Purpose To compare and correlate the diagnostic efficiency of acoustic radiation force impulse (ARFI) elastography with biochemical markers for assessing hepatic changes in overweight and obese children. Methods This prospective study was approved by the institutional ethics committee. It included 54 overweight and obese children and 50 normal children (as a control group) in the age range 5-18 years. For all children, we performed grayscale ultrasonography to diagnose fatty liver, ARFI elastography to measure liver stiffness, and biochemical evaluation for aspartate aminotransferase (AST), alanine aminotransferase (ALT), and serum triglyceride (TG) levels. Results Of the 54 obese children, AST was elevated in 13 (24.1%) and ALT was elevated in 16 (29.6%); however, only 4 (25%) of these 16 obese children with abnormal aminotransferase levels had an AST/ALT ratio [0.8. Furthermore, all children with abnormal aminotransferase levels with AST/ALT ratio [0.8 also had abnormal readings of ARFI elastography. The TG was elevated ([150 mg/dL) in 2 out of 54 (3.7%) obese children. None of the normal children showed abnormal levels of aminotransferase and TG. Three out of 54 (5.6%) obese children did not show fatty liver changes, while 29 (53.7%) showed grade-I fatty liver changes, and 22 (40.7%) showed grade-II fatty liver changes. The mean (SD) ARFI value was 1.13 m/s (SD 0.199) for obese children and 1.02 m/s (SD 0.11) for children in the control group. Of the 54 obese children, 49 (90.7%) showed ARFI values of \1.19 m/s (normal), 4 (7.4%) had ARFI values from [1.19 to \1.75 m/s, and 1 (1.9%) had an ARFI value [1.75 m/s. Four children with an increased ARFI value also had an AST/ALT ratio [0.8. However, one obese child with a raised ARFI value did not have an elevated AST/ALT ratio, and none of his aminotransferase levels were abnormal. All normal children had ARFI values\1.19 m/s. Conclusion ARFI elastography shows excellent correlation with AST/ALT ratios in obese children and may be used as a noninvasive tool to detect nonalcoholic fatty liver disease (NAFLD) and associated hepatic changes, especially in pediatric patients, for whom liver biopsy is not always feasible.Keywords Children Á Obesity Á Liver Á Elastography Sommario Scopo Confrontare e correlare l'efficienza diagnostica di Acoustic Radiation forza d'impulso (ARFI) elastografia con marcatori biochimici nella valutazione delle alterazioni epatiche nei bambini in sovrappeso e obesi. Metodi Questo studio prospettico è stato approvato dal comitato etico istituzionale. 54 bambini in sovrappeso e obesi e 50 bambini normali (controlli) della fascia di età 5-18 years sono stati inclusi. In tutti i bambini, abbiamo eseguito l'ecografia in scala di grigi per la diagnosi di fegato grasso, ARFI elastografia per misurare la rigidità del fegato, e la valutazione biochimica per aspartato aminotransferasi (AST), alanina aminotransferasi (ALT) e livelli di trigliceridi nel siero (TG). Conclusione ARFI elastography mostra un'eccellente correlazione con il rapporto A...

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Segmentation defects are often seen with congenital atlantoaxial dislocation (AAD) though an associated absence of posterior arch of C2 and butterfly C3 is rare. Apart from rarity, the combination of formation and segmentation defects adds to the management dilemma. We report a case of AAD with assimilated atlas, absent C2 posterior arch, C3 butterfly vertebra with floating posterior elements, and fused C4–C6. The child was managed by C1–C2 fusion alone with immediate symptomatic improvement. The presence of formation defects such as adjacent butterfly vertebra and absent posterior elements does not alter the management of AAD. Fusing the C1–C2 joints appears to be a balanced approach.

The saddle shape of the sub-axial cervical spine prevents such lateral dislocations. It is imperative to study the radiology in multiple planes to assess the 'multiplanar dislocation'. Correction is possible with proper planning and manipulation of facets and bodies using the available instrumentation. Though not obtained in this case, a preoperative MRI and a CT angiogram are important in surgery planning.

Purpose: Pseudoaneurysms of the common carotid artery secondary to high-velocity fragment injuries to the head and neck in patients are uncommon lesions. Multi-detector computed tomography angiography should be performed on all patients suffering from high-speed fragment injuries of the head and neck. <br /> Case presentation: We share our experience with the endovascular management approach for the closure of 2 separate pseudoaneurysms involving the left common carotid artery.<br /> Conclusions: Numerous options for surgical and endovascular treatment of these lesions are available. Endovascular therapy in patients with common carotid artery pseudoaneurysms offers a reliable and non-invasive management option. It helps in the mitigation of its rupture and thromboembolic complications. <br /> Key words: pseudoaneurysm, carotid artery, covered stent, traumatic neck injuries.