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Balloon dilatation of esophageal strictures in children
catheters were removed for infection, and one for venous thrombosis with arm swelling. C o n c l u s i o n s : Obstruction of central venous structures does not preclude placement of long-term CVCs. However, these patients m a y be at increased risk for infection and/or thrombosis; thus, prophylactic antibiotic and/or anticoagulant therapy should be considered. As this is the early stage of an ongoing study, more patients will n e e d to be followed before m o r e definitive conclusions can be drawn. T a k e H o m e P o i n t s : 1. Obstruction of the central veins should not preclude p l a c e m e n t of long-term CVCs ifPTA can be successfully accomplished. 2. Due to their imaging and interventional capabilities, radiologists are uniquely suited to deal with central venous obstruction w h e n it is tmexpectedly e n c o u n t e r e d during routine catheter placement. 3. This patient population m a y be at increased risk for developing catheter associated complications.
P-33 Balloon Dilatation of Esophageal Strictures in Children Jeanne G. Hill, MD, John O. Herlong, MD, Medical University of South Carolina, Charleston, SC, William Yaakob, MD, T. J. Marlow, Roderick I. Macpherson, MD, Edward Tagge, MD, et al Purpose: This study will define the role of balloon dilatation u n d e r fluoroscopic guidance in the treatment of esophageal strictures in children. Methods: We retrospectively reviewed t h e charts and radiographs of 95 balloon dilatations in 40 pediatric patients (age range 11 days to 21 years) at MUSC from October 1989 t h r o u g h September 1996. Results: Most esophageal strictures OCCUlTed at the site of surgical anastomosis status post esophageal atresia repair (26/40, 67.5%). Other etiologies included reflux esophagitis (5), surgical anastomotic strictures other than EA repair (4), congenital stenoses (3), ftmdopllcations (2), and caustic ingestion (1). EBD successfully treated 35 of 41 strictures for a success rate of 85%. Six pro, cedures had mild complications including transient episockes~l~e'~t~ration, reversible apnea, and balloon r u p t u r q ~ Y ~ ~ [ i~ij~y. T w o procedures were c o m l ~ f l ~ ~'-~[c]~tl'fffars of the esophagus, one of w h i c h was subseq~elht~o~difficult rigid e n d o s c o p y and biopsy; there were no episodes of perforation. Conclusion: Esophageal balloon dilatation is a safe, minimally invasire, and effective treatment of m a n y benign esophageal strictures in children. Although severe reflux esophagitis and caustic ingestion are less amenable to this m o d e of treatment, EBD should be t h e managem e n t of choice in anastomotic and congenital strictures.
P-34 CT and MR Imaging of N o n - A c c i d e n t a l Pediatric Head T r a u m a Nicolas Petitti, MD, PhD, Bowman Gray School of Medicine, Winston-Salem, NC, DanielW. Williams III, MD P u r p o s e : Head trauma from child abuse is a major cause of morbidity and mortality in the pediatric age group, and the incidence continues to increase. We review the CT and MR f'mdings of head traurna due to nonaccidental injury and stress the significant role of the radiologist in bringing attention to the possibility of child abuse. M e t h o d s : A literature review as well as a review of CT and MR scans of patients with head trauma from d o c u m e n t e d child abuse cases was performed for the purposes of this study. Results: A head CT, can demonstrate the findings seen with the "shaken-baby syndrome," i.e., subdural hematomas, subarachnoid hemorrbages, shearing injury and diffuse brain swelling, in addition, a direct blow to the calvarium m a y p r o d u c e a scalp h e m a t o m a and/or skull fracture, an epidural hematoma, or a parenchymal contusion/ hemorrhage, all of w h i c h can be demonstrated on a CT study. MR imaging can be usefifl if the CT scan is normal. Small subdural hematomas, cortical contusions and shearing injury are better demonstrated by MR imaging.
864
Conclusion: By knowing what to search for in a study and w h i c h modality (CT or MR) to use, a radiologist can have a significant role in diagnosing child abuse.
P-35 Improving Virtual C o l o n 0 s c o p y w i t h a Fecal Contrast A g e n t Elizabeth L. Teigen, MD, Bowman Gray School of Medicine, Winston-Salem, NC, David J. Vining, MD, D. McCorquodale,BS, C. Siege, BS, Paul F. Hemler, PhD, David W. Gelfand, MD, et al Objective: To develop a m e t h o d for opacifying and digitally subtracting feces from spiral CT image data prior to virtual colonoscopy processing in order to eliminate t h e need for cathartic bowel cleansing. M e t h o d s a n d Materials: Twenty volunteer patients enrolled in this study drank low-density barium formulations three times per day over the course of three days and collected stool specimens on the last two days. The stool specimens were scanned with spiral CT, and the CT images were analyzed to determine t h e m e a n and standard deviation attenuation values of each specimen. Results: The stool s p e c i m e n s were all h o m o g e n e o u s l y opacified within twenty-four hours of beginning the oral contrast administration with an average increase in attenuation values above 200 Hounsefield Units (HU), thus making stool easy to distinguish against the average soft tissue attenuation value of 20-40 HU. C o n c l u s i o n : This exhibit describes a m e t h o d for h o m o g e n e o u s l y opacifying fecal matter prior to virtual colonoscopy processing. This w o r k will allow for the development of c o m p u t e r m e t h o d s to digitally subtract opacified feces from spiral CT image data in order to render unobstructed endoscopic views of the colon. This project was supported by a grant from E-Z-Em, inc., Westbury, NY. T a k e H o m e P o i n t s : (1) Residual feces are a problem even w h e n cathartic agents are used to cleanse the colon prior to performing virtual colonoscopy. (2) Prior to utilizing virtual colonoscopy on a routine basis, this problem m u s t be addressed. (3) Our m e t h o d of opacifying feces with an oral low-density formulation and digitally subtracting the feces from spiral CT image data promises to benefit virtual colonoscopy and colorectal cancer screening.
P-36 Gastrointestinal and Hepatobiliary Complications following Orthotopic Cardiac T r a n s p l a n t a . tion David H. Stemerman, MD, Temple University Hospital, Philadelphia, PA, AlanJ. Woronoff, MD, Jessica Berliner, MD, Cynthia L. Jackson, MD, Michael A. Ringold, MD, Dina F. Caroline, MD P u r p o s e : The purpose of this exhibit is to discuss and display the s p e c t r u m of gastrointestinal (GD and hepatobilllary morbidity w h i c h occurs following cardiac transplantation. M e t h o d s a n d Materials: Records of patients undergoing orthotopic cardiac transplantation at Temple University Hospital b e t w e e n January 1990 and August 1995 were restrospectively reviewed. 297 patients (215 males, 82 females, age range of 1 m o n t h to 66 years) are included in this study. Results: Of this group, 78 patients (26%) developed 33 different gastrointestinal and 11 different hepatobilllary complications in the posttransplant period. 40 patients (51%) developed more than one gastrointestinal or hepatobilliary illness. Most complications were minor. 17 patients (22%) developed significant GI morbidity, and only 11 patients (14%) developed major hepatobilliary complications. The most c o m m o n complication was gastritis (19%). Cholelithiasis (18%), diverticulitis (17%), gastric and duodenal ulcers (15%), ascites (13%), and pancreatitis (10%) were the n e x t m o s t c o m m o n causes of morbidity. Twenty five patients (32%) suffering from GI or hepatobilliary complications died, one of w h i c h was directly related to the complication. Of the 78 patients, radiologic examinations assisted in the diagnosis and treatment for 47 (60%).
P-33 Balloon Dilatation of Esophageal Strictures in Children Jeanne G. Hill, MD, John O. Herlong, MD, Medical University of South Carolina, Charleston, SC, William Yaakob, MD, T. J. Marlow, Roderick I. Macpherson, MD, Edward Tagge, MD, et al Purpose: This study will define the role of balloon dilatation u n d e r fluoroscopic guidance in the treatment of esophageal strictures in children. Methods: We retrospectively reviewed t h e charts and radiographs of 95 balloon dilatations in 40 pediatric patients (age range 11 days to 21 years) at MUSC from October 1989 t h r o u g h September 1996. Results: Most esophageal strictures OCCUlTed at the site of surgical anastomosis status post esophageal atresia repair (26/40, 67.5%). Other etiologies included reflux esophagitis (5), surgical anastomotic strictures other than EA repair (4), congenital stenoses (3), ftmdopllcations (2), and caustic ingestion (1). EBD successfully treated 35 of 41 strictures for a success rate of 85%. Six pro, cedures had mild complications including transient episockes~l~e'~t~ration, reversible apnea, and balloon r u p t u r q ~ Y ~ ~ [ i~ij~y. T w o procedures were c o m l ~ f l ~ ~'-~[c]~tl'fffars of the esophagus, one of w h i c h was subseq~elht~o~difficult rigid e n d o s c o p y and biopsy; there were no episodes of perforation. Conclusion: Esophageal balloon dilatation is a safe, minimally invasire, and effective treatment of m a n y benign esophageal strictures in children. Although severe reflux esophagitis and caustic ingestion are less amenable to this m o d e of treatment, EBD should be t h e managem e n t of choice in anastomotic and congenital strictures.
P-34 CT and MR Imaging of N o n - A c c i d e n t a l Pediatric Head T r a u m a Nicolas Petitti, MD, PhD, Bowman Gray School of Medicine, Winston-Salem, NC, DanielW. Williams III, MD P u r p o s e : Head trauma from child abuse is a major cause of morbidity and mortality in the pediatric age group, and the incidence continues to increase. We review the CT and MR f'mdings of head traurna due to nonaccidental injury and stress the significant role of the radiologist in bringing attention to the possibility of child abuse. M e t h o d s : A literature review as well as a review of CT and MR scans of patients with head trauma from d o c u m e n t e d child abuse cases was performed for the purposes of this study. Results: A head CT, can demonstrate the findings seen with the "shaken-baby syndrome," i.e., subdural hematomas, subarachnoid hemorrbages, shearing injury and diffuse brain swelling, in addition, a direct blow to the calvarium m a y p r o d u c e a scalp h e m a t o m a and/or skull fracture, an epidural hematoma, or a parenchymal contusion/ hemorrhage, all of w h i c h can be demonstrated on a CT study. MR imaging can be usefifl if the CT scan is normal. Small subdural hematomas, cortical contusions and shearing injury are better demonstrated by MR imaging.
864
Conclusion: By knowing what to search for in a study and w h i c h modality (CT or MR) to use, a radiologist can have a significant role in diagnosing child abuse.
P-35 Improving Virtual C o l o n 0 s c o p y w i t h a Fecal Contrast A g e n t Elizabeth L. Teigen, MD, Bowman Gray School of Medicine, Winston-Salem, NC, David J. Vining, MD, D. McCorquodale,BS, C. Siege, BS, Paul F. Hemler, PhD, David W. Gelfand, MD, et al Objective: To develop a m e t h o d for opacifying and digitally subtracting feces from spiral CT image data prior to virtual colonoscopy processing in order to eliminate t h e need for cathartic bowel cleansing. M e t h o d s a n d Materials: Twenty volunteer patients enrolled in this study drank low-density barium formulations three times per day over the course of three days and collected stool specimens on the last two days. The stool specimens were scanned with spiral CT, and the CT images were analyzed to determine t h e m e a n and standard deviation attenuation values of each specimen. Results: The stool s p e c i m e n s were all h o m o g e n e o u s l y opacified within twenty-four hours of beginning the oral contrast administration with an average increase in attenuation values above 200 Hounsefield Units (HU), thus making stool easy to distinguish against the average soft tissue attenuation value of 20-40 HU. C o n c l u s i o n : This exhibit describes a m e t h o d for h o m o g e n e o u s l y opacifying fecal matter prior to virtual colonoscopy processing. This w o r k will allow for the development of c o m p u t e r m e t h o d s to digitally subtract opacified feces from spiral CT image data in order to render unobstructed endoscopic views of the colon. This project was supported by a grant from E-Z-Em, inc., Westbury, NY. T a k e H o m e P o i n t s : (1) Residual feces are a problem even w h e n cathartic agents are used to cleanse the colon prior to performing virtual colonoscopy. (2) Prior to utilizing virtual colonoscopy on a routine basis, this problem m u s t be addressed. (3) Our m e t h o d of opacifying feces with an oral low-density formulation and digitally subtracting the feces from spiral CT image data promises to benefit virtual colonoscopy and colorectal cancer screening.
P-36 Gastrointestinal and Hepatobiliary Complications following Orthotopic Cardiac T r a n s p l a n t a . tion David H. Stemerman, MD, Temple University Hospital, Philadelphia, PA, AlanJ. Woronoff, MD, Jessica Berliner, MD, Cynthia L. Jackson, MD, Michael A. Ringold, MD, Dina F. Caroline, MD P u r p o s e : The purpose of this exhibit is to discuss and display the s p e c t r u m of gastrointestinal (GD and hepatobilllary morbidity w h i c h occurs following cardiac transplantation. M e t h o d s a n d Materials: Records of patients undergoing orthotopic cardiac transplantation at Temple University Hospital b e t w e e n January 1990 and August 1995 were restrospectively reviewed. 297 patients (215 males, 82 females, age range of 1 m o n t h to 66 years) are included in this study. Results: Of this group, 78 patients (26%) developed 33 different gastrointestinal and 11 different hepatobilllary complications in the posttransplant period. 40 patients (51%) developed more than one gastrointestinal or hepatobilliary illness. Most complications were minor. 17 patients (22%) developed significant GI morbidity, and only 11 patients (14%) developed major hepatobilliary complications. The most c o m m o n complication was gastritis (19%). Cholelithiasis (18%), diverticulitis (17%), gastric and duodenal ulcers (15%), ascites (13%), and pancreatitis (10%) were the n e x t m o s t c o m m o n causes of morbidity. Twenty five patients (32%) suffering from GI or hepatobilliary complications died, one of w h i c h was directly related to the complication. Of the 78 patients, radiologic examinations assisted in the diagnosis and treatment for 47 (60%).