The practice of contrast-enhanced ultrasound in children is in the setting of off-label use or research. The widespread practice of pediatric contrast-enhanced US is primarily in Europe. There is ongoing effort by the Society for Pediatric Radiology (SPR) and International Contrast Ultrasound Society (ICUS) to push for pediatric contrast-enhanced US in the United States. With this in mind, the main objective of this review is to describe the status of US contrast agent safety in non-cardiac applications in children. The five published studies using pediatric intravenous contrast-enhanced US comprise 110 children. There is no mention of adverse events in these studies. From a European survey 948 children can be added. In that survey six minor adverse events were reported in five children. The intravesical administration of US contrast agents for diagnosis of vesicoureteric reflux entails the use of a bladder catheter. Fifteen studies encompassing 2,951 children have evaluated the safety of intravesical US contrast agents in children. A European survey adds 4,131 children to this group. No adverse events could be attributed to the contrast agent. They were most likely related to the bladder catheterization. The existing data on US contrast agent safety in children are encouraging in promoting the widespread use of contrast-enhanced US.
Large, infiltrative cavernous hemangiomas of the distal colon were present in 3 children with the Klippel-Trenaunay syndrome, 2 of whom are the subject of this report. The lesion is manifested clinically as intermittent rectal bleeding starting in the first 5 years of life. The radiographic features include (a) varicose lesions in the wall of the rectosigmoid, ranging from a network of distended submucosal veins to nodular defects, (b) narrowing of the rectum by the surrounding extramural portion of the hemangioma, and (c) phleboliths within the lesion. Inferior mesenteric angiography and sigmoidoscopy are useful for preoperative confirmation. The occurrence of visceral hemangiomas in the Klippel-Trenaunay syndrome and its relevant diagnostic and therapeutic implications are discussed.
Neonatal adrenal hemorrhage can be diagnosed with a combination of ultrasound and excretory urography without resorting to surgical exploration or invasive diagnostic procedures. The radiologic findings of adrenal hemorrhage on excretory urography include downward displacement of the kidney on the affected side and a radiolucent suprarenal mass on the body nephrogram phase. Ultrasound studies reveal a sonolucent suprarenal mass. Four cases of varying degrees of adrenal hemorrhage are presented together with the radiographic and sonographic findings.
Radiologically characteristic extra-alveolar air collections in one or both inferior pulmonary ligaments developed in 14 neonates with respiratory distress on assisted ventilation. Eleven infants had radiographically visible pulmonary interstitial emphysema prior to or concurrent with the air collections. All infants subsequently exhibited pneumothorax. This variant of extra-alveolar air must be recognized because it has essentially the same pathogenesis and significance as the more commonly seen anterior pneumomediastinum.
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