Parosteal Lipoma.

Teaching Point: Recognizing the distinct imaging features of parosteal lipoma.

Fetal kidneys: additional sonographic criteria of normal development.

OBJECTIVE: The aim of this study was to establish objective criteria for the evaluation of cortical echogenicity (CE), cortical thickness (CT), and medullary thickness (MT), as well as the corticomedullary ratio (CMR), throughout gestation. METHOD: In this prospective single-center study, CE, MT, CT, and CMR were evaluated in a group of singleton pregnancies examined by ultrasound during the second and third trimesters. RESULTS: The CE evolved from a hyperechoic pattern compared with the liver or spleen during early second trimester to a hypoechogenic pattern in the third trimester, with no fetus displaying cortical hyperechogenicity after 32 weeks. CT increased from 1.8 to 2.5 mm (p < 0.05) from 21 to 25 to 34 to 37 weeks; MT from 2.7 to 5.1 mm (p < 0.0001), and the CMR decreased from 0.7 to 0.5 (p < 0.001). CONCLUSION: The CE, CT, and MT evolve with gestation. Cortical hyperechogenicity compared with the liver or spleen after 32 weeks or a CMR above 0.7 in the third trimester should raise the suspicion of a fetal nephropathy.

The impact of hydration on renal measurements and on cortical echogenicity in children.

BACKGROUND: Kidney ultrasonography is frequently performed in children; to date there are no specific guidelines regarding hydration before the examination. OBJECTIVE: Because certain renal measurements can be indicative of pathology, we used sequential US images to investigate the effect of standardised hydration in children relative to renal size, echogenicity and pelvic expansion. MATERIALS AND METHODS: Thirty-one children (7 years to 14 years old) underwent US examinations before hydration (T0) and at 30 min (T30) and 60 min (T60) after ingesting water. We measured bladder volume, inter-polar kidney size, renal volume and anterior-posterior diameter of the pelvis. Cortical echogenicity was compared to that of the liver and spleen. RESULTS: On the right side the increase in average inter-polar renal size was 2.5% at T30 and 2.6% at T60 (P < 0.05) compared to T0. On the left the increase was 3.8% at T30 and 4.3% at T60 (P < 0.05). Volume expansion for the right kidney was 16.8% at T30 and 14.0% at T60 (P < 0.05). On the left it was 12.9% at T30 and 10.2% at T60 (P < 0.05). Cortical echogenicity progressed from hypoechogenicity to isoechogenicity (P < 0.05). The percentage of expanded pelves increased with hydration (T0: 3.2%, T30: 9.7%, T60: 22.6%). CONCLUSION: Oral hydration influences renal length, volume and echogenicity in children. Hydration results in expansion of the pelvis. We recommend standardisation of hydration before US examination.

Is there a chance for regeneration of intervertebral discs? A preliminary study / Van-e esély az intervertebralis discusok regenerációjára? Elozetes tanulmány

Introduction: Segmental instability of the spine caused by the decreased height of intervertebral discs is one of the major causes of chronic low back pain affecting 70-80% of the adult population. The decrease in height is due to degenerative lesions induced by vertical compression overload of the disc. Objective: A preliminary study was performed to determine if disc degeneration due to overload could be stopped. We hypothesized that disc distraction during fission surgery from posterior approach could reduce the pressure on the discs, degeneration could be stopped, and perhaps the function could be restored. Methods: To characterize the condition of the discus, we used the determination glycosaminoglycan content, which is responsible for the disc-bound water content and thus for ensuring its elasticity. The use of gadolinium contrast agent in MRI (dGEMRIC) is an accepted method for determining the glycosaminoglycan content of the intervertebral disc, as the concentration of absorbed contrast agent is inversely proportional to the number of glycosaminoglycans in the intervertebral discs. In addition to pre- and postoperative dGEMRIC data, we examined disc height, lumbar lordosis, visual analog pain scale, and the Oswestry Disability Index. Results: All patients underwent monosegmental fusion Mowing posterior distraction of the affected segment due to segmental instability. During the surgeries, lumbar lordosis did not decrease despite posterior distraction. The heights of the discus increased by an average of 3 mm, the pain decreased, and the Oswestry Disability Index improved. In the dGEMRIC studies, an average of 309.18 units/cm(2) of gadolinium accumulated in the discs before surgery, which decreased postoperatively to 174.43 units/cm(2). All changes were significant at the p = 0.05 significance level. Conclusion: The trend of our preliminary results suggests that increasing the height of the discs can reduce the hydrostatic pressure in the discs, resulting in an increase in the amount of glycosaminoglycans, which can stop the degeneration of the discs and also initiate regeneration processes.

Comparison of Chest Computed Tomography Between the Two Waves of Coronavirus Disease 2019 in Belgium Using Artificial Intelligence.

Background In this study, we aimed to compare two outbreaks of coronavirus disease 2019 (COVID-19) in Belgium in tomographic and biological-clinical aspects with artificial intelligence (AI). Methodology We performed an observational retrospective study. Adult patients who were symptomatic in the first seven days with COVID-19 infection, diagnosed by chest computed tomography (CT) and/or reverse transcription-polymerase chain reaction, were included in this study. The first wave of the pandemic lasted from March 25, 2020, to May 25, 2020, and the second wave lasted from October 7, 2020, to December 7, 2020. For each wave, two subgroups were defined depending on whether respiratory failure occurred during the course of the disease. The quantitative estimation of COVID-19 lung lesions was performed by AI, radiologists, and radiology residents. The chest CT severity score was calculated by AI. Results In the 202 patients included in this study, we found statistically significant differences for obesity, hypertension, and asthma. The differences were predominant in the second wave. Moreover, a mixed distribution (central and peripherical) of pulmonary lesions was noted in the second wave, but no differences were noted regarding mortality, respiratory failure, complications, and other radiological and biological elements. Chest CT severity score was among the risk factors of mortality and respiratory failure. There was a mild agreement between AI and visual evaluation of pulmonary lesion extension (K = 0.4). Conclusions Between March and December 2020, in our cohort, for the majority of the parameters analyzed, we did not record significant changes between the two waves. AI can reduce the experience and performance gap of radiologists and better establish a hospitalization criterion.

A rare case of primary hyperoxaluria type 1 co-existing with autosomal-dominant polycystic kidney disease in a newborn.

We describe the first reported case to our knowledge of an infant presenting with the extremely rare association of primary hyperoxaluria type 1 (PH-1) and autosomal-dominant polycystic kidney disease (ADPKD). This diagnosis was suspected on the basis of the renal US findings and confirmed by complementary examinations. It led to severe oxalosis with very rapid onset of end-stage renal failure (ESRF) and required combined liver-kidney transplantation at the age of 18 months. The boy died 13 days after transplantation.

Update on congenital nephrotic syndromes and the contribution of US.

The clinical classification of nephrotic syndrome (NS) is based on age at presentation. However, this classification is arbitrary because the majority of early onset NS has a genetic origin and has a widespread age of onset (from fetal life to several years). The aims of this review are to illustrate the knowledge accumulated on congenital nephrotic syndrome (CNS) in terms of genetics, classification, findings at histology and US-based on a review of the literature.

A rare cause of persistent hyperparathyroidism.

In a case of patient with persistent hypercalcemia after parathyroidectomy, different imaging techniques and particularly 18F-fluorocholine PET/CT are important to localize the adenoma even in a very unusual location.

Oesophageal lesions as first manifestation of necrotising sarcoid granulomatosis.

Necrotising sarcoid granulomatosis is a rare disease associating sarcoid-like granulomas, vasculitis and necrosis in the lungs and seldom in extrapulmonary locations. We report the case of a 23-year-old woman with an initial symptom consisting of epigastric pain. Oesophagoscopy demonstrated oesophagitis. Evolution was marked by fever, dyspnoea and pulmonary lesions. The first presumptive diagnosis was Wegener disease but biopsies (of the lungs and the oesophagus) demonstrated the diagnosis of necrotising sarcoid granulomatosis. Evolution was favourable under corticoid therapy. Necrotising sarcoid granulomatosis may present as an extrapulmonary disease and is an important differential diagnosis of other disease such as Wegener disease.

Ease of using a dedicated percutaneous closure device after inadvertent cannulation of the subclavian artery: case report.

Inadvertent puncture of the subclavian artery is a relatively frequent and potentially disastrous complication of attempted central venous access. Due to its noncompressible location, accidental subclavian arterial cannulation may result in hemorrhage as the sheath is removed. We report a new case of successful percutaneous closure of the subclavian artery which had been inadvertently cannulated, using a closure device based on a collagen plug (Angio-Seal, St. Jude Medical). This was performed in a patient who had received maximal antiplatelet and anticoagulation therapies because of prior coronary stenting in the context of cardiogenic shock. There was no prior angiographic assessment, as arterial puncture was presumed to have been distal to the right common artery and vertebral arteries. No complications were observed in this high-risk patient, suggesting that this technique could be used once the procedure has been evaluated prospectively.