Biopsy versus conservative management of sonographically benign-appearing solid breast masses in adolescents.

OBJECTIVES: To determine whether the size of palpable solid breast masses in adolescents at initial sonography and their growth at follow-up sonography could be used to decide between conservative management and tissue biopsy. METHODS: This retrospective study included 37 adolescent female patients with 45 palpable benign-appearing solid breast masses on initial sonography. They were grouped as follows: group I, masses undergoing follow-up sonography with subsequent biopsy (n = 9); group II, masses undergoing biopsy without follow-up sonography (n = 13); and group III, masses undergoing follow-up sonography without biopsy (n = 23). The largest dimension, volume, volume change per month, and change in the sonographic appearance were analyzed to predict the need for biopsy. A combination of a largest dimension greater than 3 cm and volume change per month greater than 16% was used to assess the need for biopsy. Sonograms of 22 masses were correlated with histopathologic diagnoses. RESULTS: None of the masses that underwent follow-up sonography showed changes in their sonographic appearance. All masses that underwent biopsy were benign on histopathologic analysis. There was no significant difference in the largest dimension among the groups at initial sonography or between groups I and III at follow-up sonography. The volume change was smaller for fibroadenomas (n = 7; mean, 22.67%) than benign phyllodes tumors (n = 2; mean, 45.30%) in group I, but the difference was not significant (P = .384). However, the volume change for groups I and III showed a significant difference (P = .026). Neither size greater than 3 cm nor volume change greater than 16% predicted pathologic outcomes. CONCLUSIONS: If the combined criteria for assessing benignity of palpable breast masses had been used, biopsy could have been reduced by 89% in group I and deemed not necessary in 96% of group III breast masses.

Pulmonary interstitial glycogenosis in the setting of lung growth abnormality: radiographic and pathologic correlation.

Pulmonary interstitial glycogenosis (PIG) is a rare pediatric interstitial lung disease. We report a case of a term boy presenting with tachypnea at birth requiring supplemental oxygen. Chest radiographs followed by high-resolution CT (HRCT) demonstrated hyperinflation and diffuse interstitial markings interspersed with multiple cystic spaces. An open lung biopsy demonstrated a minor component of PIG superimposed upon poor alveolarization. PIG in the setting of lung growth abnormality might be more common than previously described. Additionally, radiographic findings associated with most pediatric interstitial lung diseases are nonspecific, and histopathologic correlation is essential for diagnosis.

Role of breast sonography in imaging of adolescents with palpable solid breast masses.

OBJECTIVE: The purpose of this study was to assess the role of sonography in the diagnosis and management of palpable solid breast masses in adolescents and to correlate the sonographic findings with the histopathologic findings and clinical outcome. MATERIALS AND METHODS: A retrospective study was conducted with the breast sonograms of 20 adolescent girls 13-19 years old who presented with palpable breast masses found to be solid at breast sonography. The Stavros sonographic criteria were used to assess the benignity or malignancy of solid breast masses. All sonographic findings were correlated with histopathologic or clinical follow-up findings. RESULTS: Sonography showed 21 solid masses in 20 patients (one patient had bilateral solid breast masses). All but six solid masses were presumed benign according to the Stavros sonographic criteria. All solid masses were proved benign at histopathologic or clinical follow-up examination. CONCLUSION: Sonography was not useful for predicting the histologic diagnosis of all solid benign breast masses in adolescent patients. The Stavros sonographic criteria, however, were useful for predicting benignity in 65% of the breast masses on which histopathologic examination was performed. Tissue biopsy may be performed on solid breast masses that do not meet the criteria for benign masses according to the Stavros sonographic criteria.

CT findings of a unicameral calcaneal bone cyst containing a fluid-fluid level.

Calcaneal unicameral bone cysts often contain fluid, but rarely contain fluid-fluid levels. We present a case focusing on the CT findings of a large calcaneal bone cyst with a fluid-fluid level and a review of the literature.

Ruptured retroperitoneal lymphatic malformation.

Retroperitoneal lymphatic malformations can cause significant displacement, pressure, or entrapment of adjacent organs raising suspicion of a malignant retroperitoneal tumor. They often mimic ascites but may rarely be a cause of ascites. Computed tomography (CT) imaging findings in an infant with a cystic retroperitoneal lymphatic malformation and massive chylous ascites are reported.

Clinical and surgical correlation of hip MR arthrographic findings in adolescents.

OBJECTIVE: The purpose of this study was to analyze the utility of MRA-H in adolescents by comparing the results of imaging with surgical findings and/or clinical outcome. MATERIAL AND METHODS: After obtaining appropriate IRB approval, the Radiologic Information System database was queried for all patients 13-18 years of age who underwent MRA-H from 2004 through 2013. The electronic medical record was reviewed for clinical history, clinical examination findings, and operative notes. MRA-H images were reviewed for soft tissue abnormalities (labral tear, paralabral ganglion, articular cartilage loss, synovitis, ligament tears) and bony abnormalities (cam-type femoroacetabular impingement (FAI), pincer-type FAI, hip dysplasia). MRA-H findings were correlated with surgical findings and with clinical outcomes. RESULTS: Twenty-six patients with labral tears by MRA-H were included in study and grouped as follows: Group I) patients who underwent surgical management (n=10); group II) patients managed non-surgically (medication, intra-articular injection, physical therapy) (n=9); group III) patients lost to follow up after being advised to have surgery (n=7). With regard to presenting symptomatology, 87.5% of patients with labral tear had groin pain. Of those patients who were diagnosed with a labral tear, 52% were categorized as idiopathic labral tears, 26% as secondary tears (secondary to abnormal bony morphology), and 22% as traumatic labral tears. The labral tears were found to be anterior in 61% and posterior in 22%. Associated articular cartilage lesions were found in 29% of patients. In group I (surgical patients), MRA-H labral findings were confirmed at surgery in 9/10. Seventy percent of labral tears in our study had some form of abnormal bony morphology. Nine of the 12 patients with bone abnormalities were derived from group I patients. Six out of 7 patients with cam-type FAI had a labral tear. CONCLUSION: Labral tears diagnosed by MRA-H in the adolescent population correlated well with clinical examination and surgical findings. Also, MRA-H contributed by defining bony morphology that was directly applied to surgical management. Non-surgical management of labral tears diagnosed on MRA-H had a generally favorable outcome.

Sonographic features of physiologic neonatal breast enlargement.

The varying presentations of neonatal breast enlargement on imaging have been underreported in the literature. Our case report profiles a 3-week-old female patient who presented with a history of left breast enlargement with redness and tenderness for 2 days, who was clinically diagnosed and managed for neonatal mastitis, which was actually a neonatal breast enlargement with adjacent cellulitis. Awareness that physiologic neonatal breast enlargement can be associated with adjacent cellulitis without mastitis can prevent unnecessary hospitalization and treatment with parenteral antibiotics.

Cervical lymph node fine needle aspiration in patients with no history of malignancy.

OBJECTIVE: The purpose of this study is to determine the utility of cervical lymph node fine needle aspiration (FNA) in patients with sonographically normal lymph nodes and without history of malignancy. METHODS: A total of 24 adult patients without prior history of malignancy who had ultrasound-guided FNA of a single enlarged cervical lymph node were identified. Images of lymph nodes in these patients were retrospectively evaluated for characteristics indicative of malignancy-shape, sharpness of borders, absence of an echogenic hilum, calcifications, necroses/cysts, and peripheral vascularity. These results were correlated with histopathologic findings. Findings were also correlated with specific clinical findings that may have lead to the referral for FNA RESULTS: The only sonographic characteristic with a significant association with lymph node malignancy was the absence of an echogenic hilus. No significant correlation was found between the clinical findings evaluated and the cervical lymph node benignity or malignancy. CONCLUSION: The presence of a sonographic echogenic hilus in the lymph nodes of patients with no history of malignancy favors benignity. This feature and other sonographic and clinical findings must be considered when deciding whether FNA is indicated.

Sonographic appearance of ruptured ovarian cyst in the neonatal period.

Rupture is a rare complication of ovarian cysts diagnosed during the prenatal period. We present a case that focuses on the postnatal sonographic appearance of rupture of an ovarian cyst after vaginal delivery. Histopathologic correlation is provided. The main sonographic features include complicated ascites and a collapsed cystic structure in the abdomen. Ruptured ovarian cyst should be included in the differential diagnosis of unexplained ascites in a newborn girl.

Characteristic sonographic findings of hepatic erosion by umbilical vein catheters.

OBJECTIVE: The purpose of this series is to describe findings seen on abdominal sonography in neonates with erosion into the liver by umbilical vein catheters (UVCs). METHODS: Four neonates with erosion of the UVC into hepatic parenchyma within a 2-year period were identified. A retrospective case analysis was performed to determine the symptoms and clinical scenario of presentation. Plain radiographs were examined to establish the location of the UVC placement, and abdominal sonograms were reviewed. RESULTS: All 4 neonates had abdominal distension within 9 days of UVC placement, and in all of them, the UVC tip was located below the hemidiaphragm and superimposed over the liver. Sonographic examination of all patients showed intraparenchymal liver lesions with an echogenic rim and hypoechoic center. Two neonates also had subcapsular fluid collections. Complex ascites was seen in all 4 patients. The fluid was proven to be total parenteral nutrition by paracentesis in 2 patients. Treatment consisted of removal of the UVC. All patients were followed for a period of 2 to 18 months and showed clinical resolution of symptoms or sonographic improvement of the liver lesions. CONCLUSIONS: A characteristic liver lesion can be seen on sonography with hepatic erosion by UVCs. Our study shows the importance of a high index of suspicion of UVC erosion into the liver in neonates with catheters positioned in the liver. When such neonates have abdominal distension, prompt abdominal sonograms should be obtained.

MRI findings of an intermuscular lipoma in a 2-year-old.

We report the MRI findings of a large deep intermuscular lipoma in a 2-year-old child with a painless palpable shoulder mass, and its differentiation from liposarcoma and other soft-tissue masses. To our knowledge, the imaging features of deep lipomas in children have not been reported.

Utility of computed tomographic renal angiogram in the management of childhood hypertension.

The purpose of this study was to evaluate the utility of computed tomography (CT) renal angiogram (CTRA) in the management of childhood hypertension. This is a retrospective study of 24 children with clinical suspicion of renovascular disease who underwent CTRA examinations. CTRA demonstrated surgically correctable etiology of hypertension in 38% of the patients [5 with renal artery stenosis (RAS) and 4 with renal pathology]. In 5 patients, CTRA findings of RAS were confirmed by catheter angiogram. CTRA missed RAS in 1 patient in whom catheter angiogram showed beaded narrowing of the renal artery. All 6 patients with RAS had resolution of hypertension immediately after angioplasty or surgery. One patient with diffuse renal artery stenosis had an ipsilateral multicystic dysplastic kidney. In this patient hypertension resolved spontaneously as the dysplastic kidney shrunk in size. Seven patients had a renal etiology for hypertension. In 3 of these patients hypertension resolved after nephrectomy. Malignant hypertension in the 4th patient with reflux nephropathy was controlled medically after she underwent bilateral ureteral reimplantation. The remaining 3 patients with renal etiology were managed medically. We found that the etiology was central for hypertension in 4 patients with brain abnormalities, obesity in 1 overweight patient, essential hypertension in 4 patients, and thoracic aorta coarctation in 1 patient. Our study showed that in all except 1 instance CTRA could diagnose a surgically correctable cause for hypertension. CTRA provided useful information for the management of pediatric hypertension in all our patients.

Sonographic appearance of bladder malacoplakia.

We report sonographic features of bladder malacoplakia (multiple polypoid solid masses) in a 16-year-old girl with Russell-Silver syndrome who presented with renal failure and urinary tract infection.