Biomedical subjects
Publications and source records attributed to K D Eggli.
Colovesical fistulas in children are most often associated with high anorectal imperforations. Acquired enterovesical fistulas in children only rarely have been reported as a consequence of an inflammatory process. We present a case of an acquired colovesical fistula formed by the erosion of an abscess at the distal end of a colonic duplication in a child who presented with fever of unknown origin.
OBJECTIVE: To ascertain the relation between postoperative neurologic complications and variables occurring before, during, and after hypothermic cardiopulmonary bypass surgery to correct congenital heart disease in young infants. DESIGN: Prospective analysis of mortality and neurologic morbidity before hospital discharge; systematic comparison with patient characteristics, metabolic status, surgery variables; and preoperative neurologic findings of the patients. SETTING: Intensive care unit in tertiary care center. PATIENTS: Consecutive sample of 91 full-term infants who underwent 100 operations between January 1989 through December 1992. Nine infants had more than one operation during the study period. MAIN OUTCOME MEASURES: Levels of alertness, tone, focal signs, dyskinesia, pyramidal signs, seizures, and death. RESULTS: Reduced level of alertness at discharge from the hospital in 19% of patients; seizures in 15% (70% focal); severe hypotonia in 11% before surgery, and in 7% at discharge from hospital; generalized pyramidal findings in six (7%); asymmetry of tone in 5%; and chorea that did not persist in 11%. Results of cranial ultrasound tests were abnormal in 20% of patients. Of these those with abnormal cranial ultrasound examinations 55% were abnormal before surgery. Overall mortality was 18%. Of the patients who died, 59% had interrupted aortic arch or hypoplastic left heart syndrome. Mortality for patients with these lesions was 40%. Alertness (P = .005), chorea (P = .03), and hypotonia (P = .02) were associated with duration of deep hypothermia longer than 60 minutes. No association was found among other outcomes and study variables, except the relation between severe left-sided heart lesions and mortality. CONCLUSIONS: Mortality and neurologic morbidity after open heart surgery on young infants may be due to several factors, including type of lesion, preexisting brain abnormalities, duration of deep hypothermia, and strokes.
In pediatric oncology, therapeutic decisions are made based on tumor response to chemotherapeutic agents. Sequential measurement of tumor bulk and its percent change on therapy must be accurately assessed. Will 3-dimensional (3-D) volumetric determination improve our ability to assess tumor response to therapy? Forty-five CT scans of pediatric patients with unresectable thoracic or abdominal neoplasia were assessed for tumor bulk by the standard "2-dimensional (2-D)" volume formula (cross-sectional area x length) and by 3-D volumetric analysis. Thirty-two examinations were performed in follow-up, and percent change in tumor size was calculated. The 2-D volume calculation overestimated tumor volume by more than 50% on all but two examinations when the 2-D volume was compared with the 3-D volume. In 28% of follow-up examinations, the 2-D calculation of percent change differed by more than 10% from the 3-D volume. Fifteen percent differed by over 25%. This changed the response category of one patient from "no response" to "partial response". 3-D volumetric analysis, easily performed by a trained technologist, will give more accurate assessment of the actual tumor bulk and its subsequent changes in size in response to therapy.
Thirteen children initially suspected to have an intrathoracic or intraabdominal mass had malposition of the liver and/or spleen discovered by ultrasound. This group consisted of five children with diaphragmatic eventration or hernia and eight with wandering spleen or liver. Careful ultrasonographic examinations were diagnostic in all patients; seven had surgical confirmation. CT, MRI, nuclear scan and fluoroscopic imaging were useful in select instances. The liver and spleen have a characteristic anatomic configuration and sonographic appearance that should enable them to be recognized, and pathological alterations appreciated, even when these organs are ectopic in location or malformed.
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Seventeen (13 male, 4 female) patients, aged 13 months to 13 years, with benign cystitis had imaging findings that mimicked those of rhabdomyosarcoma. Our experience indicates that in the child with hematuria, dysuria, and frequency plus cystographic or sonographic demonstration of a bladder with reduced capacity and circumferential wall thickening or sonographic findings of isoechoic bladder wall thickening (focal, multifocal or circumferential distribution), intact mucosa, and bullous lesions should strongly suggest inflammation and not malignancy. When an inflammatory lesion is suspected, follow-up imaging should be performed in 2 weeks, which if normal will preclude biopsy.
The liver, spleen, and pancreas are three of the most frequently imaged intra-abdominal organs. Each organ is a complex structure affected by multiple pathologic processes. However, in order to recognize the pathologic changes that affect each organ, one must have a detailed knowledge of the broad spectrum of normal variants that can be seen when imaging the upper abdomen. This review explores the wide variability in appearance of the normal liver, spleen, and pancreas during cross-sectional imaging (CT, US, and MRI), stressing a thorough understanding of normal anatomy and the affect of physiologic variants.
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Ewing's sarcoma is a highly malignant tumor of uncertain origin. A strong relationship is suggested between Ewing's sarcoma and tumors of neural origin. The radiologic manifestation of Ewing's sarcoma are protean and lesions may be lytic, mixed lytic-sclerotic, or rarely, predominantly sclerotic. The lower extremity long bones are predominantly affected and most lesions are diaphyseal or metadiaphyseal. CT and particularly MR imaging are invaluable in further delineating the extent of disease not readily manifested on plain radiographs. Gallium scintigraphy and gadolinium-enhanced MR images are best for following the response to therapy. Ewing's sarcoma must be distinguished from other round cell tumors including lymphoma, neuroblastoma, and primitive neuroectodermal tumor of bone as well as from osteosarcoma.
The vast majority of pulmonary masses in children are nonmalignant. Most pediatric nodular disease is granulomatous in origin. Infections and congenital lesions outnumber neoplastic lesions. Pulmonary metastatic disease most often results from Wilms' tumor and is followed in frequency by the sarcomas. Primary pulmonary malignancy is rare in the child.
We present a case of primary lymphoma of bone arising in the proximal tibial epiphysis of a 16-year-old boy. To the best of our knowledge, primary lymphoma of bone has not been described previously as a mimicker of chondroblastoma. This case report is intended to increase awareness among clinicians and radiologists that primary lymphoma of bone can present with a long clinical prodrome and initially benign radiographic appearance. Early recognition of this unusual presentation will (hopefully) increase the likelihood of cure. However, it is recognized that in children, primary lymphoma of bone is a rare diagnosis and associated with a poor prognosis unless aggressive treatment is utilized [8].
Renal sonography detects abnormality in only 40% of pediatric pyelonephritis. In eight patients shown to have acute pyelonephritis by 99mTc DMSA renal cortical scintigraphy, five were found to have focal abnormalities of renal perfusion by color Doppler sonography in the same sites as the scintigraphic defects (sensitivity-63%). Two of the five patients had normal plain sonograms. False positive studies occurred in patients with documented chronic renal scarring. The specificity of vascular asymmetry was 70%. This preliminary report suggests that, particularly in the patient without pre-existing renal scarring, color Doppler evaluation of the renal vasculature may increase the sensitivity of sonography in the diagnosis of pyelonephritis in children.
Two patients with different patterns of soft tissue and bone involvement demonstrate the variability of extracutaneous manifestations of juvenile xanthogranuloma, a non-X histiocytosis, better known to dermatologists than to radiologists.
Fatty infiltration of the liver may occur in healthy children. The ultrasonographic, CT, and MRI findings are identical to those already described in the adult population.
Orbital abnormalities encountered in the pediatric population differ substantially from those found in adult patients. Retinoblastoma, the most serious intraocular tumor, is often difficult to diagnose, but use of computed tomography (CT) (which reveals the characteristic focal calcification) and magnetic resonance (MR) imaging allows this tumor to be differentiated from pseudogliomas, such as Coats disease, and retrolental fibroplasia. CT and MR imaging help in the differentiation of orbital cellulitis from preseptal, lacrimal, and eyelid infectious processes and of orbital pseudotumor from Graves disease. In cases of orbital trauma, CT is excellent for detecting orbital fractures and metallic foreign bodies; MR imaging is better for depicting ocular and optic nerve injuries. Both modalities allow the differentiation of rhabdomyosarcoma from dermoid, cavernous hemangioma, and lymphangioma and provide helpful information for the diagnosis of many other tumors. Since CT and MR imaging have widely expanded the capabilities of orbital imaging, it is more important than ever before for radiologists to understand pediatric orbital disease.
The 1980s witnessed the development of many new contrast agents useful in radiographic and MRI to enhance the contrast discrimination between tissues and improve lesion conspicuity. In addition to improved efficacy, these agents are generally safer and cause less patient discomfort than older radiographic contrast media. The injection of any foreign material into the body always holds some risk, however, and it is the responsibility of clinicians and radiologists jointly to use these agents judiciously in the best interest of the patient.
Ninety-one children 1 week to 10 years old with culture-documented febrile urinary tract infection were evaluated with renal sonography and renal cortical scintigraphy by using 99mTc-labeled dimercaptosuccinic acid (DMSA). On the basis of previous experimental studies, DMSA scintigraphy was used as the standard of reference for the diagnosis of acute pyelonephritis. The DMSA scans showed changes consistent with acute pyelonephritis in 63% (57/91) of the patients. Sonograms showed changes consistent with acute pyelonephritis in 24% (22/91) of the whole group and in only 39% (22/57) of the patients with scintigraphically documented acute pyelonephritis. Pertinent sonographic findings were areas of increased cortical echogenicity in 14 patients and decreased echogenicity in eight, including three patients with renal abscesses. Dilatation of the renal collecting system was noted in nine patients and renal enlargement was noted in three. We conclude that renal sonography is a relatively insensitive test for the detection of acute inflammatory changes of renal cortex. Therefore, it should not be used as the primary imaging technique for the diagnosis of acute pyelonephritis. However, sonography is a useful technique in evaluating the nature of the defects seen on the DMSA scan and in detecting obstructive uropathies that may be associated with urinary tract infections.
Recognition of the combination of retromalleolar swelling and talocalcaneal distraction seen on well positioned lateral radiographs of the ankle suggests the presence of subtalar joint distention, either in association with ankle joint abnormality or as an isolated finding.