A Traumatic Quinceañera: Acute Superior Mesenteric Artery Syndrome in an Adolescent Girl.

ABSTRACT: A 15-year-old girl presented with 3 days of progressive abdominal distention, pain, and bilious hematemesis. Her symptoms began after her quinceañera, during which she wore a tight corset. On examination, she was thin and had significant abdominal distention and pain. A computed tomography revealed a massively dilated stomach and proximal duodenum to the region of the superior mesenteric artery (SMA) with distal decompression. An upper gastrointestinal fluoroscopy demonstrated marked dilation of the stomach through the mid third portion of the duodenum with distal decompression and an associated linear compression on her duodenal wall. We believe that she developed acute SMA syndrome. Superior mesenteric artery syndrome is a partial bowel obstruction caused when the third portion of the duodenum is compressed as it passes between the SMA and the aorta. Although the SMA syndrome is most commonly described as a condition associated with chronic, severe weight loss resulting in a narrowing of the SMA to aorta angle and subsequent duodenal compression, it can present acutely from causes such as a postoperative complication, blunt trauma, or external compression. Previously described acute SMA syndrome from external compression has been the result of medically necessary causes, such as body casting. In this case, the tight gown was likely the inciting factor for her development of SMA syndrome; however, she was placed at high risk for the condition by being underweight at baseline and experiencing food restriction for several days preceding her quinceañera. She was treated conservatively with nasogastric decompression and parenteral nutrition, and has since completely recovered.

Ovarian lesion volumes as a screening tool for malignancy in adolescent ovarian tumors.

BACKGROUND: Preoperative evaluation of ovarian tumors for malignancy is essential to determine appropriate treatment. Our study assessed the utility of ovarian lesion volumes to screen for malignancy in adolescent ovarian lesions. METHODS: A retrospective chart review of adolescent patients (8-18years) who underwent an ovarian operation from January 2008 to December 2012. Data included demographics, ultrasonographic volume measurements, and tumor markers. Volumes were calculated using the prolate ellipsoid formula. Data are presented as medians. RESULTS: One hundred twenty-three females were included at a median age of 13.7years (IQR 12.5-16). Eight patients had malignancies. The median benign lesion volume was significantly smaller than malignant [152cm3 (IQR 57-592)vs. 1548cm(3) (IQR 627-2105), p=0.001]. A receiver operating characteristic (ROC) curve analysis (AUC 0.84, p=0.001) revealed a threshold ovarian lesion volume of <184cm(3) (100% sensitivity, 54% specificity, NPV 100%, PPV 13%) to accurately screen for malignancy. This held true when applied to our dataset as none of the 62 girls with volumes <184cm(3) had malignant pathology. CONCLUSIONS: This is the first documented use of ovarian lesion volumes as a screening tool in adolescent ovarian lesions. This should be used in conjunction with tumor markers and other imaging features to better screen for malignancy.

Extrarenal Wilms tumor: a case report and review of the literature.

Extrarenal Wilms tumors are extremely rare with only isolated case reports in the pediatric literature. We present the case of a 2-year old boy who presented with a large abdominal mass and constipation. Pathologic diagnosis of the tumor was extrarenal Wilms tumor (ERWT) with favorable histology. We discuss the diagnostic workup, radiologic and operative findings, treatment and review of the literature.

Multimodality imaging of tracheobronchial disorders in children.

The trachea and bronchial airways in children are subject to compromise by a number of extrinsic and intrinsic conditions, including congenital, inflammatory, infectious, traumatic, and neoplastic processes. Stridor, wheezing, and respiratory distress are the most common indications for imaging of the airway in children. Frontal and lateral chest and/or neck radiography constitute the initial investigations of choice in most cases. Options for additional imaging include airway fluoroscopy, contrast esophagography, computed tomography (CT), and magnetic resonance (MR) imaging. Advanced imaging techniques such as dynamic airway CT, CT angiography, MR angiography, and cine MR imaging are valuable for providing relevant vascular and functional information in certain settings. Postprocessing techniques such as multiplanar reformatting, volume rendering, and virtual bronchoscopy assist in surgical planning by providing a better representation of three-dimensional anatomy. A systematic approach to imaging the airway based on clinical symptoms and signs is essential for the prompt, safe, and accurate diagnosis of tracheobronchial disorders in children.

Basidiomycetous fungal Inonotus tropicalis sacral osteomyelitis in X-linked chronic granulomatous disease.

Osteomyelitis is a common clinical manifestation of chronic granulomatous disease, a disorder of phagocytic function. Fungal organisms account for a significant proportion of these infections. We describe the clinical presentation and subsequent destructive sacral osteomyelitis with a basidiomycetous mold, Inonotus tropicalis, in a patient with an X-linked chronic granulomatous disease.