Pediatric arteriography in abdominal and extremity lesions. Clinical experience, indications, and technic.

Abstract

Arteriography in children for the diagnosis of abdominal and extremity lesions has received relatively scant interest, in contrast to cardiac and cerebral arteriography. This technic in adults has proved eminently successful for the clinical management of a variety of pathologic conditions involving the solid and hollow viscera and extremities. The value of arteriography in children and adults is predicated on the fact that radiographically demonstrable vascular alterations reflect underlying pathologic processes in the vessels and/or surrounding tissues. Thus, the size and extent of a lesion, the differentiation of benign from malignant tumors, the location of bleeding sources, the detection of anatomical variations, and frequently the specific etiology of a lesion maybe determined from the vascular pattern observed. In surgical lesions this information is invaluable since it may determine the operative approach and significantly reduce the time of exploratory laparotomy. Not merely the positive findings of arteriography are useful, but also the lack of findings is important in ruling out a tentative clinical impression. The percutaneous technic of catheterization obviates the need for surgical arteriotomy and facilitates both midstream aortography (simultaneous contrast visualization of the aorta and its branches) and selective arteriography (contrast visualization of the individual aortic branches and their respective end organs). This latter procedure provides greater diagnostic detail and clarity of the vessels investigated, permits collimation of the x rays over the specific area being examined, and utilizes smaller amounts of contrast material. The purpose of this report is to describe our experience with percutaneous aortography and selective arteriography in a group of children presenting with and suspected of various renal, adrenal, hepatic, and extremity lesions. Clinical Material and Selection of Patients In the series, 52 children and adolescents were studied by arteriography. The age and sex distribution are shown in Table 1. The youngest patient examined was a child thirteen months of age and the oldest sixteen years. The clinical indications, arteriographic findings, and final diagnosis are summarized in Table II. The clinical indications were listed as the major complaint or finding or clinical suspicion. The final impression was established by tissue biopsy, exploratory laparotomy, autopsy, or the subsequent clinical course. Since the ultimate indications and usefulness of arteriography as well as its limitations must still be determined for pediatric patients, these were selected at random. The types of lesions that have been studied and in which this method appears diagnostically effective are tumor masses, traumatic injury, the location of obscure gastrointestinal bleeding sites, vessel obstruction, vascular malformations, portal hypertension with varices, and vessel anomalies.