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M T Wallach

Publications and source records attributed to M T Wallach.

9 recordsLinked to original sources
PubMed2001

CT of the duodenum: an overlooked segment gets its due.

Abdominal computed tomography (CT) is frequently performed to evaluate gastrointestinal pathologic conditions, and the majority of the gastrointestinal radiology literature has concentrated on the colon, stomach, and distal small bowel. In a description of CT findings of duodenal pathologic conditions, congenital, traumatic, inflammatory, and neoplastic diseases are presented. Congenital duodenal anomalies such as duplications and diverticula are usually asymptomatic, while annular pancreas and malrotation may manifest in the 1st decade of life. CT plays a vital role in the diagnosis of traumatic duodenal injury. Primary inflammatory processes of the duodenum such as ulcers and secondary involvement from pancreatitis can reliably be diagnosed at CT. Infectious diseases of the duodenum are difficult to diagnose, as the findings are not specific. While small bowel malignancies are relatively rare, lipoma, adenoma, and adenocarcinoma, as well as local extension from adjacent malignancies, can be diagnosed at CT. Careful CT technique and attention to the duodenum can result in reliable prospective diagnoses.

Duodenal Diseases↗
PubMed1999

Selective use of ultrasonography for acute appendicitis in children.

BACKGROUND: To evaluate the role of ultrasonography in children with equivocal signs of acute appendicitis, and correlate with initial clinical impression and pathological findings. METHODS: This is a prospective evaluation of all children presenting with a possible diagnosis of appendicitis during a 14-month study period. Patients with unequivocal clinical signs of appendicitis underwent appendectomy without ultrasonography. Patients with equivocal signs had documentation of the clinical impression and subsequent abdominal ultrasound. Statistical analysis of results was performed using the chi-square test (P <0.05 significant). RESULTS: Two hundred fifteen consecutive children were enrolled. Signs were unequivocal in 116 and equivocal in 99. Seven patients in the first group had a normal appendix at operation. Of the 99 patients with equivocal signs, there were 28 true positives, 3 false positives, 64 true negatives, and 4 false negatives. In equivocal cases, sensitivity of the initial clinical impression versus ultrasound was 50% and 88%, respectively (P <0.05). Specificity was 85% and 96%, respectively. The positive and negative predictive values improved from 63% to 90% and 78% to 94%, respectively, with the use of ultrasonography. CONCLUSIONS: The low false positive rate (6%) in clinically obvious cases of appendicitis does not, in our opinion, warrant ultrasonography. In clinically equivocal cases, ultrasonography is a fast, sensitive, and specific diagnostic modality to diagnose or rule out appendicitis, avoiding the need for prolonged observation and/or hospitalization.

Acute Disease↗
PubMed1997

Wandering spleen presenting as duodenal obstruction after repair of congenital diaphragmatic hernia.

The most common presentation of the wandering spleen in children is torsion with infarction. Duodenal obstruction by the spleen has not been reported previously. Wandering spleen can accompany congenital diaphragmatic hernia (CDH) because of its loss of retroperitoneal fixation. If absence of normal splenic fixation is found during repair of CDH, splenopexy should be performed to eliminate the risk of torsion, infarction, or, as described here, duodenal obstruction.

Duodenal Obstruction↗
PubMed1995

Cat scratch disease in two children presenting with fever of unknown origin: imaging features and association with a new causative agent, Rochalimaea henselae.

OBJECTIVE: To report the clinical course, imaging findings, and method of diagnosis of two patients with systemic manifestations of cat scratch disease, presenting with fever of unknown origin. DESIGN: Case study. PATIENTS: Two children with fever of unknown origin who had multiple lesions in the liver and spleen, shown on ultrasound, computed tomography, and magnetic resonance imaging. Initial diagnoses were Kawasaki disease (case 1) and metastatic neuroblastoma (case 2). RESULTS: Biopsy material showed granulomatous hepatitis in both patients. The diagnoses were confirmed by positive assays for Rochalimaea henselae, currently thought to be the causative agent of cat scratch disease. CONCLUSION: Cat scratch disease presenting as fever of unknown origin is now well described and can be more readily diagnosed because of the availability of new serologic assays, as well as polymerase chain reaction assays for R henselae DNA in tissue specimens.

Bartonella henselae↗
PubMed1994

Adrenal hemorrhage in abused children: imaging and postmortem findings.

OBJECTIVE: Adrenal hemorrhage associated with child abuse has received little attention in published reports. We review imaging studies or pathologic findings of adrenal hemorrhage in five cases of proved child abuse. SUBJECTS AND METHODS: The imaging findings in three children with adrenal hemorrhage were analyzed retrospectively. All three had abdominal CT scans and skeletal radiographs. One also had abdominal sonograms and MR images. The pathologic findings in two other abused children with adrenal hemorrhage who died of head injuries were also studied. In all five cases, a history of trauma was not initially known; child abuse was later confirmed. RESULTS: Unilateral hemorrhage in the right adrenal gland was found in all patients. Enhanced CT scans of the abdomen showed a low-attenuation, oval mass separating the limbs of the adrenal gland. Sonograms in one case showed a small, heterogeneous mass in the right adrenal gland. MR images obtained 3 weeks later showed an area of high signal intensity within the right adrenal gland on both T1- and T2-weighted images, consistent with subacute hemorrhage. In both deceased children, autopsy showed hemorrhage in the right adrenal gland, mainly within the medulla with some extension beyond the capsule in one case. All five children had associated abdominal visceral injuries or rib fractures or both, on the same side as the hemorrhage. CONCLUSION: Imaging findings of adrenal hemorrhage are similar to those previously described in patients with accidental trauma. Pathologic sections of the gland reveal predominantly medullary involvement with hemorrhage. The presence of adrenal hemorrhage in a child should prompt a search for other associated injuries and raise the possibility of unsuspected trauma.

Adrenal Gland Diseases↗
PubMed1994

Benign cystitis in children mimicking rhabdomyosarcoma.

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.

Adolescent↗
PubMed1993

Gastrointestinal hemorrhage associated with gastric polyps in Menkes disease.

We describe two infants with Menkes disease who had serious gastrointestinal bleeding from solitary gastric polyps. Hemorrhage in one patient was acute and proved fatal. Histopathologic examinations showed submucosal vascular ectasia with mucosal hyperplasia, edema, and ulceration. Gastric polyps may represent an underappreciated clinical abnormality in Menkes disease.

Gastrointestinal Hemorrhage↗