Imaging in pediatric urology.

A multitude of disorders of the genitourinary tract can occur in children. Although some entities may be diagnosed clinically, radiologic imaging is often necessary for diagnosis and management. The radiologic work-up has been discussed using a problem-oriented approach in five clinical situations: urinary tract infection, hydronephrosis or hydroureter, trauma, swollen scrotum, and hematuria. This discussion provides some general guidelines, although the evaluation of each child may need to be individualized depending on their specific clinical symptomatology.

Uterine anomalies in Wilms' tumor survivors.

BACKGROUND: The association between Wilms' tumor (WT) and genitourinary (GU) anomalies has long been appreciated; however, associated GU anomalies have been described almost exclusively in males. METHODS: To investigate whether females with WT also have an increased prevalence of GU anomalies, the authors evaluated the uterine anatomy of 24 WT survivors using magnetic resonance imaging and ultrasonography. RESULTS: Two of 24 female survivors (8%) had anomalies. One had a septate uterus, and a limited molecular analysis of her constitutional DNA revealed no mutations or deletions of the tumor suppressor gene WT1. Another survivor with the WAGR syndrome (WT, aniridia, GU anomalies, and retardation), with the characteristic 11p13 deletion including WT1, had a uterine anomaly (hypoplastic vs. unicornuate). CONCLUSIONS: Because uterine malformations are rare in the general population, this finding suggests an association between WT and uterine malformations and also may partially explain the fertility deficit previously demonstrated in adult female WT survivors. Pelvic ultrasonography in adult female WT survivors can alert survivors and clinicians to possible fertility problems that may lead to problem pregnancies and adverse pregnancy outcomes.

Radioaerosol assessment of lung improvement in cystic fibrosis patients treated for acute pulmonary exacerbations.

We compared bronchopulmonary distribution homogeneity of a radioaerosol before and after hospitalization in 20 patients with cystic fibrosis (CF) with pulmonary exacerbations in order to assess lung improvement. Deposition homogeneity was quantified in terms of skew (an index of distribution symmetry), derived from frequency distribution histograms generated from gamma camera images of the lungs following radioaerosol inhalation. Lower skew values indicate enhanced distribution homogeneity. Right lung skew (RLS) was significantly reduced following therapy (1.00 +/- 0.49 to 0.84 +/- 0.47), whereas skew in the left lung was unchanged (0.95 +/- 0.38 to 0.87 +/- 0.40). The reduction in RLS was significant in patients with Shwachman-Kulczycki (SK) clinical scores less than 50 (1.27 +/- 0.53 to 0.90 +/- 0.42), but not in patients with scores greater than 50 (0.81 +/- 0.38 to 0.80 +/- 0.52). These results indicate that treatment affected the right lung more than the left lung, particularly in patients with SK scores less than 50, and suggests that radioaerosol lung imaging may be valuable in identifying sites of impairment to be targeted during treatment. Statistically, skew was less sensitive an indicator of acute change than several other clinical indices that improved following hospital treatment.