With the increased routine use of prenatal ultrasonography, subdiaphragmatic masses in the fetus are identified more frequently. Suprarenal masses often are presumed to be neuroblastoma and are removed surgically postnatally. We sought to better understand the natural history of subdiaphragmatic extralobar pulmonary sequestration, and to determine if subdiaphragmatic extralobar pulmonary sequestration can be distinguished preoperatively from neuroblastoma. The literature was reviewed for cases of prenatally diagnosed suprarenal masses that proved ultimately to be either subdiaphragmatic extralobar pulmonary sequestration or neuroblastoma. The distinguishing features of the two lesions were identified and an algorithm was created on the basis of these distinctions. Prenatally diagnosed subdiaphragmatic extralobar pulmonary sequestration is no longer rare, with one case being reported for every 2.5 cases of neuroblastoma. On prenatal ultrasonography subdiaphragmatic extralobar pulmonary sequestration usually is echogenic, is left‐sided, and can be identified in the second trimester. Neuroblastoma is most often cystic, right‐sided, and identified in the third trimester. In summary, subdiaphragmatic extralobar pulmonary sequestration must be considered in the differential diagnosis of the suprarenal mass identified on prenatal ultrasonography. Using the algorithm which we propose, the correct diagnosis can be determined prenatally in 95% of patients.

SUMMARY:The programmable CSF shunt valve has become an important tool in hydrocephalus treatment, particularly in the NPH population and in pediatric patients with complex hydrocephalus. The purpose of this study is to provide a single reference for the identification of programmable shunt valves and the interpretation of programmable shunt valve settings. Four major manufacturers of programmable shunts agreed to participate in this study. Each provided radiographic images and legends for their appropriate interpretation. Issues of MR imaging compatibility for each valve are also discussed.ABBREVIATIONS: H ϭ high; L ϭ low; M ϭ medium; NPH ϭ normal pressure hydrocephalus; P/L ϭ performance levels H ydrocephalus affects between 1% and 2% of the population.1 It accounts for 70,000 hospital admissions annually and the placement of between 18,000 and 33,000 CSF shunts in the United States each year.2 Because one-third of all shunts fail within 1 year of placement and the manifestations of shunt failure are protean, patients with shunts frequently undergo radiographic evaluation.3 These evaluations include not only cross-sectional imaging with CT and MR imaging but also plain radiographs of the shunt system.Most CSF shunts consist of 3 components: a ventricular catheter, a valve, and a distal catheter. A shunt is a completely internalized system, as opposed to an external ventricular drain in which a ventricular catheter drains to a collection system at the bedside. The catheter components of a shunt are made from Silastic (Dow Corning, Midland, Michigan), a form of rubber tubing resistant to breakdown in the body. They are frequently impregnated with radiopaque material to aid in their radiographic visualization. The ventricular catheter sits within 1 of the ventricular spaces in the brain, most commonly the right lateral ventricle. The ventricular catheter is connected to a valve that regulates flow. To counter a siphoning effect associated with upright posture, many shunt systems also include an antisiphon device; this reduces overdrainage when the patient is standing.Historically, shunt valves permitted a fixed amount of CSF drainage. This required the surgeon to select a specific valve for implantation, and if overdrainage or underdrainage resulted, a second operation was required to change the valve. The programmable valve is an important advancement in shunt technology. It provides the option of changing the opening pressure of the valve transcutaneously, most commonly with a device using a coded magnetic field. Although most valves placed in the United States are still fixed-pressure valves, the programmable valve has become an important tool in hydrocephalus treatment, particularly in the NPH population and in pediatric patients with complex hydrocephalus. 4 Patients with NPH often require multiple adjustments of opening pressure to optimize cognitive function and gait stability, while avoiding overdrainage and the secondary subdural effusion. Other patients with hydrocephalus have a very narrow therapeutic w...

It has been stated that congenital cartilage rings in the esophagus do not respond to dilation and should be resected. The authors report on 3 infants with congenital esophageal stenoses who were treated successfully with hydrostatic balloon dilation. Based on the appearance during dilation the authors believe that these stenoses were cartilage rings. The technique is described in detail. Balloon dilation is the treatment of choice for these patients. Resection should be reserved for those who do not respond to this form of therapy.

eckel diverticulum is the most frequent congenital malformation of the gastrointestinal tract, occurring in approximately 2% of the population. Diagnosis of Meckel diverticulum in the pediatric population is made most often by a nuclear medicine scan and also by fluoroscopy, plainfilm radiography, computed tomography, and magnetic resonance imaging. We present a case of Meckel diverticulum evident in utero on a prenatal sonographic examination performed at 33 weeks' gestational age. There were no prenatal complications, and postnatal surgery confirmed Meckel diverticulum. In view of the rarity of Meckel diverticulum, we hope this information will aid radiologists involved in fetal sonography to help determine the differential diagnosis of anechoic intraabdominal masses in the fetus. Case ReportA 20-year-old woman, gravida 1, para 0, was referred for a detailed morphologic survey at 33 weeks' gestational age because of an abdominal abnormality seen on an outside sonographic examination. A complete assessment revealed a healthy male fetus growing appropriately with a normal amniotic fluid index and a tubular fluid-containing structure in the right hemiabdomen. The fluid-filled structure appeared to change slightly in shape during the examination, suggesting peristalsis. No color Doppler flow was detected within the mass. Serial sonograms revealed no change in the size or configuration of the cystic mass, which became isoechoic to the fetal loops of bowel at term. Because no other bowel dilatation was evident, the mass was thought to most likely represent an intestinal duplication cyst, Meckel diverticulum, or a focal area of bowel stenosis or atresia (Figures 1 and 2).

statistically significant with 11 (STD 2.5) or 46% additional correct responses answered on the post-test compared to the pre-test. Mean performance on the live skills assessment was 88%. Exit survey showed a mean participant satisfaction score of 4 (STD 0) based on a Likert scale of 1-4; group mean confidence to use RUSH in clinical practice scored 3.3 (STD 0.5). Conclusions: Ultrasound education lends itself well to the international setting where visual and hands-on teaching modalities have the potential to tackle barriers to learning, such as language and other sociocultural differences. The outcomes of this study support the idea that ultrasound education can play a role at the frontlines of educational outreach to medically underserved regions.