Maria Raissaki

Objectives: Choledocholithiasis often coexists with symptomatic cholelithiasis, and early detection is crucial to prevent complications. In these patients, the common bile duct (CBD) may appear non‐dilated on ultrasonography (US). Studies on the temporal evolution of CBD measurements and corresponding bilirubin levels are currently lacking. Herein, we aim to evaluate the temporal evolution and correlation of CBD/intrahepatic duct (IHD) dilatation with serum bilirubin levels in patients with choledocholithiasis. Methods: In this single‐center prospective study, we included 46 patients with acute right upper quadrant pain, sonographically confirmed cholelithiasis and MRCP/ERCP confirmed choledocholithiasis. CBD/IHD US measurements and serum total/direct bilirubin levels were obtained at p < .01. Results: Prevalence of CBD dilatation increased from 34.8% at t1 to 69.6% at t2 and 95.7% at t3. Mean CBD diameters increased from 5.7 ± 2.3 mm to 8.2 ± 2.7 mm and 12.1 ± 2.5 mm ( p < .0001). IHD dilatation incidence increased from 2.1 to 19.6% and 78.3%. Total/direct bilirubin levels progressed between all time‐points, with the greatest increase between t1 and t3 ( p = .0003/ p = .0006). Sensitivity of CBD dilatation for diagnosing choledocholithiasis was 34.8, 69.6, and 95.7% increasing to 56.5%/78.3%, 87%/91.3% and 95.7%/95.7% when combined with total/direct bilirubin across t1, t2, and t3, respectively. Conclusions: In patients with choledocholithiasis, emergency US may be false‐negative. Serial US assessment of CBD diameter, particularly when combined with bilirubin trends, substantially improves diagnostic sensitivity. Repeat US and laboratory investigations within up to 3 days are supported for appropriate patient management.

We describe a case of a 7.5-year-old boy with a 7-week history of recurrent right knee swelling despite joint aspiration, persisting limping, and mild motion restriction, following a minor injury. Initial magnetic resonance imaging (MRI), ultrasound, and joint fluid analysis yielded non-specific synovitis. The child was investigated for juvenile idiopathic arthritis (JIA) and referred for a repeat MRI. Questioning by the attending radiologist disclosed falling onto wood sticks 10 weeks previously. Florid enhancing synovitis, prominent popliteal lymph nodes, and a linear foreign body were identified and ultrasonographically confirmed. During the operation, a 3-cm wooden splinter was successfully removed. This case highlights the uncommon challenge of differentiating between JIA and foreign body-induced synovitis and emphasizes the importance of detailed history by the radiologist and meticulous imaging techniques.

Chest imaging in children presents unique challenges due to varying requirements across age groups. For chest radiographs, achieving optimal images often involves careful positioning and immobilisation techniques. Antero-posterior projections are easier to obtain in younger children, while lateral decubitus radiographs are sometimes used when expiratory images are difficult to obtain and for free air exclusion. Chest CT protocols should be age-dependent to minimise radiation exposure and motion artefacts. MRI is primarily used in specialised centres to reduce radiation exposure, requiring specific expertise and sedation in younger children. Respiratory distress syndrome is a leading cause of morbidity in preterm neonates, diagnosed through characteristic radiographic findings and a history of prematurity. Bronchopulmonary dysplasia is the most common complication of extreme preterm birth and chronic oxygen therapy; imaging is used for predicting outcomes for the assessment of severe cases. Transient tachypnoea of the newborn and meconium aspiration syndrome are common in term infants, with specific imaging characteristics aiding in their differentiation. Congenital lung malformations present diagnostic and management challenges, with imaging playing a crucial role in diagnosis and surgical planning. Finally, imaging is essential in detecting complications from pneumonia in children, such as empyema and necrotic pneumonia, or in identifying foreign object aspiration. Clinical relevance statement: This review summarises current radiology practice of paediatric chest pathologies, aiding in the accurate diagnosis and management of neonatal and congenital pulmonary conditions and pneumonia complications, ultimately improving patient outcomes through precise imaging interpretation and targeted clinical intervention. Key Points: Chest radiographs should be systematically assessed for pathology. Ensure accurate differential diagnosis of neonatal lung diseases by collecting information on gestational age, method of delivery, presenting symptoms, ventilation type, and fetal ultrasound findings. Radiographs and ultrasound are initial diagnostic tools for paediatric pulmonary disease; CT should be reserved for complex cases. Referral to paediatric hospital should be considered when the use of chest MRI is indicated.

Screening for developmental dysplasia of the hip (DDH) in Greece is being performed according to the guidelines issued by the Institute of Child Health in 2015. Screening strategies include universal clinical screening and selective (based on clinical findings or risk factors) sonographic screening. Clinical examination is performed by neonatologists and paediatricians and findings are recorded in the baby’s Health-Book. Whenever clinical examination is suspicious (however non-specific), children are referred for an ultrasound scan and/or to a (paediatric) orthopaedic surgeon. In the case of a positive clinical examination, children are referred to a (paediatric) orthopaedic surgeon, who treats them, when needed. All types of abduction devices are used for treatment (Pavlik, Tubingen), as well as plaster cast, which is preferred in older babies. There are no official guidelines over the selection of the sonographic method for screening; however, the mostly used technique is Graf’s, according to publications from Greek centers. Training of operators on the sonographic examination technique is carried out during radiology residency, depending on hospital availability/expertise, through seminars with hands-on workshops and/or during fellowships. Radiologists and certified paediatric orthopaedic surgeons are the only ones legally allowed to perform neonatal/infantile hip sonography in Greece. Emphasis on the benefits of universal screening and standardized techniques are increasingly taught and repeated, which may eventually influence the decision-making process and standardize the performance of hip sonography within the next few years.

Leptospirosis is a reemerging zooanthroponosis with a worldwide distribution, though it has a higher incidence in areas with tropical climate. A characteristic finding of the disease is its wide spectrum of symptoms and organ involvement, as it can appear either with very mild flu-like manifestations or with multiorgan failure, affecting the central nervous system (CNS) with a concomitant hepatorenal dysfunction (Weil’s syndrome) and significant high mortality rate. We report herein a fatal case of a 25 years old female, previously healthy, with impaired neurological status. She had high fever and severe multiorgan failure. The clinical data and the epidemiological factors were not conclusive for the diagnosis, and the first serology test from the cerebrospinal fluid (CSF) and sera samples were negative. When the repetition of the blood test showed elevated IgM antibodies, Leptospirosis was the presumptive diagnosis. Although CNS involvement is rare, the diagnosis should be considered when there is an elevated risk of exposure. The diagnostic protocol should encompass direct evidence of the bacterium and indirect measurement of antibodies. Timely detection and management are imperative to forestall complications and fatality associated with the disease.

Aim To investigate whether linear measurements or ratios on the Graf's "standard plane" ultrasound images of the neonatal/infantile hip, can support the clinically important differentiation between type I and type II hips. Material and methods A total of 60 Graf type II hips and 124 randomly selected Graf type I hips, matched to the gestational age at delivery, birth weight, delivery mode, and age at the time of the examination, were identified through our hip screening service, during a period of two years. The images were diagnostically suitable, following anatomical identification and usability check, according to Graf. Anatomical landmarks including the lower limb of the os ilium, the bony rim, the silhouette of the os ilium, the labrum and the femoral head's borders, were used to determine the measurements and ratios which quantified their inter-relationships. Results The indices which differed significantly between type I and type II hips included: (a) the width of the "bony roof" (cut-off value 5.91 mm, sensitivity: 75%, specificity: 70%), (b) the ratio of the width of the "bony roof" to the femoral head's width (cut-off value 0.40, sensitivity 83%, specificity 71%), and (c) the ratio of the cartilaginous acetabular roof's width (including the labrum), to the width of the femoral head (cut-off value 0.450, sensitivity 82%, specificity 67%). Conclusions Newly introduced measurements and calculated ratios on "standard plane" ultrasound images can be used as additional indices in the differentiation between Graf's types of "centered hips", thus increasing the diagnostic certainty of the examiner in borderline cases and limiting unnecessary re-examinations or treatment.

The most common acute infection and leading cause of death in children worldwide is pneumonia. Clinical and laboratory tests essentially diagnose community-acquired pneumonia (CAP). CAP can be caused by bacteria, viruses, or atypical microorganisms. Imaging is usually reserved for children who do not respond to treatment, need hospitalisation, or have hospital-acquired pneumonia. This review discusses the imaging findings for acute CAP complications and the diagnostic role of each imaging modality. Pleural effusion, empyema, necrotizing pneumonia, abscess, pneumatocele, pleural fistulas, and paediatric acute respiratory distress syndrome (PARDS) are acute CAP complications. When evaluating complicated CAP patients, chest radiography, lung ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) can be used, with each having their own pros and cons. Imaging is usually not needed for CAP diagnosis, but it is essential for complicated cases and follow-ups. Lung ultrasound can supplement chest radiography (CR), which starts the diagnostic algorithm. Contrast-enhanced computed tomography (CECT) is used for complex cases. Advances in MRI protocols make it a viable alternative for diagnosing CAP and its complications.

In infants without a history of trauma, subdural haemorrhages should raise the concern for an abusive head injury, particularly when they are associated with bridging vein clotting/rupture or with septations. However, non-haemorrhagic, fluid-appearing subdural collections (also called hygromas) may also be the result of abuse. Subdural collections have also been uncommonly observed in patients with benign enlargement of the subarachnoid spaces (BESS) and a few large-scale studies accurately investigate the incidence and the significance. Currently, there is a wide variation of practices in children with BESS and subdural collections. Due to the social risks associated with abuse evaluation and the perceived risk of radiation exposure, there might be a reluctance to fully evaluate these children in some centres. The diagnosis of physical abuse cannot be substantiated nor safely excluded in infants with BESS and subdural collection(s), without investigation for concomitant traumatic findings. The exact prevalence of occult injuries and abuse in these infants is unknown. In macrocephalic infants with subdural collections and imaging features of BESS, thorough investigations for abuse are warranted and paediatricians should consider performing full skeletal surveys even when fundoscopy, social work consult, and detailed clinical evaluation are unremarkable.

Purpose The present study aims to investigate the occurrence and severity of HRCT abnormalities in symptomatic never-smokers, passively exposed to cigarette smoke. Materials and methods A total of 135 never-smokers with respiratory symptoms, without underlying lung disease, underwent paired inspiratory–expiratory HRCT and completed the secondhand smoking (SHS) exposure scale questionnaire. Individuals passively exposed to tobacco consisted the secondhand smoking group (SHS group) (n = 68); the remaining 67 controls were never exposed to SHS. Statistical analysis was performed using the Kolmogorov–Smirnov, x² and Pearson Point-Biserial correlation tests. P < 0.05 was statistically significant. Results HRCT findings in SHS group included bronchial wall thickening (98.5%), mild cylindrical bronchiectasis (44%), ground-glass opacities (17.6%), and mosaic attenuation pattern (53%). Air trapping occurred in 65% of expiratory scans. Differences in occurrence of findings between SHS group participants and controls were statistically significant (p < 0.0001). There was significant correlation between exposure to tobacco smoke in hours/day and in number of cigarettes/day and the presence of mosaic attenuation pattern, ground-glass opacities, cylindrical bronchiectasis and air trapping, respectively (p < 0.05). Cumulative SHS exposure in years was also strongly correlated with the presence of ground-glass opacities, mosaic attenuation pattern, cylindrical bronchiectasis, and air trapping, as well as with the frequency of respiratory symptoms (p < 0.05). Conclusion HRCT findings attributed to SHS are mostly related to airway involvement and are correlated with the duration and grade of exposure to environmental tobacco smoke. SHS followed by lifestyle adjustments should be considered in symptomatic non-smokers with such HRCT findings.