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J S Donaldson

Publications and source records attributed to J S Donaldson.

At least 37 records · Page 2Linked to original sources
PubMed1992

Ultrasound screening of high-risk infants. A method to increase early detection of congenital dysplasia of the hip.

Congenital dysplasia of the hip (CDH) continues to be missed by routine physical screening examinations in the early months when treatment is most effective. Real-time ultrasonography (US) is valuable in the detection of CDH in the young infant. We performed a prospective study to evaluate one US screening strategy that targets a select "high-risk newborn" population at risk for CDH aiming to increase the early diagnosis of this condition. From 1772 consecutive births at one hospital, we identified 97 (5.5%) newborns with risk factors for CDH: breech delivery, 73 babies; family history, 26 babies; postural abnormalities, five babies; and oligohydramnios, four babies. Eleven newborns had two risk factors. We studied 69 of these newborns with US. There were four cases of CDH in this group. Three of these babies had completely normal pediatric physical examination results at the time of the US study (at 14, 75, and 100 days, respectively) despite dysplasia diagnosed by US. All were successfully treated with a harness as outpatients. We conclude that a screening program entailing identification and subsequent US of the hip of newborns with specific physical and historical risk factors for CDH increases early diagnosis. Further analysis suggests this approach is cost-effective.

Female↗
PubMed1992

Clinical application of ultrasonography in the diagnosis of intussusception.

Sixty-five consecutive patients seen in a pediatric emergency department, in whom the diagnosis of intussusception was considered, had an ultrasound examination of the abdomen before a barium enema. The mean age of the patients was 1.7 years (range 2 weeks to 5 years). Intussusception was detected by ultrasonography in all 20 cases proved by barium enema. There were three false-positive ultrasound results (sensitivity = 100%, confidence interval (Cl) = 86% to 100%; specificity = 93%, Cl = 86% to 96%). Normal findings on ultrasonography correlated with a negative barium enema results in 42 of 42 cases (negative predictive value = 100%, Cl = 94% to 100%). No intussusception was missed by ultrasonography. To determine which patients would most benefit from ultrasonography, we divided patients into either a high-risk group (81% with intussusception) or a low-risk group (14% with intussusception) on the basis of clinical symptoms (p less than 0.01). If each high-risk child had a barium enema and each low-risk child had an ultrasound study as their initial diagnostic test, 89% of the patients in this study would have undergone only one examination. We conclude that ultrasonography can be used as a rapid, sensitive screening procedure in the diagnosis or exclusion of childhood intussusception. Children considered at low risk of having intussusception on the basis of clinical symptoms should initially have an ultrasound examination; patients at high risk should have an immediate barium enema.

Barium Sulfate↗
PubMed1992

Congenital and acquired orthopedic abnormalities in patients with myelomeningocele.

This article presents a radiologic review of the spectrum of acquired and congenital orthopedic abnormalities found in patients with myelomeningocele. These abnormalities are caused predominantly by muscle imbalance, paralysis, and decreased sensation in the lower extremity. Iatrogenic injury, such as a postoperative tethered cord, may also cause bone abnormalities. Selected images were obtained from more than 800 children. Important entities presented include spinal curvatures such as kyphosis, scoliosis, and lordosis; subluxation and dislocation of the hip, coxa valga, contractures of the hip, and femoral torsion; knee deformities; rotational abnormalities of the lower extremity and external and internal torsion; ankle and foot abnormalities such as ankle valgus, calcaneus foot, congenital vertical talus (rocker-bottom deformity), and talipes equinovarus; and metaphyseal, diaphyseal, and physeal fractures. Familiarity with congenital abnormalities and an understanding of the pathogenesis of acquired disorders in patients with myelomeningocele are essential for proper radiologic interpretation and timely therapy.

Child↗
PubMed1992

Azygoesophageal recess: normal CT appearance in children.

The azygoesophageal recess is the interface of the subcarinal portion of the mediastinum and the right lower lobe. The configuration of the recess on CT can be used as a sensitive indicator of abnormality in the mediastinum. In normal adults the recess is concave. A convex contour is a normal variant, particularly in young adults. The normal appearance of the azygoesophageal recess in children has not been studied. Accordingly, we reviewed chest CT examinations performed in 253 children ranging from 1 month to 20 years old. Forty patients were excluded from further analysis either because the recess could not be evaluated properly or because underlying disease caused the mediastinum to have an abnormal configuration. An age-related spectrum of normal configurations was observed in the remaining 213 patients. A convex or straight contour was found in 96% of children less than 3 years old. Scans of children 3-12 years old revealed a spectrum of configurations. The typical adult concave configuration was seen in 78% of adolescents more than 12 years old. Overall, in only 90 (42%) of 213 children in this study was a concave recess observed on CT. Our experience shows a convex azygoesophageal recess on CT should be considered the normal configuration in infants and young children. Recognition of this age-related variation is useful in the CT evaluation of the mediastinum in children.

Adolescent↗
PubMed1991

Vascular rings: 10-year review of imaging.

Radiologic studies of 47 children with surgically proved vascular rings were retrospectively reviewed. On radiographs, a right-sided or bilateral aortic arch and the presence of tracheal narrowing were signs indicative of vascular rings. On barium esophagograms, a double or right aortic arch appeared as deep persistent posterior indentation of the esophagus. On computed tomographic (CT) scans and magnetic resonance (MR) images, the diagnosis of vascular rings was based on vascular branching patterns, the side of the aortic arch or presence of two arches, and narrowing of the airway. Although the diagnosis of a complete vascular ring can usually be established with certainty by means of radiography and esophagography, CT and MR imaging add valuable anatomic detail about exact arch configuration, tracheobronchial compression, and brachiocephalic vessel branching.

Adolescent↗
PubMed1991

Pediatric musculoskeletal MR imaging.

In a review of the indications and uses for magnetic resonance (MR) imaging of the pediatric musculoskeletal system, MR evaluation of conditions unique to the pediatric musculoskeletal system were emphasized. Indications for MR imaging of the pediatric musculoskeletal system include evaluation of bone marrow, neoplastic processes, and periarticular disorders.

Bone Diseases↗
PubMed1991

Calcification of the ligamentum arteriosum in children: a normal finding on CT.

Calcification of the ligamentum arteriosum is a rare finding on plain radiographs. We commonly have seen the calcification on unenhanced CT scans of the chest, a finding not previously reported. A retrospective review of unenhanced CT scans of the chest was undertaken to determine the frequency of the described finding. Seven (13%) of 53 patients had a well-demarcated focus of calcification in the region of the ligamentum arteriosum. None of these patients had evidence of a patent ductus arteriosum. Calcification within the ligamentum arteriosum was seen in 13% of routine CT examinations of the chest in children and should not be confused with a pathologic process producing mediastinal calcifications.

Adolescent↗
PubMed1991

Radiographic imaging of foreign bodies in the hand.

Injuries involving foreign bodies in the hand are common. Index of suspicion should be high in any hand injury, particularly with a proper history. Plain radiographs should be obtained liberally and multiple views always taken. Xeroradiography, if available, is helpful if the plain radiographs are normal and a foreign body is suspected. Ultrasound is useful particularly in the detection of non-radiopaque foreign bodies and can provide guidance for removal of foreign objects if they are not readily found at surgery. Computed tomography (CT) and magnetic resonance imaging (MRI) may be used in rare instances if other studies have failed to detect a suspected foreign object, particularly a small wood or wood-like fragment. CT and MRI are the best studies to evaluate complications of retained foreign bodies.

Foreign Bodies↗
PubMed1990

Computed tomography in patients with esophageal perforation.

Contrast esophagram is the diagnostic procedure of choice in patients with clinically suspected perforation of the esophagus. In patients in whom the usual clinical signs or symptoms are unrecognized and in whom the diagnosis is obscure, the diagnosis of a perforated esophagus may be suggested by the finding of mediastinal fluid and air on CT. Three patients are reviewed. The perforations included one spontaneous, one from erosion of an esophageal carcinoma, and one iatrogenic. In two of the three patients, the diagnosis of perforated esophagus had not been made initially and in one patient the initial esophagram was interpreted as normal. Computed tomography of the chest in each patient led to the suspected diagnosis of perforated esophagus. Prompt appropriate surgical intervention followed. The findings of mediastinal fluid and more importantly mediastinal air on CT of the chest are strongly suggestive of esophageal perforation.

Adult↗
PubMed1989

Ultrasound of the distal pouch in infants with imperforate anus.

Optimal surgical management of the newborn with imperforate anus depends on accurate determination of the level of the rectal pouch. Eighteen children with imperforate anus were evaluated with ultrasound. The distance from the end of the pouch to the perineum was measured. Ultrasound correctly predicted the level of the distal pouch in all 12 children who had confirmation of the pouch level by surgery or by distal contrast stomagrams. Six children have not yet had definitive surgery. Five children with a pouch to perineum (P-P) distance of less than or equal to 10 mm and three of six children with a P-P distance of 10 to 15 mm had successful correction by a simple perineal anoplasty. Three of six children with a P-P distance of 10 to 15 mm and all of those (seven) with a P-P distance greater than 15 mm were diverted with colostomies.

Anus, Imperforate↗
PubMed1989

Splenic microabscesses in the immune-compromised patient.

Four immune-compromised children who were receiving antineoplastic chemotherapy (three for leukemia), presented with recurrent episodes of fever and left upper abdominal pain. Blood cultures grew enteric gram-negative organisms in three children. Multiple blood cultures were negative for fungus although three patients had mucocutaneous and urinary candidiasis. All remained febrile and symptomatic despite treatment with broad spectrum antibiotics and antifungal chemotherapy. Computed tomography (CT) scans in all patients showed 2- to 10-mm focal defects in the spleen. The larger defects could be seen by ultrasonography but not on the live-spleen nuclear scan. A splenectomy was performed 2 to 4 weeks after the onset of symptoms in each child, and the cut surface of the spleens showed multiple small abscesses. All operative cultures were negative. A histological examination confirmed Candida infection in two patients and Aspergillus in one. Necrotizing granulomas strongly suggestive of fungus were seen in the fourth child. The patients defervesced and appeared well within three days. Antifungal therapy was continued. One child remains in remission from acute lymphocytic leukemia; one continues on chemotherapy; and one has recurrent widespread tumor. The patient with Aspergillus died following a bone marrow transplantation 6 months after the splenectomy. He had disseminated aspergillosis. An immune-compromised patient with persistent unexplained fever should have a CT scan of the abdomen. The presence of multiple splenic lesions strongly suggests fungal disease. If antifungal therapy does not result in complete resolution of fever and the splenic lesions, a splenectomy is indicated.

Abscess↗
PubMed1989

Giant iatrogenic splenic pseudocyst.

Partial splenic arterial embolization was used to treat hypersplenism in a 10-year-old boy with portal hypertension secondary to congenital hepatic fibrosis. After embolization the spleen remained enlarged, but the boy's platelet count increased and his variceal bleeding ceased. One month later, he returned with vomiting and an abdominal mass. Computed tomography showed a large cyst of the spleen with a small rim of residual splenic tissue. Percutaneous drainage with ultrasound guidance yielded 2,800 mL of brown fluid. Wedge-shaped infarctions are described early after splenic embolization, and these areas eventually fibrose and contract. In this case, the embolization resulted in splenic necrosis and liquefaction with pseudocyst formation. This unusual complication was effectively treated without surgery.

Child↗
PubMed1989

Neck and thorax venous aneurysm: association with cystic hygroma.

Eight of 15 patients with mediastinal cystic hygroma were found to have abnormal enlargement of neck or thoracic veins. Five of these children had aneurysmal dilatation of the superior vena cava (SVC). Three more had mild enlargement of the SVC, which was revealed only after comparison with 20 children with no evidence of mediastinal disease. Although the association of venous aneurysms and cystic hygromas has not been previously observed, their coexistence does not appear to be coincidental: None of the patients had other causes of dilatation of the SVC. Knowledge of aneurysmal veins may be helpful to the surgeon planning resection of a cystic hygroma.

Adolescent↗
PubMed1989

Radiographic evaluation of subureteric injection of teflon to correct vesicoureteral reflux.

The imaging studies of 83 children (115 ureters) with vesicoureteral reflux who were treated by subureteric injection of Teflon (STING) were reviewed. On plain films, the Teflon rarely may be seen as faintly radiodense. On sonography, it is echogenic and has variable acoustic shadowing. On CT it is dense (160-466 H). Postsurgical cystography showed cessation of reflux in 83 ureters (72%). Complications of STING were uncommon. No granulomatous masses were identified in the region adjacent to the STING. Transient, free peritoneal fluid developed in three children and ureteral dilatation in six, three of whom required intervention. In one child, most of the Teflon disappeared from the original site of injection, as noted on a follow-up CT scan; possibly it had been extruded into the bladder. The STING procedure probably will become more popular. Knowledge of its radiologic appearance is important for the radiologist in order to effectively evaluate these children postoperatively.

Adolescent↗
PubMed1989

Pulmonary sequestration. Diagnosis by ultrasound.

Sonographic imaging of a basilar chest mass in each of three newborns and in a 2-month-old infant either confirmed or correctly suggested the diagnosis of surgically documented pulmonary sequestration. The appearance of each mass was that of a highly echogenic lesion, the homogeneity of which was interrupted only by vascular structures. In two cases, an artery was identified arising from the aorta and extending into the mass, thus confirming the diagnosis. Chest sonography should be utilized when the possibility of a pulmonary sequestration is considered.

Bronchopulmonary Sequestration↗