Case Report: Pleuropulmonary Blastoma in a 2.5-Year-Old Boy: 18F-FDG PET/CT Findings

Pleuropulmonary blastoma (PPB) is a rare invasive primary malignancy in the thoracic cavity that occurs mainly in infants and children. It is often misdiagnosed and not treated correctly and promptly due to the lack of specificity of clinical symptoms and conventional imaging presentations. We report a 2.5-year-old boy who underwent X-ray chest radiography, chest CT, and 18F-FDG PET/CT. PET/CT images demonstrated a sizeable cystic-solid mass with heterogeneous increased glucose metabolism in the left thoracic cavity. The diagnosis of PPB (type II) was finally confirmed by a CT-guided puncture biopsy of the active tumor tissue. This case highlights the critical role of 18F-FDG PET/CT in the diagnosis of PPB in children.

Phantom study for comparison between computed tomography- and C-Arm computed tomography-guided puncture applied by residents in radiology

Purpose Comparison of puncture deviation and puncture duration between computed tomography (CT)- and C-arm CT (CACT)-guided puncture performed by residents in training (RiT). Methods In a cohort of 25 RiTs enrolled in a research training program either CT- or CACT-guided puncture was performed on a phantom. Prior to the experiments, the RiT’s level of training, experience playing a musical instrument, video games, and ball sports, and self-assessed manual skills and spatial skills were recorded. Each RiT performed two punctures. The first puncture was performed with a transaxial or single angulated needle path and the second with a single or double angulated needle path. Puncture deviation and puncture duration were compared between the procedures and were correlated with the self-assessments. Results RiTs in both the CT guidance and CACT guidance groups did not differ with respect to radiologic experience (p = 1), angiographic experience (p = 0.415), and number of ultrasound-guided puncture procedures (p = 0.483), CT-guided puncture procedures (p = 0.934), and CACT-guided puncture procedures (p = 0.466). The puncture duration was significantly longer with CT guidance (without navigation tool) than with CACT guidance with navigation software (p < 0.001). There was no significant difference in the puncture duration between the first and second puncture using CT guidance (p = 0.719). However, in the case of CACT, the second puncture was significantly faster (p = 0.006). Puncture deviations were not different between CT-guided and CACT-guided puncture (p = 0.337) and between the first and second puncture of CT-guided and CACT-guided puncture (CT: p = 0.130; CACT: p = 0.391). The self-assessment of manual skills did not correlate with puncture deviation (p = 0.059) and puncture duration (p = 0.158). The self-assessed spatial skills correlated positively with puncture deviation (p = 0.011) but not with puncture duration (p = 0.541). Conclusion The RiTs achieved a puncture deviation that was clinically adequate with respect to their level of training and did not differ between CT-guided and CACT-guided puncture. The puncture duration was shorter when using CACT. CACT guidance with navigation software support has a potentially steeper learning curve. Spatial skills might accelerate the learning of image-guided puncture. Key Points: Citation Format

Ultrasound guided percutaneous catheterization of the brachiocephalic vein by small caliber catheter: An alternative to epicutaneo-caval catheter in newborn and premature infants

Background: Umbilical Venous Catheter (UVC) and Epicutaneo-Caval Catheters (ECC) are reference catheters in the neonatal period. However, many factors such as the corpulence of neonates, poor venous capital, and anatomical variants can complicate ECC insertion or make it impossible. In newborns with failed ECC insertion, we developed an hybrid technique that combines the insertion of a long-lasting silicone or polyurethane small caliber catheter, usually used as a ECC in newborns, with the ease and speed of ultrasound guided puncture of the brachiocephalic vein (BCV). Methods: Three years retrospective single center experience of ultrasound guided BCV insertion of silicon or polyurethane small caliber central catheter in a tertiary neonatal intensive care in case of insertion fail of ECC. Results: Twenty-one echo guided BCV-ECC insertions were performed in 20 newborns. Median age was 16 days (range: 0–110 days), median weight was 1700 g (range: 605–4960 g) at insertion. In most cases, insertion was on the left side (17/21). No failures were noted. Only one attempt was necessary in all cases. Insertion time, when noted, was always of <45 min. The median duration of use of these catheters was 11 days (range 3–35 days). No complication was noted during insertion or catheter use, including catheter-related infections and thrombosis. Conclusion: Echo guided percutaneous catheterization of the brachiocephalic vein with a long lasting silicone or polyurethane small caliber catheter is a safe alternative to the ECC if insertion has failed. However, it requires a mastery of ultrasound-guided insertion technique in term and premature neonates.

Subaortic left brachiocephalic vein and real-time ultrasound-guided puncture

We describe a subaortic left brachiocephalic vein, a congenital anomaly that can be suspected during the rapid central vein assessment before central venous catheterization. Since the vein descends vertically/obliquely rapidly from its origin, we suggest that the puncture should be made at a greater angle (50°–60°) than what is usually used to puncture this vein (20°–30°). Failure to identify this anomaly may cause a failed puncture or complications from the puncture of adjacent blood vessels.

Ultrasonographic detection of meningoencephalitis in a dog

The aim of this report is to disseminate ultrasound findings of meningoencephalitis in a dog, diagnosed by analysis of cerebrospinal fluid collected by guided-ultrasound puncture. The patient presented walking in circles, absence of bilateral threat reflex, decreased left eyelid reflex, divergent strabismus of the right eye, negative nasal sensation on the right side, and an increase in volume of skullcap with the presence of open fontanelle. The clinical suspicion was hydrocephalus and/or inflammatory/infectious disease. The distemper rapid test was negative. The hematological profile showed an increase in alanine aminotransferase enzyme. Ultrasound examination was performed with patient in sternal decubitus, using a linear transducer (9.0 MHz). Images were obtained in longitudinal and transverse sections through the temporal windows and bregmatic fontanelle. The presence of a marked anechogenic content with moderate amount of floating hyperechogenic spots was observed, with retraction and increased echogenicity of the brain. Cerebrospinal fluid was collected using the bregmatic fontanelle for ultrasound-guided puncture, under general anesthesia. Meningoencephalitis was indicated by mononucleated cells and red blood cells founded in cerebrospinal fluid analysis. However, the patient not return to start treatment and investigate the cause of the meningoencephalitis.

A Bladder Teratoma after Oocyte Retrievals

Oocyte recovery by means of transvaginal ultrasound-guided puncture was first described in 1985, and the procedure has gained widespread popularity. The literature consistently reports that complications related to oocyte retrievals are rare. Yet this report describes a woman with a long-term complication after egg retrievals.