Hair whorl as an indicator of a mediastinal plexiform neurofibroma.

We report a boy with neurofibromatosis type 1 (NF-1) who had nonspecific respiratory symptoms and a mediastinal mass. In addition to multiple caté au lait macules and subcutaneous neurofibromas, he had a hair whorl over the spine at the level of a deep mediastinal mass demonstrated by CT scan and MR examination. Thoracoscopy and biopsy of the mass revealed a plexiform neurofibroma. The clinical sign of a hair whorl may assist the clinician in early recognition of a paraspinal plexiform neurofibroma.

Diagnostic imaging in children with urinary tract infection: review of current concepts and suggested guidelines.

Symptomatic urinary tract infection (UTI) in childhood is estimated to occur with a frequency of up to 3% through adolescence. The practitioner caring for children requires both anatomic and physiologic information concerning the urinary tract to assist in diagnosis, treatment, and prognosis. Advances in diagnostic imaging have resulted in numerous methods for evaluation of the urinary system. These procedures differ in the type of information obtained, risk or discomfort to the patient, and cost. Selection of the proper test(s) requires an understanding of these factors. Based on our survey of recent pertinent literature and our clinical experience, we present guidelines for appropriate diagnostic imaging in children with UTI, and we discuss the benefits and limitations of available imaging techniques along with concepts regarding the pathogenesis of UTI and causes of renal damage from UTI.

Excretory urography with iohexol: evaluation in children.

A multicenter clinical study was conducted using iohexol, a second-generation nonionic contrast medium, for excretory urography performed in 130 children. Doses of iohexol (300 mg iodine/ml) ranged between 150 and 660 mgI/kg (0.5 and 2.2 ml/kg). Iohexol was tolerated well, and no significant adverse reactions occurred. Sixty-five iohexol urograms were evaluated to determine the minimum dose for adequate visualization of the kidneys and collecting systems. A dose greater than 300 mgI/kg (1.0 ml/kg) always resulted in a urogram of diagnostic quality, while visualization was insufficient for diagnosis in 10% of studies done with doses of 150-300 mgI/kg (0.5-1.0 ml/kg). Another 65 iohexol urograms were compared in a blinded manner with a similar number of studies performed using iothalamate meglumine at comparable iodine concentration and dose. Visualization of calyces and pelvoinfundibular structures achieved with iohexol was rated better with statistical significance, but there was no difference in visualization of the renal parenchyma or ureters. Use of iohexol in excretory urography may be advantageous in children who are at greatest risk for an adverse reaction to contrast media or in those most likely to benefit from use of a low osmolality contrast agent.

Imaging of foregut duplication cysts.

There are many types of diagnostic imaging studies available for the evaluation of foregut duplication cysts. Esophagography may be helpful in confirming the presence of a mediastinal mass, explaining esophageal symptoms, or defining the location of a lesion, but it is rarely diagnostic. Digital subtraction angiography can successfully be used in place of pulmonary arteriography to define vascular anatomy. Computed tomography is often diagnostic, although the attenuation number may be slightly elevated and not that of water. Computed tomography will clarify the relationship of the mass to adjacent mediastinal structures, and may also assist in percutaneous guided aspiration. Surgical resection is often necessary in an infant because of respiratory distress with airway compromise. In asymptomatic patients with a round to oval, nonenhancing, thin walled, cystic mass demonstrated on CT, a thoracotomy may be avoided and the patients may be followed by chest radiography.

Invasive gastric candidiasis.

A case of invasive gastric candidiasis is reported. The frequency and importance of Candida sp. as a gastric pathogen is reviewed.

Pediatric digital subtraction angiography: intraarterial and intracardiac applications.

Intraarterial digital subtraction angiography (IA-DSA) was performed in 80 pediatric patients. Forty-four underwent arterial injections with digital filming techniques. Of the 130 injections, DSA imaging was good or excellent in 121, often allowing resolution of vessels 1 mm in size. Thirty-six of the 80 patients underwent cardiac evaluation with intra-cardiac injections. Improved contrast resolution with IA-DSA allowed the use of smaller catheters (3-4F) and smaller amounts of contrast material. Immediate availability of subtracted images (no film processing delay) resulted in shorter total procedure time. Outpatient studies are possible. IA-DSA provides several notable advantages for the pediatric patient.

Ultrasonographic features of glomerulocystic disease in infancy: similarity to infantile polycystic kidney disease.

Glomerulocystic kidney disease (GCD) is an unusual condition characterized pathologically by cystic dilatation of Bowman's space and the first portion of the proximal convoluted tubule. We report the serial ultrasound findings in an asymptomatic infant with GCD which were initially confused with infantile polycystic kidney disease. We emphasize the nonspecificity of ultrasonographic findings in cystic renal disease in early infancy and suggest a protocol for the diagnostic work-up of bilateral renal cystic disease in children.

Hyperimmunoglobulinemia E syndrome: pulmonary imaging considerations.

The Hyper IgE syndrome is a rare disease consisting of recurrent sinusitis and pneumonia, pneumatoceles, chronic dermatitis, and elevated serum levels of IgE. The primary radiographic abnormalities are recurrent alveolar lung disease and pneumatoceles. Pneumothorax may occasionally occur as in one of our cases. Other causes of pneumatoceles are usually easily excluded by the history and other clinical data. Pulmonary scintigraphy and computed tomography may add information valuable to the management of these patients.

Orthognathic surgery for children. Analysis of 88 consecutive cases.

A retrospective analysis of 88 consecutive pediatric patients who underwent surgical correction of their dentofacial deformities is presented. There were twice as many female as male patients and the most common deformities were of the skeletal Class II type. The LeFort I osteotomy was the most frequently performed operation. The effect of controlled hypotensive anesthesia on the duration of both anesthesia and surgery, estimated blood loss and incidence of transfusion is discussed. Surgery for the correction of dentofacial deformities can be performed on children and adolescent patients with little morbidity and few complications.

Central nervous system hypoxia in children due to near drowning.

Fourteen children who experienced acute, profound central nervous system hypoxia secondary to near drowning, aspiration, or respiratory arrest underwent CT examination. During the first week after the episode, the most frequent finding was a loss of gray-white matter differentiation. Other findings included effacement of sulci and cisterns, focal areas of edema in the cerebral cortex or basal ganglia, and hemorrhagic infarctions of the basal ganglia. Subsequent CT scans obtained from two weeks to five months after the hypoxic episode showed progression of cerebral loss from cortical infarction with gyral hemorrhage and enhancement to global parenchymal atrophy. The prognosis is poor in these patients: seven children experienced severe neurologic deficits and seven died.

Herpes simplex encephalitis: CT findings in the neonate and young infant.

The computed tomographic (CT) findings in six cases of neonatal herpes simplex encephalitis (HSE) are reviewed and compared with previous reports. The diagnoses were made on the basis of isolation of the virus from a brain biopsy specimen in one case, from cerebrospinal fluid in two cases, from tracheal aspirate in one case, and on clinical grounds in two cases. Five infants survived; all had significant neurologic deficits. CT showed bilateral cerebral involvement with relative sparing of the lower neuraxis in all cases. Bilateral patchy low-density zones involving the periventricular white matter more than the cortical gray matter were seen initially in four of the six infants. Hemorrhage and/or calcifications in the thalamus, insular cortex, periventricular white matter, and along the corticomedullary junction were present in five infants. Severe cerebral necrosis eventually resulted in all six infants. Unlike older patients, only one infant had predominantly temporal lobe involvement. These findings agree with the CT descriptions reported by others.

Pseudoreduction of intussusception: is ileal reflux the end point?

Two cases of unsuccessful hydrostatic reduction of intussusception are reported. Both were associated with barium filling multiple loops of distal ileum, despite lack of complete reduction of the intussusception. The presence of free ileal reflux does not guarantee successful reduction. Careful examination of the cecum for residual intussusceptum and of non-contrast-filled small-bowel loops for evidence of remaining small-bowel obstruction is essential to recognize unsuccessful reduction.