First Case of Ascaris lumbricoides Infestation Complicated with Hemophagocytic Lymphohistiocytosis.

Ascariasis is a common soil-transmitted helminth infestation worldwide. Ascaris lumbricoides infestation is generally asymptomatic or cause nonspecific signs and symptoms. We report a 5-year-old male with hemophagocytic lymphohistiocytosis associated with A. lumbricoides infestation. The presented patient recovered completely after defecating an A. lumbricoides following intravenous immunoglobulin (IVIG) and mebendazole treatment. We wanted to emphasize that because helminth infestation is easily overlooked, the diagnosis of ascariasis should be considered in patients who live in endemic areas and treated timely to prevent severe complications.

Sonographic measurement criteria for the diagnosis of internal jugular phlebectasia in children.

BACKGROUND: To establish sonographic (US) criteria for the diagnosis of internal jugular phlebectasia (IJP) in children and to determine reliable cutoff values of US measurements with high specificity and sensitivity. METHODS: We used B-mode US for the measurement of internal jugular vein transverse (T) and anteroposterior (AP) diameter, and cross-sectional area (CSA) at rest and during the Valsalva maneuver (VM) in 21 patients, aged 15 months to 16 years, diagnosed with IJP, and compared the results with those of 88 healthy children. Receiver operating characteristics curves were used to determine the optimal cutoff values. RESULTS: Patients with IJP had higher T, AP diameters, and CSA at rest and during VM than controls on the same side (p < 0.001). Receiver operating characteristics curves showed that CSA during the VM on both sides yielded the best results (cutoff value 220 mm(2) with 92.3% sensitivity, 92% specificity on the right side; 188 mm(2) with 90% sensitivity, 87.5% specificity on the left side). AP diameter offered better specificity and sensitivity (≥85%) than T diameter during VM on both sides. CONCLUSIONS: We suggest using an AP diameter >15 mm as a cutoff point for both sides for the diagnosis of IJP in daily practice. US measurement of the jugular vein diameter might help increasing clinicians' awareness of clinically unrecognized cases of IJP and identifying borderline cases that require follow-up.

Can sonographic peritoneal thickness be used to follow pediatric patients on peritoneal dialysis?

BACKGROUND: Peritoneal dialysis (PD) is an effective and successful therapy for end-stage renal disease (ESRD). However, PD does not have a life-long effectiveness, and peritoneal membrane failure is commonly observed in long-term PD patients. We hypothesized that ultrasonography could be used to follow these patients. METHODS: We recruited two patient groups (age range 3-18 years), of whom 20 had ESRD with ongoing PD for ≥24 months (study group) and 20 were pre-dialysis non-ESRD patients (control group). None of the patients had peritonitis during the preceding 3 months, and none had a history of abdominal surgery or malignancy. We measured the sonographic thickness of the parietal peritoneum and obtained Doppler indices of the superior mesenteric artery (SMA) by trans-abdominal ultrasonography. RESULTS: Peritoneal thickness as determined by sonography was significantly greater in the PD group than in the controls. The correlation between duration of PD and thickness of the peritoneal membrane was linear and statistically significant. We categorized all 20 patients as either rapid transporters or slow transporters for both creatinine and glucose. The peritoneal membranes of patients who were rapid transporters for both creatinine and glucose were significantly thicker than those of the slow transporters. No statistical difference was found between the Doppler indices of the SMA between the groups. CONCLUSION: Thickness of the parietal peritoneum as determined by sonography is associated with PD duration and transport characteristics. We conclude that ultrasonography is a non-invasive and practical method which can be useful for following PD patients.

Value of pelvic sonography in the diagnosis of various forms of precocious puberty in girls.

PURPOSE: To evaluate the role of pelvic sonography (US) in the diagnosis and differentiation of various forms of precocious puberty in girls, and to explore reliable cutoff points of pelvic US measurements for differentiating between these conditions. METHODS: Uterine length, uterine cross-sectional area, uterine volume, fundocervical ratio, and ovarian volumes of 143 healthy girls were compared with those of 125 girls with different forms of sexual precocity. Ovaries were morphologically classified as homogenous, paucicystic, multicystic, macrocystic, and isolated cystic. RESULTS: Almost all US measurements of girls with central precocious puberty in the 0- to 8-year age group were significantly increased compared with controls and girls with premature thelarche and adrenarche (p < 0.05, except for ovarian volumes in premature thelarche group), whereas no statistically significant difference was found in the 8- to 10-year group (p > 0.05). Ovarian morphology distributions did not differ significantly between patient subgroups, but all had more mature forms compared with controls. Due to the wide overlap between the measurements, no reliable cutoff points could be determined by charting receiver operating characteristics curves. CONCLUSIONS: Pelvic US can improve the diagnosis of central precocious puberty in girls of 0-8 years of age but provides no reliable type differentiation alone. It provides no valuable information for this diagnosis in girls of 8-10 years of age.

Imperforate hymen causing bilateral hydroureteronephrosis in an infant with bicornuate uterus.

A rare case of imperforate hymen associated with bicornuate uterus in an infant is presented as a cause of bilateral hydroureteronephrosis and pelvic mass in infancy. The importance of postoperative radiologic evaluation for diagnosis of accompanying uterine abnormalities is introduced. A 8-month-old girl with restlessness and intermittent fever was brought to the daily outpatient clinic by her parents. Ultrasound exam showed bilateral grade 4 hydroureteronephrosis and a large cystic pelvic mass. Magnetic resonance scan of the pelvis revealed marked hematocolpos. A cruciate incision was made over the hymen under general anesthesia. During a 6-month followup gradual resolution of bilateral hydroureteronephrosis was documented. Although the details of the uterine anomaly were obscured in preoperative imaging, postoperative US and MR demonstrated bicornuate uterus. Postoperative pelvic radiologic examination is highly recommended to verify the resolution of hematocolpos and to screen for any concomitant anomalies that can have long-term clinical significance.

Superior herniation of the thymus into the neck--a familial pattern.

Superior herniation of normal mediastinal thymus into the anterior neck is a rare cause of neck masses in children. It is defined as intermittent migration of the broadest part of the normal thymus out of the thorax into the suprasternal region during Valsalva maneuver with an increase in the intrathoracic pressure. The fact that the mass apparent only during Valsalva maneuver and typical ultrasound characteristics usually allow the diagnosis but computerized tomography scan or magnetic resonance imaging is necessary to assess the extent of the mass. We report the first and the only siblings with the most dramatic degree of superior herniation of normal mediastinal thymus. We discuss the findings of imaging and the differential diagnosis. We try to remind this entity to avoid unnecessary biopsy or surgery and their potential risk of altering immune function.