Chest radiograph findings in children with COVID-19-A retrospective analysis from a tertiary care paediatric hospital in South India.

OBJECTIVE: The primary aim of this study is to document the chest X-ray findings in children with COVID-19 pneumonia. The secondary aim is to correlate chest X-ray findings to patient outcome. METHODS: We performed a retrospective analysis of children (0-18 years) with SARS-CoV-2 admitted to our hospital from June 2020 to December 2021. The chest radiographs were assessed for: peribronchial cuffing, ground-glass opacities (GGOs), consolidation, pulmonary nodules and pleural effusion. The severity of the pulmonary findings was graded using a modification of the Brixia score. RESULTS: There were a total of 90 patients with SARS-CoV-2 infection; the mean age was 5.8 years (age range 7 days to 17 years). Abnormalities were seen on the CXR in 74 (82%) of the 90 patients. Bilateral peribronchial cuffing was seen in 68% (61/90), consolidation in 11% (10/90), bilateral central GGOs in 2% (2/90) and unilateral pleural effusion in 1% (1/90). Overall the average CXR score in our cohort of patients was 6. The average CXR score in patients with oxygen requirement was 10. The duration of hospital stay was significantly longer in those patients with CXR score >9. CONCLUSION: The CXR score has the potential to serve as tool to identify children at high risk and may aid planning of clinical management in such patients.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) created a global pandemic in early March 2020. There are very few studies describing the lung changes in affected children. We performed a retrospective study in children, aged between 0 days and 18 years, who tested positive for this virus. This study was conducted in a paediatric tertiary care hospital in South India. Chest X-ray (CXR) was done in children with moderate and severe SARS-CoV-2 infection; these X-rays were reviewed and scoring was done to assess the degree of abnormality. It was seen that the duration of hospital stay was longer in children with a high CXR score. Amongst the children with score >9, 60% needed oxygen support during their treatment. Thus, CXR score can play a role in the prediction of disease outcome in SARS-CoV-2 infection.

Jejunal Intramural Hematoma: Masquerading as a Mass Lesion.

Jejunal intramural hematoma (JIH) is rare. A 5-year-old girl, a known attention-deficit hyperactivity disorder child with paraneoplastic symptoms, on imaging showed a suspicion of Jejunal intramural mass with internal bleeding. Laparotomy showed a JIH. Evacuation of hematoma and Histopathological Examination (HPE) ruled out tumor. Possible explanation of the manifestation is suggested.

Granulomatous Herpetic Encephalitis A Possible Role for Inflammasomes.

BACKGROUND: Granulomatous herpetic encephalitis is a rare inflammatory complication of acute herpes simplex encephalitis. METHODS: We describe 3 cases of granulomatous herpetic encephalitis in children arising between 1 to 10 years after the initial presentation with acute herpes simplex encephalitis. We focus on the clinical course and neuroimaging phenotype with a discussion of possible mechanisms underpinning this entity. RESULTS: The clinical course was highly variable. However, the dominant neuroimaging phenotype in each of our cases was that of confluent gyriform cortical enhancement with predominantly solid foci of enhancement in the subjacent white matter +/- deep gray nuclei. Cerebrospinal fluid was negative for herpes simplex virus DNA in all cases. All 3 cases required brain biopsy to help establish the diagnosis. CONCLUSIONS: Increased recognition of granulomatous herpetic encephalitis in children will facilitate earlier diagnosis and treatment. Although the exact role played by the host immune response, genetics, and environment in determining the different outcomes of herpes simplex encephalitis remains to be determined, we postulate a role for inflammasome dysregulation in this entity.

Acute Appendicitis in Infants - A Report of Two Cases.

Acute appendicitis is the most common surgical emergency in children. However, it is uncommon in neonates and infants. Often it can be challenging to diagnose acute appendicitis in children due to atypical clinical presentation and nonspecific symptoms. This is particularly true in neonates and infants. A high level of clinical suspicion is needed to diagnose infantile appendicitis. Delayed diagnosis is associated with higher perforation rates and increased disease-related morbidity. Imaging plays a key role in the prompt diagnosis of acute appendicitis and its complications. We report two cases of perforated appendicitis in babies <6 months old.

Spinal Dysraphisms: A New Anatomical-Clinicoradiological Classification.

Background Spinal dysraphisms refer to the congenital abnormalities of the spine and spinal cord due to aberrations in the processes of gastrulation, primary neurulation, and secondary neurulation. Embryology of many complex spinal dysraphisms are yet poorly understood and there is no agreeable anatomical-clinicoradiological classification with inclusion of recently documented and complex spinal dysraphisms. Aims and Objectives The main objective of this study was to review the imaging features of spinal dysraphisms with a better understanding of embryological abnormalities and propose a new classification inclusive of all complex and unusual dysraphisms based on anatomical and clinicoradiological correlation. Materials and Methods This was a retrospective single institutional observational study of 391 cases of spinal dysraphism for 10 years in our institution. Of 391 cases included in the study, 204 were males and 187 were females. Also, 123 cases belonged to the 0-6 months age group, 38 cases belonged to the 7-12 months age group, 156 belonged to the 1-5 years age group, 39 cases belonged to the 6-10 years age group, and 35 cases belonged to 10-20 years age group. Results An anatomical-clinicoradiological analysis of cases yielded a high proportion of cases of spinal lipomas, including lipomyeloceles and lipomyelomeningoceles (31.3%) and posterior myelomeningocele (14.2%). Anterior myelocoele (0.2%), sacral chordoma(0.2%), and intrasacral meningocele (0.2%) formed the least proportion of cases. A new classification was proposed based on the analysis of acquired data. Conclusion A structured approach in imaging spinal dysraphism is necessary for imaging evaluation in recent years. The proposed new classification based on clinicoradiological correlation and anatomic location is inclusive of unusual and complex dysraphisms.

Page Kidney in a Child with Severe Pelviureteric Junction Obstruction.

There are various causes of Reno Vascular Hypertension in children reported in the literature. Amongst these, Page kidney gets a rare mention. This phenomenon is a result of the accumulation of blood or urine in the perinephric or subcapsular space, resulting in compression of renal parenchyma, microvascular ischemia, alteration in the renin-angiotensin apparatus, and high renin hypertension. It has been well documented and studied in adults. Only a few cases are reported in the paediatric population. We report a rare presentation of Page kidney in a 5 year 8 months old girl. She initially presented with Dietl's crisis secondary to left Pelviureteric Junction obstruction (PUJO) causing massive hydronephrosis. She developed Page kidney phenomenon after spontaneous rupture of the pelvicalyceal system formed a tight compressive urinoma. She was managed successfully with internal JJ stenting and ultrasound-guided aspiration of the urinoma followed by elective delayed Pyeloplasty. To our knowledge, this is the first documented case of Page kidney in a child with severe PUJO.

Segmental Spinal Dysgenesis-"Redefined".

STUDY DESIGN: Retrospective single institutional observational study. PURPOSE: Segmental spinal dysgenesis (SSD), a complex spinal dysraphic state caused by notochord malformation disorders, is named after its morphological presentation where a spine segment is dysgenetic, malformed or absent. This study's objective was to examine and reassess SSD imaging findings and correlate them with an embryological explanation. OVERVIEW OF LITERATURE: Scott and his colleagues defined SSD as segmental agenesis or dysgenesis of the lumbar or thoracolumbar vertebrae and underlying spinal cord. Tortori-Donati and his colleagues defined it as a morphologic continuum ranging from hypoplasia to an absent spinal cord segment. METHODS: Fifteen children, whose imaging findings and clinical features were consistent with SSD, were included in the study. Magnetic resonance imaging (MRI) was performed per institutional spine protocol. RESULTS: Five children (33.3%) presented with a high-ending bulbous cord with no caudal segment, six (40%) presented with a dorsal or lumbar segmental dysgenetic cord with a low-lying, bulky caudal cord but without significant spinal canal narrowing, and four (26.6%) presented with segmental caudal dysgenesis with severe kyphoscoliosis, gibbus deformity, and spinal canal narrowing with a normal distal segment (normal or low-lying). CONCLUSIONS: SSD is a complex spinal anomaly in children requiring clinical-radiological assessment followed by multidisciplinary management based on the extent and severity of the dysgenetic cord and the type of SSD. MRI plays a crucial role in both diagnosing and classifying SSD prior to surgical treatment to prevent further impairment.

Primary diffuse leptomeningeal oligodendrogliomatosis: A case report and literature review.

Primary leptomeningeal oligodendrogliomatosis (PLO) is a rare low-grade intracranial and spinal canal subarachnoid neoplasm without an obvious primary neoplasm in the brain or spinal cord parenchyma. We present here the serial progression of radiological findings of this rare disease in a 2-year-old male child whose clinical status deteriorated over a period of 4 months with the main complaint of partial seizures. During this period, the MR findings progressed from mild hydrocephalus with minimal leptomeningeal enhancement to leptomeningeal multiple cystic lesions in the entire neuraxis including the spine.