Fatty Wilms' tumor simulating teratoma; occurrence in a child with horseshoe kidney.
An unusually fatty wilms' tumor occurred in a young girl. Because of the abundant fat it radiologically simulated a teratoma.
Biomedical subjects
Publications and source records attributed to J S Donaldson.
An unusually fatty wilms' tumor occurred in a young girl. Because of the abundant fat it radiologically simulated a teratoma.
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A review of the imaging studies of five children with Wilms tumor and nephroblastomatosis demonstrated that contrast-enhanced computed tomography (CT) can show the multifocal involvement of nephroblastomatosis more accurately than either excretory urography or real-time ultrasound (US). In all five children, CT demonstrated multiple areas of nephroblastomatosis along the renal cortex. US showed a single intrarenal mass in each child (one bilaterally) but did not show the cortical nephroblastomatosis. Excretory urography also demonstrated only the dominant mass of the Wilms tumor. The superiority of CT is attributed to better spatial resolution and soft-tissue contrast differentiation and clear demarcation between nonenhanced nephroblastomatosis and enhanced normal renal parenchyma. Contrast-enhanced CT is therefore recommended for the evaluation of clinically abnormal and contralateral kidneys in all children with suspected Wilms tumor.
Nephroblastomatosis, a congenital lesion of infants and children, is marked by the persistence of metanephric blastema in the kidney. Computed tomography (CT) has previously been reported to be the best way to image these precancerous lesions. The authors discuss the radiologic and surgical implications of a case of macroscopically visible nephroblastomatosis demonstrated at histologic examination but not detected with CT in the contralateral kidney of a patient with Wilms tumor.
When acute renal vein thrombosis is associated with renal failure, aggressive therapy to eliminate the venous obstruction is indicated. There are reports of successful treatment of this condition with thrombolytic agents administered systemically or directly into the renal vein. Renal arterial administration of urokinase was used successfully to treat acute renal vein thrombosis associated with renal failure in a 9 1/2-year-old child.
A piece of wood in the hand of an 11-year-old girl was not visible on radiographs, but was diagnosed by ultrasonography. Ultrasonography is useful for disclosing radiographically silent foreign bodies.
Wilms tumor, the most common solid childhood malignancy, is frequently associated with pulmonary metastases, while hepatic metastases occur less frequently. Metastases to the lower lobes of the lungs, when deep in the costophrenic sulcus, may simulate an intraabdominal mass. The differentiation of these lesions is important both diagnostically and therapeutically. Three cases are presented in whom pulmonary sulcus metastases simulated abdominal lesions on computed tomography and could not be clearly localized as thoracic in origin on liver/spleen scintigraphy. Ultrasound evaluation was the most useful; however, integration with other imaging techniques was necessary to correctly identify these lesions as being of pulmonary origin.
Normal thoracic aortic dimensions in adults have been established by means of computed tomography (CT), but such measurements are not available in children. To establish normal standards, contrast material-enhanced chest CT scans of 117 children and adolescents, ranging in age from 2 weeks to 19 years, were reviewed retrospectively. Patients with congenital heart disease, vascular anomalies, renal disease, hypertension, and connective-tissue disorders were excluded, resulting in 97 studies. Diameters of the thoracic aortas were measured at three levels. Interobserver and intraobserver variances were determined. A direct linear relationship to patient age was observed, and regression analysis was performed. These standards help in differentiating the normal from the abnormal aorta on chest CT scans of children.
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Since 1980, we have treated 23 abscesses in 21 pediatric patients by percutaneous needle aspiration or catheter drainage or both. Percutaneous management has been completely successful in 16 of 21 patients and 18 of the 23 abscesses. In two patients, abscess drainage was technically successful and improved the patient's condition, but surgery was later required because of other complicating conditions. There were three failures of percutaneous aspiration or catheter drainage. Three serious complications occurred, but there was no mortality. Percutaneous management of abscesses is often a safe and effective procedure in pyogenic liver and postoperative abscesses.
Hydrothorax and/or ascites may be the most striking finding in children with right diaphragmatic hernia. The clinical, radiographic, and pathologic findings of five children with right diaphragmatic defects through which the liver had herniated are described. Three presented with a right hydrothorax, one with a right hydrothorax and ascites, and another with ascites. All four children with large right hydrothoraxes were found to have an incarcerated peritoneal sac filled with fluid in the right side of the chest at surgery or autopsy. Lymphatic congestion and obstruction was the probable cause for the fluid collection, which tended to enlarge with time. This condition may be life threatening, and two of the four patients died soon after birth because of hypoplasia of the lungs. Fetal ultrasonography in both had disclosed right intrathoracic cystic masses, and in one, intrauterine aspiration to decompress the lungs had been attempted. The other two patients are alive and well following surgical repair at 1 week and 7 months of age. Ascites was present in two patients and was believed to be due to hepatic venous obstruction, a mechanism similar to that responsible for the Budd-Chiari syndrome.
Children with neuroblastoma presenting with opsomyoclonus are a diagnostic dilemma; they may not have a palpable mass or elevated urine catecholamines and the neurologic manifestation often precedes the discovery of a primary tumor by several months. The delay in diagnosis probably reflects the difficulty in detecting small lesions. Even with high-resolution computed tomography (CT), difficulty was recently experienced in identifying small retroperitoneal lesions in three patients who presented with opsomyoclonus. Calcifications in these small neoplasms resembled contrast material within adjacent small-bowel loops that were not discernible until additional, unenhanced scans were obtained. It is recommended that the initial CT evaluation in patients presenting with opsomyoclonus be performed without bowel or intravenous contrast enhancement.
It has been well documented that children with severe neuromuscular disorders have tall vertebrae, presumably a consequence of altered mechanical forces. This finding was present in four neonates who were born with severe "floppy" hypotonia due to Werdnig-Hoffmann disease (two cases), nonspecific neonatal myopathy, and congenital muscular dystrophy. Fetal vertebral development is normally modified by intrauterine muscle tension and fetal activity.
A case of hepatic oil embolization following bipedal lymphangiography is presented. The CT appearance, pathogenesis, clinical significance, and differential diagnosis are discussed.
A rectal cuff abscess following corrective surgery for Hirschsprung disease is an uncommon but serious complication requiring prompt diagnostic and therapeutic attention. Plain films and examinations using contrast medium are insensitive to detection of an abscess due to surgical disruption of the normal anatomy. Computed tomography may be easy to interpret if the corrective surgery performed is well understood. An explanation of the Soave procedure and a case report are presented demonstrating the value of CT in examination of the postoperative pelvis. Knowledge that a cuff abscess following a Soave procedure for Hirschsprung disease can be easily detected by CT will aid in the early diagnosis and treatment, preventing long-term sequelae.
Each case of conjoint twins is unique. Preoperative imaging is helpful to determine the feasibility of separation. Shared and separate organs can be delineated; and operative technique and problems anticipated. We performed ultrasonography, CT, magnetic resonance imaging, and arteriography preoperatively on ischiopagus conjoint twins. The single most helpful study was CT performed during a bolus intravenous contrast medium injection into one twin. Arteriography was also very helpful. The other studies were complementary but added little additional structural details. Sedation of conjoint twins is complicated yet crucial for optimal imaging studies. A combination of oral and intramuscular sedation was used and worked well for all of the studies.
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