Javier Lucaya

Congenital pyriform sinus fistula: A cause of acute left-sided suppurative throiditis and neck abscess in children

Acute bacterial thyroiditis or neck abscesses in children can be caused by infection through pyriform sinus fistulae which usually originate from the tip of the left pyriform sinus. They are thought to be remnants of either the third or fourth pharyngeal pouches. CT, ultrasound and gastrointestinal contrast studies are all useful in clarifying the pathological process and showing the extent.

Spontaneous involution of pulmonary sequestration in children : a report of two cases and review of the literature

Background. Two cases of pulmonary sequestration which regressed spontaneously are presented. Objective. To demonstrate the value of imaging studies in the diagnosis and follow-up of some forms of congenital masses of the lung in asymptomatic patients. Material and methods. We reviewed the clinical records and imaging studies of two asymptomatic children, one newborn and the other 3 months old, with thoracic masses which demonstrated variable degrees of spontaneous involution. Results. Abdominal ultrasound performed on the newborn with a palpable mass showed a triangular echogenic mass with a large central feeding vessel arising from the aorta. The mass had disappeared on follow-up US exam performed 6 years later. CT was performed in the 3-month-old patient with a persistent retrocardiac mass. A soft-tissue density mass in the left pulmonary base with a large feeding vessel arising from the aorta was visualised on contrast-enhanced CT. Five years later, a new CT scan showed significant shrinkage of the mass and no vessel. Conclusion. Radiological techniques such as real-time US with Doppler imaging and contrast-enhanced CT may establish the diagnosis of pulmonary sequestration by demonstrating the mass and its systemic vessel, thereby eliminating the need for more aggressive imaging procedures. Partial or total disappearance of these masses represents a further example of involutive pathology and suggests that not all cases of pulmonary sequestration should be surgically treated.

The Coffin-Siris syndrome. A report of four cases and review of the literature.

Four additional cases of the Coffin-Siris syndrome bring the number of reported cases to 16. This disorder is characterized by the absence or hypoplasia of the nails, especially those of the fifth fingers and toes, growth retardation and mental deficiency, microcephaly, coarse facial appearance, sparse scalp hair and lax joints. Feeding difficulties and respiratory problems are common in infancy. Absence or hypoplasia of the distal and middle phalanges, especially those of the fifth fingers and toes and retarded bone maturation are the most common radiological features.

Non-operative management of traumatic pancreatic pseudocysts associated with pancreatic duct laceration in children

Objective. To assess the successful non-operative management in traumatic pancreatic pseudocysts (TPP) associated with duct laceration in children. Surgical therapy (cystogastrostomy or distal pancreatectomy with splenic salvage) has been classically considered the treatment of choice for those pseudocysts. Materials and methods. This report presents the clinical and imaging findings in two children with TPP and pancreatic duct disruption observed either on endoscopic retrograde cholangiopancreatography or injection via catheter drainage. Results. Both children responded to long-term cyst drainage. Conclusion. Although the experience is limited, the authors suggest that pancreatic injury associated with duct laceration can respond to non-operative management.

Mastocytosis with skeletal and gastrointestinal involvement in infancy. Two case reports and a review of the literature.

Two cases of mastocytosis with skeletal involvement in children three and six months old are reported. Bone lesions, either sclerotic or lytic, were encountered in their skeletal surveys. Gastrointestinal lesions in children with mastocytosis are exceedingly rare; in addition to skeletal lesions, one of our patients had a large duodenal ulcer. The diagnosis of mastocytosis was established by skin biopsy in both patients. A review of the literature is also presented.

Expanding upon the Unilateral Hyperlucent Hemithorax in Children

Unilateral hyperlucent hemithorax is a common pediatric chest radiographic finding that may also be seen at computed tomography. It may result from congenital or acquired conditions involving the pulmonary parenchyma, airway, pulmonary vasculature, pleural space, and chest wall, as well as from technical factors such as patient rotation. Unilateral hyperlucent hemithorax has a broad differential diagnosis that includes unilateral emphysematous or bullous disease, pneumatocele, foreign body aspiration, Swyer-James syndrome, congenital lobar emphysema, endobronchial mass, unilateral pulmonary agenesis, proximal interruption of the pulmonary artery, scimitar syndrome, diaphragmatic hernia, and Poland syndrome. Although certain causes of unilateral hyperlucent hemithorax are clinically significant and potentially life threatening, others are of minimal or no clinical significance. When evaluating a patient with this finding, it is important to establish whether the apparent unilateral hyperlucent hemithorax is truly too lucent (hypoattenuating) or if the contralateral hemithorax is too opaque (hyperattenuating). It is imperative that radiologists be aware of the various causes of unilateral hyperlucent hemithorax so that they may diagnose the underlying condition and appropriately guide patient management.

Thoracic Findings of Systemic Diseases at High-Resolution CT in Children

Pulmonary involvement in systemic diseases is common, but the radiographic appearance of early-stage pulmonary changes is often subtle. Computed tomography (CT) has higher sensitivity and specificity than radiography, and high-resolution CT is the method of choice for accurate assessment of diffuse parenchymal lung disease. Even with reductions in the peak voltage and tube charge to minimize the exposure of pediatric patients to radiation, CT performed with a meticulous acquisition technique can provide detailed information. In some cases, high-resolution CT may depict clinically silent lung lesions. The information provided by CT is invaluable for planning therapy in pediatric patients with pulmonary involvement in connective tissue disease (eg, juvenile rheumatoid arthritis, dermatomyositis, systemic sclerosis, systemic lupus erythematosus, or mixed connective tissue disease), vasculitis, a primary or acquired immune deficiency disorder, immotile cilia syndrome, cystic fibrosis, or Langerhans cell histiocytosis.

Pitfalls in chest imaging

It is well recognized that imaging of the chest in children is not exempt from difficulties, some of which are related to the technique itself and others to the frequently uncooperative patient. The chest radiograph continues to be the most common radiologic examination performed to assess chest lesions in children; however, CT and, increasingly, US are also used for this purpose. The potential pitfalls of radiography, US and CT for chest imaging in children and their possible causes are discussed and illustrated herein. Failure to properly interpret these features could lead to misdiagnosis and inappropriate treatment. MRI using ultrashort echo time (TE) sequences has recently been incorporated in the study of vessels and lung parenchyma; however, it is not within the scope of this review to discuss the pitfalls of MRI.

Intraosseous haemangioma of the ilium.

Intraosseous haemangioma, an uncommon benign vascular tumour, is most commonly seen in adults and tends to involve the vertebrae and the skull. Lesions of flat bones are rare and the imaging findings in these patients are non-specific. We report a unique case of intraosseous haemangioma in the ilium of a 7-year-old girl studied by US, radiography, scintigraphy, CT and MRI.

Intrahepatic biliary stones in children

Intrahepatic biliary stones in seven non-Oriental patients were studied in all by sonography, in four patients by computed tomography and in four patients by percutaneous transhepatic cholangiography. Four patients had extrahepatic biliary atresia treated with portoenterostomies, one patient had undergone partial liver transplantation and of the remaining two, one had cystic fibrosis and the other immunodeficiency syndrome. All sonograms were abnormal and showed echogenic foci within the liver, with or without associated signs of biliary tract dilatation. CT confirmed the biliary tract dilatation yet calculi were identified in one patient only. PTC was particularly helpful in the patient with immunodeficiency in whom features typical of sclerosing cholangitis were found. This report emphasizes the variable radiological appearance of bile stones which to our knowledge have rarely been described in children with entities other than Oriental cholangitis.