Patricia Winchester

Extramedullary Hematopoiesis in Patients with Thalassemia Anemia

Abstract A high incidence of thoracic extramedullary hematopoiesis (TEH) was found among patients with thalassemia intermedia. The masses occurred from T2-T11; a few were unilateral in location. The usual clinical course of such patients appears to be related to the physiological requirements for the development of such masses. The pathogenesis of TEH is discussed.

Family Study of Vesicoureteral Reflux

A retrospective analysis of 242 families revealed that the incidence of reflux among siblings of children with reflux was 2.2 per cent. In a prospective study of 24 families, 8 of 50 siblings (16 per cent) had reflux. Although the incidence of reflux in the prospective study is surprisingly high infections was absent in all affected siblings in whom cultures were obtained and in only 2 siblings (4 per cent) was surgical correction necessary.

Imaging of prenatally detected intra-abdominal extralobar pulmonary sequestration

Intra-abdominal extralobar pulmonary sequestration is a rare congenital anomaly which may present as an abdominal mass. We describe a case of intra-abdominal extralobar pulmonary sequestration detected prenatally as a left suprarenal mass. The ultrasound, computed tomography and magnetic resonance imaging findings are illustrated and correlated with the pathologic findings.

Osteomyelitis in a neonatal intensive care unit.

Neonatal osteomyelitis presents with few clinical signs despite multiple sites of involvement. Four cases of osteomyelitis due to Staphylococcus aureus or Candida albicans were encountered in a neonatal intensive care unit. Three were unsuspected clinically and were detected as incidental radiologic findings. The fourth presented with soft-tissue abscesses. Long bone metaphyses were most frequently affected. Other sites included iliac bones, clavicles, and spine. On follow-up the bones healed, but one patient was left with hip deformity secondary to destruction of the cartilaginous femoral heads and another patient developed obstructive hydrocephalus due to Candida ventriculitis. Complete skeletal survey is indicated in any infant with osteomyelitis at one site to seek additional silent areas of involvement.

Postnatal resolution of large ovarian cysts detected in utero. Report of two cases.

Two cases of spontaneous resolution of large ovarian cysts in newborns are presented. In both cases the cysts were detected prenatally with ultrasound. In one case the cyst disappeared before birth; in the other, the cyst resolved several weeks postnatally. Both infants also displayed labial, uterine and vaginal enlargement, signs of maternal estrogen stimulation. These large ovarian cysts are also most likely under some hormonal stimulation and may undergo spontaneous resolution and therefore obviate the need for surgery.Two cases of spontaneous resolution of large ovarian cysts in newborns are presented. In both cases the cysts were detected prenatally with ultrasound. In one case the cyst disappeared before birth; in the other, the cyst resolved several weeks postnatally. Both infants also displayed labial, uterine and vaginal enlargement, signs of maternal estrogen stimulation. These large ovarian cysts are also most likely under some hormonal stimulation and may undergo spontaneous resolution and therefore obviate the need for surgery.

Magnetic resonance imaging of myocardial infarction during prothrombin complex concentrate therapy of hemophilia A

Abstract In patients with hemophilia, prothrombin complex concentrates (PCCs) have been successfully used to bypass inhibitors to factor VIII during bleeding episodes. The use of PCCS, including FEIBA (factor eight inhibitor bypassing activity), has been associated with thromboembolic complications. Myocardial infarction (MI) is a rare but serious complication, reported in 13 previous cases, six in the pediatric age group. In all four patients who died during the acute MI, autopsy revealed extensive myocardial hemorrhage. The hearts of three other patients examined at least 5 months after the acute MI showed no evidence of prior hemorrhage. Magnetic resonance (MR) imaging has been shown to be able to evaluate the sequelae of myocardial infarction in adults with coronary artery disease and in children with Kawasaki syndrome. We report the first case of the use of MR imaging in the evaluation of myocardial damage during the acute stage of a FEIBA-associated MI in a 10-year-old boy.

Adventitial cystic disease of the femoral vein in a 5-year-old boy mimicking deep venous thrombosis

Adventitial cystic disease of the vein is a rare vascular anomaly with 32 reported cases. A 5-year-old boy initially presented with painless leg swelling. He was misdiagnosed with deep vein thrombosis and treated with 3 months of warfarin. When swelling failed to improve, a magnetic resonance venogram showed a mural cystic lesion of the left common femoral vein. In the operating room, the cyst was excised, relieving the obstructive effect and restoring flow. The swelling resolved within days. This is the first reported case of adventitial cystic disease of the vein occurring in a pediatric patient.

Calcified neonatal renal vein thrombosis demonstration by CT and US

Two cases of calcified renal vein thrombosis (RVT) were diagnosed, incidentally, within the first weeks of life. The CT images present the virtually diagnostic branching pattern of calcification that has been previously noted on pathology specimen radiographs. The CT and US images show peripheral renal vein, central renal vein and inferior vena cava calcification conforming to the two theoretical origins of intravascular calcification. The patients had normal laboratory results and no symptoms related to renal vein or inferior vena cava thrombi.

Aortic aneurysm secondary to umbilical artery catheterization

A 14-month-girl presented with an asymptomatic posterior mediastinal mass. She had a history of prematurity, umbilical artery catheterization, and sepsis. The diagnosis of aortic aneurysm was made by dynamic computed tomography. The aneurysm was successfully resected.

Neonatal septic "dislocation" of the hip: true dislocation or pathological epiphyseal separation?

The clinical and roentgenologic appearance of septic dislocation of the hip may be caused by either a true dislocation or a pathological epiphyseal separation due to osteomyelitis. Arthrography of the hip permits differentiation in the neonate. The significance of these two anatomical possibilites is discussed in terms of follow-up and results of neonatal infections about the hip, and a case of pathological epiphyseal separation at the hip diagnosed in the neonatal period by aspiration and arthrography and followed up for 3 years is presented.