Color Doppler flow imaging of pediatric soft tissue masses.

The blood flow pattern within and around soft tissue tumors was analyzed to determine if color Doppler images could aid in the differential diagnosis. The study comprised 49 children with 50 masses: 24 inflammatory lesions, eight malformations, six neoplasms, five cysts, and seven traumatic lesions. A peripheral pattern (flow around the mass) was noted in eight of 50 lesions (16%). A mixed pattern (flow within and around the lesion) was noted in eight of 50 lesions (16%), and a central pattern (flow in the central region of the mass) was noted in 10 of 50 lesions (20%). Flow was absent in 24 lesions (48%). The peripheral pattern was observed only in abscesses. The other patterns were seen most frequently in lymphadenitis but were not specific for that diagnosis. Our experience suggests that color Doppler imaging is useful only in the diagnosis of abscess. In other lesions, color Doppler imaging alone is insufficient for diagnosis.

Diffuse neonatal hemangiomatosis: CT findings in an adult.

Diffuse neonatal hemangiomatosis (DNH) is a rare disorder that usually presents in infancy and has a high mortality rate. We report a long-term adult survivor of DNH who presented with multiple calcifications in the bowel wall, liver, spleen, and adrenal glands on CT. Diffuse neonatal hemangiomatosis needs to be added to the causes of visceral calcifications.

Imaging rounds. Bilateral condensing osteitis of the clavicles.

The following case illustrates the roentgenographic and clinical findings of a condition of interest to the orthopaedic surgeon. The initial history, physical findings, and roentgenographic examinations are found on the first two pages. The following pages present the final clinical and roentgenographic differential diagnosis.

CT of inflammatory abdominal aortic aneurysm: development from an uncomplicated atherosclerotic aneurysm.

The etiology and natural history of inflammatory abdominal aortic aneurysm are poorly understood. We report a case of inflammatory abdominal aortic aneurysm that developed from an uncomplicated aneurysm over a period of 6 1/2 months.

Childhood cerebellar astrocytomas: is there a role for postoperative irradiation?

Eighty children with astrocytomas of the cerebellum were treated at Washington University Medical Center in St. Louis, Missouri from 1928-1980. The most important predictor of recurrence was completeness of surgical removal. Of 40 patients whose tumors were totally removed, only one recurred (2.5%). Forty cases were subtotally removed and 14 subsequently recurred (35%). Postoperative irradiation did not significantly improve survival in the patients with incompletely excised tumors; however, there was lack of uniformity in the radiation therapy. Although a survival advantage could not be demonstrated, there was a trend toward a lowering of the recurrence rates in patients with subtotally excised solid tumors who received radiation therapy.

Astrocytomas of the cerebellum in children.

Between 1928 and 1980, 84 children (aged 19 years or younger) with an astrocytoma of the cerebellum were managed at Washington University Medical Center-Barnes Hospital. Fifty-eight children were treated with surgery only and 26 received surgery and postoperative irradiation. The 5-, 10-, and 25-year actuarial disease-free survival rates for the entire group were 92%, 88%, and 88%, respectively. Age at diagnosis and extent of surgery were prognostic factors, but no correlation with survival times was found for gross appearance of the tumor or postoperative irradiation. Posttreatment neurological function was excellent in the 58 patients alive at the end of the study; 92% were completely normal or had only a mild neurological deficit and 75% were employed or attending school.