Susan L. Williamson

The ultrasonographic diagnosis of typhlitis (neutropenic colitis).

Typhlitis is a necrotizing inflammatory disease of the cecum, usually with secondary infection. It is most often found in acute leukemia patients on chemotherapy but has also been reported in other patients on chemotherapeutic drugs. Diagnostic features of typhlitis have been reported on plain radiographs, barium enema, angiography, CT, and one other reported case with ultrasound. We report three cases of typhlitis with a characteristic echogenic thickening of the mucosa on ultrasound. The sonographic findings in the one previous report were identical to those of our three cases. We believe that the sonographic findings of typhlitis are unique and that ultrasound offers an easy noninvasive method of diagnosing this potentially lethal disease.

High resolution ultrasound with Doppler: A diagnostic adjunct in orbital and ocular lesions in children

Twenty-six infants and children with orbital and ocular pathology were examined with ultrasound (US) utilizing real-time imaging and Duplex Pulsed Doppler evaluation. Twenty-two of these patients underwent concurrent orbital computed tomography (CT) and two had magnetic resonance imaging (MRI). Orbital and periorbital lesion included hemangioma, dermoid, lymphangioma, rhabdomyosarcoma, encephalocoele and abscess. Ocular lesions included infection, trauma, retinal detachment, retinoblastoma, Coats disease, and persistent hyperplastic primary vitreous. High resolution US with Doppler provided unique diagnostic information in patients with penetrating ocular trauma, orbital and periorbital masses, and intraocular structural abnormalities. High resolution US examination of the eye and periorbital tissues is readily performed using widely available equipment and often delineates subtle structural abnormalities not shown by CT or MRI.

High resolution ultrasound characterization of soft tissue masses in children

Forty-two soft tissue masses in infants and children were examined with high resolution ultrasonography. Sonography was diagnostically specific in 17/42 (40%), useful but not diagnostic in 24/42 (58%), and misleading in 1/42 (2%) of soft tissue masses. Lesions with diagnostic sonographic features included cystic hygroma, fibromatosis colli, lymphadenopathy with abscess formation, and one case of osteomyelitis.

The distended gasless abdomen: a fertile field for ultrasound.

Ultrasonography has proven to be a helpful imaging modality in evaluating the child with a distended gasless abdomen. The presence of an unsuspected mass can easily be detected as well as the presence of ascites and/or abnormally dilated loops of small bowel. Thickened loops of bowel can also be easily detected in the abdomen with very little gas. Closed loop obstruction and intussusception, as well as meconium ileus equivalent (distal intestinal obstruction syndrome), are described.

Extracardiac chest ultrasonography in infants and children: radiographic and clinical implications.

Extracardiac chest ultrasonography was performed in 51 children for characterization and localization of pleural disease (29 children), for evaluation of chest and mediastinal masses (12), and for determining the cause of unilateral chest radiographic opacification (10). Ultrasonography clearly differentiated drainable fluid from pleural thickening, accurately characterized chest and mediastinal masses, guided aspiration and drainage procedures, and allowed rapid diagnosis of causes of unilateral opaque hemithorax.

Prognostic factors for healing of bone lesions in histiocytosis X.

Healing characteristics and rates of resolution were retrospectively reviewed in 38 bone lesions in 18 patients with histiocytosis X. Signs which tended to indicate future healing were a change from a nontrabecular pattern to a trabecular pattern by 10 weeks, a nonsclerotic lesion to one with sclerosis by 13 weeks, and loss of distinct margins by 24 weeks. Complete healing then occurred within 36 to 40 weeks after development of these favorable signs. The earliest occurrence of a favorable sign was 6 weeks. A trabecular pattern was found in 90% of the lesions, outside the skull, which eventually healed. Fifty-eight percent (22 of 38) of the lesions completely healed in an average of 13.6 months. Five months was the most rapid occurrence of healing in any of our cases.

Focal spinal abnormalities on bone scans in ankylosing spondylitis: a clue to the presence of fracture or pseudarthrosis

Four cases of ankylosing spondylitis are presented in which radionuclide bone studies indicated focal abnormalities of the spine. In three patients, the area of abnormal nuclide uptake corresponded to a site of pseudarthrosis, and in the fourth an acute fracture was present. As such focal lesions on bone scans are unusual in cases of chronic ankylosing spondylitis in which a complication is not apparent, their presence can be a useful finding.

Screening spinal ultrasound in newborns with neural tube defects.

Twenty‐six newborns with spina bifida had complete spinal ultrasound (US) prior to initial surgical repair of the neural tube defects. Associated anomalies were found on screening US in seven infants and included diastematomyelia (two cases), hydromyelia (two cases), and dural fat deposits (three cases). Initial surgical therapy was altered in one infant with diastematomyelia. Four closed simple meningoceles showed no internal neural elements on US and none were found at surgery.

The opaque chest: when to suspect a bronchial foreign body

A bronchial foreign body should be strongly suspected in a child with an opaque chest without a previous history of airways disease when there is: (1) any sign of volume loss or atelectasis in the lung density and (2) bronchiectasis within the lung density. Ultrasound may be helpful to rule out the presence of pleural fluid and may even demonstrate the bronchiectasis when the bronchi are fluid-filled.

Indium 111 white blood cell scanning in the pediatric population

Indium-111 leukocyte scanning is a reliable means of locating acute infection in adults, but its use in the pediatric population has not been extensively documented. The results of scans on 30 children retrospectively reviewed are presented. Acute infections were detected in 15 of 16 patients (94% sensitivity) with one false negative scan. There were 8 truly negative and 6 falsely positive studies (57% specificity).