ABSTRACT
We report a now 13-year-old male with trisomy 21, hypothyroidism, and insulin-dependent diabetes who developed acute hemiplegia due to the antiphospholipid antibody syndrome (APS) at age four. The risks of long-term anticoagulation were initially considered to be high; hence, he was treated with monthly infusions of intravenous immunoglobulin (IVIG) at 2 g/kg for 2 years and then every other month for 7 years. Antiphospholipid antibodies were no longer detectable within 6 months and have continued to be negative. There was no clinical deterioration or further changes on magnetic resonance arteriography over 7 years. IVIG may be an alternative therapeutic choice for children with APS who are not candidates for conventional anticoagulation.
Subject(s)
Antiphospholipid Syndrome/drug therapy , Cerebral Arteries/drug effects , Immunoglobulins, Intravenous/therapeutic use , Thrombosis/diagnosis , Adolescent , Antiphospholipid Syndrome/complications , Antiphospholipid Syndrome/pathology , Brain/blood supply , Brain/pathology , Cerebral Arteries/pathology , Down Syndrome/complications , Down Syndrome/pathology , Humans , Magnetic Resonance Imaging , Male , Thrombosis/etiology , Thrombosis/pathology , Treatment OutcomeABSTRACT
Milk of calcium bile is uncommon and occurs mainly in the adult population. The authors report on 2 children, each having a distinct clinical history and presentation, and each with milk of calcium bile/calculi possessing differing chemical composition and highly notable gross morphology. J Pediatr Surg 36:644-647.
Subject(s)
Calcium Carbonate/analysis , Cholelithiasis/chemistry , Child , Cholecystectomy, Laparoscopic/methods , Cholelithiasis/surgery , Cholelithiasis/ultrastructure , Female , Follow-Up Studies , Humans , Male , Risk Assessment , Treatment OutcomeABSTRACT
BACKGROUND: The leukodystrophies constitute a wide spectrum of cerebral disorders of varying etiology. The imaging appearances on CT and MRI are recognizable as abnormalities of white matter; however, it may be impossible to arrive at the correct diagnosis based on imaging studies alone. PATIENTS AND METHODS: Three patients of varying age and clinical symptomatology diagnosed with metachromatic leukodystrophy (MLD) had remarkably similar MRI appearances. A "tigroid" or "leopard-skin" appearance was demonstrated within deep white matter in each case. RESULTS: All of the patients had biochemical confirmation of MLD. CONCLUSION: Although the "tigroid" pattern previously was considered to be pathognomonic of Pelizaeus-Merzbacher disease, the diagnosis of MLD must now be considered when these MRI appearances are encountered.
Subject(s)
Brain/pathology , Leukodystrophy, Metachromatic/diagnosis , Magnetic Resonance Imaging , Cerebroside-Sulfatase/deficiency , Child , Child, Preschool , Contrast Media , Demyelinating Diseases/diagnosis , Diagnosis, Differential , Diffuse Cerebral Sclerosis of Schilder/diagnosis , Female , Gadolinium , Humans , Leukodystrophy, Metachromatic/blood , Male , Tomography, X-Ray ComputedABSTRACT
We report a case of a teratoid Wilms tumor arising within a supernumerary ectopic ureteropelvic structure in a 7-year-old boy. The tumor was near the right kidney but was completely separate from it. On the contralateral side, the child had a duplication of the ureteral system. Pathologic examination revealed the mass to be completely enveloped by a fibromuscular sac lined by urothelium. The tumor had a botryoid, polypoid architecture and, in addition to areas of classic Wilms tumor, had extensive squamous, mucinous, and columnar elements. Teratoid Wilms tumors are rare and, to the best of our knowledge, have not previously been described as arising either in anomalous urinary structures or at 7 years of age.
Subject(s)
Choristoma/pathology , Kidney Neoplasms/diagnosis , Ureteral Diseases/pathology , Wilms Tumor/diagnosis , Child , Humans , Male , PelvisABSTRACT
Wilms' tumor is the most common childhood renal tumor. This article describes the epidemiology, histopathologic features, and clinical manifestations of Wilms' tumor along with the spectrum of imaging findings using different modalities. The distinguishing features of other renal tumors encountered in children, such as clear cell sarcoma, rhabdoid tumor, congenital mesoblastic nephroma, multilocular cystic renal tumor, renal cell carcinoma, and angiomyolipoma are also reviewed.
Subject(s)
Diagnostic Imaging , Kidney Neoplasms/diagnosis , Child , Child, Preschool , Humans , Infant , Infant, Newborn , Kidney Neoplasms/congenital , Nephroma, Mesoblastic/congenital , Nephroma, Mesoblastic/diagnosis , Wilms Tumor/diagnosisABSTRACT
We made an in vitro model of a wooden foreign body using both fresh and dry pine wood in both fat and soft-tissue background mediums. Air/wood/background medium interfaces were studied with MR and CT to determine which method provided the best image contrast for detecting a wooden foreign body. CT was demonstrated to be superior to MR in the evaluation of the orbit in the in vitro model.
Subject(s)
Eye Foreign Bodies/diagnosis , Magnetic Resonance Imaging , Models, Anatomic , Orbit/pathology , Tomography, X-Ray Computed , Wood , Animals , Artifacts , Humans , Image EnhancementABSTRACT
A case of an intraorbital wooden foreign body mimicking air on standard CT window setting and on MR is presented. Its higher attenuation with higher CT window setting as well as its elongated and well-delineated shape on both CT and MR helped to distinguish it from air.
Subject(s)
Eye Foreign Bodies/diagnosis , Magnetic Resonance Imaging , Orbit/pathology , Tomography, X-Ray Computed , Wood , Child , Humans , Image Enhancement , MaleABSTRACT
Myocardial calcification has been rarely described in premature infants after myocardial infarction and myocarditis with coxsackievirus B1. In adults and older children, metastatic myocardial calcification has been reported in chronic renal failure. We report a case of myocardial calcification in a 680-gm preterm infant after a prolonged course of renal failure complicated by secondary hyperparathyroidism. Subclinical myocardial injury was evidenced by a high serum creatine phosphokinase MB band concentration, which probably provided a susceptible substrate for the deposition of calcium crystals, because the multiplication product of serum calcium and inorganic phosphorus levels transiently exceeded 75 mg x mg/100 ml, indicating serum saturation during the course of secondary hyperparathyroidism. We report this case as an unusual complication of renal immaturity in extremely low birth weight infants and an indication of a relatively intact parathyroid glandular function in them. Hypoxia, myocardial dysfunction, and renal failure are common complications in such infants, and in the presence of renal failure, the serum levels of calcium and inorganic phosphorus should be maintained below the pathologic level to avoid ectopic calcification of the tissues, including the myocardium.
Subject(s)
Calcinosis/etiology , Cardiomyopathies/etiology , Hyperparathyroidism, Secondary/complications , Infant, Premature, Diseases , Kidney Failure, Chronic/complications , Calcinosis/diagnosis , Calcinosis/drug therapy , Calcium/blood , Cardiomyopathies/diagnosis , Cardiomyopathies/drug therapy , Creatine Kinase/blood , Dehydration/complications , Dehydration/therapy , Dopamine/therapeutic use , Echocardiography , Female , Fluid Therapy , Furosemide/therapeutic use , Humans , Hyperkalemia/drug therapy , Hyperparathyroidism, Secondary/etiology , Infant, Low Birth Weight , Infant, Newborn , Kidney Failure, Chronic/drug therapy , Kidney Failure, Chronic/therapy , Phosphorus/blood , Polystyrenes/therapeutic use , Potassium/bloodABSTRACT
CT examination of the abdomens of two children demonstrated sites of high attenuation in the stomach, which were revealed to be bubble gum. Investigation of the CT appearance of samples of chewing gum showed that it consistently has high attenuation (178-345 HU). The attenuation of gum base, which contains calcium carbonate, was 476 HU. In addition, examination of a volunteer who had swallowed bubble gum confirmed the CT appearance.
Subject(s)
Abdomen , Calcinosis/diagnostic imaging , Chewing Gum , Foreign Bodies/diagnostic imaging , Adult , Child , Child, Preschool , Diagnosis, Differential , Humans , Male , Tomography, X-Ray ComputedABSTRACT
In a young girl with localized scleroderma a circumscribed area of lysis developed in the calcaneus beneath the involved skin and soft tissues of the foot. A biopsy revealed vascular changes characteristic of scleroderma associated with infarction and severe resorption of the bone. A geographic pattern of bone destruction in a child with localized scleroderma has not previously been reported.
Subject(s)
Calcaneus , Osteolysis/complications , Scleroderma, Localized/complications , Biopsy , Calcaneus/diagnostic imaging , Calcaneus/pathology , Child, Preschool , Female , Humans , Osteolysis/diagnostic imaging , Osteolysis/pathology , Radiography , Scleroderma, Localized/diagnostic imaging , Scleroderma, Localized/pathology , Skin/pathologyABSTRACT
The distribution of [111In]oxine-labeled leukocytes was studied by whole-body gamma camera imaging in nine pediatric patients. Images were obtained at approximately 24 hr after administration of the material. Organ distribution was estimated from stored data by manual region of interest assignment. Dosimetry estimates based on geometric mean and conjugate view absolute activity calculations showed close agreement in these patients. Leukocytes were distributed in liver, spleen and marrow. The mean percent uptakes +/- s.d. were: spleen, 31.2 +/- 18.3%; liver, 26.3 +/- 10.8%; and marrow, 14.2 +/- 5.7%. A significant portion (28.3 +/- 9.9%) of administered white cell activity was found outside these organs in the remainder of the body. Mean organ absorbed doses (rad/mCi) were: spleen, 115.0 +/- 84.8; liver, 13.9 +/- 7.8; marrow, 7.6 +/- 3.8; and total body 2.5 +/- 1.0. The mean organ absorbed doses (rad/dose administered) were: spleen, 13.7 +/- 10.6; liver, 1.48 +/- 0.62; marrow, 0.79 +/- 0.26; and total body, 0.28 +/- 0.09.
Subject(s)
Hydroxyquinolines , Indium Radioisotopes , Leukocytes , Organometallic Compounds , Oxyquinoline , Pediatrics , Radiation Dosage , Adolescent , Bone Marrow , Child , Child, Preschool , Female , Humans , Infant , Liver , Male , Oxyquinoline/analogs & derivatives , SpleenABSTRACT
Fourteen patients with slipped capital femoral epiphysis (SCFE) who had high-resolution and magnification bone scintigraphy during treatment were studied. By demonstrating the vascular status of the femoral head and physiologic condition of the growth plate, scintigraphy was found to assist the clinician in the management of patients with this disorder.
Subject(s)
Epiphyses, Slipped/diagnostic imaging , Femur Head/diagnostic imaging , Acute Disease , Adolescent , Child , Chronic Disease , Epiphyses, Slipped/therapy , Female , Humans , Male , Pain Management , Radionuclide ImagingABSTRACT
Mass lesions in the chest can usually be best evaluated by conventional means, primarily plain chest film examination. Fluoroscopy is often useful, especially to differentiate normal thymus from abnormal anterior mediastinal masses and to evaluate possible vascular masses. It makes sense to do a barium swallow for most middle mediastinal masses before resorting to the more expensive CT or MRI. In addition to the added expense, the marked increase in radiation dose should also be considered when CT is contemplated.
Subject(s)
Thoracic Diseases/diagnostic imaging , Child , Child, Preschool , Diagnosis, Differential , Humans , Infant , Lung/abnormalities , Mediastinal Diseases/diagnostic imaging , Pneumonia/diagnostic imaging , RadiographyABSTRACT
Hepatobiliary imaging has been used to demonstrate that defects in the region of the gallbladder fossa in sulfur colloid studies correspond to normal gallbladder and not tumor. We report a case of delayed filling of a portion of the gallbladder due to a Phrygian cap anomaly. The case demonstrates that without delayed images incomplete filling of the gallbladder can be confused with a mass lesion in the liver.
