Mediastinal lymphangioma in a child.

We report a case of a male child with a cystic mass in his left side of the neck with extension to the mediastinum. This article highlights the clinical and para-clinical findings and management of these cases. In conclusion, it is necessary to evaluate the mediastinum for extension of the cyst in cases with cystic hygromas of the neck. Surgical resection of the tumor through a cervical incision can be considered.

Extra pulmonary tuberculosis in children: two years study.

Tuberculosis (TB) is an important health problem in developing countries, with varying clinical presentations depending on the organs/systems involved. To study the spectrum of clinical and paraclinical aspects of extra pulmonary TB in children suffering from pulmonary TB. This study has been carried out on 65 children with tuberculosis, admitted in TB wards of National Research Institute of Tuberculosis and Lung Disease (N.R.I.T.L.D) during 2004-2006. All patients were investigated according to specific diagnostic criteria including; history of contact with TB patient, clinical manifestations, radiological findings, tuberculin test and bacteriologic or pathologic results and after confirmation, treatment was administered. Out of 65 cases, 14 had different types of extra pulmonary tuberculosis, and data concerning following factors were studied: age, gender, race, site of involvement, bacteriology, pathology, ADA (ascitic fluid), PCR (tissue specimens), history of close contact, HIV tests (ELISA), tuberculin test, radiological findings, and immunological studies (in disseminated TB). Of 14 cases, 8 were girls and 6 were boys with mean age of 8.75 ± 4.2. Nine patients were Iranian and 5 were Afghan. History of close contact was detected in 4 cases. Type of involvement was: 5 cervical adenitis, 3 osteoarticular disease, 2 peritonitis and 2 disseminated form of tuberculosis, one pericarditis, one renal tuberculosis. Radiological findings showed 4 pulmonary disease and 3 osteoarticular involvement. Tuberculin skin tests greater than 15 mm observed in 5 cases, 9 patients had 0-5 mm induration. 4 cases had concomitant pulmonary and extra pulmonary involvement. Positive AFB in gastric lavage was recognized in 4 cases, in which 3 showed positive cultures for MTB. Pathological examinations in 10 cases revealed granuloma with caseation compatible with tuberculosis, five in lymphadenopathy, three in osteoarticular, two in abdominal tuberculosis. According to this study, 20% of patients had extra pulmonary involvement, which is comparable to other reports (20-25%) and TB lymphadenitis is the most common from of presentation.

Radiologic manifestation of pulmonary tuberculosis in children admitted in pediatric ward-Massih Daneshvari Hospital: a 5-year retrospective study.

Despite the extensive preventive and therapeutic measures present against tuberculosis (TB), this disease still remains as one of the important causes of mortality and morbidity in the world. Considering the high incidence of TB in children, rareness of its' clinical features and complexity of bacteriologic diagnosis in this age group paraclinical studies, especially radiologic evaluations, is useful for reaching a final diagnosis. This 5 year study was conducted in National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Massih Daneshvari Hospital, Tehran, Iran. This retrospective study was conducted on 70 children (43 (61%) female and 27 (38.5%) male) aged between 5 months to 15 years old during a five year period (from 2001-2006) in pediatric ward. It was performed on children who were confirmed to have TB by various clinical, bacteriologic and radiologic features and tuberculin skin test. We studied the radiologic features of pulmonary TB in these children. Right lung involvement was observed in 65%, left lung 23% and bilateral involvement was detected in 12%. Also middle and superior lobes were the most common lobes affected. The commonest radiographic feature was hilar (mediastinal) lymphadenopathy; 70% detected on chest x-ray (CXR) and 85% on CT scan. Lymph nodes on right side were affected more; 25% were calcified. Also nodular infiltration of lung parenchyma was observed in 35% of CXRS and 61% of CT scans. This was followed by patchy consolidation detected in 25% and 35% of CXRs and CT scans respectively. We also observed that children <3 yr. of age had the highest lymph node involvement but the least parenchymal lesions as compared to older children. It is concluded that primary TB is the most common form of pulmonary TB in children. This could be in the form of hilar lymphadenopathy with or without lung parenchymal involvement. Also radiologic features could provide valuable information in regard to diagnosis, treatment and follow-up of pulmonary TB in children.

Scimitar syndrome.

Scimitar syndrome or congenital pulmonary venolobar syndrome is a rare anomaly most commonly consisting of partial pulmonary venous drainage into the hepatic portion of the inferior vena cava, right lung hypoplasia, dextroposition of the heart, and anomalous systemic arterial supply from aorta or one of its branches to the right lung. We report a four-year-old girl with recurrent pneumonia and failure to thrive, who was diagnosed as having scimitar syndrome.