Usefulness of Chest Computed Tomography for Diagnosis of Idiopathic Pneumomediastinum with Negative Findings on Plain X-Ray

Idiopathic pneumomediastinum is rare in children. Few cases of patients with pneumomediastinum show negative findings on X-ray examination. Chest computed tomography (CT) was very useful for the diagnosis and evaluation of the extent of pneumomediastinum. We report here a case of idiopathic pneumomediastinum in a 15-year-old boy who exhibited no significant chest X-ray finding. The patient was referred to our institute for the further evaluation of pre-cordial pain and breathing difficulty. Precordial pain suddenly developed, when he was carrying a portable shrine on his shoulder (day of onset). He was admitted to another institute 3 days after onset because of worsening precordial pain. On admission, he presented with 98% saturation of hemoglobin in the peripheral blood under room air. Plain chest X-ray also revealed no abnormal findings. A half-dissolved gastrographin swallow showed no leakage of gastrographin from the pharynx and esophagus to the mediastinum, and no diverticulum within the esophagus. Plain chest CT revealed extensive emphysema around the trachea from the neck to the portion inferior to the carina of trachea. The patient was diagnosed with idiopathic pneumomediastinum because the cause was unclear. We decided to admit him to our institute under fasting conditions and rest. His symptoms improved 3 days after onset. The lesion had disap-peared 8 days after onset on chest CT. When young people experience precordial pain which increases on inspiration, we must consider pneumomediastinum in a differential diagnosis, and it is important to perform chest CT.

Is computed tomography cystography indicated in children with pelvic fractures?

Purpose: Pelvic fracture evaluation with abdominopelvic computed tomography (CT) and formal CT cystography for rule out of urine bladder injury have been commonly employed in pediatric trauma patients. The additional delayed imaging required to obtain optimal CT cystography is, however, associated with increased doses of ionizing radiation to pelvic organs and represent a significant risk in the pediatric population for future carcinogenic risk. We hypothesized that avoidance of routine CT cystography among pediatric pelvic fracture victims would not result in an appreciable rate of missed bladder injuries and would aid in mitigating the radiation exposure risk associated with these additional images.Methods: A retrospective cohort study involving blunt trauma pelvic fractures among pediatric trauma patients (age<14) between the years 1997 and 2016 was conducted utilizing the Israeli National Trauma Registry. Statistical analysis was performed using SAS statistical software version 9.4 via the tests of Chisquare test and two-sided Fisher’s exact test. Ap value of less than 0.05 was considered statistically significant.Results: A total of 1072 children were identified from the registry for inclusion. Mean age of patients was 7.7 years (range 0-14) and 713 (66.5%) were male. Overall mortality in this population was 4.1% (44/1072). Only 2.1% (23) of pediatric patients with pelvic fractures had bladder injury identified, with just 9 children having intraperitoneal bladder rupture (0.8% of all the patients).Conclusion: The vast majority of blunt pediatric trauma victims with pelvic fractures do not have urine bladder injuries. Based on our study results we do not recommend the routine utilization of CT cystography in this unique population.

Chest X-rays in detecting injuries caused by blunt trauma

BACKGROUND:The appropriate sequence of different imagings and indications of thoracic computed tomography(TCT)in evaluating chest trauma have not yet been clarified at present.The current study was undertaken to determine the value of chest X-ray(CXR)in detecting chest injuries in patients with blunt trauma.METHODS:A total of 447 patients with blunt thoracic trauma who had been admitted to the emergency department(ED)in the period of 2009–2013 were retrospectively reviewed.The patients met inclusion criteria(age>8 years,blunt injury to the chest,hemodynamically stable,and neurologically intact)and underwent both TCT and upright CXR in the ED.Radiological imagings were re-interpreted after they were collected from the hospital database by two skilled radiologists.RESULTS:Of the 447 patients,309(69.1%)were male.The mean age of the 447 patients was 39.5±19.2(range 9 and 87 years).158(35.3%)patients were injured in motor vehicle accidents(MVA).CXR showed the highest sensitivity in detecting clavicle fractures[95%CI 78.3(63.6–89)]but the lowest in pneuomediastinum[95%CI 11.8(1.5–36.4)].The specificity of CXR was close to 100%in detecting a wide array of entities.CONCLUSION:CXR remains to be the first choice in hemodynamically unstable patients with blunt chest trauma.Moreover,stable patients with normal CXR are candidates who should undergo TCT if significant injury has not been ruled out.

非外伤性儿童急诊颅脑CT检查结果阳性的临床预测因子

目的寻找非颅脑外伤儿童的急诊颅脑 CT 结果阳性的临床预测因子。资料与方法回顾性分析行急诊颅脑 CT 检查的 374 例非颅脑外伤急诊儿童(≤14 岁)的资料,以年龄、性别、抽搐、头痛、头晕/眩晕/行走不稳、晕厥、呕吐、发热、易发因素、体格检查异常、意识障碍作为临床因子;通过多因素 Logistic 回归分析寻找非颅脑外伤儿童的急诊颅脑 CT 结果阳性的独立临床预测因子。结果颅脑 CT 结果阳性 29 例,阳性率为 7.8%;多因素 Logistic 回归分析表明,易发因素(OR=12.109,95%CI 1.96~74.80)、体格检查异常(OR=3.704,95% CI 1.17~11.72)、意识障碍(OR=9.593,95% CI 2.80~32.83)是颅脑 CT 检查结果阳性的临床预测因子。结论易发因素、体格检查异常、意识障碍是非颅脑外伤儿童急诊颅脑 CT 检查结果阳性的独立临床预测因子。

The Utility of Diagnostic Imaging in Fish Bone Impaction

Objectives: The purpose of this pilot study was to obtain an Australian perspective on evaluating the utility of plain film radiography and computed tomography (CT) to rule out fish bone impaction in the upper aerodigestive tract in the emergency department (ED) setting. Methods: A retrospective multicentre cohort study was conducted. A total of 73 patients met the inclusion criteria. A subgroup of patients underwent CT. We studied the sensitivity and specificity of x-ray and CT along with other demographic variables to determine the likelihood of true fish bone impaction. Results: Out of the 73 patients, 28 patients had true bone impaction. The sensitivity for x-ray was 42.9% and specificity was 73.3%. The sensitivity of CT was 87.5% and specificity was 71.4%. We found a significant difference in the mean age of presentation for true bone and false bone impaction, P = 0.02. Conclusion: Due to the low sensitivity of x-ray we do not recommend the utilisation of plain film radiography to rule out bone impaction Advances in low dose radiation multidetector CT scanners may replace plain film radiography as a screening tool.

小儿非外伤性睾丸急症MSCT表现(附17例分析)

目的探讨小儿非外伤性睾丸急症的MSCT表现及其临床应用价值。方法回顾性分析17例行MSCT检查并经临床、手术及病理证实的小儿非外伤性睾丸急症病例资料。结果急性睾丸和(或)附睾炎13例,表现为睾丸体积肿大,密度可不均,鞘膜积液明显;增强后睾丸及鞘膜较明显不均匀强化;患侧精索增粗,强化较健侧明显。睾丸扭转4例,表现为睾丸肿大,密度不均,内见高低混杂密度影;增强后睾丸轻度不均匀强化;精索增粗,强化程度不及健侧精索。结论小儿非外伤性睾丸急症影像特征随病变发展有多种表现,MSCT能从形态上全面、直观、多方位、多角度显示病变细节及与邻近解剖结构的关系,结合增强扫描可进一步明确病变性质,在诊断和鉴别诊断小儿非外伤性睾丸急症中具有重要价值。

Clinical studies on diffuse axonal injury in patients with severe closed head injury

OBJECTIVE: To discuss the clinical criteria for diagnosing diffuse axonal injury (DAI). METHODS: Clinical and computed tomographic features of 117 patients with severe closed head injury were analyzed. The authors preliminarily put forward CT diagnostic criteria of DAI, that is, 1) single or multiple small intraparenchymal hemorrhages in the cerebral hemispheres (