knowledge that this anomaly does not carry an inevitably poor prognosis.

Long-term prostaglandin (PG) therapy has recently been associated with gastric mucosal hyperplasia. We reviewed the clinical and radiologic (especially sonographic) records of eight patients with complex congenital heart disease who were on PG therapy. Feeding problems, vomiting, and abdominal distension were present in six patients. Barium meal revealed antral narrowing in three patients, suggestive of hypertrophic pyloric stenosis in two. Sonography showed a variable degree of increased gastric mucosal lobulation often accompanied by a marked polypoid or lobular appearance. Cortical hyperostosis related to PG therapy was seen in three patients. PG-associated gastric mucosal hyperplasia can cause feeding problems and pronounced gastric lobulation.

A 2-year-old girl presented with a large right middle lobe cavitating lesion, complicated by life-threatening hemoptysis secondary to hyperimmunoglobulinemia E (hyper IgE) syndrome (Job's syndrome). This proved to be a bronchial artery pseudoaneurysm which was successfully embolized.

Technological advances in three-dimensional computer software packages have resulted in fairly widespread acceptance of 3D imaging for musculoskeletal studies. We have recently applied this technology to axial CT images of the pediatric trachea for children with congenital tracheal stenosis, in an effort to replace tracheo-bronchography with a safer, less invasive modality to image the pediatric trachea. This method has provided our surgical colleagues with images which they find easier to interpret because they are more anatomically oriented with respect to regional mediastinal structures, which can be included or removed from the image at will. The images can also be manipulated and rotated through various projections, thus facilitating surgical planning.

While trauma is still the leading cause of death in the pediatric age range, it is surprising how little the CT appearances of pediatric chest injury have been investigated in the literature. We have reviewed the CT findings of blunt chest trauma in 44 children for whom chest CT examinations were requested to investigate the extent of intrathoracic injury. We noted a propensity for pulmonary contusions to be located posteriorly or posteromedially, and for them to be anatomically nonsegmental and crescentic in shape. This is possibly attributable to the relatively compliant anterior chest wall in children. The CT appearances of other major thoracic injuries are described, including pulmonary lacerations, pneumothoraces, malpositioned chest tubes, mediastinal hematomas, aortic injury, tracheobronchial injury, hemopericardium, and spinal injuries with paraspinal fluid collections. Children demonstrating findings incidental to the actual injury yet important to the subsequent therapy are also presented. We conclude that, in the event of clinically significant blunt chest trauma, the single supine chest examination in the trauma room is insufficient to adequately identify the extent of intrathoracic injury. With the exception of concern for aortic injury for which aortography is indicated, a dynamically enhanced CT scan of the thorax should be performed as clinically significant findings may result in altered therapy.

Aggressive fibromatosis is a locally invasive, non-metastasizing tumour of fibrous origin and variable radiologic appearance. The authors describe a child with intrathoracic aggressive fibromatosis that mimicked congenital malformation of the lung.

The CT appearance of asymptomatic splenic necrosis in a 11-year-old girl with Wegener's granulomatosis is presented. Sonography showed splenic inhomogeneity with patency of the splenic artery and vein. Follow-up CT showed lobulation and shrinkage of the spleen with return to a normal attenuation.

In spite of rapidly expanding interest in digital radiography (DR) (1,2,3,4), there have been relatively few reports in pediatrics (5,6) and none involving the pediatric emergency room setting. We therefore set out to determine the utility and diagnostic accuracy of digital imaging in pediatric patients seen in our emergency room.

The authors reviewed the medical histories and radiological examinations of five pediatric patients with a histologic diagnosis of Wegener's granulomatosis (WG) seen over a six year period in whom a total of 22 thoracic CT scans were performed. Involvement of both the upper and lower respiratory tracts was seen in all patients at presentation. One patient had subglottic stenosis necessitating tracheotomy. Pulmonary hemorrhage occurred in three patients at initial diagnosis. Classic cavitary lung nodules were seen in two patients--one at initial presentation, the other at relapse. The plain radiographic lower respiratory tract manifestations of pediatric WG were protean both at initial presentation and during follow up. Similarly, disease expression was highly variable on thoracic CT examinations but, overall, multifocal parenchymal infiltrates with or without small peripheral nodules were the commonest thoracic CT manifestations. As a consequence of cytotoxic and corticosteroid therapy the long-term prognosis of WG has improved considerably in recent years. Knowledge of the varied patterns of the primary disease and potential for iatrogenic complications are necessary for successful radiologic assessment of pediatric patients with WG.