Nancy S. Rosenfield

Intracranial calcifications in childhood leukemia: An association with systemic chemotherapy*

Children with acute lymphocytic leukemia were examined for evidence of intracranial calcifications withroentgenograms of the skull and computerized tomography. Of 39 children in their initial complete remission, ten were found to have subcortical cerebral calcifications. Significant associations were found between the presence of cerebral calcifications and systemic treatment with large cumulative doses of methotrexate.

Brain MR in patients with Langerhans cell histiocytosis: Findings and enhancement with Gd-DTPA

The brains of eight patient with Langerhans Cell Histiocytosis (LCH) were studied with magnetic Resonance Imaging (MRI). One scan was normal and a spectrum of abnormalities was seen in the others. Five patients had absence of the posterior pituitary bright spot, and four with evidence of pituitary dysfunction had a lesion in the region of the hypothalamus. An orbital extraconal mass was noted in one child with exopthalmus. This decreased in a follow-up study after Vinblastine therapy. The cerebellum was abnormal in two patients; the area of the dentate nuclei exhibited abnormal signal in one asymptomatic child and the MRI of another boy with a ten year history of progressive cerebellar dysfunction showed cerebral and cerebellar atrophy. Three of the five patients with deficiency of antidiuretic hormone (ADH) were studied both before and after the administration of intravenous Gadolinium-DTPA. In all three, after administration of the contrast agent, there was enhancement of involved areas.

Cholelithiasis and Wilson disease

We have studied three children with Wilson disease who had clinical symptoms suggestive of cholecystitis as well as radiologic evidence of gallstones, subsequently proven at the time of laparotomy. The gallstones from the patients with Wilson disease had an appreciably higher content of cholesterol than gallstones from age-matched children with hemolytic disease. Since gallstones may be present for years before they produce clinical symptoms, young patients with Wilson disease should undergo routine investigation for the presence of stones; cholelithiasis should also be considered in the differential diagnosis of abdominal pain in such patients.

Prospective analysis of bone changes in treated childhood leukemia.

Serial knee radiographs were obtained from 58 children with leukemia. Leukemic bone changes were found in approximately half of those radiographed at the time of diagnosis but were consistently absent in children older than 10 years. The bone abnormalities persisted for as long as 10 months after treatment was started and did not occur or reappear at the time of relapse. Dense metaphyses simulating the appearance of lead poisoning developed in 20 of 58 patients during chemotherapy.

CT differentiation of benign and malignant lung nodules in children

The superiority of computed tomography (CT) for detection of lung nodules has been documented and attempts have been made to distinguish benign from malignant lesions in adults. We attempted to characterize lung nodules in 12 children with solid malignant tumors (aged 8 months to 17 years) in an effort to differentiate benign from metastatic disease. All scans were performed at 10-mm contiguous intervals on a GE 9800 CT scanner. The scans were retrospectively viewed by two pediatric radiologists independently and without knowledge of the pathological findings. All biopsies were done via open thoracotomy. The CT findings were correlated with pathology results. Twelve children had 13 nodules biopsied. Six of these showed malignancy, two showed inflammatory changes, and two had a reactive subpleural lymph node. In three children, no abnormality was found and a biopsy was not obtained. One child had a metastatic nodule in one lung, and a simultaneous inflammatory nodule in the other. The radiologists agreed with each other on the CT interpretation in 11 of 13 surgically explored areas. They correctly predicted malignancy in four cases and correctly excluded it in two cases. However, they were simultaneously incorrect in five instances. Our conclusion is that, contrary to reports in adults, a tiny nodule may be either benign or malignant. Malignancy cannot be separated from benign disease by CT established criteria.

Sonographic evaluation of ureterectasis in children : the significance of peristalsis

The presence or absence of ureteral peristalsis was noted during real-time sonography of 61 dilated ureters in children. The findings were correlated with diagnoses established using standard radiographic and radionuclide imaging techniques. Of the 47 dilated ureters that exhibited peristalsis 44 were classified as not obstructed when assessed with standard imaging and functional studies. The most frequent etiology for ureteral dilatation associated with peristalsis was high grade vesicoureteral reflux (31 ureters). Three peristaltic ureters were shown to be mildly to moderately obstructed. Absence of peristalsis was noted in 14 ureters: 13 were severely obstructed, while in 1 the involved kidney had no function. In the pediatric age group the demonstration of peristalsis in a dilated ureter is frequently associated with vesicoureteral reflux and is seldom associated with obstruction. Obstruction, if present, usually is mild. Aperistaltic ureterectasis implies severe obstruction or poor renal function.

Failure of development of the growing breast after radiation therapy

Four cases are presented in which young girls received radiation therapy to treat childhood malignancies. Subsequently, one breast, which had been included in the radiation field in each case did not develop. This phenomenon has been seen after orthovoltage as well as supervoltage therapy, but is not mentioned in recent diagnostic imaging literature.

Is renal ultrasound a reliable indicator of a nonobstructed duplication anomaly

Twelve kidneys which had a non-obstructed duplication anomaly on excretory urography were studied sonographically. Ten of the twelve kidneys had a single central renal sinus echo complex; only two kidneys had a split sinus complex typical of duplication. Sonography is not a reliable technique to identify a nonobstructed duplication anomaly.

Single, mediastinal, unilobar lung -a rare form of subtotal pulmonary agenesis

We describe a case of a full-term infant with severe respiratory failure and pulmonary insufficiency caused by an anomaly consisting of a single, unilobar lung arising from the trachea and situated in the middle mediastinum. Plain film, echocardiogram, and surgical aspects will be described and correlated with the post mortem findings and embryologic considerations. We were unable to find a similar case reported in the literature and conclude that this rare lesion represent an intermediate form between total and unilateral pulmonary agenesis.

Evaluation of Solitary Simple Renal Cysts in Children

Because there is a proportionately higher incidence of solid renal neoplasm in children than in adults early operative intervention is more common in these cases. For this reason the most important consideration when evaluating children is to exclude the presence of a malignant neoplasms. The clinical features, radiologic manifestations and management of solitary simple renal cysts in 3 children are discussed. We suggest that the increased accuracy and availability of newer imaging techniques now permit this entity to be managed in a fashion similar to its more common adult counterpart. Surgical exploration should be reserved for those cases in which there is doubt as to the benign nature of the cyst.