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Ultrasound education improves by simulator training, however, the acceptance of ultrasound simulator training has not been investigated. Therefore we evaluated the participants response to simulator education during an ultrasound course of abdominal emergencies at an international ultrasound congress, at a regular ultrasound course and during courses at a regional hospital and an university hospital. Altogether, 62.3% of the participants judged the simulator image quality to be good. 84.3% considered the case selection to be good and 92.7% of the participants viewed the educational benefit to be good. 98.5% whished to have further ultrasound simulator courses to be developed and 95.3% of the participants opted for the integration of simulator training into the conventional ultrasound education.

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The initial method for evaluating pediatric chest disease remains the plain chest roentgenogram. When more precise definition of chest disease is required, computerized tomography (CT), magnetic resonance imaging (MRI), or ultrasonography (US) may be useful. In general, CT offers the widest spectrum of applicability. MRI is especially useful because no ionizing radiation is used and images can be acquired in multiple planes. MRI is most valuable when vascular anatomy needs to be defined or when tumor invasion of the spinal canal is suspected. US is helpful in evaluating diseases of the pleura and for characterizing and localizing pleural fluid and masses. US can differentiate normal thymus from other anterior mediastinal masses. Doppler techniques are valuable in evaluating suspected pulmonary sequestration and identifying the feeding vessel.

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The diagnosis of pulmonary sequestration has traditionally relied on angiographic demonstration of a systemic artery to the sequestered lung tissue. Rarely, extralobar sequestration can be associated with tension hydrothorax, which in the past has invariably led to fetal hydrops and death. The authors report the cases of three infants who had initially undergone color and spectral Doppler analysis; in two of them, extralobar sequestrations were associated with congenital hydrothorax. All three patients underwent surgical resection and histopathologic evaluation of their sequestrations. On the basis of the findings, the authors believe that torsion of the sequestration occludes the efferent venous and lymphatic channels, initiating the accumulation of pleural fluid and subsequent hydrops through systemic venous obstruction. Color Doppler made possible the identification of minute feeding vessels, obviating further diagnostic studies.

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Histoplasmosis can present a diagnostic dilemma if unusually large masses of lymph nodes, invasive mediastinal fibrosis, or pericarditis result from the infection. These rare, late sequelae are often first suspected from findings on chest radiographs obtained for unrelated reasons. Organisms are not always evident at histologic analysis at this stage. Mediastinal granulomas consist of lobulated masses of enlarged lymph nodes with central caseation, a peripheral thin capsule, and, occasionally, calcification. The mass does not invade or compromise adjacent anatomic structures. Mediastinal fibrosis invades and can seriously compromise the function of the tracheobronchial tree, superior vena cava, pulmonary arteries and veins, and esophagus; its symptoms mimic those of many other disorders. Pericarditis is commonly accompanied by pericardial effusion, pneumonia, and adenopathy. Although the radiologic findings of these conditions are nonspecific, they can be used with the clinical findings to suggest a diagnosis. Complications of histoplasmosis should be included in the differential diagnosis for patients residing in areas endemic to Histoplasma capsulatum.

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Atlanto-occipital subluxation (AOS) in individuals with Down syndrome is discussed using five new cases and nine patients previously presented in the literature. Although AOS is likely due to ligamentous laxity, it was associated with atlantoaxial instability in only two youngsters. Reducible C1-C2 rotary subluxation was present in a third. Posterior movement of the occiput with respect to C1 occurred on extension and reduced on flexion in all but one individual who demonstrated anterior subluxation. Neurological problems are described in only two individuals: one with severe atlantoaxial subluxation (AAS) and the other with multiple cervical spine anomalies. Since AOS is usually detected on films obtained to screen children with Down syndrome for AAS, the atlanto-occipital joint should be carefully studied on these radiographs. The clinical significance of AOS needs to be determined.

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The epidemic of the acquired immunodeficiency syndrome (AIDS) has affected all geographic regions of the United States. Indeed, it is likely that a majority of U.S. hospitals have cared for patients who are infected with the human immunodeficiency virus (HIV), the virus that causes AIDS. More than 46,000 individuals with HIV infection have fulfilled the strict diagnostic criteria for AIDS (1). All of these patients with AIDS have been seriously ill and have been hospitalized, often multiple times and for prolonged periods. Another, larger group patients with HIV infection has had another form of the disease, the so-called AIDS-related complex. Many of these patients have also spent time in hospitals. An even larger group of individuals has been infected with HIV but has remained asymptomatic to date. Some of these persons have been admitted to hospitals or have received outpatient diagnostic procedures for intercurrent medical or dental complaints that were unrelated to their asymptomatic HIV infection. At the time of their medical evaluation, some of these asymptomatic individuals were known to have a positive HIV antibody test. It is likely, however, that the serologic status of the majority of asymptomatically infected patients was unknown. Thus, by now a very large number of health-care personnel in the United States, including diagnostic radiology staff, have assisted in the care of HIV-infected patients.

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Diagnosis of disc space infection in childhood is often delayed and is usually made on the basis of multiple roentgenographic, laboratory, and nuclear imaging studies. Four cases of septic discitis in children are described. Special emphasis is placed on the diagnostic findings with magnetic resonance imaging. Magnetic resonance sensitivity for this entity and its role in comparison with other imaging modalities are discussed.

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In three pediatric patients having CT of the chest done under general anesthesia, we encountered multiple areas of macroatelectasis in the lung. All patients had malignant disease, and the chest findings could have been interpreted as metastatic spread to the lung. To prevent this critical false-positive diagnosis, we believe general anesthesia for CT of the chest should be given with controlled rather than spontaneous ventilation.

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The authors review the imaging techniques currently used to study some of the more common emergency medical and surgical problems that are encountered in children and that are not covered elsewhere in this volume.

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Magnetic resonance imaging has potentially broad applications in pediatric practice. Although further studies are needed to determine its exact role in comparison with the other imaging modalities, magnetic resonance has shown increased sensitivity in lesion detection in many disease processes. Since MR does not use ionizing radiation and does not require intravenous contrast to identify vascular structures, it becomes an ever more attractive imaging tool for pediatric diagnosis. Thus, the early results of MR imaging have shown promise and the future of MR appears exciting.

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This article has presented an overview of the sonographic detection of fetal anomalies. Fortunately, fetal anomalies are relatively rare, but the information that is obtained with sonography can facilitate obstetric management and counseling of the expectant parents.

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Hyperimmunoglobulinemia E (Job or Buckley) syndrome is an immunodeficiency disease associated with recurrent pyogenic infections, chronic eczematoid dermatitis, and mucocutaneous candidiasis. Association of this condition with osteoporosis and recurrent fractures is presented by a case report and by review of other reports describing similar findings. Other immunodeficiency syndromes with associated skeletal abnormalities are discussed.

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We have reported a case of epicranial arachnoid cyst, a developmental abnormality that occurs at the obelion, and have reviewed characteristic clinical and radiologic features that facilitate diagnosis.

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In a 20-month period, 13 percutaneous nephrostomies were placed in 10 pediatric patients ranging in age from one day to six and one-half years. The procedure was successful in all cases with no significant complications. Final diagnoses included ureteropelvic junction obstruction, ureterovesical junction obstruction, posterior urethral valves, and pyonephrosis. Localization of the obstruction as detected on initial antegrade nephrostography was found to be incomplete or incorrect in three patients. In one patient, both ureteropelvic and ureterovesical junction obstruction were present. In the other two patients, the misdiagnosis probably related to the difficulty of filling a distended, obstructed ureter prior to drainage.

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In 1982, the American Association of Women Radiologists surveyed women radiologists practicing in the United States to acquire information concerning their training, practice patterns, lifestyles, and opinions about employment equity. This report summarizes the resulting data from 336 responses to the 1,700 questionnaires that were distributed. As would be expected with the increasing number of women currently graduating from medical school, women radiologists responding to the questionnaire are younger than the group of radiologists as a whole. However, geographic distribution and percentage of board certification (96%) are comparable for the two groups. Data from the survey indicate that at least 61% of women radiologists are involved in private practice and 39% in academic radiology. For all radiologists, the respective figures are 82% and 18%. Most women responding to the survey believed that their income was comparable to that of men in similar positions. On the other hand, 56% of respondents perceived inequities in the ability of women radiologists to secure desirable jobs.

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The size and echogenicity of the pancreas was evaluated with real-time and static sonography and correlated in an independent and retrospective manner with amylase values in 17 asymptomatic children, 19 children with acute pancreatitis, and 2 with chronic pancreatitis. A ratio of the greatest anteroposterior dimension of the body of the pancreas relative to the transverse lumbar vertebral body measurement (P/V ratio) greater than 0.3, when associated with a hypoechoic pancreatic parenchyma, was indicative of acute pancreatitis. The predictive value of a positive sonogram was found to be 0.93, whereas the predictive value of a negative sonogram was 0.78. These data indicate that sonography is a useful adjunct to amylase determinations in the detection of pancreatitis in children.

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