ABSTRACT
Plasma cell granulomas are lesions of uncertain histogenesis arising in a variety of locations, most commonly the lung. Treatment for these lesions is complete surgical excision if possible. Unresectable pulmonary lesions respond to oral corticosteroids and radiation therapy. We report the long-term outcome of two unusual pediatric cases of cardiac plasma cell granulomas originating within the right ventricle and posterior aspect of the left ventricle. The limited literature reports advocate surgical resection for this entity, with no discussion of alternative treatment strategies for unresectable lesions. We prospectively evaluated the response to postoperative oral steroid therapy, as complete surgical excision was not possible in either case. Sequential echocardiography demonstrated additional significant reduction in the size of the masses and the patients remain asymptomatic at 9 and 5.5 years follow-up, without evidence of obstruction or recurrence. Oral corticosteroids should be considered as a treatment option for any unresectable plasma cell granuloma.
Subject(s)
Glucocorticoids/administration & dosage , Granuloma, Plasma Cell/therapy , Prednisone/administration & dosage , Administration, Oral , Biopsy , Cardiac Surgical Procedures , Echocardiography , Female , Follow-Up Studies , Granuloma, Plasma Cell/diagnosis , Heart Ventricles/drug effects , Heart Ventricles/pathology , Humans , Infant , Magnetic Resonance Imaging , Male , Microscopy, Electron , Prospective Studies , Treatment OutcomeABSTRACT
OBJECTIVE: To determine the frequency of thymic involvement in Langerhans' cell histiocytosis and describe its imaging appearance before and after treatment. MATERIALS AND METHODS: A retrospective review of the radiology and clinical records of all patients diagnosed with Langerhans' cell histiocytosis at DeVos Children's Hospital between 1992 and 1998. RESULTS: Of the 14 patients diagnosed with Langerhans' cell histiocytosis, 7 demonstrated multisystem involvement. The thymus was involved in 5 of 7 patients. The thymus was enlarged in 5; thymic contours were nodular/lobulated in 2; cystic changes were noted in 4; and dystrophic vascular-appearing calcifications were seen in 1. In all cases, findings regressed or resolved following chemotherapy. CONCLUSION: The thymus is commonly involved in Langerhans' cell histiocytosis, especially in multisystem disease. Radiologically, the thymus is enlarged and may be smooth or lobulated/nodular in contour, possibly containing cysts and calcifications.
Subject(s)
Histiocytosis, Langerhans-Cell/diagnostic imaging , Thymus Gland/diagnostic imaging , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Radiography, Thoracic , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
Ultrasound (US)-guided peripheral venipuncture was performed for peripheral insertion of 222 central venous catheters over a 12-month period. Initial placement was successful in 218 patients but unsuccessful in eight; placement was successful in four the next day (success rate, 98%; complication rate, 5%). Catheters were in place from 3 days to 6 months (mean, 36 days). US guidance allowed successful venipuncture for placement of central venous catheters in children.
