Acute mastoiditis is a serious complication of acute otitis media in children. Suppurative disease in the mastoid region occasionally spreads to the adjacent dura mater of the posterior and middle cranial fossae and the sigmoid sinus by means of thrombophlebitis, osseous erosion, or anatomic pathways, producing intracranial complications. Computed tomography (CT) should be performed early in the course of the disease to classify the mastoiditis as incipient or coalescent and to detect intracranial complications. On the basis of the clinical features and imaging findings, the disease is managed conservatively with intravenously administered antibiotics or treated with mastoidectomy and drainage plus antibiotic therapy. CT is therefore a decisive diagnostic tool in determining the type of therapy. In addition, magnetic resonance imaging is performed in patients with clinical symptoms or CT findings suggestive of intracranial complications because of its higher sensitivity for detection of extraaxial fluid collections and associated vascular problems.
We present data on 3 years of clinical experience using PACS involving developments on worklists, preloading and archiving strategies in a teaching paediatric hospital with all modalities connected to a commercial PACS. A method allowing generation of and handling of different worklists for computed radiography examinations has been developed in our centre. Worklists and archiving strategies are presented and discussed. We conclude that, with adequate worklists and efficient preloading implementation, current PACS could be used successfully in several clinical settings of a multimodality department.
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