Renata Boldrini Pathology Unit Bambino Gesù Pediatric Hospital Piazza S.Onofrio 4, 00165, Rome, Italy Alessandro Inserra General and Thoracic Surgery Unit Bambino Gesù Pediatric Hospital Piazza S.Onofrio 4, 00165, Rome, Italy doi:10.1016/j.jpedsurg.2011.10.072 References [1] Torabi A, Lele SM, DiMaio D, et al. Lack of a common or characteristic cytogenetic anomaly in solitary fibrous tumor. Cancer Genet Cytogenet 2008;181(1):60-4. [2] Van de Rijn M, Lombard CM, Rouse RV. Expression of CD34 by solitary fibrous tumors of the pleura, mediastinum, and lung. Am J Surg Pathol 1994;18:814-20. [3] Travis WD. Sarcomatoid neoplasms of the lung and pleura. Arch Pathol Lab Med 2010;134(11):1645-58. [4] England DM, Hochholzer L, McCarthy MJ. Localized benign and malignant fibrous tumors of the pleura: a clinicopathologic review of 223 cases. [erratum in Am J Surg Pathol. 1991; 15(8):818]Am J Surg Pathol 1989;13(8):640-58. [5] De Perrot M, Fischer S, Bründler MA, et al. 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[12] Suter M, Gebhard S, Boumghar M, et al. Localized fibrous tumours of the pleura: 15 new cases and review of the literature. Eur J Cardiothorac Surg 1998;14:453-9. [13] Veronesi G, Spaggiari L, Mazzarol G, et al. Huge malignant localized fibrous tumor of the pleura. J Cardiovasc Surg 2000;41:781-4. [14] De Perrot M. Fibrous tumors of the pleura. Curr Treatment Options Oncol 2000;1:293-8. Glowing in the dark: should the time of day determine radiographic imaging in the evaluation of abdominal pain in children? To the Editor, I read with interest the article titled “Glowing in the dark: time of day as a determinant of radiographic imaging in the evaluation of abdominal pain in children” written by Burr et al and published in the January issue of the Journal of Pediatric Surgery [1]. The authors have highlighted the important issue of utilization patterns of ultrasonography (US) vs computed tomography (CT) in the evaluation of abdominal pain in children during the day and night. The authors have also raised concern for the relatively increased usage of the CT scan facility at night because of nonavailability of a radiologist at night. I find the article very interesting on several accounts and also have some pertinent queries as detailed below. Whether, and if so, when a patient with abdominal pain should undergo US or CT or US followed by CT should be dictated by the history, detailed clinical assessment, and provisional diagnosis of the patient and not by the time of the day as has been noted in this study. As a general rule, all patients with an acute abdomen particularly pediatric patients who require imaging should first undergo US. The CT scan should be reserved as a complementary or problem-solving tool when US is suboptimal or equivocal for any reason. A dedicated US would obviate the need for a CT scan in a significant number of cases and also suggest alternative and quite often nonsurgical diagnosis, thereby reducing the number of unnecessary surgical procedures. Under no circumstances should CT be used as an alternative to US because of a lack of emergency radiologists in a facility. I cannot think of a tertiary care hospital without an on-call radiologist or at least a radiology resident. Ideally, such patients can be referred to a hospital where the requisite facilities exist. Another question is that if radiologists are not available for US, then who interprets the CT scans? Are the emergency department physicians or surgeons competent enough to interpret the CT scans? It may be mentioned here that, although CT scan is considered to be more objective and reproducible than US, there is a lot of subjectivity involved in the interpretation of CT scans particularly in the emergency setting. Besides, the technique of CT scans, ideally, should not be left entirely up to the discretion of the CT technician particularly when dealing with pediatric patients where radiation dose reduction depends on the CT technique and length of coverage. Emergency department physicians can be encouraged to learn and practice preliminary/basic US in the emergency setting in the absence of a radiologist. It could be quite useful if one can diagnose free fluid in the abdomen (especially in the pelvis), probe tenderness in a particular area, identify the presence or absence of hydronephrosis, and others, which really does not require extensive training. Another point, which the authors have also highlighted, is that not all patients with abdominal pain who arrive in the emergency department especially at night need to be hastily subjected to imaging. What is needed is a thorough clinical assessment and, if required, admit the patient. There is a definite role for observation, initial hematologic investiga- tions, provisional treatment, and periodic reevaluation in 437 Correspondence