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Accurate measurement of anterior urethral stricture length is critical to determine the appropriate surgical approach. Retrograde urethrogram is often used to determine stricture location and length. However, the adult literature shows that retrograde urethrogram may underestimate stricture length. We investigated the role of sonographic urethrogram in the preoperative evaluation of adolescent urethral stricture disease.Between June 2008 and February 2009 we retrospectively evaluated 12 pediatric patients with urethral stricture disease using retrograde and sonographic urethrogram. Stricture length was categorized by 2 radiologists as I-less than 1, II-1 to 3 and III-greater than 3 cm. On sonographic urethrogram stricture length was measured as the longest extent of the urethral abnormality.Mean patient age was 16.9 years (range 9.5 to 20.8). Retrograde urethrogram classified 7 cases as category I, 4 as category II and none as category III stricture, and 1 with no evidence of stricture. Sonographic urethrogram revealed strictures greater than 1 cm in all 7 category I cases and 2 of the 4 category II cases had strictures longer than 3 cm. One patient in whom retrograde urethrogram showed a category II stricture was stricture-free on sonographic urethrogram. One patient with a negative retrograde urethrogram had a stricture on sonographic urethrogram. Sonographic urethrogram upgraded stricture length in 10 of the 12 patients and outperformed retrograde urethrogram in 11.Sonographic urethrogram is effective for evaluating adolescent urethral stricture disease. It may provide more accurate measurement of stricture length and improve preoperative planning.

The purpose of this study was to determine the prevalence, distribution, risk factors, and clinical outcome associated with the detection of unsuspected pulmonary emboli (PE) in routine thoracic MDCT examinations of pediatric oncology patients.We used our hospital information system to retrospectively identify all consecutively registered pediatric oncology patients 18 years old and younger who underwent contrast-enhanced thoracic MDCT for indications other than PE from July 2004 to May 2008. Two pediatric radiologists in consensus reviewed diagnostic-quality images from consecutive routine thoracic MDCT examinations for the presence and anatomic distribution of PE. The distribution of PE was assessed according to pulmonary arterial level and lobe. Clinical and radiology reports were reviewed for demographic data, type of underlying neoplasm, prospective embolus detection, risk factors, treatment, and outcome. Subgroups of patients with and without PE were compared with respect to type of neoplasm and risk factors.The study sample consisted of 468 children (249 boys, 219 girls; mean age, 9.5 +/- 5.7 years) who underwent a total of 1,002 thoracic MDCT examinations. Nine of the 468 children (1.9%) had PE, including seven with venous thromboembolism and two with tumor emboli. In these nine patients, the pulmonary arterial locations of 17 emboli were nine (53%) segmental, five (29%) lobar, two (12%) central, and one (6%) subsegmental. Classified by lobar location, six of 11 PE (55%) were in the left lower lobe, four (36%) were in the right lower lobe, and one (9%) was in the right upper lobe. PE were not detected prospectively in five of the nine patients (56%). All PE in this subgroup were solitary and located either within the segmental pulmonary arteries (four PE) or a lobar pulmonary artery (one PE). Underlying coagulation disorder (p0.001) and history of deep venous thrombosis or PE (p0.01) were risk factors for unsuspected PE. Two of nine patients (22%) with unsuspected PE died of causes not directly related to PE. The other seven patients survived, four of whom were not treated for PE.PE are unsuspected findings at nearly 2% of routine thoracic MDCT examinations of pediatric oncology patients. More than one half of PE were not detected prospectively at initial CT image interpretation, but lack of diagnosis and treatment did not appear to have a negative influence on patient outcome. Underlying coagulation disorder and a history of deep venous thrombosis or PE were risk factors for unsuspected PE.

The aim of this study was to determine whether a lateral chest radiograph provides additional diagnostic information to a posteroanterior (PA) radiograph in the screening of asymptomatic children with positive purified protein derivative (PPD) skin tests in a nonendemic area.This was an Institutional Review Board-approved, Health Insurance Portability and Accountability Act-compliant, retrospective study of 605 consecutive pediatric patients (294 males, 311 females; mean age, 10.8 ± 5.2 years) with positive PPD skin test results, who underwent PA and lateral chest radiographs between July 2003 and May 2009 at a tertiary care pediatric hospital in a nonendemic area for tuberculosis (TB). Two pediatric radiologists independently reviewed each chest radiograph for evidence of abnormalities that may be indicative of acute or chronic TB infection. The reviewers first analyzed the PA radiograph alone and subsequently evaluated the PA and the lateral radiograph together to determine whether any observed abnormality was identified only on the lateral radiograph. When an abnormality was detected on both PA and lateral radiographs, the reviewers determined whether the abnormality on the lateral radiograph changed the reviewer's decision based on the PA radiograph alone. Assessment of nonconcordance between PA and lateral chest radiographs for each reviewer was evaluated by the McNemar test of matched binary pairs. Agreement between reviewers for detecting abnormalities on radiographs was evaluated by using the kappa (κ) statistic.The frequency of an abnormal chest radiograph related to TB was 1.8% (11/605). The PA radiograph showed abnormalities in all 11 (100%) children with radiographic abnormalities. Lateral radiographs showed abnormalities related to TB in 2 (18.2%) of 11 cases found to be abnormal on PA radiographs. Nine (81.8%) of 11 abnormalities on PA radiographs were not detected on the lateral chest radiographs. There was statistical evidence of nonconcordance between PA and lateral chest radiographs in detecting TB-related abnormalities for reviewer 1 (P.001) and reviewer 2 (P = .004). In cases with abnormalities observed on both PA and lateral radiographs, there were no cases in which information obtained from the lateral chest radiograph resulted in a change in interpretation based on the PA radiograph alone. A high level of agreement was observed between the two independent reviewers in detecting TB-related abnormalities on PA radiographs (κ = 0.84, P.001).A PA radiograph alone is sufficient for TB screening of asymptomatic pediatric patients with positive PPD skin test results in an area non-endemic for TB.

Testicular epidermoid cyst is a rare benign tumor in children. Although this entity is widely described in adults in literature, there are no large series describing the pathological and radiological findings in children. Knowledge of the sonographic features seen in children may alter surgical treatment. To describe the specific US characteristics of testicular epidermoid cyst in children and to correlate these findings with pathology. All children with pathologically proven epidermoid cyst and preoperative sonograms diagnosed at a single children’s hospital between 1978 and 2008 were included. For each child, the medical records, preoperative US and pathological specimens were reviewed and correlated. Eleven patients (ages 1–17 years old) met our criteria. Nine cysts had characteristic target or onion ring appearances, the youngest patient had a simple cyst-like lesion, one cyst had a heterogeneous appearance, and more than 80% of the cysts presented daughter cysts attached along the periphery of the main cyst. In addition to the commonly described findings of the epidermoid cyst (the target and onion ring appearances), simple cysts and the presence of daughter lesions are newly described findings that point to the diagnosis of this benign entity in children.

A potential advantage of pulmonary CT angiography (CTA) is its ability to show alternative diagnoses in patients without evidence of pulmonary embolism (PE), but the frequency and spectrum of alternative diagnoses have yet to be determined in the pediatric population. Our purpose was to determine the frequency and types of alternative diagnoses identified in children with clinically suspected but excluded PE.We used our hospital information system to identify all consecutive pediatric patients (18 years old) with clinically suspected PE who underwent pulmonary CTA from July 2004 to March 2008. Two experienced pediatric radiologists reviewed by consensus a series of 96 consecutive diagnostic-quality pulmonary CTA studies without evidence of PE from 89 patients. Each study was systematically reviewed by consensus for a possible alternative diagnosis in the lungs, mediastinum, central airways, cardiovascular system, pleura, and skeleton.The study population consisted of 89 children (28 boys and 61 girls; mean age 13.4 +/- 4.7 years; range, 2 months-18 years; 34 inpatients, 62 outpatients) who underwent a total of 96 pulmonary CTA studies without evidence of PE. Thirty-nine (41%) of 96 pulmonary CTA studies were normal. Alternative diagnoses were identified for each of the remaining 57 (59%) studies, including: pneumonia (n = 22), atelectasis (n = 22), malignancy (n = 3), congenital heart disease (n = 2), pulmonary hypertension (n = 2), pericardial effusion (n = 2), pulmonary nodules (n = 1), rib fractures (n = 1), right atrial thrombus (n = 1), and fat embolism (n = 1). Seventeen patients showed pleural effusions that were associated with coexisting pneumonia (n = 8), atelectasis (n = 8), or rib fractures (n = 1).Among children with clinically suspected but excluded PE, pulmonary CTA frequently shows positive findings. Although pneumonia and atelectasis are most common, a variety of other alternative diagnoses may be detected throughout the thorax.