John R. Sty

Primary cerebral germinoma and ventriculoperitoneal shunt metastasis

A case of peritoneal metastasis via a ventriculoperitoneal shunt 14 months following biopsy and irradiation of an intracerebral germinoma is presented. Metastatic abdominal disease has been controlled at 32 months postmetastatic diagnosis by abdominal irradiation and systemic chemotherapy. The occurrence of ventriculoperitoneal shunt metastases and control of extracranial metastases from intracerebral germinomas are discussed.

Occult fracture of the calcaneus — another toddler's fracture

Fractures of the calcaneus have been considered rare among children. We feel this may be erroneous since in the last 12 months we have seen 10 such fractures among children, 19 and 41 months of age, who presented with acute limping. The fractures were detected with bone imaging which was performed when initial radiographs were noncontributory. Subsequent radiographs of the calcaneus were positive for fracture in 4 of 10 while follow up radiographs confirmed healing fractures in the two children so evaluated. The sensitivity of bone imaging for the detection of occult fractures in toddlers is emphasized.

Composite cerebral neuroblastoma and astrocytoma. A mixed central neuroepithelial tumor.

This report describes an exceptional example of cerebral neuroblastoma in association with neoplastic glial cells, which were frequently arranged in clusters around the supporting blood vessels. The neuroblastic nature of the tumor was confirmed by the presence of numerous dense‐core vesicles in the cell processes. The glial nature of the associated cells was confirmed by their positivity for glial fibrillary acid protein by immunoperoxidase staining and by the presence of abundant cytoplasmic filaments of intermediate size on electron microscopy. Of particular interest was the presence of dense‐core vesicles in some of the glial cells, and that of a basal lamina underlying the perivascular glial cells. The tumor was interpreted as a composite cerebral neuroblastoma and astrocytoma. No undifferentiated neuroepithelial stem cells could be identified. The cytogenesis of this mixed neuroepithelial neoplasm is uncertain.

Technetium 99m pertechnetate thyroid scintigraphy: congenital hypothyroid screening

Technetium 99m pertechnetate thyroid scans were performed on 57 infants referred for evaluation of suspected congenital hypothyroidism. Thyroid anatomy may be characterized by four general types, based on the scintigraphic findings: (1) normal size and location; (2) ectopic location; (3) no detectable thyroid activity; (4) normal location with increased size or uptake. There are diverse etiologies of congenital hypothyroidism. Correlation of thyroid scintigraphy with blood T4 and TSH levels allows specific etiological diagnosis in the majority of cases of congenital hypothyroidism.

Hemimegalencephaly: Clinical, EEG, neuroimaging, and IMP-SPECT correlation

Iofetamine-single photon emission computed tomography (IMP-SPECT) was performed on 2 girls (5 1/2 and 6 years of age) with histories of intractable seizures, developmental delay, and unilateral hemiparesis secondary to hemimegalencephaly. Electroencephalography (EEG) revealed frequent focal discharges in 1 patient, while a nearly continuous burst suppression pattern over the malformed hemisphere was recorded in the other. IMP-SPECT demonstrated a good correlation with neuroimaging studies. In spite of the different EEG patterns, which had been proposed to predict contrasting clinical outcomes, both IMP-SPECT scans disclosed a similar decrease in tracer uptake in the malformed hemisphere. These results are consistent with the pattern of decreased tracer uptake found in other interictal studies of focal seizures without cerebral malformations. In view of recent recommendations for hemispherectomy in these patients, we suggest that the IMP-SPECT scan be used to compliment EEG as a method to define the extent of abnormality which may be more relevant to long-term prognosis than EEG alone.

The role of radionuclide studies in pediatric gastrointestinal disorders

Radionuclide techniques are currently used to fully evaluate many congenital and acquired abnormalities of the gastrointestinal tract of children. Frequently, the anatomic and functional data provided by the nuclear examination are definitive. In the study of many disease entities, tracer techniques have replaced more cumbersome or invasive procedures. Although the radiopharmaceuticals and instrumentation are similar as applied to both children and adults, the uniqueness of children and their disease entities requires special consideration when performing and interpreting their studies. In this review, the principle radionuclide examinations used in the evaluation of pediatric gastrointestinal disorders are detailed and examples are illustrated.

Radionuclide hepatobiliary imaging in the detection of traumatic biliary tract disease in children

Abstract99m Technetium IDA (99m Tc-IDA) hepatobiliary imaging was used as a diagnostic procedure in children with suspected biliary trauma. A total of eleven 99mTc-IDA examinations were performed in eight children and correlated with the standard radiographs, 99mTc sulfur colloid liver scans, ultrasonographic studies and the clinical course. This technique is recommended in children who are clinically stable and in whom trauma to the biliary system is suspected. The 99mTc-IDA images accurately indicate parenchymal and bile duct injury.

The child with acute leg pain

Diagnostic imaging is an essential component in the evaluation of a child with acute lower extremity pain or limp. Most, but not all, of the etiologies are traumatic. Frequently, the history and clinical examination are not specific. Radionuclide bone imaging is extremely rewarding in these circumstances. It represents the most useful examination used in evaluating the pathophysiology and full extent of the disorder. This article discusses the clinical presentation, pathophysiology, and characteristic imaging observations in the more common problems associated with hip and/or leg pain.

Computerized tomography in hemophiliacs with head trauma

Intracranial hemorrhage secondary to head trauma is a major cause of morbidity and mortality in patients with bleeding disorders. Indications for head computerized tomographic scanning (CT scan) on patients with bleeding disorders who sustain head trauma are not well established. We retrospectively reviewed the medical records and head CT scan results of 21 patients with bleeding disorders. Five patients had more than one episode of head trauma. The severity of head trauma per episode was classified according to objective clinical findings as minor in 12 episodes, moderate in 12, and severe in four. In three of four patients with severe head trauma, the CT scan showed evidence of intracranial hemorrhage. In this series, all 17 patients with 24 episodes of moderate or minor head trauma had normal head CT scans. We conclude that a larger prospective study is needed to further evaluate the diagnostic value of head CT scan in hemophilia patients with minor or moderate head trauma, as defined in this study.

Inflammatory fibroid polyp of the stomach in a child

A large inflammatory fibroid polyp of the stomach with endo-exophylic growth is described in a 5-year-old. CT and UGI demonstrate the lesion.