Neonatal Gastric Web Located in the Body of Stomach: A Case Report

Gastric web is a rare gastric anomaly and almost all the reported cases have been located in the distal antrum. We experienced a case of neonatal gastric web that was located in the body of stomach, and we report the findings of the upper gastrointestinal series and ultrasonography.

Usefulness of MR Cholangiography in the Evaluation of Neonatal Cholestasis: Comparison with 99mTc DISIDA Scan

PURPOSE: To evaluate the diagnostic validity of MR cholangiography as a second-line imaging tool following sonography in the evaluation of neonatal cholestasis, we compared MR cholangiography with 99mTc DISIDA scan. MATERIALS AND METHODS: We retrospectively evaluated sonography, 99mTc DISIDA scan and MR cholangiography in twenty-two neonates and infants (age range, 23-103 days; mean age, 57 days) presenting with conjugated hyperbilirubinemia. Of the 22 patients, 15 were diagnosed as biliary atresia by operative cholangiography and liver biopsy and six as neonatal hepatitis by imaging finding and clinical data. Remaining one patient was diagnosed as neonatal hepatitis by operative cholangiography and liver biopsy. Two independent observers for each study were assigned to review the images of 99mTc DISIDA scan and MR cholangiography without giving the final diagnosis or other clinical data. Diagnostic accuracy and interobserver variability for each study were evaluated. RESULTS: On 99mTc DISIDA scan, biliary atresia was mistaken for neonatal hepatitis in eight patients and vice versa in four patients. On MR cholangiography, it was mistaken biliary atresia as neonatal hepatitis and vice versa in each two patients. Sensitivity, specificity, accuracy, positive and negative predictive values of 99mTc DISIDA scan were 48%, 47%, 48%, 66% and 30%, respectively, and those of MR cholangiography were 90%, 71%, 84%, 87% and 81%, respectively. Interobserver variabilities for 99mTc DISIDA scan and MR cholangiography were 0.62 and 0.85, respectively. CONCLUSION: In the evaluation of patients with neonatal cholestasis, it would be advisable to use MR cholangiography, having superior diagnostic accuracy to 99mTc DISIDA scan, as a second-line imaging tool following sonography.

Ultrasonographic and CT findings of Cervical Ectopic Thymus of an Infant

We report a case of ectopic thymus in the left submandibular area of a two-month-old boy. On US and CT scans, a well-marginated, 3 x 2cm-sized solid mass along the left carotid sheath, anteromedial to the sternocleidomastoid muscle and posterior to the submandibular gland, was seen. CT attenuation of the mass showed that it was similar to that of normal thymus in the anterior mediastinum. Although a rare disease, ectopic thymus should be included in the differential diagnosis of cervical masses along the carotid sheath in infants.

Abdominal ultrasonographic Manifestation of Henoch-Schonlein Purpura

PURPOSE: The purpose of this study was to describe the ultrasonographic features and assess the diagnosticvalue of sonography in the evaluation of children with Henoch-Schonlein purpura. MATERIALS AND METHODS: BetweenOctober 1993, and Febuary 1998, 67 children with Henoch-Schonlein purpura underwent abdominal ultrasonography,which in 13 was used for follow up. Bowel wall thickness and location, pattern of color Doppler signal in thethickened bowel wall, the size and location of enlarged mesenteric lymph node and the presence of ascites wereevaluated. RESULTS: In 42 cases(63%), sonographic findings were positive, and indicated mesentericlymphadenopathy(n=21), small bowel wall thickening(n=20), and ascites(n=17). Thickened bowels were demonstrated atthe ileum in 11 cases, the jejunum in five, the duodenum in one, and combined wall thickening at the duodenum andjejunum in two ; thickening of the duodenum and ileum was seen in one case. Thickness varied from 3 to 10mm(mean :6.5 mm). On follow-up sonography, regression of bowel wall thickening was observed earlier than that of mesentericlymphadenopathy or ascites, and correlated well with improved abdominal symptoms. CONCLUSION: Abdominalultrasonographic manifestations of Henoch-Schonlein purpura were bowel wall thickening, mesenteric lymphadenopathyand ascites. Sonography was a simple and useful method for the evaluation of gastrointestinal manifestation ofHenoch-Schonlein purpura.

The Grade of Vesicoureteral Reflux in Voiding cystourethrography: Comparison with Ultrasonography and Tc99m-DMSA renal Scintigraphy

PURPOSE: To evaluate the prevalence of abnormalities seen on sonography and renal scintigraphy, according tothe grade of vesicoureteral reflux (VUR) on in voiding cystourethrography (VCUG). MATERIALS AND METHODS: Onehundred and forty-nine patients (age range : 1 months - 10 years) with urinary tract infection underwentsonography, VCUG, and renal scans, and 32 showed VUR on VCUG. We retrospectively evaluated the frequency andcharacteristic findings of sonographic abnormalities according to the grade of VUR, and also the frequency ofcortical defects seen on renal scans of 32 patients with VUR. The remaining 117 patients without VUR were alsoevaluated for the frequency of abnormal findings seen on sonography and renal scans. RESULTS: Among 32 patients(49 kidneys) with VUR, abnormal findings were not detected in 17 (29 kidneys) on sonography ; thus, findings wereabnormal in 15(20 kidneys, 41%). Among these 20 kidneys, renal calyceal and/or pelvic dilatation and dilatation ofdistal ureter were seen in 11, all of which were grade 4-5 VUR. Renal pelvic dilatation only was noted in eightkidneys ; two were grade 1-3 and six were grade 4-5 VUR. Nineteen patients (24 kidneys, 49%) showed focal corticaldefects on renal scintigraphy. Six kidneys were grade 1-3, and 18 kidneys were grade 4-5 VUR. Of 117 patientswithout VUR, 34 patients (29%) showed renal pelvic dilatation on sonography and in 14 patients (12%), corticaldefects were seen on renal scintigraphy. CONCLUSION: Among 32 patients with VUR, 41% showed abnormal sonographicfindings and in 49%, cortical defects were seen on renal scintigraphy. With a higher grade of VUR, the prevalenceof abnormalities increased on both sonography and renal scintigraphy. Sonographic demonstration of renal calicealand/or pelvic dilatation associated with ipsilateral distal ureteric dilatation was the characteristic finding inhigh grade VUR.

Ultrasonographic Analysis of Normal Thymus in Infants

PURPOSE: To analyse the ultrasonographic findings of normal thymus in infants and determine the pathologic findings. MATERIALS AND METHODS: Forty two infants without a history of chronic disease, tumor or steroid therapy were scanned in the axial planes with a 7.0 MHz sector transducer. Bilaterality, homogeneity, and the shape and intensity of thymic echogenicity were analysed; shapes were classified as one of three types, namely bilobate, quadrangular or triangular. The intensities of thymic echogenicity were compared with those of the liver and spleen under the same conditions (time-gain compensation, depth and gain). RESULTS: Bilaterality was seen in 36 cases, homogeneity in 35, homogeneity and bilaterality in 29, inhomogeneity and bilaterality in seven, and homogeneity and unilaterality in six. No case showed inhomogeneity and unilaterality. The shape was bilobate in 23 case, quadrangular in 13 and triangular in six, while the outer border was convex in 29 cases and straight in 13. In no case was echogenicity of the thymus greater than that of the liver or spleen. Transverse diameters were 21-47mm (mean, 37.0mm; SD, 9.4mm) and depths were 10-37.5mm (mean, 25.8mm; SD, 5.9mm). CONCLUSION: The usual findings of normal thymus in infants are bilaterality and homogeneity, convex or shaight outer border, and echointensity less than or equal to that of the liver and spleen. The possibility of thymic pathology is suggested when ultrasonography shows unilaterality, inhomogeneous echogenicity, and echogenicity greater than that of the liver and spleen.

Early Periventricular Leukomalacia: MRI and Ultrasonographic Correlation on First one Month of Life

PURPOSE: To compare the findings of early periventricular leukomalacia on MR imaging and on US. MATERIALS AND METHODS: MR imaging was performed in 17 neonates in whom well-demarcated increased periventricular echogenicity was seen on sonography. One more patient was included during the same period because MR imaging of this patient showed a periventricular lesion not suspected on previous US. Initial sonography was performed within 6 days of birth and was followed up between one week and one month later. MR images were obtained within the first month of life. RESULTS: Twelve of 17 neonates showed abnormal periventricular signal intensities on MR imaging. Follow up sonography revealed cystic changes in two cases and heterogeneous hyperechogenicities in three. All patients except the two with cystic changes showed normal periventricular echogenicity on final sonography, On MR imaging,11 cases showed multifocal periventricular increased signals on T1-weighted images, and two cases showed mainly decreased signals representing cysts. Positive findings were more evident on T1-weighted than on T2-weighted image. CONCLUSION: on T1-weighted imaging, the characteristic finding of early periventricular leukomalacia was multifocal periventricular hyper or hypointensities, and hyperintense lesions were more common than hypointense. In the diagnosis of early noncystic periventricular leukomalacia, MR imaging was more objective than US.