Salomine Theron

Chylothorax as a complication of pulmonary tuberculosis in children

Chylothorax is a rare clinical entity characterized by a milky white aspirate with increased triglyceride levels. The commonest aetiology is malignancy and trauma. Pulmonary tuberculosis is an extremely rare cause of chylothorax. Two children with chylothorax and pulmonary tuberculosis are described. One child had bilateral and the other unilateral chylous effusions. Extensive mediastinal and hilar lymphadenopathy was demonstrated. Diseased lymph nodes may infiltrate other intrathoracic structures such as the thoracic duct, and they can also obstruct the cisterna chyli and thoracic duct. A possible explanation for the development of a chylothorax in our patients is obstruction of the thoracic duct by tuberculous lymphadenopathy with subsequent increase in pressure in the surrounding lymphatic system and leaking of chyle into the pleural space.

Pulmonary infections in HIV-positive children

Infection of the lungs and airways by viral, bacterial, fungal and protozoal agents, often producing atypical radiographic features, is common in children with human immunodeficiency virus (HIV) infection. Conventional chest radiography and chest CT remain the most useful imaging modalities for evaluation of the immunocompromised patient presenting with a suspected pulmonary infection. In this review the radiological features of acute lung infections in this population are discussed.

CT features of tuberculous intracranial abscesses in children

BackgroundIntracranial tuberculous (TB) abscesses still cause a diagnostic dilemma on both CT and MRI as they may mimic neoplasms. Recognition of TB abscesses may prompt further imaging and appropriate trial of therapy, and may reduce the need for biopsy.ObjectiveTo report the CT features of eight intracranial TB lesions in children initially diagnosed as neoplasms and eventually treated as TB abscesses.Materials and methodsWe undertook a 3-year retrospective review of children with an initial CT diagnosis of intracranial neoplasm who were subsequently diagnosed as having TB abscesses.ResultsEight patients out of 60 with an initial diagnosis of a neoplasm on CT were misdiagnosed and were ultimately determined to have TB abscesses after biopsy or a trial of anti-TB therapy. The most consistent constellation of findings for the lesions were low density (n = 5), ring enhancement (n = 8), cerebral hemisphere location (n = 7), mass effect (n = 6), surrounding oedema (n = 5) and absence of a soft-tissue-density mass (n = 8).ConclusionIn endemic regions, intracranial lesions with these appearances on CT should undergo further imaging and possibly a trial of anti-TB therapy before considering biopsy.

Follicular bronchiolitis in an HIV-positive child.

A HIV-positive child was noted to have multiple small nodules with areas of consolidation on the chest radiograph (Fig. 1). Miliary tuberculosis (TB) was diagnosed, but there was no response to treatment. CT images demonstrated diffuse reticulonodular opacification and central consolidation (Fig. 2). Follicular bronchiolitis (FB) was diagnosed following open lung biopsy. Few examples of interstitial disease in HIV-positive children other than lymphocytic interstitial pneumonitis have been reported because children are not subjected to open lung biopsy [1]. FB is one of these, and is characterized

An unusual cause of proptosis: aneurysmal bone cyst of the anterior skull base

A 14-year-old girl presented with mild left-sided proptosis and headache. CT revealed a multiloculated, expansile lesion in the anterior skull base. MRI demonstrated a multicystic, expansile lesion of the anterior skull base (Fig. 1), extending into the anterior cranial fossa, left ethmoid bone and clivus, and filling the left nasal passage. The left orbit was deformed with resultant proptosis. Multiple fluid-fluid levels were seen on the sagittal images (Fig. 2). After administration of gadolinium there was

The effects of misinterpretation of an artefact on multidetector row CT scans in children

BackgroundArtefacts reflect problems with radiographic technique rather than true pathology. These may be misinterpreted as pathology with serious consequences. An artefact caused such problems in one paediatric imaging department.ObjectiveTo determine the incidence, and consequences of misinterpretation, of a CT artefact in a paediatric imaging department.Materials and methodsA retrospective review of images and reports of paediatric CT scans over a set period with a known artefact was performed. Reports were correlated with reviewers’ evaluation of the presence of artefact and reviewed for correct identification of artefact, misinterpretation as pathology, and action taken as a result.ResultsA total of 74 CT scans had been performed over the study period and an artefact detected by reviewers on 32 (43%). Six (18.75%) of these were misinterpreted as pathology, of which three (9.4%) were reported as tuberculous granulomas, two (6.2%) as haemorrhages and one (3.1%) as an unknown hyperdensity. Two patients (6.2%) had subsequent MRI studies performed, and treatment for tuberculosis was continued in one patient (3.1%).ConclusionNo initial report identified the artefact. One-fifth of the scans with the artefact were misinterpreted as pathology and half of these misinterpretations led to further action. Artefacts result in false diagnoses and unnecessary investigations; vigilance is needed.

Transtympanic facial nerve palsy after mountain bike accident.

Transtympanic facial nerve paralysis is rare. Previously cases of transtympanic facial nerve paralysis from welding have been reported.1 Our patient is a 47-year-old man who presented with facial nerve palsy and hearing loss after falling from a bicycle and sustaining a foreign body in the ear. Computed tomography demonstrated a foreign body penetrating the tympanic membrane, disrupting the ossicles and abutting the tympanic facial nerve in the middle ear (Figs. 1 and 2). Kojima et al.2 reported a penetrating vestibular injury due to a twig entering the external auditory meatus in a child who was rock climbing. Treatment included tympanotomy under general anesthesia and exploration of the tympanic cavity with removal of the foreign body and reconstruction of the middle ear. He has residual facial nerve palsy and has regained 70% hearing.