A comparison between ultrasonography and single-phase computed tomography for preoperative assessment of solid abdominal tumors in children

Abstract Objective: This study aimed to estimate the performance of single-phase-enhanced computed tomography and ultrasonography examinations in the preoperative evaluation of solid abdominal tumors and their relationship with relevant adjacent structures in children. Methods: This retrospective study included 50 pediatric patients with malignant solid abdominal tumors treated with surgical resection between 2009-2017. Preoperative computed tomography and ultrasonography were compared to operative findings (gold standard) in the diagnosis of invasion or encasement of adjacent structures. Accuracy, sensitivity, specificity, and positive and negative predictive values were evaluated. Results: Renal (20.4%) and neuroblastic (19.4%) tumors were the most common. Complete surgical resection with negative margins was achieved in 44 (88%) patients. The comparison between single-phase-enhanced computed tomography and ultrasonography findings showed the following results: sensitivity = 90.3% vs 86.6%, specificity = 86.8% vs 94.6%, negative predictive value = 95.3% vs 94.4%, positive predictive value = 75.3% vs 86.9%, and accuracy = 87.9% vs 92.2%. The correlation (kappa index) between computed tomography and ultrasonography examinations was 0.72 (p < 0.001). In 14% (7/50) of the patients, the invasion of adjacent structures was diagnosed by ultrasonography but not by computed tomography (1 patient had 2 invaded structures).

Ultrasound findings of pubertal development in girls with cystic fibrosis and their association with clinical outcomes and Tanner staging

ABSTRACT Objective: Patients with cystic fibrosis (CF) have a high incidence of pubertal and growth delay. In girls with CF, pubertal delay has an important psychological impact. Still, only a few studies have explored the occurrence of pubertal delay in girls with CF. The aims of this study were to compare the pubertal development of girls with CF compared with healthy controls regarding Tanner staging and pelvic ultrasound and, in girls with CF, correlate the findings with those of spirometry, body mass index, Shwachman-Kulczycki score (SKS), and genotyping. Subjects and methods: This was a cross-sectional, case-control study including 35 girls with CF aged 6-17 years and following up at the Pediatric Pulmonology Outpatient Clinic of a tertiary hospital. These patients were compared with 59 healthy controls who had undergone pelvic ultrasound as part of another study conducted by the same group. Girls with CF were consecutively enrolled in the study during their annual routine check-up visit. Data collected in the CF group included spirometry and anthropometric results, SKS values, bone age, occurrence of current cystic fibrosis-related diabetes (CFRD) and Pseudomonas aeruginosa colonization, history of meconium ileus, genotype, ultrasound parameters, and Tanner stage. Results: Pelvic ultrasound findings and Tanner stage reflected less pubertal development in girls with CF compared with healthy controls. Pubertal stage in patients with CF who presented CFRD (3.17 ± 1.16), had chronic colonization by Pseudomonas aeruginosa (3.10 ± 1.10), or were homozygous for the F508del mutation (1.91 ± 1.30) was more delayed than in controls (3.41 ± 1.41). Tanner stage correlated with age at menarche, bone age, and anthropometric and ultrasound data. Conclusions: Girls with CF presented a delay in pubertal development evaluated by Tanner stage and ultrasound parameters, which was more evident in the presence of comorbidities.

Hamartoma fibroso infantil – tumor raro em crianças / Fibrous hamartoma of infancy: a rare tumor in children

O Hamartoma Fibroso Infantil (HFI) é um tumor raro de característica benigna com representação histológica trifásica própria. Acomete tipicamente crianças de até 2 anos, predominantemente do sexo masculino. Apresenta usualmente diâmetro menor de 5 cm, ocorrendo classicamente em áreas como a parede torácica, braços, axilas e região inguinal, porém já foram descritos acometimentos de estruturas genitais, cabeça, pescoço e estruturas distais. Em sua avaliação, patologias como fibrolipoma, lipoblastoma, fibrosarcoma e rabdomiosarcoma devem sempre ser consideradas como diagnóstico diferencial. Atualmente, em sua abordagem, exames de imagem como ultrassonografia e ressonância nuclear magnética vem tornando-se importantes ferramentas no processo investigativo e preparatório à terapêutica empregada, que baseia-se na excisão da lesão. Apresentamos a seguir um relato de caso de criança com 4 meses de idade com lesão expansiva em braço esquerdo diagnosticada como HFI após investigação, excisão e análise histopatológica.

Fibrous hamartoma of infancy (FHI) is a rare, benign tumor with a characteristic three-phase histological pattern. It typically affects children up to two years of age, predominantly male. It is usually smaller than 5 cm in diameter, occurring classically in areas such as the chest wall, arms, underarms and groin, but it may as well affect genital structures, head, neck and distal structures. In its evaluation, disorders like fibrolipoma, lipoblastoma, fibrosarcoma and rhabdomyosarcoma should always be considered as a differential diagnosis. Currently, in its approach, imaging tests such as ultrasound and magnetic resonance imaging have become important tools in the investigative and preparatory process for the treatment to be used, which is based on excision of the lesion. The following is a case report of a 4-month old with an expansive lesion in the left arm diagnosed as FHI after investigation, excision and histopathology.

Vaginal ectopic ureter diagnosed by magnetic resonance imaging in a child with complete transverse vaginal septum and hydrocolpos

Ectopic ureter draining into the vagina is a rare cause of urinary incontinence. Some cases have been reported in association with malformations of the genitourinary tract, but very few published cases are associated with vaginal septum. Our article describes the case of a girl who presented with hydrocolpos shortly after birth and was found to have a complete transverse vaginal septum. Despite successful correction of this genital anomaly, the patient developed persistent dribbling of clear fluid from the genital area. Extensive testing revealed unilateral kidney dysplasia and probable genital ectopia of the corresponding ureter. Magnetic resonance imaging (MRI) showed insertion of the ureter into the upper third of the vagina. The patient underwent nephroureterectomy of the dysplastic kidney with subsequent improvement in urinary incontinence. Ureteral ectopia is difficult to diagnose with conventional imaging methods (plain radiography, ultrasound, and CT). MRI has proved to be an excellent method for assessment of genitourinary tract conditions, particularly when other diagnostic modalities have failed or are limited, due to the high resolution of MRI scans and the possibility of native image acquisition on all three orthogonal planes. MRI is the best diagnostic modality for visualization of the course and insertion of ectopic ureters, and enables precise surgical correction.