Adding Value to the Magnetic Resonance Examination in a Case of Brachial Plexus Birth Palsy.

We report a case of brachial plexus birth palsy in an infant with the inability to move the left upper limb since birth. There was neither history of birth trauma nor any complications during delivery. Magnetic resonance imaging (MRI) of brachial plexus showed postganglionic injury with musculoskeletal abnormalities. The child underwent surgical repair of the plexus and is on physical rehabilitation. In this case report, we discuss the utility of a single MRI examination with an elaborate discussion on various MRI signs of brachial plexus injury including secondary musculoskeletal manifestations. The case reiterates the significance of two-in-one approach while imaging these cases with MRI. Apart from reporting the damage to the brachial plexus, the radiologist should actively search for glenohumeral dysplasia. Awareness of classification and assessment of glenohumeral dysplasia should be routinely included as an integral part of imaging report as it adds incremental value to the overall patient management and functional outcome.

Neuroblastoma involvement of the falx cerebri.

Involvement of the falx cerebri in infants with stage 4 neuroblastoma is thought to be rare. The falx is derived from the neural crest and thus may be a location for primary neuroblastoma. Its propensity for metastasis is unknown. Management of neuroblastoma in this location is potentially challenging. We describe two children less than 18 months of age who were successfully managed with chemotherapy alone (without radiation or surgery) for falx involvement with neuroblastoma.

Imaging of congenital mesoblastic nephroma with pathological correlation.

BACKGROUND: There are a variety of imaging findings for congenital mesoblastic nephroma (CMN) and two main pathological variants: classic and cellular. OBJECTIVE: To determine whether imaging findings in children can predict the likely pathological variant. MATERIALS AND METHODS: We reviewed imaging in children with pathology-proven CMN. Imaging findings correlated with gross and histological appearance. RESULTS: In 15 boys and 15 girls with CMN, US was performed in 27, CT in 19, and MRI in 7. Cystic components were readily identified on US; central hemorrhage was better differentiated on CT. MRI demonstrated high sensitivity for both. Histology confirmed classic CMN in 13 children, cellular CMN in 14 and "mixed" CMN in 3. Age at presentation was significantly higher in children with the cellular variant. Of 15 solid or predominantly solid tumors and 10 lesions with a hypoechoic ring, 12 and 7, respectively, had pathology consistent with classic CMN. In contrast, five of seven with intratumoral hemorrhage and all with a large cystic/necrotic component had pathology consistent with the cellular variant. CONCLUSION: The imaging appearance of CMN is often determined by the pathological type of tumor. Findings suggestive of the classic variant include a peripheral hypoechoic ring or large solid component. In comparison, cystic/necrotic change and hemorrhage is much more common in cellular CMN.

The fetal cerebellar vermis: assessment for abnormal development by ultrasonography and magnetic resonance imaging.

Fetal magnetic resonance provides a new tool in the imaging of the posterior fossa and is proving useful in cases that are difficult to assess sonographically by allowing further assessment of the fourth ventricle, cisterna magna, and vermian growth and development. We describe various criteria with which to evaluate vermian growth, including vermian biometry and the relationship between the superior and inferior lobes. We demonstrate 2 markers of normal vermian development: the primary fissure and fastigial point. We illustrate the tegmento-vermian angle, "closure" of the fourth ventricle, and communication of the fourth ventricle with the basal cisterns during development and in several disorders. We correlate those features with the expected embryological course of development and illustrate identification of these features and associated abnormalities of the posterior fossa, brain stem, and central nervous system in mid-trimester scans of fetuses with abnormal development. Correlation with contemporaneous ultrasound examinations is demonstrated.

CT of the chest in the evaluation of idiopathic pulmonary arterial hypertension in children.

BACKGROUND: Idiopathic pulmonary arterial hypertension (IPAH) is a rare disease in children. By definition it is a diagnosis of exclusion, and CT of the chest is primarily performed to exclude other causes. Previous studies have defined CT features suggestive of the diagnosis of IPAH, but these have all been limited to the adult population. OBJECTIVE: Contrast-enhanced chest CT and high-resolution CT findings in IPAH were evaluated in an attempt to define features consistently seen in children with this condition. MATERIALS AND METHODS: The chest CT scans performed at initial presentation were reviewed in 17 children with echocardiographic or angiographic evidence of IPAH. RESULT: There were nine boys and eight girls, ranging in age from 1 month to 17 years. The extrapulmonary findings included cardiomegaly with right-sided cardiac enlargement, which was seen in 13 children. The central pulmonary arteries were enlarged in 15 children, with peripheral enlargement in two. In six children this resulted in bronchial compression. In addition, mediastinal and hilar lymphadenopathy was noted in three children. Prominent intrapulmonary features included a peripheral vasculopathy, with enlarged tortuous vessels, seen in eight children. Ill-defined ground-glass centrilobular opacities were also noted in eight children, representing the most common parenchymal abnormality. Other findings included septal lines in five, diffuse ground-glass opacification in four and focal hyperlucent zones in three. Mosaic attenuation was seen in one child. CONCLUSION: A variety of imaging findings are identified in IPAH. Features particularly consistent with the diagnosis include peripheral vasculopathy and centrilobular opacities in the setting of cardiomegaly and central pulmonary arterial enlargement.

First trimester ultrasound diagnosis of lethal multiple pterygium syndrome.

OBJECTIVE: Diagnosis of lethal multiple pterygium syndrome in the first trimester of pregnancy. METHODS: A 38-year-old woman attended our ultrasound (US) clinic at 11.2 weeks gestation. She has had two previous stillbirths affected by lethal multiple pterygium syndrome. Transabdominal and transvaginal US were performed and identified a recurrence. Autopsy findings are compared to the fetal US findings. RESULTS: Fetal US showed a markedly increased nuchal translucency, fixed flexion deformities of the elbows and knees bilaterally, cutaneous webs across both elbow joints and absent fetal movements. The patient decided to terminate the pregnancy and a D&C was performed. Pathology of intact fetal parts showed flexion deformity of the right elbow with a cutaneous web, and ulnar deviation of the right wrist. CONCLUSION: Increased nuchal translucency, absent limb movements, multiple joint contractures and cutaneous webs on US allowed the diagnosis of lethal multiple pterygium syndromes in the first trimester of pregnancy.