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This article compares the technical factors-in particular, tube current and voltage-and the resultant exposure to radiation associated with CT examinations performed at a children's hospital and at more general community hospital emergency departments (EDs).CT scans obtained at community hospital EDs were retrospectively reviewed and compared with CT scans obtained at a children's hospital, to assess differences in kilovoltage, tube current, and volume CT dose index (CTDIvol) used. The number of scans obtained during the contrast-enhanced phase was also assessed. Parametric and nonparametric statistical analyses were used to test differences.A total of 233 body CT examinations were performed at community hospitals, and 287 were performed at a children's hospital. At both types of hospital, the median patient age was 12 years (p = 0.66). Of the body CT scans obtained at community hospitals that focused on the care of adult patients, 194 of 233 (83%) used a tube voltage of 120 kVp, 29 of 233 (12%) used 100 kVp, and two of 233 (1%) used 80 kVp. Of the body CT scans obtained at the children's hospital, 121 of 287 (42%) used a tube voltage of 120 kVp, 129 of 287 (45%) used 100 kVp, and 36 of 287 (13%) used 80 kVp. The median tube current was also lower at the children's hospital (110 vs 125 mA) (p0.001). At the community hospitals, 11 of 233 studies were multiphasic, whereas at the children's hospital, there were no multiphasic studies. For all CT types, the median CTDIvol was 4.9 mGy (range, 2.5-8.2 mGy) at the children's hospital and 8.6 mGy (range, 6.0-14.4 mGy) at the community hospitals (p0.001).The results of this study suggest that a large proportion of children who undergo CT at community hospitals receive relatively higher radiation doses than children who undergo CT at children's hospitals. This finding is related to the higher tube settings (in particular, kilovoltage) used at community hospitals.

OBJECTIVE. Our objective was to characterize the CT findings in children with acute appendicitis and to compare the CT appearance of the normal and abnormal appendix. MATERIALS AND METHODS. CT scans of 20 children (mean age, 8.6 years old) with surgically proven appendicitis were retrospectively reviewed. The CT studies were evaluated for the presence of a visualized appendix, appendiceal caliber and wall thickness, appendicoliths, pericecal inflammation, and abscess. Fifty children of similar age to the study group who did not have an appendicitis and who had undergone CT scans for acute trauma served as the control population. RESULTS. CT scans revealed the appendix in 25 (50%) of 50 control patients and in 11 (55%) of 20 patients with appendicitis. Appendiceal diameter ranged between 3 and 8 mm (mean, 6 mm) in the control group and between 8 and 12 mm (mean, 10 mm) in patients with appendicitis (p i) of 20 patients with appendicitis and in none of the control patients. Pericecal inflammation was seen in 19 (95%) of 20 patients with appendicitis and abscess was seen in 10 (50%) of 20 patients. Specific signs of appendicitis, defined as either an inflamed appendix or appendicolith with associated inflammatory changes, were seen in 16 (80%) of 20 patients. CONCLUSION. Our results suggest that CT findings of the healthy appendix are distinct from those of the abnormal appendix and that CT scans can be useful in diagnosing appendicitis in a pediatric population.

On unenhanced CT scans, a variety of mediastinal masses contain areas with attenuation values higher than the attenuation value of the chest wall musculature. The increased attenuation may be diffuse or focal and may be a result of calcium deposition, high iodine content, or areas of acute hemorrhage. This report illustrates the gamut of high-attenuation mediastinal masses seen on unenhanced CT. Masses that are of high attenuation only on IV contrast-enhanced images (e.g., aberrant vessels) are not included.

The term diastematomyelia was introduced in 1837 by Ollivier to describe a spinal cord split in two dorsoventrally [1 ]. A fibrous or bony septum is usually present between the cord segments. Diastematomyelia is most frequent in the thoracolumbar spine, but rarely it may affect the cervical spine. To our knowledge, basicranial diastematomyelia has not been described previously. We present a case of cervical and basicranial diastematomyelia and discuss the possible embryology of basicranial diastematomyelia.

Forty-three control patients (neonate to 17 years old) were studied by upper gastrointestinal series to determine the position of key duodenal landmarks and the mobility of the duodenojejunal flexure with manual displacement. These results were compared with the duodenal positions of 35 children of similar ages with surgically documented malrotation. Nine criteria were identified as a useful means of detecting subtle abnormalities of duodenal position. The normal duodenojejunal flexure was found to be readily displaceable in neonates and could be pushed to the right of the spine in over two-thirds of patients less than 4 months old. Over 4 years of age, mobility was very limited. A mobile duodenum discovered on fluoroscopic examination or by positioning of a transpyloric feeding tube should not be considered indicative of malrotation in infancy.

The clinical and radiographic findings of eight low-birth-weight neonates (mean, 900 g) with perforations of the duodenum or jejunum associated with transpyloric feedings are reported. In four patients, the perforations occurred distal to any known tube position. In experimental studies in young rabbits, Silastic or polyvinyl chloride tubes were sewn in place with the tube tips in the proximal duodenum or proximal jejunum, and either normal oral feedings or feedings through the tubes were given. Perforations and gross or microscopic abnormalities of the bowel mucosa in the area of the tubes and beyond were more frequent in rabbits with tube feedings than those given normal oral feedings. It appears that tube feedings induce some degree of mucosal damage and contribute to bowel perforation.

The usefulness of computed tomography (CT) in evaluating benign and malignant pelvic mass was assessed in 17 children. By comparison with conventional radiography, CT provided supplementary diagnostic information in 29% of patients and more clearly defined the extent of lesions in 59%. In 47% of patients, the CT findings aided treatment planning. Unique diagnostic information was provided, especially in patients with benign disease, whereas delineation of the extent of disease and help in treatment planning occurred with both benign and malignant masses.

The usefulness of sonography in determining the location and internal consistency of a pelvic mass and in predicting a specific diagnosis was assessed in 70 girls ranging in age from neonate to 19 years. Sonography was correct in determining the site of origin in 39 of 40 surgically proven cases. Among the various sonographic patterns observed, cystic uterine masses and cystic adnexal masses were the most specific, representing hydrometrocolpos or intrauterine pregnancy and benign ovarian cysts, respectively. A nonspecific sonographic pattern was encountered with complex or solid adnexal masses, which were proven to be ovarian teratomas, hemorrhagic ovarian cysts, and pelvic abscesses. Occasionally, a specific diagnosis of ovarian teratoma could be made when echogenic foci produced shadowing in a complex adnexal mass. Our results indicate that sonography in girls is reliable in determining the site of origin of a mass and can suggest a specific diagnosis of hydrometrocolpos, benign ovarian cyst, or intrauterine pregnancy.

In a review of 26 cases of sequestration, six patients with unusual radiographic features are described in detail. Three children had congestive heart failure, and congenital heart disease was suspected. One patient with a cystic upper lobe sequestration was thought to have a pneumatocele or infected cyst. In two other cases the sequestrations had features of a solid mass lesion. One of these was erroneously diagnosed as a mesothelioma or bronchogenic cyst, and the other as a carcinoma.

Sinus histiocytosis with massive lymphadenopathy is an unusual disease characterized by prominent lymph node enlargement, especially in the cervical region. The clinical course is benign although prolonged, and no specific treatment is required. The etiology and pathogenesis are unknown. Four cases of sinus histiocytosis are reported, one in association with mediastinal lymph node enlargement and two in patients with orbital enlargement. One other patient had cervical masses. The radiologic features are reviewed to increase awareness of this entity as a cause of lymph node and orbital enlargement.