Cystic meningiomas in children: a diagnostic challenge.

Two cases of cystic meningioma in children are presented. The MR imaging features of each case presented difficulties in differential diagnosis because of the cystic nature of the neoplasms and their location. Cystic areas in meningiomas are encountered more frequently in children than in adults. Meningioma must be included in the differential diagnosis of cystic intracranial tumors in children.

Radiation-induced meningioma in children: report of two cases and review of the literature.

Meningioma developed in two children who had received high-dose cranial radiation for malignant brain tumors. Meningioma as a radiation-induced neoplasm has received little notice in the radiologic literature. Thirty-three cases have been reported since 1953, primarily in the neurosurgical literature. The current cases differ from those previously reported in having a much shorter latency period between irradiation and the development of meningioma.

Clinical impact of radiograph misinterpretation in a pediatric ED and the effect of physician training level.

Radiograph interpretation in the pediatric emergency department (ED) is commonly performed by pediatric emergency medicine (PEM) attendings or physicians-in-training. This study examines the effect of physician training level on radiograph interpretation and the clinical impact of false-negative radiograph interpretations. Data were collected on 1,471 radiographs of the chest, abdomen, extremity, lateral neck, and cervical spine interpreted by PEM attendings, one PEM fellow, one physician assistant, and emergency medicine, pediatric and family practice residents. Two hundred radiographs (14%) were misinterpreted, including 141 chest (16%), 24 extremity (8%), 20 abdomen (12%), 14 lateral neck (18%), and 1 cervical spine radiograph (2%). Physicians-in-training misinterpreted 16% of their radiographs versus 11% for PEM attendings (P = .01). Twenty (1.4%) radiographs had clinically significant (false-negative) misinterpretations, including 1.7% of physician-in-training and 0.8% of attending interpretations (P = 0.15). No morbidity resulted from the delay in correct interpretation. Radiograph misinterpretation by ED physicians occurs but is unlikely to result in significant morbidity.

Use of irradiated lymphocytes from immune donors for treatment of disseminated varicella.

Four children with acute lymphocytic leukemia who had disseminated varicella were treated with infusions of apheresed, irradiated lymphocytes from healthy donors who had recently recovered from infection with varicella-zoster virus. Each patient had cessation of new lesion formation and umbilication of old lesions within 24 hours of the first lymphocyte transfusion. There were no side effects attributable to the infusions. A controlled trial of infusions of irradiated lymphocytes should be considered for treatment of disseminated infection with varicella-zoster virus in immunocompromised hosts.

Heterotopic Tc-99m MDP uptake secondary to phlebitis.

A patient with blastomycosis complained of pain in his lower back after the administration of amphotericin B and parenteral alimentation via a femoral venous catheter. A bone scan that was performed to exclude bony involvement with blastomycosis showed abnormal tracer accumulation in the right paravertebral region. Computed tomography revealed the venous catheter to lie in the right ascending lumbar vein. There was calcification of a portion of the right psoas muscle. In addition, the epidural venous plexus was calcified from L2 to L4. It was this dystrophic calcification that caused the heterotopic accumulation of bone tracer.

Chronic, recurrent multifocal osteomyelitis. Case report and review of the literature.

Chronic recurrent multifocal osteomyelitis (CRMO) is an unusual inflammatory process involving multiple osseous sites, often recurrently. The authors recently diagnosed CRMO in an 8-year-old girl who had complained of toe pain for several weeks. A number of other involved, asymptomatic areas were discovered by bone scan. Biopsy of the lesions did not reveal any pathogens. Antibiotics and inflammatory agents were not used, and the patient recovered. A review of previously reported cases of CRMO showed 1) that this entity affects children almost exclusively, 2) that from two to 18 sites, usually in the extremities, can be affected at one time, and 3) that about 20 percent of the patients develop a pustular rash on their palms and soles. Other than an elevated erythrocyte sedimentation rate, there are no consistent laboratory abnormalities, and cultures of affected bone are negative. Histopathology typically shows a chronic inflammatory response, sometimes with granulomas. Antiinflammatory agents and antibiotics offer little consistent beneficial effect. The disease is self-limited, and patients usually recover fully, although exacerbations may occur. In the proper clinical setting, CRMO should be considered, since recognition of this entity avoids costly and potentially harmful diagnostic and therapeutic interventions.

Periarticular soft tissue calcification and ossification in the septic joint.

We encountered three infants who developed juxta-articular calcification adjacent to the anterolateral aspect of the ilium. All had had drainage of a septic hip using an anterior approach. Calcification was not found among five infants whose septic hips were drained using a posterior approach. Some surgeons who employ the anterior approach facilitate exposure of the joint capsule by elevation of the origins of the sartorius and rectus femoris muscles. We feel this juxta-articular calcification in this setting is a sequla of anterior surgical drainage of the hip in which there has been surgical elevation of the iliac periosteum. It does not imply an unfavorable outcome.

Chronic lung disease in premature infants: a retrospective evaluation of underlying factors.

A retrospective case-control study involving 99 premature infants requiring vigorous respiratory support was conducted to investigate the relative contribution of various etiologic factors in the development of chronic lung disease (CLD). Nineteen of the 99 developed CLD. Background and management factors up to the development of CLD, with attention to mode of ventilation (tube, or face mask/nasal prongs) were investigated. Infants in the CLD group had significantly lower birth weights (BW) (p less than .001) and gestational ages (p less than .01) than those in the non-CLD group. There was no difference in the incidence of intrathoracic airleak or symptomatic patent ductus arteriosus. Of the CLD group, 74% were intubated compared with 35% in the non-CLD group (p less than .002). There was no difference between the groups in the morbidity score of initial pulmonary disease or in the duration of ventilation with various pressures and oxygen concentrations. Multiple logistic regression analysis revealed that intubated infants were 4.8 times more likely to develop CLD than nonintubated infants, and infants with low BW had a 3.2-fold greater risk of developing the disease.

Imaging in acute renal infection in children.

Infection is the most common disease of the urinary tract in children, and various imaging techniques have been used to verify its presence and location. On retrospective analysis, 50 consecutive children with documented upper urinary tract infection had abnormal findings on renal cortical scintigraphy with 99mTc-glucoheptonate. The infection involved the renal poles only in 38 and the poles plus other renal cortical areas in eight. Four had abnormalities that spared the poles. Renal sonograms were abnormal in 32 of 50 children. Excretory urograms were abnormal in six of 23 children in whom they were obtained. Vesicoureteral reflux was found in 34 of 40 children in whom voiding cystourethrography was performed. These data show the high sensitivity of renal cortical scintigraphy with 99mTc-glucoheptonate in documenting upper urinary tract infection. The location of the abnormalities detected suggests that renal infections spread via an ascending mode and implies that intrarenal reflux is a major contributing factor.

Developmental stenosis of the cervical spine in children.

Developmental stenosis of the cervical spine results in a reduction of the caliber of the cervical spinal canal that is greatest in the anteroposterior dimensions. This usually becomes symptomatic in adults when a myelopathy may result from compression of the cervical cord by small osteophytes or by hyperextension injury without fracture or dislocation. Although incidence and prevalence data are not available, this condition does occur in the pediatric population since we have encountered three adolescents with this condition. The diagnosis of cervical spinal stenosis can be suggested when narrowing of the sagittal diameter of the spinal canal on a lateral cervical radiograph is identified. Subsequent corroboration can be obtained with myelography, computed tomography, or magnetic resonance imaging.

Cervical kyphosis in diastrophic dwarfism: CT and MR findings.

A 3-year-old boy with diastrophic dwarfism was evaluated for truncal and upper extremity weakness. A severe cervical gibbus was found. Cord compression was documented with MRI.