Person: Lee, Edward
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Lee
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Lee, Edward
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Publication An Unusual Case of Pleuropulmonary Blastoma in a Child with Jejunal Hamartomas(Hindawi Publishing Corporation, 2013) Lucia-Casadonte, Chantal; Kulkarni, Sakil; Restrepo, Ricardo; Gonzalez-Vallina, Ruben; Brathwaite, Carole; Lee, EdwardWe report a rare case of 9-month-old girl who presented with a choking episode and was found to have an incidental finding of a lung cyst and iron deficiency anemia leading to the diagnosis of pleuropulmonary blastoma (PPB) and a jejunal hamartoma. Our patient is the eighth that has been reported with the association of PPB with jejunal hamartoma and the first one in the radiological literature. PPB is the pulmonary analog of other dysontogenetic neoplasms in childhood. A biological sequence has been described with the three types of PPB to be interrelated as part of pathologic progression. PPB can be associated with other cysts and/or neoplasms in different organs. PPB is part of a hereditary neoplasia predisposition syndrome in up to 40% of cases. Mutations in DICER gene have been described with PPB. Hence, a pediatric patient diagnosed with PPB should be screened for associated conditions during childhood and adolescence including intestinal polyps. Obtaining family history for other neoplasms or cysts is important information that should raise the possibility of PPB in pediatric patients with cystic lung lesions. The presence of this syndrome should alert the clinician to screen and follow up patients and their relatives.Publication Magnetic resonance imaging in children: common problems and possible solutions for lung and airways imaging(Springer Berlin Heidelberg, 2015) Ciet, Pierluigi; Tiddens, Harm A. W. M.; Wielopolski, Piotr A.; Wild, Jim M.; Lee, Edward; Morana, Giovanni; Lequin, Maarten H.Pediatric chest MRI is challenging. High-resolution scans of the lungs and airways are compromised by long imaging times, low lung proton density and motion. Low signal is a problem of normal lung. Lung abnormalities commonly cause increased signal intenstities. Among the most important factors for a successful MRI is patient cooperation, so the long acquisition times make patient preparation crucial. Children usually have problems with long breath-holds and with the concept of quiet breathing. Young children are even more challenging because of higher cardiac and respiratory rates giving motion blurring. For these reasons, CT has often been preferred over MRI for chest pediatric imaging. Despite its drawbacks, MRI also has advantages over CT, which justifies its further development and clinical use. The most important advantage is the absence of ionizing radiation, which allows frequent scanning for short- and long-term follow-up studies of chronic diseases. Moreover, MRI allows assessment of functional aspects of the chest, such as lung perfusion and ventilation, or airways and diaphragm mechanics. In this review, we describe the most common MRI acquisition techniques on the verge of clinical translation, their problems and the possible solutions to make chest MRI feasible in children.Publication Synthesis and characterization of a model extracellular matrix that induces partial regeneration of adult mammalian skin.(Proceedings of the National Academy of Sciences, 1989) Yannas, I. V.; Lee, Edward; Orgill, Dennis; Skrabut, E. M.; Murphy, GeorgeRegeneration of the dermis does not occur spontaneously in the adult mammal. The epidermis is regenerated spontaneously provided there is a dermal substrate over which it can migrate. Certain highly porous, crosslinked collagen-glycosaminoglycan copolymers have induced partial morphogenesis of skin when seeded with dermal and epidermal cells and then grafted on standard, full-thickness skin wounds in the adult guinea pig. A mature epidermis and a nearly physiological dermis, which lacked hair follicles but was demonstrably different from scar, were regenerated over areas as large as 16 cm2. These chemical analogs of extracellular matrices were morphogenetically active provided that the average pore diameter ranged between 20 and 125 microns, the resistance to degradation by collagenase exceeded a critical limit, and the density of autologous dermal and epidermal cells inoculated therein was greater than 5 x 10(4) cells per cm2 of wound area. Unseeded copolymers with physical structures that were within these limits delayed the onset of wound contraction by about 10 days but did not eventually prevent it. Seeded copolymers not only delayed contraction but eventually arrested and reversed it while new skin was being regenerated. The data identify a model extracellular matrix that acts as if it were an insoluble growth factor with narrowly specified physiochemical structure, functioning as a transient basal lamina during morphogenesis of skin.Publication MRI of the Normal Appendix in Children: Data Toward a New Reference Standard(Springer Science and Business Media LLC, 2016-06) Swenson, David W.; Schooler, Gary R.; Stamoulis, Catherine; Lee, EdwardBackground Magnetic resonance imaging (MRI) might prove useful in the diagnostic evaluation of pediatric appendicitis in the effort to avoid exposing children to the ionizing radiation of CT, yet there is a paucity of literature describing the normal range of appearances of the pediatric appendix on MRI. Objective To investigate MRI characteristics of the normal appendix to aid in establishing a reference standard in the pediatric population. Materials and methods We conducted a retrospective study of children and young adults (≤18 years of age) who underwent lumbar spine or pelvis MRI between Jan. 1, 2013, and Dec. 31, 2013, for indications unrelated to appendicitis. Two board-certified radiologists independently reviewed all patients’ MRI examinations for appendix visualization, diameter, intraluminal content signal, and presence of periappendiceal inflammation or free fluid. We used the Cohen kappa statistic and Spearman correlation coefficient to assess reader agreement on qualitative and quantitative data, respectively. Results Three hundred forty-six patients met inclusion criteria. Both readers visualized the appendix in 192/346 (55.5%) patients (kappa = 0.88, P < 0.0001). Estimated median appendix diameter was 5 mm for reader 1 and 6 mm for reader 2 ([25th, 75th] quartiles = [5, 6] mm; range, 2–11 mm; r = 0.81, P < 0.0001). Appendix intraluminal signal characteristics were variable. Periappendiceal inflammation was present in 0/192 (0%) and free fluid in 6/192 (3.1%) MRI examinations (kappa = 1.0). Conclusion The normal appendix was seen on MRI in approximately half of pediatric patients, with a mean diameter of ~5–6 mm, variable intraluminal signal characteristics, no adjacent inflammatory changes, and rare surrounding free fluid.Publication Intraabdominal Lymphatic Malformations: Pearls and Pitfalls of Diagnosis and Differential Diagnoses in Pediatric Patients(American Roentgen Ray Society, 2017) Francavilla, Michael L.; White, Candace L.; Oliveri, Brandon; Lee, Edward; Restrepo, RicardoLymphatic malformations (LMs) are among the most common pediatric lesions. Due to their rarity, tendency to present later in life than their superficial counterparts, and often incidental identification, intra-abdominal LMs pose a diagnostic dilemma and more prevalent pathologies must be first carefully excluded. Although the diagnosis of the majority of intra-abdominal LMs can be reliably made based on clear understanding of characteristic imaging findings, histologic correlation may be necessary in some cases.Publication Acute Pancreatitis in Pediatric Patients: Demographics, Etiology, and Diagnostic Imaging(American Roentgen Ray Society, 2016-03) Restrepo, Ricardo; Hagerott, Heidi E.; Kulkarni, Sakil; Yasrebi, Mona; Lee, EdwardObjective: To provide updates on acute pancreatitis in children regarding imaging, etiologies and complications. Methods: After reviewing current pediatric literature, we discuss the epidemiology, the role of imaging and imaging findings in the diagnosis of acute pancreatitis as well as the etiology and complications. Conclusion: The incidence of acute Pancreatitis is increasing in children. Imaging plays a role in diagnosis, establishing etiology, evaluating complications and possibly in predicting the course.Publication Advances in Multidetector CT Diagnosis of Pediatric Pulmonary Thromboembolism(The Korean Society of Radiology, 2016) Thacker, Paul G.; Lee, EdwardAlthough pediatric pulmonary thromboembolism is historically believed to be rare with relatively little information available in the medical literature regarding its imaging evaluation, it is more common than previously thought. Thus, it is imperative for radiologists to be aware of the most recent advances in its imaging information, particularly multidetector computed tomography (MDCT), the imaging modality of choice in the pediatric population. The overarching goal of this article is to review the most recent updates on MDCT diagnosis of pediatric pulmonary thromboembolism.