PEDIATRIC SONOGRAPHIC IMAGING AND INTERVENTION IMAGING ：儿科超声成像和干涉成像.pptVIP

PEDIATRICHEAD AND NECKMASSES:INTERVENTIONALRADIOLOGICALMANAGEMENT WILLIAM E. SHIELS II , D.O.ChairmanChildren’s Radiological Institute andDepartment of RadiologyChildren’s HospitalColumbus, Ohio Pediatric Head and Neck GOALS Provide imaging management update Diagnostic imaging approach Current state of the art Interventional Radiology Dx role Therapeutic options Pediatric Head and Neck FOCUS Congenital Inflammatory Neoplastic Benign Malignant Juvenile Nasal Angiofibroma Highly vascular tumor-benign Male predilection, 7-21 yrs Often present with epistaxis Nasopharynx, max/sphenoid sinuses CT +Contrast for Diagnosis Embolization prior to surgery Cervical Adenitis Non-suppurative Sonography for diagnosis Suppurative- neck abscess US guided drainage US guided Bx, FNA Esp. cat scratch, mycobacterial Complicated Neck Abscess Not acute emergency May compromise airway Bacterial: Grp A. Strep; Staph CT best to diagnose, Sono to Tx Dissects laterally, up, down May dissect to mediastinum extrapleural Branchial Cleft Cyst Branchial cleft remnants Second BC most common Cysts, sinuses, fistulae Same course to tonsillar fossae Unilocular cyst, +/- infection US or CT/MR for diagnosis Successful percutaneous ablation Vascular Malformations Venous and lymphatic malformations Slow flow MRI and US (pre-treatment) Arteriovenous malformations High flow, no ST mass MRI, angiography (pre-treatment) Lymphatic Malformation Lymphatic ductal malformation Posterior triangle most common Any space in neck, shoulder, Mediastinum, may invade airway Macrocystic (hygroma), microcystic Non-operative treatment +/- successful WHERE ARE WEWITHTREATMENT? Dual-DrugTime Limited ContactSclerotherapy of Cervicofacial Lymphatic Malformations MECHANISM DETERGENT (Sotradecol) Opens cellular channels Lipoprotein membrane ETHANOL Denatures proteins Cell destruction Inflammatory response LOCATIONS / TYPES LOCATIO