Kook Sang Oh

Unilateral pulmonary vein atresia: Clinical and radiographic spectrum

SummaryThree cases of unilateral pulmonary vein atresia are presented to illustrate part of the clinical and radiographic spectrum of this anomaly. One patient had major associated cardiovascular abnormalities and pulmonary hypertension, one had recurrent hemoptysis, and the other patient was asymptomatic with normal pulmonary artery pressure and no associated abnormalities. In one case, serial catheterizations indicated that the pulmonary vein atresia was acquired. This report stresses the radiographic, hemodynamic, and angiographic findings in patients with unilateral severe pulmonary venous obstruction. The embryology, pathology, and surgical approach are also discussed. The diagnosis should be strongly suspected before cardiac catheterization when typical features are present on the chest radiograph and isotopic ventilation perfusion scan.

Coexistent neuroblastoma and Hirschsprung's disease —Another manifestation of the neurocristopathy?

Abnormalities of neural crest development may be manifested in a wide variety of ways ranging from von Recklinghausens disease to Sipples syndrome — pheochromocytoma and medullary thyroid carcinoma. We report here yet another manifestation — coexistent multiple neuroblastomas and Hirschsprungs disease in a newborn. In a review of the English literature we have found the combination of neuroblastoma and Hirschsprungs disease recorded only once previously [2]. However, the relationship between the two diseases was not discussed. The two diseases may be at the extremes of a spectrum of neural crest developmental pathology, i. e., Hirschsprungs representing a deficiency and neuroblastoma representing malignant proliferation of cells of neural crest origin.

Late-onset Bochdalek's hernia with obstruction: Radiographic spectrum of presentation

Three patients with late-onset Bochdaleks hernia are presented. All three had obstruction of the herniated bowel and, in two patients, this was complicated by strangulation and necrosis. The spectrum of roentgenographic manifestation included obvious findings of bowel in the chest in one patient; in another, the findings simulated pneumonia associated with reflex bowel ileus in the abdomen. The third patient had a massive pleural effusion, with what appeared to be associated bowel ileus. In spite of the misleading presentation it is imperative that the correct diagnosis be made early since the incidence of strangulation and severe morbidity is high.

Early clinical experience with direct peritoneal enhancement for abdominal computed tomography

Abstract Improved visualization of the peritoneal cavity and its contents has recently become possible by performing abdominal paracentesis and intraperitoneal infusion of 7–15% meglumine diatrizoate prior to abdominal CT. Enhanced morphologic detail has been demonstrated in cadavers and prompted us to study a select group of patients with known or suspected abdominal masses. Case material is presented demonstrating the applicability of this technique in: localizing masses to the intra or extraperitoneal space; detecting tumor implants on the solid viscera and peritoneum; distinguishing between masses and adjacent viscera excluding invasion; defining the mural thickness of the hollow viscera; and illustrating normal CT anatomy. The indications and limitations of the technique are discussed.

Transient myocardial ischemia of the newborn infant

Ten full-term newborn infants with transient myocardial ischemia developed radiographic evidence of cardiomegaly and pulmonary venous congestion within the first few hours of life. In five patients, radiographic findings returned to normal during the first week of life. In the remaining five patients, radiographic findings improved within the second week and eventually became normal. Echocardiography done on six patients demonstrated left ventricular dysfunction in all six patients. Those infants with documented perinatal insults tend to have a protracted clinical course with eventual recovery. Pathophysiology and clinical course are discussed.

Coexistent transient pulmonary edema and pericardial effusion

Eight (23%) of 35 children with acute pericardial effusions due to infection or juvenile rheumatoid arthritis (JRA) had associated transient pulmonary edema demonstrated on plain chest radiographs. The presence or absence of radiographic pulmonary edema correlated well with clinical and hemodynamic parameters in patients with JRA but not in those with infectious pericarditis. There was no definite relationship between radiographic edema and amount of pericardial fluid as estimated echocardiographically or removed at pericardiocentesis. Rapidity of pericardial fluid accumulation could not be assessed in this study. Children of young age with underlying JRA were the most likely subjects to have radiographic pulmonary edema in conjunction with an acute pericardial effusion.

Traumatic aneurysm of the ascending aorta in a child.

A case of traumatic aneurysm of the ascending aorta in a child is reported. This complication must be suspected in a child who sustains severe injury from closed thoracic trauma and develops an abnormally wide anterior mediastinum. A mechanism for ascending aortic rupture and aneurysm is proposed. Aortography is essential when aortic injury and its complications are suspected.

Computed tomographic evaluation of spontaneous healing of splenic hematoma

Computed tomography has been successfully used to demonstrate spontaneous healing of splenic hematoma in a child. It showed shrinkage of the hematoma with revascularization and subsequent complete healing.