Preparing for the Unexpected

Gottesman, None Michael; Patel, Roshni; Parnes, Gregory; Ortiz, A. Orlando

doi:10.1016/j.rcl.2021.03.003

Cited by 2 publications

(1 citation statement)

References 20 publications

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“…In the pediatric population, common incidental findings include scoliosis, vertebral hemangiomas, congenital fusion, abnormal segmentation, os odontoideum, and spina bifida occulta [15]. Radiologists reviewing spinal MRIs are recommended to evaluate for extraspinal incidental findings, including thyroglossal duct cysts, hepatic masses, lung nodules, and renal cysts, given that they occur at a nontrivial rate and early detection can significantly improve outcomes [23].…”

Section: Isolated Incidental Intradural Spine Tumorsmentioning

confidence: 99%

Approaches to Incidental Intradural Tumors of the Spine in the Pediatric Population

Hersh¹,

Lubelski²,

Theodore³

et al. 2023

Pediatr Neurosurg

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Background: Incidental intradural tumors of the spine in the pediatric population are rare lesions whose management remains unclear. Surgeons must balance the risks of iatrogenic deficits and complications after surgical resection against the risks from progressive growth of the tumor. Moreover, the natural history of an incidental finding can be difficult to predict. Here we review the literature on incidental intradural tumors of the spine and present considerations for their management. Summary: Growth of the tumor or changes in radiographic features are usually indications for resection. Asymptomatic lesions can be found in patients with genetic syndromes that predispose to tumor formation, such as neurofibromatosis type 1 and 2, schwannomatosis, and Von-Hippel-Lindau syndrome, and careful workup of a genetic cause is warranted in any patient presenting with multiple tumors and/or cutaneous features. Close follow-up is generally favored given the heavy tumor burden; however, some recommend pre-emptive resection to prevent permanent neurological deficits. Incidental intradural tumors can also occur in association with hydrocephalus, significant syringomyelia, and cord compression, and surgical treatment is usually warranted. Tumors may also be discovered as part of the workup for scoliosis, where they are not truly incidental to the scoliosis but rather are contributing to curve deformation. Key Messages: Thorough workup of patients for associated genetic syndromes or comorbidities should be undertaken in pediatric patients with incidental intradural tumors. Further research is needed into the natural history of these incidental lesions. Incidental tumors can often be managed conservatively with close follow-up, with surgical intervention warranted for expanding tumors or new-onset symptoms.

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Section: Isolated Incidental Intradural Spine Tumorsmentioning

confidence: 99%

Approaches to Incidental Intradural Tumors of the Spine in the Pediatric Population

Hersh¹,

Lubelski²,

Theodore³

et al. 2023

Pediatr Neurosurg

View full text Add to dashboard Cite

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Thoracic Inlet in Cervical Spine CT of Blunt Trauma Patients: Prevalence of Pathologies and Importance of CT Interpretation

et al. 2022

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Background: The thoracic inlet of blunt trauma patients may have pathologies that can be diagnosed on cervical spine computed tomography (CT) but that are not evident on concurrent portable chest radiography (pCXR). This retrospective investigation aimed to identify the prevalence of thoracic inlet pathologies on cervical spine CT and their importance by measuring the diagnostic performance of pCXR and the predictive factors of such abnormalities. Methods: This investigation was performed at a level-1 trauma center and included CT and concurrent pCXR of 385 consecutive adult patients (280 men, mean age of 47.6 years) who presented with suspected cervical spine injury. CT and pCXR findings were independently re-reviewed, and CT was considered the reference standard. Results: Traumatic, significant nontraumatic and nonsignificant pathologies were present at 23.4%, 23.6% and 58.2%, respectively. The most common traumatic diagnoses were pneumothorax (12.7%) and pulmonary contusion (10.4%). The most common significant nontraumatic findings were pulmonary nodules (8.1%), micronodules (6.8%) and septal thickening (4.2%). The prevalence of active tuberculosis was 3.4%. The sensitivity and positive predictive value of pCXR was 56.67% and 49.51% in diagnosing traumatic and 8.89% and 50% in significant nontraumatic pathologies. No demographic or pre-admission clinical factors could predict these abnormalities. Conclusions: Several significant pathologies of the thoracic inlet were visualized on trauma cervical spine CT. Since a concurrent pCXR was not sensitive and no demographic or clinical factors could predict these abnormalities, a liberal use of chest CT is suggested, particularly among those experiencing high-energy trauma with significant injuries of the thoracic inlet. If chest CT is not available, a meticulous evaluation of the thoracic inlet in the cervical spine CT of blunt trauma patients is important.

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Preparing for the Unexpected

Cited by 2 publications

References 20 publications

Approaches to Incidental Intradural Tumors of the Spine in the Pediatric Population

Approaches to Incidental Intradural Tumors of the Spine in the Pediatric Population

Thoracic Inlet in Cervical Spine CT of Blunt Trauma Patients: Prevalence of Pathologies and Importance of CT Interpretation

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