RESUMO
BACKGROUND: Sonographic evaluation of juxtadiaphragmatic lesions is frequently the initial imaging modality of choice in the pediatric population. The increasing sophistication of sonographic and Doppler technologies has led to the suggestion in the literature that lesions suspected of being juxtadiaphragmatic pulmonary sequestrations can be confidently imaged by ultrasound examination alone. OBJECTIVE: To present four cases which raise concern over the accuracy of sonographic examination of these lesions. MATERIALS AND METHODS: We present four such lesions for which an initial erroneous diagnosis of pulmonary sequestration was suggested on an initial ultrasound examination. CONCLUSION: The potential of a missed diagnosis of neuroblastoma has led us to propose that any lesion not demonstrating unequivocal sonographic findings of pulmonary sequestration should undergo further investigation and, if necessary, tissue sampling or excision.
Assuntos
Sequestro Broncopulmonar/diagnóstico por imagem , Ultrassonografia Doppler , Adenoma/complicações , Adenoma/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Sequestro Broncopulmonar/etiologia , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Micoses/complicações , Micoses/diagnóstico por imagem , Neuroblastoma/complicações , Neuroblastoma/diagnóstico por imagem , Neoplasias Torácicas/complicações , Neoplasias Torácicas/diagnóstico por imagem , Ultrassonografia Pré-NatalAssuntos
Síndromes de Imunodeficiência/diagnóstico por imagem , Adolescente , Agamaglobulinemia/diagnóstico por imagem , Osso e Ossos/diagnóstico por imagem , Criança , Pré-Escolar , Imunodeficiência de Variável Comum/diagnóstico por imagem , Síndrome de DiGeorge/diagnóstico por imagem , Feminino , Doença Granulomatosa Crônica/diagnóstico por imagem , Humanos , Hipergamaglobulinemia/diagnóstico por imagem , Imunoglobulina M , Lactente , Recém-Nascido , Síndrome de Job/diagnóstico por imagem , Masculino , Radiografia Torácica , Imunodeficiência Combinada Severa/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVES: Traumatic diaphragmatic injuries (DI) in infants and children are uncommon and are often associated with multiple severe injuries. Delayed presentation can be life threatening due to organ herniation and strangulation. We present the imaging findings in a relatively large population of children who experienced this rare injury. METHODS: Medical records of all patients admitted to our Trauma Service from 1977 to 1998 with DI were retrospectively reviewed recording imaging, clinical and surgical or autopsy findings. RESULTS: Of sixteen patients with DI (7 females, 9 males; age 3 weeks to 15 years), 14 suffered from blunt trauma secondary to high-energy impact, and 2 from penetrating injuries. Unilateral DI occurred equally on each side, with one bilateral injury. Associated injuries, present in 81%, included severe head injuries, visceral, mesenteric and vascular injuries and multiple fractures. Six patients died from multiple organ failure (3), head injury (2), and shock (1). Findings in the initial chest X-ray suggested the diagnosis in 13 (81%) of 16 injuries, and CT demonstrated irregularity and thickening of the diaphragm in 4 out of 7. CONCLUSIONS: Plain film findings suggested the diagnosis in most; CT and MR were useful adjuncts. High index of suspicion and awareness of the mechanism of injury can lead to prompt diagnosis, early repair, and decreased morbidity and mortality.
Assuntos
Diagnóstico por Imagem , Diafragma/lesões , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Ruptura , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/etiologiaRESUMO
Torsion of an accessory lobe of the liver and of the gallbladder is a rare etiology for acute abdominal pain in children and infants. We report a case of an 8-year-old girl who was admitted with acute epigastric pain and vomiting, after her brother had jumped on her back. Physical examination revealed an afebrile child with a nontender right upper quadrant (RUQ) mass. Color Doppler ultrasound and contrast-enhanced CT demonstrated a heterogeneous, avascular mass with displacement of a thickened-wall gallbladder. A contorted, congested accessory lobe of the liver and the gallbladder were resected at laparotomy. Imaging and operative findings are presented and a differential diagnosis is discussed in order to increase awareness of this rare condition.
Assuntos
Lesões nas Costas/complicações , Doenças da Vesícula Biliar/etiologia , Hepatopatias/etiologia , Dor Abdominal/etiologia , Lesões nas Costas/etiologia , Criança , Diagnóstico Diferencial , Feminino , Doenças da Vesícula Biliar/diagnóstico , Humanos , Hepatopatias/diagnóstico , Anormalidade TorcionalRESUMO
In 11 children the endoscopic criteria for gastritis were correlated with radiologic and pathological findings. An etiologic classification is proposed. The diagnoses included gastric involvement by Crohn's disease (five children), eosinophilic gastroenteritis (one), diffuse varioliform gastritis (two), erosive gastritis associated with Campylobacter pylori infection (two) and idiopathic erosive gastritis (one). Eight of the nine double-contrast barium studies and only one of the three single-contrast examinations correlated with the endoscopic and histologic findings. In 10 children the endoscopic results correlated well with the biopsy findings.