Hepatic hemangioendothelioma: prenatal sonographic findings and evolution of the lesion.

We describe a case of hepatic hemangioendothelioma that was first suspected based on prenatal sonographic findings at 19 weeks' menstrual age. At 16 weeks, the patient presented with a markedly elevated maternal serum alpha-fetoprotein level. Serial sonographic examinations revealed that the fetus had cardiomegaly, hepatomegaly with a hepatic mass and dilated intrahepatic vessels, a single umbilical artery, and a placental chorioangioma. Arteriovenous shunting within the hepatic mass was seen using color Doppler and pulsed Doppler sonography. An enlarged artery arising from the abdominal aorta supplying the mass was demonstrated. Postnatal physical examination and radiologic studies supported the diagnosis of hepatic hemangioendothelioma. The evolution in the sonographic appearance of this hepatic lesion in utero over a 17-week period is described.

Complications of voiding cystourethrography in the evaluation of infants with prenatally detected hydronephrosis.

PURPOSE: We determined complications in infants undergoing voiding cystourethrography as part of the evaluation for prenatally detected hydronephrosis. MATERIALS AND METHODS: We retrospectively reviewed the records of infants referred to our institution for the evaluation of prenatal hydronephrosis from 1992 to 1997. Infants with a prenatal history of bilateral hydronephrosis, bladder distention and oligohydramnios, oligohydramnios only or a prenatal abnormality involving any other organ system were excluded from study. Of 206 patients 129 male and 49 female infants underwent postnatal voiding cystourethrography at our institution. Chart review and a telephone interview with the parents were done to assess lower urinary tract infection, pyelonephritis, hospital admission for urosepsis, gross hematuria, urinary retention or skin rash. RESULTS: Postnatal voiding cystourethrography was normal in 138 patients but it diagnosed bilateral vesicoureteral reflux in 15, unilateral vesicoureteral reflux in 20, ureterocele in 4 and refluxing megaureter in 1. Of the 129 male infants evaluated 101 had undergone circumcision as a newborn, 14 were uncircumcised and the circumcision status of 14 was unknown. At voiding cystourethrography suppressive antibiotics were administered to 166 infants, 7 were not on suppressive antibiotics and antibiotic status was unknown in 5. No patient had a lower urinary tract infection, pyelonephritis or urosepsis. In addition, there were no episodes of urinary retention, gross hematuria or skin rash. CONCLUSIONS: While the reported rate of new or recurrent infection associated with voiding cystourethrography is as high as 6%, we did not identify any infectious or other complications in infants undergoing voiding cystourethrography for prenatal hydronephrosis. When properly performed, we believe that voiding cystourethrography is safe and presents little risk in these patients.

Bilateral smooth-muscle tumors of the adrenals in a child with AIDS.

We report a case of bilateral smooth muscle tumors (SMT) involving the adrenal glands in an 11-year-old female with acquired immunodeficiency syndrome (AIDS). The SMT of the right adrenal gland extended into the inferior vena cava, producing a tumor thrombus.

MR diagnosis of meniscal tears of the knee: value of fast spin-echo vs conventional spin-echo pulse sequences.

OBJECTIVE: Contrast can be similar on fast spin-echo and conventional spin-echo MR images, but data acquisition is faster with fast spin-echo sequences. This study was designed to evaluate the performance of fast spin-echo sequences in the detection of meniscal tears in the knee, with the established conventional spin-echo technique used as a reference standard. SUBJECTS AND METHODS: We imaged 66 consecutive patients (129 menisci) who were referred for MR examination with suspected meniscal tears. We used our routine two-dimensional, multisection, long repetition time/double-echo spin-echo sequence and one of two fast spin-echo sequences. The fast spin-echo parameters were chosen to minimize the loss of high-resolution detail while otherwise maintaining the sequence as close as possible to the spin-echo sequence. We then did a retrospective evaluation of the fast spin-echo images, using the spin-echo images as the gold standard. RESULTS: Fast spin-echo images showed only 30 (65%) of the 46 meniscal tears seen on the conventional spin-echo images. In addition, four of the 30 tears seen with both sequences were diagnosed with greater confidence on the conventional spin-echo images. In the cases in which both sequences allowed a diagnosis of definite meniscal tear, the abnormalities tended to be more conspicuous on the spin-echo images. CONCLUSION: Our results suggest that the fast spin-echo sequence should not be used for the diagnosis of meniscal tears.