Lung ultrasound (LUS) is increasingly utilized for diagnosing pediatric pneumonia due to its bedside accessibility, radiation-free nature, and high diagnostic sensitivity. However, broader clinical adoption remains hindered by operator dependency, inconsistent interpretation, and training challenges, particularly among trainees and less-experienced health care providers. Currently, there is an unmet need for practical tools that help trainees reliably detect pneumonia-related ultrasound findings. In this technical innovation study, we evaluated a semi-automated, artificial intelligence (AI)-assisted system designed to identify clinically relevant lung abnormalities, including pleural line thickening, consolidation morphology, and B-line patterns. Our computerized analysis demonstrated the system's technical capability to accurately detect these structural changes with minimal user interaction. Although our primary aim was to assess diagnostic feasibility, the intuitive nature and real-time visual annotations provided by this AI tool highlight its strong potential for future integration into educational contexts. By visually assisting trainees in recognizing key sonographic features, this technology can facilitate learning, improve detection skills, and effectively support the training of health care providers performing pediatric LUS.

The American College of Radiology (ACR) and Society for Pediatric Radiology (SPR) have published practice parameters for pediatric fluoroscopic contrast enema (CE) exams. The purpose of our quality assurance (QA) study was to assess adherence to neonatal (< 2 days of age) CE practice parameters at a large tertiary care pediatric hospital. Image database review identified all CE exams performed on children ≤ 2 days old at our institution between February 2019 and August 2022. Two pediatric radiologists conducted independent review of CE imaging and reports for six subjective quality criteria. One radiologist assessed six objective quality metrics. Data were summarized as counts and percentages and inter-reviewer agreement po was calculated for the subjective metrics. 70 neonatal CEs met inclusion criteria and were reviewed. For subjective criteria: A small-caliber rectal catheter was used in 93

BACKGROUND:Focused abbreviated survey technique (FAST) brain magnetic resonance imaging (MRI) (i.e., sedation-free abbreviated MRI) is progressively being implemented in the daily clinical practice of multiple pediatric institutions for neuroimaging assessment of children presenting with neurological disorders. OBJECTIVE:To survey current awareness, imaging practices, and perception of members of the European Society of Pediatric Radiology (ESPR) regarding pediatric FAST brain MRI. MATERIALS AND METHODS:A survey consisting of seven questions related to FAST brain MRI was distributed electronically to all ESPR members. RESULTS:A total of 64 responses from 27 different countries (17 of which were European) were received, corresponding to a 4% response rate. Among responders, 68% were full-time pediatric radiologists and the great majority (94%) were aware of current clinical use of FAST brain MRI in the pediatric setting. Moreover, 83% already apply this imaging approach in daily work activity, more commonly for a few years (85%). The most cited advantage for adopting this imaging approach was radiation risk reduction (95%). Major reported obstacles to routine implementation were technical/human resource limitations (63%), potential medicolegal implications (55%), and lower image quality reducing diagnostic accuracy (53%). Diverse protocols are used, including utilization of inhouse/custom developed solutions (68%) or one of multiple commercially available/published protocols (17%), or both (15%). Near all participants (97%) expressed desire for formal consensus recommendations from the ESPR on the topic. CONCLUSION:Despite widespread knowledge and high clinical adoption rate of pediatric FAST brain MRI among participants, clinical indications/protocols remain variable and some barriers persist in the daily practice, highlighting the need for evidence-based consensus-driven guidelines.

Central skull base osteomyelitis with sellar epidural abscess and neurovascular narrowing are a unique combination of imaging findings resulting from complicated acute paranasal sinusitis. Nonspecific clinical presentation and insidious onset with atypical initial imaging findings often pose a diagnostic challenge. We present two cases of acute sinusitis, which progressed to central skull base osteomyelitis and additional intracranial complications. Maintaining a high index of suspicion and a multidisciplinary approach during preoperative workup are essential for timely management.

OBJECTIVE:Few studies have described long-term respiratory sequelae of adolescent (people aged 10-19 years) tuberculosis (TB) survivors. We hypothesized that compared with healthy adolescents with no history of TB, survivors of adolescent pulmonary TB have greater respiratory impairment (reduced lung function) and disability (symptoms and activity limitations). METHODS:In this prospective cohort study in Lima, Peru, we used spirometry, oscillometry, and the St George's Respiratory Questionnaire (SGRQ) to evaluate, on 2 separate occasions, the lung health of adolescents successfully treated for pulmonary TB and matched healthy controls. TB survivors with abnormal lung function underwent chest computed tomography (CT). Using mixed-effects regression with an interaction term for time since treatment completion and random effects for individual and matched pairs, we modeled changes in lung function and disability over 24 months from treatment completion, comparing findings between TB survivors and controls. RESULTS:Compared with 101 controls (median age 17 years, 56% male), 101 TB survivors (median age 18 years, 56% male) had less favorable forced expiratory volume in 1 second, forced vital capacity, total airway resistance (R5), small airway resistance (R5-20), and reactance area (AX). Over the study period, AX, R5, and R5-20 improved for TB survivors but remained worse than controls. TB survivors had persistently greater respiratory disability (measured by SGRQ). Chest CTs of TB survivors demonstrated architectural distortion, reticular patterns, nodules, and bronchiectasis. CONCLUSION:Adolescent TB survivors experience persistent, symptomatic chronic lung disease despite bacteriological cure. Our findings highlight the need for respiratory assessments beyond treatment completion.

Pleural tuberculosis (TB) is the most common presentation of extrapulmonary TB and the most common cause of pleural effusion worldwide. Effusion due to TB is rare in children younger than 5 years and more common in adolescent boys. Pleural disease can range from small effusions associated with parenchymal disease in young children to large effusions seen mostly in older children and adolescents. The effusion can progress from a simple effusion to complicated pleural disease with the development of TB empyema or involvement of the chest wall. There is a paucity of information on the management of complicated TB pleural disease. Although most children will be treated conservatively, surgical intervention may be required to prevent post-TB lung disease and functional loss. Bronchopleural fistula (BPF) is a rare complication in children but can be very difficult to manage, especially in children with severe chronic or cystic lung disease, leading to prolonged hospitalization. Interventional bronchoscopy may have a role in the management of persistent BPF with the placement of either blood clots or valves, but there is limited evidence for these procedures in paediatrics.

The pediatric skull base develops through a complex sequence of events from fetal development through adolescence and may result in numerous normal variants and embryonic remnants that can mimic pathology on imaging. This review highlights the embryologic basis and imaging appearance of common central skull base developmental variants encountered in children. Focusing on synchondroses, clefts, foramina, notochordal remnants, and pneumatization-related variants, we emphasize age-dependent findings and key imaging features that provide radiologists with a reference to support confident interpretation and the ability to distinguish benign developmental variants from true pathology in children.

Infants experience facial fractures infrequently due to their limited mobility, and when such injuries do occur, the mandible is among the most affected facial bones. Isolated mandibular condylar fractures, however, are rarely reported in this age group. Clinical detection is particularly challenging in nonverbal infants, making careful imaging assessment essential when evaluating facial trauma. This case series presents infants with condylar fractures that were first identified on head CT studies, emphasizing key clinical considerations and the importance of evaluating the mandibular condyles on every head CT.

BACKGROUND AND PURPOSE:The sphenoid bone forms from multiple ossification centers. Its body develops through the fusion of presphenoid and postsphenoid cartilages separated by the intersphenoid synchondrosis. Variations in ossification can lead to persistent craniopharyngeal duct remnants, potentially associated with pituitary dysfunction or tumors. We aimed to determine the timeline of closure of these synchondroses and associated foramina in children without skull base abnormalities on CT scans. MATERIALS AND METHODS:This retrospective study analyzed CT scans of children aged 0-6 years from a tertiary pediatric hospital (2018-2022). Scans with abnormalities or skull anomalies were excluded. Two pediatric radiologists assessed synchondroses and foramina, classifying them as patent or fused. Sample size was determined using area under the curve (AUC) analysis. Statistical methods included descriptive analysis, interrater reliability (Cohen κ, intraclass correlation coefficient), Mann-Whitney U test, and cut-point analysis with bootstrapping to determine closure times. RESULTS:We analyzed 160 scans (94 boys, 58.8%; 66 girls, 41.2%) with a median age of 1.4 years (interquartile range: 0.3-3.7). Interrater reliability was strong (κ > 0.80) for most structures, moderate for detecting intrapresphenoid synchondrosis and pneumatization, and weak for intrapostsphenoid synchondrosis. Cut-point analysis demonstrated that the intersphenoid synchondrosis fused first at 4 months, followed by the intrapresphenoid synchondrosis, the anterior and posterior foramen, with pneumatization occurring last at 24.8 months; all with an AUC >80%. Pair-wise threshold differentiation showed pneumatization followed the closure of intersphenoid synchondrosis, intrapresphenoid synchondrosis, and anterior foramen by 22.8, 22.7, and 17.4 weeks, respectively. CONCLUSIONS:The sphenoid body synchondroses and foramina show a predictable closure timeline within the first year of life, while pneumatization commences after the second year. Understanding this timeline provides radiologists with a reference standard for interpreting CT examinations that include the skull base (eg, head, maxillofacial, temporal bone CTs) in children younger than 2 years of age, supporting more confident interpretation and potentially reducing overcalling and related follow-up imaging.

BACKGROUND Left main bronchus compression (LMBC) is an uncommon cause of respiratory morbidity in children. Vascular compression between the left pulmonary artery and descending thoracic aorta causes severe dynamic airway obstruction. Posterior aortopexy is an established surgical treatment, but outcome data from low- and middle-income countries (LMICs) remain limited. METHODS Retrospective descriptive case series reviewed children 0–12 years with LMBC secondary to vascular compression who underwent posterior aortopexy between 2002-2023. Clinical, bronchoscopic and radiological findings, operative details, and outcomes were analysed. RESULTS Twenty-nine children, median age of 18 months (IQR 6–36) were included. Presenting features were stridor (69%), recurrent infections (69%), and wheeze refractory to therapy (52%). Bronchoscopy demonstrated ≥75% obstruction with pulsatile vascular compression in all patients. CT confirmed bronchial narrowing in 75% of cases, with most airways ≤3 mm in diameter. All underwent posterior aortopexy. Post-operative bronchoscopy showed marked airway improvement in all, with <50% residual compression in 86% and complete decompression in 14%. No operative or immediate post-operative deaths occurred. Medium-term survival was 97%, with complete resolution of respiratory symptoms at 2–3 years. CONCLUSIONS Isolated LMBC due to vascular compression is a rare but surgically correctable cause of paediatric airway obstruction. Posterior aortopexy provides safe, effective relief with excellent outcomes, even in LMICs. Early recognition and bronchoscopic assessment are essential to prevent irreversible lung injury.

Most artificial intelligence (AI) research in radiology has focused on adults. Understanding macro-level trends in pediatric radiology AI can help guide, streamline, and bolster future research. To detail the current landscape of published AI research in pediatric radiology, filling a key research gap, as most radiology AI research has focused on adults. We conducted a scoping review, with a comprehensive literature search of Medline, Embase, Web of Science, and Cochrane Library from 2005 to 2024. Literature included for review were (1) original articles, (2) investigations that focused on pediatric populations (<18 years of age), and (3) articles with direct applications to clinical radiology and AI. We extracted each article’s study information, clinical application of focus, imaging modality, and the use of AI. We used descriptive frequencies to analyze summary statistics, and Chi-square testing to determine differences between categories. In total, we found 4,376 articles and included 789 articles in the review. The top three countries most active in scholarship related to AI in pediatric radiology were China (220, 27.9

INTRODUCTION:Neonatal lung biopsy guides management of unusually severe, diffuse lung disease with an uncertain diagnosis. Childhood interstitial lung disease (chILD) constitutes a diverse group of uncommon respiratory diseases which are associated with major morbidity and mortality. The incidence, outcome and mortality of chILD and other severe respiratory diseases in resource-limited settings (RLS) are unclear. OBJECTIVE:This retrospective, descriptive study examined lung biopsy in an RLS on infants up to 3 months of age to diagnose and facilitate management. This study included neonates with severe respiratory distress not responding to surfactant replacement. RESULTS:Lung biopsy was diagnostic in 94% (29/31) of patients without procedure-related mortality. The mean gestational age at birth was 35.8 weeks (SD ± 4.6). The mean presentation age was 20 days of life (IQR 1-28). Of 31 participants, 16% (n = 5) had histological findings in keeping with pulmonary interstitial glycogenosis (PIG) only. Sixteen percent (n = 5) of biopsies showed findings in keeping with adenosine triphosphate (ATP)-binding cassette subfamily A member 3 (ABCA3) deficiency in combination with features of PIG on electron microscopy. Surfactant protein (SFTP)-B deficiency and undefined surfactant deficiency were equally prevalent (6% (n = 2). Pulmonary hypertension (PHT) featured in 61% (n = 17) of infants. Genetic testing was performed on 29% (n = 9) of infants, with 56% (n = 5) showing normal results. The cohort mortality was 42% (n = 13). CONCLUSIONS:ChILD should be considered in neonates with severe respiratory distress and PHT not responding to surfactant replacement. Lung biopsy is safe and diagnostic and may prevent long and futile treatment. Histopathological diagnosis frequently assists treatment decisions. Future multicentre studies should include children from an RLS to collect information on diagnoses, genetics and treatment responses.

INTRODUCTION:Pneumocystis jirovecii pneumonia (PJP) is a significant cause of morbidity and mortality in children with advanced HIV disease (AHD) and other immunosuppressive conditions. Acquired tracheal stenosis in children living with HIV (CLHIV) has not been described. CASE PRESENTATION:A 4-month and 3-week-old child living with HIV presented with persistent respiratory symptoms after mechanical ventilation for 10 days for confirmed PJP and cytomegalovirus (CMV) pneumonia at the age of 3 months and 1 week. She tested positive for HIV at 3 months of age and had a high viral load of log 2.7 copies/mL. She was re-admitted to the PICU with multilobar pneumonia, requiring non-invasive ventilation with metapneumovirus identified from nasopharyngeal aspirate. Persistent wheeze and stridor were noted. During hospitalization, the mother was diagnosed with confirmed tuberculosis (TB). The child was referred for bronchoscopy due to the possibility of pulmonary TB and airway compression. A chest CT scan revealed short segment tracheal stenosis of >50% but no signs of TB as a possible cause. Bronchoscopy demonstrated significant narrowing occurring in the midtracheal region with the acquired nature configuration. The stenosis was successfully dilated twice, first with rigid bronchoscopy, followed by dilatation with flexible bronchoscopy and an angioplasty balloon. CONCLUSION:Acquired tracheal stenosis in CLHIV is not well documented, although many young children with HIV infection have been ventilated for severe pneumonia. Bronchoscopy should be considered in children with persistent respiratory symptoms, and endoscopic procedures can be safely performed in immunosuppressed children.

INTRODUCTION:There is a scarcity of data on the utilization of thoracotomy for lung pathology in children in low- and middle-income countries (LMICs). These countries have high burdens of infectious diseases, especially tuberculosis, hydatic disease and Human immunodeficiency virus (HIV). METHODS:This is a retrospective descriptive study reviewing the indications for thoracotomy in a single center in a LMIC country. The study included all children under the age of 13 who underwent thoracotomy for pulmonary disease or vascular conditions affecting the airways at Tygerberg Hospital between January 2018 and December 2022. The indications for thoracotomy were classified into five groups: infectious, congenital, diagnostic, traumatic or neoplastic. Data collected included age, sex, HIV status, indication for the thoracotomy, procedures performed, complications of surgery and the final diagnosis after surgery. RESULTS:One hundred seventy-two children who had undergone thoracotomy were studied with 182 thoracotomies performed. Infectious diseases (54.9%) were the most common indication for thoracotomy followed by congenital (35.2%), diagnostic (4.9%), traumatic (3.3%) and neoplastic (1.6%). The most common indication for thoracotomy was airway compression due to tuberculosis (TB) lymph nodes (21.4%), followed by hydatic cysts (20.9%) and vascular malformations (11.5%). CONCLUSION:LMICs still face a significant burden of infectious and congenital diseases requiring thoracotomy, as compared to higher-income countries where neoplastic indications are most common. During the study period, hydatid cysts have become more prevalent and is now the most common indication for thoracotomy in the study setting. Thoracotomy can be safely performed in an LMIC setting with low morbidity and mortality, also in HIV-positive children.

Purpose This study examined the occurrence and MRI characteristics of perinatal arterial ischemic stroke (PAIS) in children with cerebral palsy (CP) and suspected term hypoxic-ischemic injury (HII). Methods A retrospective review of brain MRI scans was conducted on children with CP and suspected term HII in South Africa. Results Out of 1620 children with CP included in the study, 15 (0.9%) had PAIS. The most common site of infarct was the left middle cerebral artery. The majority of infarcts were unilateral, and 67% of cases exhibited cystic changes. Among children with PAIS, 47% exhibited concurrent HII, with the predominant patterns being basal-ganglia-thalamus (BGT) and watershed (WS). In cases of isolated PAIS (53%), network injuries were prevalent in 88% of children, most commonly involving the posterior limbs of the internal capsule, cerebral peduncles, thalami, and corpus callosum. Conclusions The study highlights that PAIS is a relatively rare condition in children with CP, predominantly occurring in the left middle cerebral artery.