Mesenteric Lymphadenopathy in Childhood Epidemic Aseptic Meningitis: Sonographic Features and Clinical Significance

PURPOSE: To evaluate the sonographic features of mesenteric lymphadenopathy in childhood epidemic aseptic meningitis and to assess their clinical significance. MATERIALS AND METHODS: Thirty-three patients (25 male, 8 female; mean age, 8.6 years) with a diagnosis of aseptic meningitis were prospectively evaluated with abdominal ultrasonography for the presence of enlarged mesen-teric nodes. The size and number of enlarged mesenteric lymph nodes were analyzed in relationship with the pa-tient's age, between the patients with abdominal pain or diarrhea (16 cases, 48%) and asymptomatic patients(17 cases, 52%). RESULTS: Mesenteric lymphadenopathy was seen in 31 patients (94%), all 16 symptomatic and 15 of the 17 asymp-tomatic patients. The number of enlarged nodes was most prevalent between 6 -10, seen in 16 patients (52%) and the largest node ranged in size from 4 to 8 mm. Among the 31 patients with mesenteric lymphadenopathy, the mean size of the largest node was statistically different between the symptomatic (6.0 mm) and asympto-matic (5.0 mm) groups (p = 0.021). The number of enlarged nodes and the patient's age were not statistically d-ifferent between the two groups. CONCLUSION: Mesenteric lymphadenopathy was seen in almost all cases of childhood epidemic aseptic meningitis, and may be related to the mesenteric lymphadenitis caused by enterovirus.

Recurrent Pediatric Mesenteroaxial Gastric Volvulus: Case Report Focusing on Ultrasonographic and CT Findings

Gastric volvulus is a rare condition, and it is classified as the organoaxial or mesentericaxial type according to the axis of rotation. We experienced 1 case of pediatric recurrent mesenteroaxial gastric volvulus and we report here the ultrasonographic and CT findings.

US Features of Transient Small Bowel Intussusception in Pediatric Patients

OBJECTIVE: To describe the sonographic (US) and clinical features of spontaneously reduced small bowel intussusception, and to discuss the management options for small bowel intussusception based on US findings with clinical correlation. MATERIALS AND METHODS: During a five years of period, 34 small bowel intussusceptions were diagnosed on US in 32 infants and children. The clinical presentations and imaging findings of the patients were reviewed. RESULTS: The clinical presentations included abdominal pain or irritability (n = 25), vomiting (n = 5), diarrhea (n = 3), bloody stool (n = 1), and abdominal distension (n = 1), in combination or alone. US showed multi-layered round masses of small (mean, 1.5+/-0.3 cm) diameters and with thin (mean, 3.5+/-1 mm) outer rims along the course of the small bowel. The mean length was 1.8+/-0.5 cm and peristalsis was seen on the video records. There were no visible lead points. The vascular flow signal appeared on color Doppler images in all 21 patients examined. Spontaneous reduction was confirmed by combinations of US (n = 28), small bowel series (n = 6), CT scan (n = 3), and surgical exploration (n = 2). All patients discharged with improved condition. CONCLUSION: Typical US findings of the transient small bowel intussusception included 1) small size without wall swelling, 2) short segment, 3) preserved wall motion, and 4) absence of the lead point. Conservative management with US monitoring rather than an immediate operation is recommended for those patient with typical transient small bowel intussusceptions. Atypical US findings or clinical deterioration of the patient with persistent intussusception warrant surgical exploration.

High Grade MALT Lymphoma of the Ileum in a Child Presenting as Intussusception: A Case Report

Lymphoma is the third most common childhood malignancy after leukemia and brain tumor. In contrast to adult non-Hodgkin's lymphoma, that occurring in children is usually found extranodally. The most common site is the abdomen, including the gastrointestinal tract, kidney and pancreas, and the next most common is the extranodal head and neck. Gastrointestinal non-Hodgkin's lymphoma in adults is usually considered to be MALT lymphoma, a distinct B-cell type, but the occurrence of this variety in the small bowel of children is relatively rare. We report a case of high-grade MALT lymphoma occurring in a nine-year-old boy who presented with ileoileal intussusception.

Ruptured Mucinous Adenocarcinoma of the Colon in a Child: A Case Report

Carcinoma of the colon is extremely rare in pediatric patients, and due to the preponderance of poor histological characteristics and the difficulty of diagnosis, the prognosis in children is quite unfavorable. We describe a case of ruptured and disseminated mucinous adenocarcinoma of the descending and sigmoid colon in a 14-year-old boy with abdominal pain, diarrhea and fever. Ultrasonography and computed tomography revealed a large soft tissue mass containing tiny calcifications and poorly enhanced hypodense portions in the thickened descending and sigmoid colon, as well as abundant ascites. Where images reveal a mass with low attenuation, calcifications, and aggressive dissemination, mucinous adenocarcinoma may be preferentially included in the differential diagnosis of a pedriatic colon tumor.

Recent Trends of Radiological Reduction of Intussusception in Children: A Nationwide Phone Survey to Training Hospitals in Korea

PURPOSE: To assess the prevalence of various radiological reduction methods for childhood intussusception in training hospitals by means of a nationwide phone survey, and to demonstrate recent trends in this area by comparing the findings with those obtained in a survey conducted six years earlier. MATERIALS AND METHODS: Forty-seven radiologists and 36 residents in 83 (university, 54; general, 29) of 91 nationwide training hospitals were asked by telephone 1) to identify their currently used radiological reduction method, and to state 2) whether sedation was used for patient preparation, 3) how many times they had experienced bowel perforation during the previous six years, 4) whether ultrasonography was used for diagnostic purposes and 5) the grade of resident involved in night duty. The results were compared with those obtained during a 1993 survey of training hospitals in Seoul. RESULTS: 1) Air and barium reduction were used with equal frequency (40%, 33/83). Gastrografin reduction was used in six, hospitals (7%) barium reduction and ultrasonography-guided hydrostatic reduction in five (6%), and ultrasonography-guided hydrostatic reduction in four (5%), while in two (2%), air and barium reduction were used to an equal extext. Compared with the results of the 1993 survey, the use of barium reduction had decreased from 62 to 40%, though the use of air reduction showed an increase, from 5 to 40%. The frequency with which other methods were used showed no significant change. 2) In 82% of cases (68/83), patients were not sedated during preparation; the 1993 figure of 87% was thus not significantly different. 3) With regard to the incidence of perforation during the last six years, between one and three cases had been encountered at each of 30 hospitals. Air reduction was used at 17 of these (57%), and barium reduction at ten (33%). At each of five hospitals at which 3 -5 cases had occurred, air reduction had been used in all cases. 4) Ultrasonography was employed for the diagnosis of intussusception at 78/83 hospitals (94%); among these 83, this mode was always employed at 26 (31%). 5) At the majority of hospitals (42%), night duty residents were grade two, while grade one were employed at 30%, grade three at 23%, and grade four at 5%. CONCLUSION: For radiological reduction air and barium are currently used with equal frequency at training hospitals in Korea. Compared with 1993, air reduction is being used more but barium reduction less.

CT Findings of Hepatoblastoma Before and After Chemotherapy: Correlation with Pathologic Features

PURPOSE: The purpose of this study was to analyze the CT findings of hepatoblastoma before and afterchemotherapy, and to compare them with surgical and pathologic features. MATERIALS AND METHODS: Twelvehepatoblastoma patients underwent chemotherapy prior to surgery; in all cases, CT scanning was performed beforeand after chemotherapy. We reviewed the findings with special attention to changes in tumor volume, the extent andpattern of contrast enhancement, the extent of low-attenuation area in the tumor, the presence of a septum, andcalcification or ossification within the mass before and after chemotherapy. Post-chemotherapy CT findings werecompared with operative and pathologic findings. RESULTS: After chemotherapy, the volume of the tumor massdecreased in all patients, and the extent of involved segments decreased in nine(75%), the non-enhancing areawithin the mass, on the other hand, increased in nine (75%). On pre-chemotherapy CT, calcifications were detectedin seven patients(58%), and on post-chemotherapy CT, in nine (75%); the extent of calcification increased in sevenpatients. On the basis of CT findings, viable tumor and necrosis areas could not be distinguished. Massivecalcification or an osteoid mixed with loose connective tissue was noted in the mesenchymal component of thetumor; the whirling pattern of enhancement within the area of low density asen on CT scanning corresponded toosteoid mixed with loose connective tissue, which contained rich blood vessels. CONCLUSION: We describe the CTfindings of hepatoblastoma both before and after chemotherapy, highlighting the changes which occurred. Anunderstanding of these changes is helpful for the proper management of this condition.

MR Imaging of the Currarino Triad

PURPOSE: The purpose of this study was to describe the MR findings of the spectrum of the Currarino triad and to discuss the potential role of MR imaging in evaluating these anomalies. MATERIALS AND METHODS: Seven children (age range: 2-12 months) with Currarino triad were evaluated using MR imaging, plain radiography, and barium study. In addition, CT scans (n=3) and sonography (n=2) were performed. We retrospectively analyzed MR imaging findings and correlated these with the findings of other imaging modalities. RESULTS: Anorectal anomalies included anorectal stenosis in five patients and an imperforate anus in two. MR imaging findings of anorectal stenosis included an elongated thick-walled anorectal canal and dilatation of the proximal segment of the rectum. In the patients with an imperforate anus, the location of the blind rectal pouch and sphincteric musculature was delineated. In one case, a transcolostomy enema revealed a fistula not evident on MR images. Presacral masses included four teratomas and three lipomas associated with various spinal anomalies. On MR imaging, which gave better results than CT or sonography, a detailed evaluation of presacral masses and associated anomalies was possible. Sacral anomalies included a typical scimitar-shaped sacral defect in five patients, abnormal curvature in one, and malsegmentation in one. In all cases, MR imaging showed the abnormal sacrum, but plain radiography more clearly demonstrated its anomalous shape. CONCLUSION: Various anorectal anomalies, presacral masses, and other associated anomalies were demonstrated by MR imaging. When the Currarino triad is suspected, MR imaging should therefore follow plain radiographs.

Diagnosis of Hirschsprung's Disease: Accuracy of Barium Enema Findings

PURPOSE: To determine the relative accuracy of barium enema findings of Hirschsprung's disease (HD) and to calculate a level of probability for three signs combined. MATERIAL AND METHODS: Barium enema findings in 45 patients who had undergone rectal biopsy to prove or exclude the diagnosis of HD were retrospectively analyzed by evaluating the presence of a transition zone, irregular contractions and delayed evacuation of barium. Seventeen were neonates (group 1) and the other 28 were infants and children (group 2). The sensitivity, specificity, and positive and negative predictive values of the findings were compared. RESULTS: In visualization of a transition zone, sensitivity, specificity and positive predictive value were 76.5%, 72.7% and 89.7%, respectively. Sensitivity for irregular contractions and delayed evacuation of barium was 76.5% and 91.7%, respectively, whereas for specificity, the corresponding values were 63.6% and 40%. Sensitivities for radiologic signs were higher in group 1 than in group 2, but, the specificities were lower. If two or three findings were positive, the level of probability was 85 - 100%. If two findings were negative, however, the corresponding value was 30%. CONCLUSION: We conclude that the most reliable HD finding is the presence of a transition zone. Irregular contractions and the delayed evacuation of barium are not specific. Two or three positive findings may suggest a higher probability of HD than any single positive finding alone.

Abdominal Ultrasonographic Findings of Yersiniosis in Children

PURPOSE: To review abdominal ultrasonography in Yersinia Pseudotuberculosis(YP) infection. MATERIALS AND METHODS: From June 1993 through June 1994, abdominal ultrasonograms were reviewed in 36 patients with YP infection. The age of patients was from 4 to 14 years. A diagnosis of YP infection was made on the basis ofisolation of YP from stool (n=15/36, 41.7%) and by documenting at least a minimum agglutination antibody titer of1:160 or greater (n=34/36, 94.4%). RESULTS: Abdominal US findings were identifed in 33/36 (91.7%) of patients with YP infection. US abnormalities included right lower quadrant abdominal lymphadenopathy in 28/36 (77.8%) of cases ;increased bilateral renal cortical echogenecity with renal enlargement, 11/36 (30/6%) of cases ;hepatosplenomegaly, 6/36 (16.7%) of cases ; bowel wall thickening in termnal ileum and cecum, 4/36 (11/1%) of cases ; and ascites, 2/36 (5.5%) of cases. Three patients revealed no abdominal sonographic finding. CONCLUSION: We conclude that abdominal US can help in the diagnosis of YP infection when US demonstrates multiple right lower quadrant abdominal lymphadenopathy, increased renal cortical echogenecity with renal enlargement, hepatosplenomegaly, intestinal wall thickening or ascites.