Kathleen D. Eggli

Color Doppler sonography in pyelonephritis

Renal sonography detects abnormality in only 40% of pediatric pyelonephritis. In eight patients shown to have acute pyelonephritis by99mTc DMSA renal cortical scintigraphy, five were found to have focal abnormalities of renal perfusion by color Doppler sonography in the same sites as the scintigraphic defects (sensitivity-63%). Two of the five patients had normal plain sonograms. False positive studies occurred in patients with documented chronic renal scarring. The specificity of vascular asymmetry was 70%. This preliminary report suggests that, particularly in the patient without pre-existing renal scarring, color Doppler evaluation of the renal vasculature may increase the sensitivity of sonography in the diagnosis of pyelonephritis in children.

Juvenile xanthogranuloma: Non-X histiocytosis with systemic involvement

Two patients with different patterns of soft tissue and bone involvement demonstrate the variability of extracutaneous manifestations of juvenile xanthogranuloma, a non-X histiocytosis, better known to dermatologists than to radiologists.

Vascular Ring Due to Right Aortic Arch with Mirror-Image Branching and Left Ligamentum Arteriosus: Complete Preoperative Diagnosis by Magnetic Resonance Imaging

Abstract. Magnetic resonance imaging (MRI) has been increasingly employed in the evaluation of aortic arch abnormalities. We present a rare form of vascular ring, that of a right aortic arch with mirror-image branching and left ligamentum arteriosus, which was clearly defined preoperatively by MRI. The patient subsequently underwent successful surgical division of the vascular ring followed by improvement in respiratory symptoms.

Three-dimensional quantitation of pediatric tumor bulk

In pediatric oncology, therapeutic decisions are made based on tumor response to chemotherapeutic agents. Sequential measurement of tumor bulk and its percent change on therapy must be accurately assessed. Will 3-dimensional (3-D) volumetric determination improve our ability to assess tumor response to therapy? Forty-five CT scans of pediatric patients with unresectable thoracic or abdominal neoplasia were assessed for tumor bulk by the standard “2-dimensional (2-D)” volume formula (cross-sectional areaxlength) and by 3-D volumetric analysis. Thirty-two examinations were performed in follow-up, and percent change in tumor size was calculated. The 2-D volume calculation overestimated tumor volume by more than 50% on all but two examinations when the 2-D volume was compared with the 3-D volume. In 28% of follow-up examinations, the 2-D calculation of percent change differed by more than 10% from the 3-D volume. Fifteen percent differed by over 25%. This changed the response category of one patient from “no response” to “partial response”. 3-D volumetric analysis, easily performed by a trained technologist, will give more accurate assessment of the actual tumor bulk and its subsequent changes in size in response to therapy.An additional, unexpected benefit of volumetric determination and its accompanying 3-D images was their use and enthusiastic acceptance by clinicians. Pediatric oncologists and surgeons used the sequential images in conferences with parents. In the future, graphic representations of tumor response to therapy might be used in determining the best time for second-look surgery or for other therapeutic manipulations.

Benign cystitis in children mimicking rhabdomyosarcoma.

Seventeen (13 male, 4 female) patients, aged 13 months to 13 years, with benign cystitis had imaging findings that mimicked those of rhabdomyosarcoma. Our experience indicates that in the child with hematuria, dysuria, and frequency plus cystographic or sonographic demonstration of a bladder with reduced capacity and circumferential wall thickening or sonographic findings of isoechoic bladder wall thickening (focal, multifocal or circumferential distribution), intact mucosa, and bullous lesions should strongly suggest inflammation and not malignancy. When an inflammatory lesion is suspected, follow‐up imaging should be performed in 2 weeks, which if normal will preclude biopsy.

Heterotopic brain presenting as a cystic neck mass with mandibular deformity.

A congenital cystic neck mass causing respiratory distress and hypoplasia of the mandible was excised from a 3-month-old infant. The lesion was subsequently diagnosed as heterotopic brain, a rare, benign condition that should be considered in the differential diagnosis of the neonatal head and neck mass.

Intradiaphragmatic extralobar sequestration—a rare pulmonary anomaly

Extralobar pulmonary sequestrations are most commonly found within the thoracic cavity, but have been described within the abdomen. We present the case of a 16-month-old boy with an intradiaphragmatic pulmonary sequestration and demonstrate a computed tomographic scan finding that might help identify this extremely rare abnormality preoperatively.

Melnick-Needles syndrome - Four new cases

Melnick-Needles syndrome is a rare connective tissue disorder producing somatic abnormalities with characteristic radiographic features. There are less than 35 documented cases reported to date. We present four new cases of Melnick-Needles Syndrome, one of which is the first reported Asian-ancestry patient. Two girls are daughters of one of Needles original patients from family #2. Two others, from unrelated non-affected families, probably represent new mutations. All have characteristic radiographic features of the disorder.

Neonatal pneumatosis cystoides intestinalis caused by volvulus of the mid intestine.

A case of malrotation of the mid intestine with volvulus is reported in an infant in whom the clinical and radiological appearances were unusual, and had led to a misdiagnosis of necrotising enterocolitis. If the correct diagnosis had been made earlier, operation might have saved the infants life.

Delayed diagnosis of esophageal perforation by aluminum foreign bodies

Two pediatric patients presented with long-term respiratory or gastrointestinal complaints after swallowing aluminum poptops. The delay in diagnosis was due in part to poor appreciation of the relative radiolucency of aluminum.