To document current sedation practices in computed tomographic (CT) examination of children, a questionnaire was sent to a random sample of 2,000 hospitals with CT scanners in the United States. Responses were received from 834 hospitals (42%). Of these, 450 were reported to conduct pediatric CT with sedation. Approximately one-half of the examinations were conducted in pediatric hospitals or medical schools. Most hospitals did not require signed consent for CT with light sedation, even when intravenously or orally administered contrast medium was used. Signed consent for CT with deep sedation was required in 62% of hospitals. Monitoring techniques and personnel present during CT with sedation varied greatly, as did oral intake protocols for examinations with oral contrast material or no contrast material. Use of intubation during CT with oral contrast medium was rare. Orally administered chloral hydrate was the most frequently used first-line drug for sedation in most types of CT studies. The great variation in practices indicates a lack of settled standards for sedation during pediatric diagnostic examinations. Many procedures reported for pediatric CT with sedation are at variance with recommendations of the American Academy of Pediatrics.

A retrospective review of 50 sinus tracts and 87 fistulas is presented. The etiologies, methods of radiographic evaluation including computed tomography and ultrasound, means of radiographic intervention, and disposition of sinus tracts and fistulas are discussed. Despite the newer imaging modalities, a sinogram or a fistulogram is still the best means of evaluating a sinus tract or fistula when an external communication is present. Computed tomography is helpful if exact spatial delineation of the tract is necessary or an associated abscess is suspected. Ultrasound examination is generally not useful, being limited by bowel gas and surgical incisions.

We report a case of retropharyngeal tendinitis. A brief review of the literature, as well as extensive differential diagnosis, is presented. Retropharyngeal tendinitis should be a prime diagnostic consideration in patients who present with acute cervical pain, retropharyngeal calcium deposition, and prevertebral soft tissue swelling.

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