Biomedical subjects

Javier Lucaya

Publications and source records attributed to Javier Lucaya.

25 records · Page 2Linked to original sources

PubMed2003

CT findings and temporal course of persistent pulmonary interstitial emphysema in neonates: a multiinstitutional study.

OBJECTIVE: The purpose of this study was to evaluate the CT appearance, management, and temporal course of persistent pulmonary interstitial emphysema in neonates. MATERIALS AND METHODS: Criteria for inclusion in the study group included neonates with a history of prematurity who required ventilation for lung disease, development of hyperexpanded radiolucent lung lesions after typical radiographic findings of pulmonary interstitial emphysema, and CT documentation of lung abnormalities. Radiographs and CT scans were reviewed for the anatomic distribution, appearance, and presence of classic lines or dots within a radiolucent mass. We compared the management (surgical vs nonsurgical) and the temporal course in nonsurgical cases for patients in the United States and patients outside the United States. RESULTS: From seven institutions, we identified 17 patients who had persistent pulmonary interstitial emphysema with CT documentation. On CT, all lesions consisted of hyperexpanded cystic radiolucencies. Distribution was single-lobe in nine patients (left upper lobe, n = 5; left lower lobe, n = 3; right middle lobe, n = 1), multilobar in eight patients, and bilateral in six patients. Fourteen patients (82%) showed the characteristic line-and-dot pattern. All patients were initially treated conservatively; nine eventually underwent surgical resection with confirmation at pathology. Of 10 patients who underwent nonsurgical treatment for at least 1 year, lesions resolved in four patients, decreased in size in three asymptomatic patients, and enlarged in three patients, with eventual resection in two. Surgical resection was performed in 89% (8/9) of patients treated in the United States and in 13% (1/8) of patients treated outside the United States. CONCLUSION: Our study found that 82% of patients with persistent pulmonary interstitial emphysema had characteristic CT findings (central lines and dots surrounded by radiolucency). Although most patients in this series eventually underwent surgical resection, initial treatment can be conservative. The decision to perform surgery may have reflected the local medical culture.

Child, Preschool↗

PubMed2002

Potential pitfalls in cranial sonography.

BACKGROUND: We present several anatomic variants of the brain and artifacts related to scanning techniques which could be misinterpreted as lesions on neonatal cranial sonography. MATERIALS AND METHODS: The findings were derived from US studies performed on 176 premature infants and 26 full-term newborns, using the anterior, posterior and mastoid fontanelles as acoustic windows. RESULTS: The pseudolesions are divided into three groups: ventricular system (asymmetric lateral ventricle size and coarctation of the lateral ventricles); choroid plexus ("split" choroid, "truncated" choroid and choroid cyst); and brain parenchyma (peritrigonal blush, thalamic pseudolesion, pseudo-absence of the inferior vermis, occipital pseudomass and calcar avis simulating intraventricular clot). We provide images of these pseudolesions and clues to their differentiation from true brain pathology. Images of several brain disorders are included for comparison. Knowledge of these potential pitfalls is essential for proper interpretation of US brain studies and will help to avoid the use of other more invasive diagnostic tests. CONCLUSIONS: Misleading images seen on US examination of the neonatal brain that could be misinterpreted as pathology are presented, with clues to their differentiation from true lesions.

Brain↗

PubMedDate not supplied

Complicated acute pediatric bacterial sinusitis: Imaging updated approach.

Acute bacterial sinusitis is usually a clinical diagnosis. Orbital complications require emergent evaluation with computed tomography. Using the orbital septum as an anatomic landmark, such infections can be classified as pre- or postseptal and treated with the most adequate therapy, ie, oral or intravenous antibiotics or surgical endonasal drainage. Intracranial complications can be seen in 3.7% to 11% of these patients, often with subtle clinical symptoms and signs. Radiologists play a decisive role in the final management of these patients and should be familiar with the most relevant complications. In this article, we present a retrospective review of all pediatric patients referred to our department for paranasal sinuses and orbital computed tomography because of acute complicated bacterial sinusitis. They were studied with an emergent enhanced facial and cranial computed tomography within 24 hours of admission, followed by magnetic resonance imaging when intracranial complications were suspected. Particular emphasis is placed on the imaging algorithm and the most relevant complications; we correlate imaging findings with clinical and bacteriological data.

Acute Disease↗

PubMedDate not supplied

Neuroimaging in pediatric leukemia and lymphoma: differential diagnosis.

Recent advances in therapy for pediatric hematologic neoplasms have greatly improved the prognosis but have resulted in an increased incidence of associated complications and toxic effects. The main neuroimaging features in pediatric patients with leukemia or lymphoma treated with chemotherapy or radiation therapy were retrospectively reviewed. To simplify the approach and facilitate differential diagnosis, the neuroimaging features have been classified into three main categories: central nervous system manifestations of primary disease, side effects of therapeutic procedures (radiation therapy, chemotherapy, bone marrow transplantation), and complications due to immunosuppression, particularly infections. Manifestations of primary disease include cerebrovascular complications (hemorrhage, cerebral infarction) and central nervous system involvement (infiltration of the meninges, parenchyma, bone marrow, orbit, and spine). Effects of radiation therapy include white matter disease, mineralizing microangiopathy, parenchymal brain volume loss, radiation-induced cryptic vascular malformations, and second neoplasms. Effects of chemotherapy and bone marrow transplantation include hemorrhage, dural venous thrombosis, white matter disease, reversible posterior leukoencephalopathy syndrome, and anterior lumbosacral radiculopathy. Both the underlying malignancy and antineoplastic therapy can cause immunosuppression. Fungi are the most frequent causal microorganisms in immunosuppressed patients with infection. Familiarity with the imaging findings is essential for proper diagnosis of neurologic symptoms in pediatric patients with oncohematologic disease.

Adolescent↗

PubMedDate not supplied

Imaging of complications of acute mastoiditis in children.

Acute mastoiditis is a serious complication of acute otitis media in children. Suppurative disease in the mastoid region occasionally spreads to the adjacent dura mater of the posterior and middle cranial fossae and the sigmoid sinus by means of thrombophlebitis, osseous erosion, or anatomic pathways, producing intracranial complications. Computed tomography (CT) should be performed early in the course of the disease to classify the mastoiditis as incipient or coalescent and to detect intracranial complications. On the basis of the clinical features and imaging findings, the disease is managed conservatively with intravenously administered antibiotics or treated with mastoidectomy and drainage plus antibiotic therapy. CT is therefore a decisive diagnostic tool in determining the type of therapy. In addition, magnetic resonance imaging is performed in patients with clinical symptoms or CT findings suggestive of intracranial complications because of its higher sensitivity for detection of extraaxial fluid collections and associated vascular problems.

Acute Disease↗

PubMedDate not supplied

Second malignancies in pediatric patients: imaging findings and differential diagnosis.

Therapeutic advances in the treatment of pediatric neoplasms have improved the prognosis but have also increased the risk of developing rare second malignant neoplasms (SMNs). Primary neoplasms that are often associated with SMNs include lymphoma, retinoblastoma, medulloblastoma, neuroblastoma, and leukemia. The most common SMNs are central nervous system (CNS) tumors, sarcomas, thyroid and parotid gland carcinomas, and leukemia, particularly acute myeloblastic leukemia. Genetic predisposition, chemotherapy, and especially radiation therapy are implicated as pathogenic factors in SMN. All survivors of childhood cancer should have lifelong follow-up, preferably with magnetic resonance imaging, which does not require ionizing radiation and provides greater anatomic detail and resolution in the head and neck region and the CNS. A new or progressive lesion may represent recurrence of the primitive neoplastic process, late radiation injury, or, more infrequently, an SMN. Differential diagnosis can be very difficult, and outcome is often fatal. Treatment protocols should be modified to reduce the risk for SMN without compromising the effectiveness of initial therapy. Clinicians should individualize treatment for patients who are genetically predisposed to SMN. In addition, radiologists should be familiar with the long-term consequences of antineoplastic therapy to facilitate diagnosis and anticipate adverse outcomes.

Child↗

PubMedDate not supplied

Gray-scale and color Doppler sonography of scrotal disorders in children: an update.

Ultrasonography (US) is well suited to the study of pathologic conditions of the scrotum in children. US provides excellent anatomic detail; when color Doppler and power Doppler imaging are added, testicular perfusion can be assessed. Gray-scale, color Doppler, and power Doppler US were used to study a spectrum of scrotal disorders in 750 boys aged 1 day to 17 years. The entities studied included processus vaginalis-related disorders (cryptorchidism, inguinal-scrotal hernia, and hydrocele); varicocele; acute scrotum (epididymo-orchitis, torsion of the testicular appendages, and testicular torsion); scrotal tumors; testicular microlithiasis; scrotal trauma; and systemic diseases with scrotal involvement. When combined with the results of clinical and physical examination, the information obtained with US is sufficient to enable diagnosis in most cases of scrotal disease. Moreover, color Doppler imaging is essential for differentiation between processes such as epididymo-orchitis or torsion of the testicular appendages and testicular torsion, which have similar clinical manifestations (pain, swelling, and redness) but are managed differently.

Adolescent↗