Unusual initial calcification of primary and metastatic seminomas. Detection by computed tomography.

Rare large ab initio calcifications of a primary mediastinal seminoma in a 16-year-old boy and of para-aortic nodal metastatic ovarian seminoma in a 14-year-old girl are demonstrated with CT but not with conventional radiography. They are most likely dystrophic calcifications because of the absence of other germ cell tumor components and infective granulomatous disease. Routine use of CT might detect more such calcifications in untreated seminoma.

CT of the temporal bone in a patient with osteopathia striata and cranial sclerosis.

The authors present a case of congenital dysplasia affecting the long bones, skull, and other systems in a 7-year-old girl, with special attention to CT of the temporal bone, which showed abnormal ossicle fixation, a narrowed Eustachian canal, thickened sclerotic bone, and a small mastoid antrum and middle ear cavity. CT of the temporal bone can help one distinguish the etiologies of hearing loss associated with this disorder.

Surgically treated cavernous angiomas of the brain stem: report of two cases and review of the literature.

Two cases of surgically treated brain stem cavernous angiomas are presented. The previously reported cases are reviewed and the clinical features, radiographic appearance, and treatment of this condition are discussed. Symptomatic brain stem cavernous angiomas should be treated surgically and can be removed with good outcomes.

Pharyngeal fibrovascular polyp in a child.

Fibrovascular polyp of the upper aerodigestive tract is an uncommon tumor that may present in pediatric patients with symptoms ranging from dysphagia to asphyxiation and death. We present a unique case of a pediatric patient with an asymptomatic fibrovascular polyp noted as an incidental finding on a cervical ultrasound evaluation. This lesion extended from the posterior tonsillar pillar and prolapsed freely into the nasopharynx and esophagus. The literature relevant to this case is reviewed, and the etiology, pathophysiology, and management principles are discussed.

High resolution computed tomography of the temporal bone in infants and children: a review.

Pathologic conditions involving the temporal bone in infants and children are now commonly diagnosed by computed tomography (CT). The importance of utilizing high resolution computed tomography (HRCT) with magnified, thin (1.5 mm) scans in both the axial and coronal planes is stressed in order to obtain the maximal anatomic information that is critical for proper diagnosis. A retrospective analysis of 388 cases reveals a positive diagnostic yield ranging from 65% in temporal bone trauma to 20% in clinically suspected neoplasm. Selected case reports of congenital abnormalities, inflammatory processes, traumatic lesions, and tumors will be presented. We conclude that HRCT is an excellent diagnostic modality and should be used liberally to evaluate the temporal bone in children.

Conservative management of thrombosed vein of Galen malformations. Report of two cases and a review of the literature.

Spontaneously thrombosed vein of Galen malformations are rare congenital vascular malformations. Surgical treatment of these lesions based on experience with the management of patent malformations has yielded less than satisfactory results. This report reviews the literature concerning these lesions and details our experience with nonoperative management in 2 patients.

Subacute sinusitis: are antimicrobials necessary?

BACKGROUND: The need for antimicrobials in the treatment of subacute sinusitis was evaluated in 96 afebrile children who were prescribed antimicrobial (amoxicillin, amoxicillin clavulanate potassium, or trimethoprim-sulfamethoxazole) or no antimicrobial medication in addition to a decongestant and saline nasal spray for 3 weeks. METHODS: Response was determined by complete clearing of the initial radiologic abnormalities or in the case of mucosal thickening, by a significant decrease in thickness to < 6 mm within the maxillary sinuses associated with improvement of the clinical signs and symptoms of sinusitis. If there was evidence of partial clearing by radiograph, the same therapy was continued for another 3 weeks. Nonresponders demonstrated no change or worsening of clinical and radiologic findings. RESULTS: Sixty-seven of the 96 subjects (70%) responded: 58 (87%) in 3 weeks and 9 (13%) in 6 weeks. Fifty-five of the responders were in the antimicrobial treatment group, and 12 were prescribed no antimicrobial medication. Twenty-nine of the 96 subjects (30%) did not respond to treatment; 22 received an antimicrobial and seven received no antimicrobial medication. CONCLUSIONS: The number of responders and nonresponders was similar in the antimicrobial- and nonantimicrobial-treated groups (p = NS), and no single antimicrobial medication demonstrated greater treatment effectiveness.

Globoid cell leukodystrophy: comparison of neuropathology with magnetic resonance imaging.

Previous imaging studies in infants with globoid cell leukodystrophy (GLD) using computed tomography have demonstrated a reduction in cerebral white matter and increased density symmetrically in the regions of the thalami, periventricular white matter, and the internal capsules. Correlation of these findings with morphologic studies at necropsy has not been made. In particular, deposition of calcium has not been described. We have evaluated two children with GLD confirmed by the absence of leukocyte galactosylceramide beta-galactosidase activity using repeated magnetic resonance (MR) scans in each and correlated the imaging results with post-mortem analyses in one. Neuropathologic examination revealed abnormalities typical for GLD. In addition to the absence of normal myelination throughout cerebral and cerebellar white matter, MR images demonstrated the presence of a paramagnetic effect in the regions of the thalami, corona radiata, and centra semiovale. We have observed in histologic preparations from these areas a dense accumulation of globoid cells and some calcium, which we suggest may be responsible for producing the paramagnetic effect.

Venous hemangioma of the gallbladder.

An 11-year-old girl presenting with right upper quadrant abdominal pain was found to have a venous hemangioma of the posterior wall of the gallbladder. Radiographic, ultrasonographic, and angiographic findings of this entity, along with a review of the literature, are presented.

Renal atrophy or infarction in children with neuroblastoma.

Twelve children with adrenal or upper abdominal paraaortic neuroblastoma developed unilateral or bilateral renal atrophy or infarction. At presentation, the children ranged in age from 2 weeks to 9.7 years. Neuroblastomas were stage II (n = 1), III (n = 2), IV-S (n = 2), and IV (n = 7). Treatment varied but included surgery, chemotherapy, localized abdominal irradiation, and/or bone marrow transplantation. Six children developed ipsilateral renal atrophy, five experienced ipsilateral or bilateral acute perioperative renal infarction, and one developed contralateral renal infarction unrelated to surgery. During treatment, two patients required hemodialysis; both subsequently died. Creatinine concentrations in eight patients have been in the normal range. Two patients have had mildly but persistently elevated creatinine levels. Renal damage from primary effects of the tumor can develop in children with adrenal or upper abdominal neuroblastoma. Treatment, especially surgical resection of the primary tumor, chemotherapy, and radiation therapy, can compound such damage.

Radiographic changes associated with tracheal isolation of Ureaplasma urealyticum from neonates.

Recent studies show an association between the presence of Ureaplasma urealyticum in tracheal aspirates and bronchopulmonary dysplasia. We hypothesized that among infants with birth weights < or = 1,250 g and respiratory disease, those with U. urealyticum in their tracheal aspirates would have radiographic evidence of more-severe pulmonary disease more often than would those without this organism. A total of 292 low-birth-weight infants who had endotracheal aspirate cultured within 7 days of birth were enrolled. The radiographic outcome variables were pneumonia, early severe bronchopulmonary dysplasia (precocious), and chronic lung disease. Microorganisms were isolated from 128 infants (44%); U. urealyticum was isolated from 44 (15%). Pneumonia was significantly more common in infants with than without U. urealyticum (30% vs. 16%, P = .03). U. urealyticum also was associated with precocious bronchopulmonary dysplasia independent of prematurity, race, and sex (odds ratio, 2.2; P < .05). Tracheal isolation of U. urealyticum within 7 days of birth is associated with pneumonia and precocious bronchopulmonary dysplasia.

A randomized, controlled trial of very early prophylactic ligation of the ductus arteriosus in babies who weighed 1000 g or less at birth.

We speculated that prophylactic ligation of the ductus arteriosus would reduce mortality and morbidity in very-low-birth-weight infants. To test this hypothesis, we randomly assigned 84 babies who weighed 1000 g or less at birth and required supplemental oxygen either to receive standard treatment (n = 44) or to undergo prophylactic surgical ligation of the ductus arteriosus on the day of birth (n = 40). The ductus was ligated in babies in the control group only if the shunt was hemodynamically important. All the babies were followed for one year. The incidence of necrotizing enterocolitis was reduced in the group that underwent prophylactic ligation (3 of 40 [8 percent]) as compared with the control group (13 of 44 [30 percent]; P = 0.002). The frequency of death, bronchopulmonary dysplasia, retinopathy of prematurity, and intraventricular hemorrhage was similar in both groups. Because early enteral feeding may have increased the incidence of necrotizing enterocolitis, we analyzed separately the babies who were fed early. Among the infants who were fed within 14 days of birth, those who underwent prophylactic ligation had a lower incidence of necrotizing enterocolitis (1 of 11 [9 percent]) than those who did not (13 of 24 [54 percent]; P = 0.001). Within the control group, the infants who were fed within 14 days of birth and whose ductus was ligated for medical reasons within 5 days of birth had a lower incidence of necrotizing enterocolitis (2 of 10 [20 percent]) than those whose ductus was ligated later or not at all (11 of 14 [79 percent]; P = 0.004). We conclude that early surgical closure of the ductus arteriosus reduces the risk of necrotizing enterocolitis in infants of very low birth weight who require supplemental oxygen.