Tracy Kilborn

Magnetic resonance imaging versus histopathology in Wilms tumor and nephroblastomatosis: 3 examples of noncorrelation.

Magnetic resonance imaging (MRI) has become the principal tool for Wilms tumor (WT) assessment and follow-up. MRI and histopathologic findings were not congruent in 2 of the q30 scanned patients with renal masses (2008 to 2011). Three lesions thought to be WT on MRI were found to be a sclerotic nephrogenic rest (1), cystic renal dysplasia (1), and focal chronic pyelonephritis (1). The “typical” features suggesting nephroblastomatosis and WT on MRI are unreliable and such lesions require biopsy for histopathologic diagnosis, especially when nephron-sparing surgery is necessary to preserve renal function.

Imaging Features of the Brain, Cerebral Vessels and Spine in Pediatric Tuberculous Meningitis With Associated Hydrocephalus.

Background: Pediatric tuberculous meningitis (TBM) leads to high rates of mortality and morbidity. Prompt diagnosis and initiation of treatment are challenging; imaging findings play a key role in establishing the presumptive diagnosis. General brain imaging findings are well reported; however, specific data on cerebral vascular and spinal involvement in children are sparse. Methods: This prospective cohort study examined admission and followed up computed tomography brain scans and magnetic resonance imaging scans of the brain, cerebral vessels (magnetic resonance angiogram) and spine at 3 weeks in children treated for TBM with hydrocephalus (HCP; inclusion criteria). Exclusion criteria were no HCP on admission, treatment of HCP or commencement of antituberculosis treatment before study enrollment. Imaging findings were examined in association with outcome at 6 months. Results: Forty-four patients (median age 3.3 [0.3–13.1] years) with definite (54%) or probable TBM were enrolled. Good clinical outcome was reported in 72%; the mortality rate was 16%. Infarcts were reported in 66% of patients and were predictive of poor outcome. Magnetic resonance angiogram abnormalities were reported in 55% of patients. Delayed tuberculomas developed in 11% of patients (after starting treatment). Spinal pathology was more common than expected, occurring in 76% of patients. Exudate in the spinal canal increased the difficulty of lumbar puncture and correlated with high cerebrospinal fluid protein content. Conclusion: TBM involves extensive pathology in the central nervous system. Severe infarction was predictive of poor outcome although this was not the case for angiographic abnormalities. Spinal disease occurs commonly and has important implications for diagnosis and treatment. Comprehensive imaging of the brain, spine and cerebral vessels adds insight into disease pathophysiology.

Pediatric and Adult Spinal Tuberculosis: Imaging and Pathophysiology

The prevalence of tuberculosis (TB) has increased in developing and developed countries as a consequence of the AIDS epidemic, immigration, social deprivation, and inadequate TB control and screening programs. Spinal TB may be osseous or nonosseous. Classic findings of multiple contiguous vertebral body involvement, gibbus formation, and subligamentous spread with paravertebral abscesses are optimally evaluated with MR imaging. Nonspondylitic spinal TB is less well described in the literature, may develop in the absence of TB meningitis, and is often associated with meningovascular cord ischemia. Radiologists should be familiar with the spectrum of imaging findings, allowing early diagnosis and treatment of this serious condition.

Tuberculous iliac artery aneurysm in a pediatric patient

Vascular complications of tuberculous infections are rare and occur even less frequently in the pediatric population. Tuberculous pseudoaneurysms can occur either as a result of contiguous spread from a neighboring focus-invariably infected lymph nodes-or by hematogenous spread and seeding of acid-fast bacilli that lodge in the adventitia or media via the vasa vasorum. We report a case of turberculous right common iliac artery pseudoaneurysm in a 12-year-old and review the relevant literature.

Significant airway compromise in a child with a posterior mediastinal mass due to tuberculous spondylitis

An 11-year-old boy presented with gradual-onset paresis and painless scoliosis. CT and MRI demonstrated contiguous thoracic vertebral and disc destruction with a large prevertebral soft-tissue mass that demonstrated an enhancing wall. The trachea was compressed (>50%) between the soft-tissue mass and the great vessels (Figs. 1 and 2). The patient had no clinical features of acute airway compromise. The diagnosis of tuberculous spondylitis with significant airway compression was made. Mediastinal masses often present with non-specific signs and symptoms or are discovered incidentally (50%), but they can lead to the development of acute airway compromise [1, 2]. Significant airway compromise can be defined by clinical severity or by the radiological demonstration of >50% narrowing of the trachea. In one study, 88% of patients with airway compromise showed airway compression on radiological imaging [1]. Factors associated with acute airway compromise include anterior location of a mediastinal mass and a diagnosis of lymphoma [1]. Neurogenic tumours, which are posterior mediastinal masses, are not usually associated with airway compromise unless they are very large [1, 3]. Tuberculous spondylitis causes a posterior mediastinal mass in children in the form of a paravertebral abscess [4]. Thoracic involvement occurs in 83% of patients and a paravertebral mass occurs in 98% of patients imaged with MRI [4]. There is one

ABC of pediatric surgical imaging

ABC of pediatric surgical imaging / , ABC of pediatric surgical imaging / , کتابخانه دیجیتال جندی شاپور اهواز

How has the OSD affected our state hospitals

We look at the OSD process, and identify the potential impact of its deficiencies, on the state health system and teaching programs. Furthermore we look at the bargaining process available to state doctors, and suggest ways that this could be improved.