The 99mTc-DMSA renal scan and 99mTc-DTPA diuretic renogram in children and adolescents with incidental diagnosis of horseshoe kidney.

A prospective study was conducted to determine the possibility of obstructive hydronephrosis in horseshoe kidney found incidentally in school children and adolescents by using a radionuclide diuretic renogram. In a 2-year period, 22 school children and adolescents with horseshoe kidney were found in a mass renal sonography survey. They each underwent a 99mTc dimercaptosuccinic acid renal cortical scan to confirm the horseshoe kidney. Each diuretic renogram was performed with the patient in the supine position to rule out obstructive hydronephrosis. The patients were advised to empty their bladders before the intravenous injection of furosemide (1 mg x kg(-1)). The half-time for the clearance of radioactivity from the renal pelvis were calculated. Of the 22 patients, asymmetrical renal cortical function between the two kidneys was found in 14 (63.6%). Eleven kidneys (11/44, 25%) showed stasis of radioactive urine in the renal pelvic region prior to injection of furosemide. There was no incidence of bilateral hydronephrosis in these 22 patients. Only one kidney (1/44, 2.3%) showed obstructive hydronephrosis and five showed clearance of radioactive urine stasis from the renal pelvis immediately after standing up for voiding. There is a low percentage of obstructive hydronephrosis in these cases of horseshoe kidney found incidentally in children and adolescents. A follow-up cohort study on these patients would be valuable for monitoring the development of complications.

Renal cell carcinoma: unusual pediatric renal tumors.

Renal cell carcinoma (RCC), the most common renal tumor in adults, is rare in childhood, with an incidence much lower than that of Wilms' tumor. It is initially asymptomatic, but clinically overt symptoms such as an abdominal mass or hematuria may indicate late-stage disease and a poor prognosis. In this report, we describe the imaging features of pediatric RCC and emphasize the value of early diagnosis offered by ultrasonographic screening. From 1989 through 1997, we encountered five children (aged 7-15 yr) with RCC. Of these, two presented with symptoms, while the other three were asymptomatic and were identified in a large, school-based urologic ultrasonographic survey, in which more than 800,000 children were screened by our team. Reviewing the imaging features, we found that four tumors exhibited a heterogeneous nature. One patient had bilateral well-defined homogeneous tumors, which proved to be bilateral low-grade RCC. The three asymptomatic patients had smaller tumors than the other two patients. These three were treated with nephrectomy and were well after at least 15 months of follow-up. The two patients who presented with symptoms eventually died of tumor recurrence and pulmonary metastasis, respectively. The findings in these five cases of pediatric RCC add knowledge regarding the imaging features of this disease and highlight the value of ultrasonographic screening for early diagnosis.

Diagnosing the combination of renal dysgenesis, Gartner's duct cyst and ipsilateral müllerian duct obstruction.

PURPOSE: We describe the differential points in the diagnosis of the combination of renal dysgenesis, Gartner's duct cyst and ipsilateral müllerian duct obstruction. Various imaging studies and urological procedures were performed. We report our experience in detecting these anomalies in 10 girls and review the literature. MATERIALS AND METHODS: Ten girls, 7 to 13 years old, with this combination of anomalies were identified in the last 10 years. Imaging studies as well as urological procedures were selectively performed, especially at puberty following menarche. Patients received long-term followup with ultrasound. RESULTS: Cystic dilation of Gartner's duct protruded into the bladder and presented as a ureterocele in 5 patients and posterior to the bladder in 5. Surgical removal of a partial portion of a Gartner's duct cyst was performed in 5 patients for alleviation of urinary symptoms. Unilateral müllerian duct obstruction was demonstrated in all 10 patients. Excision of the vaginal septum was performed in 6 patients for relief of genital obstruction. CONCLUSIONS: When cystic dilatation of the pelvis, especially a ureterocele-like cyst without ureteral dilatation, is found in girls with ipsilateral renal dysgenesis, the possibility of a Gartner's duct cyst should be considered. For early detection and treatment of unilateral obstruction of duplicated müllerian ducts pelvic sonography should be performed at puberty, especially just after menarche, in girls with renal dysgenesis and ipsilateral Gartner's duct cyst.

A giant retroperitoneal ganglioneuroma with intraspinal involvement: report of one case.

A 9-year-old girl was discovered to have had a huge retroperitoneal mass causing moderate hydronephrosis and anterior displacement of the right kidney and which was found on a renal ultrasonographic examination. A series of examinations including (1)IVP, (2) abdominal computed tomography, (3) MRI and(4) incisional biopsy revealed a giant dumb-bell shaped retroperitoneal ganglioneuroma with intraspinal involvement. Secondary scoliosis was also noticed. We successfully resected the huge ganglioneuroma of the right retroperitoneum in a two stage procedure: her postoperative course was uneventful.

Ultrasonic demonstration of ectopic urethral ureter in duplex kidney: report of two cases.

Two cases of duplex kidney with ectopic urethral ureter are reported. Using abdominal ultrasound, the poorly functioning upper pole pelvis of the involved kidney was found to be sonolucent which may have been misinterpreted for a simple renal cyst. The corresponding ureter was dilated and drained into the proximal urethra. Ultrasound is an ideal imaging modality in the assessment of children with a duplicated renal system and may provide detailed information about this structural anomaly, such as the exact insertion of the ectopic ureter.

Splenic cysts in children.

Splenic cysts were found, incidentally, in eight children during the past nine years (1987-1995) in Taipei Municipal Women's and Children's Hospital. Five of the children were boys and three were girls. The age at diagnosis ranged from 8 to 15 years. Evidence of possible splenic cyst development was found initially by ultrasonography; six patients received further evaluation with computerized tomography (CT); one patient received radionuclide scanning. The cysts ranged from 2 cm to 14 cm in diameter. Four of the patients received surgical treatment (three partial splenectomy and one total splenectomy) because of huge splenic cysts (diameter > 10 cm). Subsequent pathological examination revealed that all cysts had epithelial cell lining in the cyst wall, meaning they were all congenital in origin. The remaining four cases were followed up at the Out-patient Clinic here. All cases had a benign clinical course.

Crossed, unfused ectopic kidney with a single ectopic ureter: report of a case.

A 10-year-old girl with an ectopic kidney and a single ectopic ureter inserted into the vaginal vestibule is reported. Abdominal sonography showed a hypoplastic left kidney located in the right lower abdomen. The associated ureter was dilated and tortuous, and did not open into the bladder. Diagnosis was confirmed by retrograde urogram via the ectopic ureteral orifice on the vestibule.

Unilateral occlusion of duplicated uterus with ipsilateral renal anomaly in young girls: a study with MRI.

Twenty-four young girls (mean age 13.0 years) with unilateral occlusion of a duplicated uterus and ipsilateral renal agenesis, dysplasia or hypoplasia were studied with magnetic resonance imaging (MRI) following ultrasound examination. Hydrocolpos (n = 4), hydrometrocolpos (n = 2), hematocolpos (n = 11), hematometrocolpos (n = 5), hematocolpometra, hematosalpinx (n = 3) and hematometra, hematosalpinx (n = 1) were noted (two of these patients had presented with hydrocolpos and hematocolpos before and after the menarche). Twenty-two of these girls presented with ipsilateral renal agenesis (right 11, left 11) with ectopic ureters to Gartner's duct cysts (GDC) in two, in one renal hypoplasia and in one renal dysplasia with ectopic ureters to GDC. MRI offered specific images of the genital tract, showing the exact type of müllerian duct anomaly and providing high diagnostic accuracy. Such preoperative identification of a uterine anomaly, complemented with appropriate surgical intervention, can assist young girls in achieving normal fertility in the future.

Magnetic resonance imaging of neuroblastoma, ganglioneuroblastoma, and ganglioneuroma.

Eighteen magnetic resonance (MR) examinations were performed in 15 children with neuroblastoma in 6 patients, ganglioneuroblastoma in 4 and ganglioneuroma in 5. The MR images of neuroblastoma and ganglioneuroblastoma presented with ill-defined margins and heterogeneous signal intensity, while ganglioneuroma had well-demarcated outlines and more homogeneous signal intensity in all sequences. The extension of these tumors, invasion to adjacent organs and encasement of vessels could be clearly identified. MR imaging appears to be a reliable technique for differential diagnosis among neuroblastoma/ganglioneuroblastoma and ganglioneuroma.

Ultrasonic detection of single ectopic ureter inserted into the urethra in girls: report of two cases.

Two girls, each with a single ectopic ureter inserted into the proximal urethra, are reported. Abdominal ultrasonography showed that the involved kidneys were small and hydronephrotic. The associated ureters were dilated and opened into the proximal urethra. Diagnosis was confirmed by voiding cystourethrogram.

Ultrasonic detection of persistent small unilateral hematocolpos in two girls.

Two girls with unilateral hematocolpos are reported. In both cases, a small amount of blood which had accumulated in the partially obstructed hemivagina was detected by real-time high resolution ultrasonography, and was confirmed by magnetic resonance imaging. Both patients were asymptomatic, and were regularly followed up at an outpatient clinic. To date, the hematocolpos persists but continues to be small.