The low utility of routine cranial imaging after pediatric shunt revision

OBJECTIVE Postoperative routine imaging is common after pediatric ventricular shunt revision, but the benefit of scanning in the absence of symptoms is questionable. In this study, the authors aimed to assess how often routine scanning results in a change in clinical management after shunt revision. METHODS The records of a large, tertiary pediatric hospital were retrospectively reviewed for all consecutive cases of pediatric shunt revision between July 2013 and July 2018. Postoperative imaging was classified as routine (i.e., in the absence of symptoms, complications, or other direct indications) or nonroutine. Reinterventions within 30 days were assessed in these groups. RESULTS Of 387 included shunt revisions performed in 232 patients, postoperative imaging was performed in 297 (77%), which was routine in 244 (63%) and nonroutine in 53 (14%). Ninety revisions (23%) underwent any shunt-related procedure after postoperative imaging, including shunt reprogramming (n = 35, 9%), shunt tap (n = 10, 3%), and a return to the operating room (OR; n = 58, 15%). Of the 244 cases receiving routine imaging, 241 did not undergo a change in clinical management solely based on routine imaging findings. The remaining 3 cases returned to the OR, accounting for 0.8% (95% CI 0.0%–1.7%) of all cases or 1.2% (95% CI 0.0%–2.6%) of cases that received routine imaging. Furthermore, 27 of 244 patients in this group returned to the OR for other reasons, namely complications (n = 12) or recurrent symptoms (n = 15); all arose after initial routine imaging. CONCLUSIONS The authors found a low yield to routine imaging after pediatric shunt revision, with only 0.8% of cases undergoing a change in management based on routine imaging findings without corresponding clinical findings. Moreover, routine imaging without abnormal findings was no guarantee of an uneventful postoperative course. Clinical monitoring can be considered as an alternative in asymptomatic, uncomplicated patients.

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Typical and atypical CT chest imaging findings of novel coronavirus 19 (COVID-19) in correlation with clinical data: impact on the need to ICU admission, ventilation and mortality

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-020-00339-3 ◽

2020 ◽

Vol 51 (1) ◽

Author(s):

Doaa M. Emara ◽

Nagy N. Naguib ◽

M. A. Moustafa ◽

Salma M. Ali ◽

Amr Magdi El Abd

Keyword(s):

Pleural Effusion ◽

Complete Recovery ◽

Clinical Findings ◽

Mediastinal Lymphadenopathy ◽

Imaging Features ◽

Imaging Findings ◽

Icu Admission ◽

Mortality Outcome ◽

Novel Coronavirus ◽

Contrast Ct

Abstract Background The aim of this study was to highlight the typical and atypical chest CT imaging features at first presentation in 120 patients who were proved to be COVID-19 by PCR and to correlate these findings with the need for ICU admission, ventilation, and mortality. We retrospectively included 120 patients 71 males (59.2%) and 49 females (40.8%) with a mean age of 47.2 ± 14.4 years. Patients subjected to clinical assessment, CBC, PCR for COVID-19, and non-contrast CT chest at first presentation. Typical and atypical imaging findings were reported and correlated with the clinical findings of the patients, the need for ICU admission, ventilation, and mortality. Results Clinically, fever was seen in 112 patients followed by dry cough in 108 patients and malaise in 35 patients. The final outcome was complete recovery in 113 cases and death in 7 cases. Typical CT findings included bilateral peripheral ground-glass opacities (GGO) in 74.7%, multilobar affection in 92.5% while atypical findings such as homogeneous consolidation, pleural effusion, mediastinal lymphadenopathy, and single lobar affection were found in 13.4, 5, 6.7, and 7.5% respectively. A statistically significant association between the presence of white lung, pleural effusion, peripheral GGO, and the need for ICU admission as well as mechanical ventilation was noted. The death was significantly higher among elderly patients; however, no significance was found between the imaging features and mortality. Conclusion CT features at first presentation can predict the need for ICU admission and the need for ventilation but cannot predict the mortality outcome of the patients.

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Alkaline phosphatase isoforms in serum after liver allograft surgery

Clinical Chemistry ◽

10.1093/clinchem/40.7.1272 ◽

1994 ◽

Vol 40 (7) ◽

pp. 1272-1277 ◽

Cited By ~ 5

Author(s):

J Randolph-Habecker ◽

J A Lott ◽

R J Tesi

Keyword(s):

Liver Transplantation ◽

Alkaline Phosphatase ◽

Liver Function Tests ◽

Clinical Findings ◽

High Molecular Mass ◽

Reference Ranges ◽

Liver Allograft ◽

Postoperative Course ◽

End Stage Liver Disease ◽

End Stage

Abstract Orthotopic liver transplantation (OLT) is now the only available treatment for end-stage liver disease; the major postoperative complications of OLT are rejection and infection. Fractionation of alkaline phosphatase (ALP) isoforms in serum by isoelectric focusing can be used to identify patients with complications. Reference ranges for liver-function tests (LFT) and liver ALP isoforms were established for post-OLT patients with stable postoperative courses and compared with those of patients with complications. We found canalicular, hepatocyte, and high-molecular-mass ALP to be statistically higher in nearly all patients with complications as compared with patients who had a stable postoperative course; these tests may identify patients requiring a liver biopsy. When used in conjunction with LFT and other clinical findings, ALP isoforms could aid in the monitoring of complications and treatment and in the adjustment of immunosuppressive therapy in stable OLT cases.

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Sponge in the belly; postoperative imaging findings of oxidized cellulose (Surgicel®)

TURKISH JOURNAL OF MEDICAL SCIENCES ◽

10.3906/sag-1206-72 ◽

2013 ◽

Author(s):

ARZU PAMPAL

Keyword(s):

Oxidized Cellulose ◽

Imaging Findings ◽

Postoperative Imaging

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Relationship between postoperative imaging findings and therapeutic effect in patients with unresectable hepatocellular carcinoma after ultrasound-guided percutaneous radiofrequency ablation

World Chinese Journal of Digestology ◽

10.11569/wcjd.v21.i33.3747 ◽

2013 ◽

Vol 21 (33) ◽

pp. 3747

Author(s):

Xue-Dan Fu ◽

Yan-Li Liu

Keyword(s):

Hepatocellular Carcinoma ◽

Radiofrequency Ablation ◽

Therapeutic Effect ◽

Imaging Findings ◽

Percutaneous Radiofrequency Ablation ◽

Ultrasound Guided ◽

Postoperative Imaging ◽

Unresectable Hepatocellular Carcinoma

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An Unusual Visit from an Old Foe: Oral Presentation of Syphilis in a Teenage Patient

Case Reports in Pediatrics ◽

10.1155/2021/7755914 ◽

2021 ◽

Vol 2021 ◽

pp. 1-3

Author(s):

Bedirhan Tarhan ◽

Sydur Rahman ◽

Diana Halloran ◽

Jeremy Sites ◽

Avni Bhatt ◽

...

Keyword(s):

Care Center ◽

Tertiary Care ◽

Hospital Medicine ◽

Adolescent Females ◽

Clinical Findings ◽

Secondary Syphilis ◽

Pediatric Hospital ◽

Syphilis Infection ◽

Macular Rash ◽

Inguinal Lymphadenopathy

The authors report an atypical case of secondary syphilis in an adolescent female presenting to a tertiary-care center with fever, weight loss, oral sores, painful inguinal lymphadenopathy, and transient macular rash. Given the lower prevalence of syphilis in adolescent females, this infection was not included on the initial differential diagnosis. The evolving presentation of syphilis over time complicates the diagnosis and management of these infections, as it did for the patient in this report. The authors provide a detailed discussion of the patient’s clinical findings, including the protean features of syphilis infection. This case is particularly relevant to the fields of general pediatrics and pediatric hospital medicine.

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High prevalence of hip lesions secondary to arthroscopic over- or undercorrection of femoroacetabular impingement in patients with postoperative pain

European Radiology ◽

10.1007/s00330-021-08398-4 ◽

2021 ◽

Author(s):

Malin K. Meier ◽

Till D. Lerch ◽

Simon D. Steppacher ◽

Klaus A. Siebenrock ◽

Moritz Tannast ◽

...

Keyword(s):

Femoroacetabular Impingement ◽

Hip Dysplasia ◽

Cartilage Damage ◽

Imaging Findings ◽

Femoral Torsion ◽

Postoperative Imaging ◽

Dichotomous Data ◽

Cam Deformity ◽

High Prevalence ◽

Incremental Increase

Abstract Objectives To compare the prevalence of pre- and postoperative osseous deformities and intra-articular lesions in patients with persistent pain following arthroscopic femoroacetabular impingement (FAI) correction and to identify imaging findings associated with progressive cartilage damage. Methods Retrospective study evaluating patients with hip pain following arthroscopic FAI correction between 2010 and 2018. Pre- and postoperative imaging studies were analyzed independently by two blinded readers for osseous deformities (cam-deformity, hip dysplasia, acetabular overcoverage, femoral torsion) and intra-articular lesions (chondro-labral damage, capsular lesions). Prevalence of osseous deformities and intra-articular lesions was compared with paired t-tests/McNemar tests for continuous/dichotomous data. Association between imaging findings and progressive cartilage damage was assessed with logistic regression. Results Forty-six patients (mean age 29 ± 10 years; 30 female) were included. Postoperatively, 74% (34/46) of patients had any osseous deformity including 48% (22/46) acetabular and femoral deformities. Ninety-six percent (44/46) had an intra-articular lesion ranging from 20% (9/46) for femoral to 65% (30/46) for acetabular cartilage lesions. Prevalence of hip dysplasia increased (2 to 20%, p = 0.01) from pre- to postoperatively while prevalence of cam-deformity decreased (83 to 28%, p < 0.001). Progressive cartilage damage was detected in 37% (17/46) of patients and was associated with extensive preoperative cartilage damage > 2 h, i.e., > 60° (OR 7.72; p = 0.02) and an incremental increase in postoperative alpha angles (OR 1.18; p = 0.04). Conclusion Prevalence of osseous deformities secondary to over- or undercorrrection was high. Extensive preoperative cartilage damage and higher postoperative alpha angles increase the risk for progressive degeneration. Key Points • The majority of patients presented with osseous deformities of the acetabulum or femur (74%) and with intra-articular lesions (96%) on postoperative imaging. • Prevalence of hip dysplasia increased (2 to 20%, p = 0.01) from pre- to postoperatively while prevalence of a cam deformity decreased (83 to 28%, p < 0.001). • Progressive cartilage damage was present in 37% of patients and was associated with extensive preoperative cartilage damage > 2 h (OR 7.72; p = 0.02) and with an incremental increase in postoperative alpha angles (OR 1.18; p = 0.04).

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Morel-Lavallee Lesions-Review of Pathophysiology, Clinical Findings, Imaging Findings and Management

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2017/25479.9689 ◽

2017 ◽

Cited By ~ 3

Author(s):

Sreelatha Diviti

Keyword(s):

Clinical Findings ◽

Imaging Findings

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UNUSUAL CT IMAGING FINDING IN PERFORATED APPENDIX.

10.36106/1800214 ◽

2021 ◽

pp. 3-3

Author(s):

sushuma reddy ◽

Sarfaraz shaikh ◽

Tulsi Manek

Keyword(s):

Diagnostic Accuracy ◽

Clinical Management ◽

Imaging Finding ◽

Ct Imaging ◽

Morbidity And Mortality ◽

Imaging Findings ◽

Surgical Emergency ◽

Perforated Appendix

Perforation of the appendix is one of the complications of appendicitis that is associated with increased morbidity and mortality and regarded as a surgical emergency. The identification of perforated appendix at imaging is not always straightforward, and atypical imaging appearances can add to the interpretive challenge.The diagnosis of perforated appendix on the basis of imaging findings can be challenging when those findings do not conform to classic appearances.This presentation allows readers to become more familiar with the varied spectrum of CT appearances of perforated appendix.The pearls and pitfalls presented also may help improve diagnostic accuracy and guide clinical management of atypical cases.

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A Case of Neurosarcoidosis with Labyrinthine Involvement

Case Reports in Radiology ◽

10.1155/2014/530431 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Peter B. Johnson ◽

Roxanne Melbourne-Chambers ◽

Amit Manohar Saindane ◽

Nilesh Desai ◽

Myrton Smith

Keyword(s):

Cranial Nerves ◽

Central Nervous System Involvement ◽

Visual Disturbance ◽

Clinical Findings ◽

Imaging Findings ◽

Pituitary Dysfunction ◽

First Case ◽

Cranial Neuropathies ◽

The Right ◽

Temporal Bones

Sarcoidosis is a chronic granulomatous disease of unknown aetiology, which may involve any organ system. It most commonly occurs in adults with childhood involvement being rare. Central nervous system involvement is seen in up to 25% and typically involves meningeal disease resulting in multiple cranial neuropathies. Other common clinical findings include seizures, headache, dementia, and pituitary dysfunction. Imaging plays a central role in the diagnosis with typical findings including pachymeningeal and leptomeningeal enhancing lesions. Other imaging findings include lacunar and major territory infarcts, hypothalamic and infundibular thickening, hydrocephalus, and cranial nerve enhancement. We present a case of an eight-year-old male patient with progressive headache, visual disturbance, unilateral sensory hearing loss, and multiple cranial neuropathies. Imaging findings demonstrated the classic pachymeningeal and leptomeningeal enhancement along much of the skull base, as well as enhancement of the right and left second and eighth cranial nerves. Extensive inflammatory changes were noted in the temporal bones and paranasal sinuses. There was also enhancement of the right and left labyrinths. Sinus biopsy confirmed sarcoidosis. We present the first case to our knowledge of sarcoid labyrinthitis.

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