Cardiovascular manifestations and cardiac magnetic resonance follow-up of multisystem inflammatory syndrome in children (MIS-C).

OBJECTIVE: This study aimed to evaluate the cardiovascular manifestations and surveillance of multisystem inflammatory syndrome in children (MIS-C) and to determine the correlation of echocardiographic findings with cardiac magnetic resonance imaging findings. METHODS: Forty-four children diagnosed as MIS-C with cardiac involvement were enrolled in this observational descriptive study. The diagnosis of MIS-C was made according to the criteria of Centers for Disease Control and Prevention. Clinical findings, laboratory parameters, and electrocardiographic and echocardiographic findings at the time of diagnosis and during follow-up were evaluated. Cardiac magnetic resonance was performed on 28 (64%) cases. The 1-year follow-up imaging was performed in all cases with abnormal initial cardiac magnetic resonance findings. RESULTS: Forty-four patients (56.8% male) with a mean age of 8.5 ± 4.8 years were enrolled in this study. There was a significant positive correlation between high-sensitivity cardiac troponin T (mean: 162 ± 444.4 pg/ml) and N-terminal pro b-type natriuretic peptide (mean: 10,054 ± 11,604 pg/ml) (p < 0.01). Number of cases with an electrocardiographic and echocardiographic abnormality was 34 (77%) and 31 (70%), respectively. Twelve cases (45%) had left ventricular systolic dysfunction and 14 (32%) cases had pericardial effusion on admission. Three cases (11%) had cardiac magnetic resonance findings that may be attributed to the presence of myocardial inflammation, and pericardial effusion was present in seven (25%) cases. Follow-up cardiac magnetic resonances of all cases were normal. Cardiac abnormalities were completely resolved in all except two cases. CONCLUSIONS: Myocardial involvement can be seen during acute disease, but MIS-C generally does not lead to prominent damage during a year of surveillance. Cardiac magnetic resonance is a valuable tool to evaluate the degree of myocardial involvement in cases with MIS-C.

SARS-CoV-2 infection showing signs of cerebral sinus vein thrombosis in the infantile period.

The clinical manifestations of SARS-CoV-2 infection mainly involve the respiratory system. However, there is increasing evidence that this virus can affect other organs, causing a wide range of clinical symptoms. This is the report of a 40-day-old patient who presented with sepsis and had no risk factors other than SARS-CoV-2 infection, whose radiological findings were compatible with cerebral sinus vein thrombosis.

Association of Gallbladder Volume and Wall Thickness With Acute Appendicitis in Pediatric Patients.

OBJECTIVES: Ultrasonography in a child with suspected appendicitis is primarily performed to detect inflamed appendix, whereas secondary findings are important in patients with a nonvisualized appendix. The aim of this study is to evaluate the gallbladder wall thickness and volume in patients with suspected appendicitis and search an association between these parameters and appendicitis. METHODS: Between January 2018 and August 2018, 113 patients with suspected appendicitis were included in this prospective study. Gallbladder and right lower quadrant were evaluated in separate sessions by different radiologists. The wall thickness along with the width, length, and height of the gallbladder was measured and recorded for each patient. Assessment of the appendix was classified as acute appendicitis, normal, and equivocal. Statistically significant association was sought between the thickness of the gallbladder wall and diagnosis of appendicitis. RESULTS: Gallbladder wall thickness was significantly higher in patients without appendicitis (P = 0.017), whereas significantly increased gallbladder volume was observed in patients with appendicitis (P = 0.004). Receiver operating characteristic analysis showed gallbladder wall thickness threshold of 0.5 mm with a sensitivity of 83.3, specificity of 93.9, and volume threshold of 41.6 mL with a sensitivity of 100 and a specificity of 0.69. CONCLUSIONS: Gallbladder wall thickness and volume measurements were associated with the diagnosis of appendicitis in pediatric patients.

A novel DCAF17 homozygous mutation in a girl with Woodhouse-Sakati syndrome and review of the current literature.

Background Woodhouse-Sakati syndrome (WSS) (OMIM#241080) is an extremely rare multisystemic disease. Alopecia, hypogonadism, loss of hearing, hypothyroidism, diabetes mellitus (DM) and neurological disorders are the components of this syndrome. The syndrome is caused by homozygous or compound heterozygous mutations in DCAF17, and has recently been implicated in the development of both male and female gonads, thus resulting in hypogonadism. Case report A 16-year-old girl with consanguineous parents was admitted to our hospital with absence of breast development and amenorrhea. Hypogonadism was detected, in the form of hypergonadotropic hypogonadism. Whole-exome sequencing was used to identify the genetic etiology underlying the hypogonadism. A novel homozygous variant c.1091 + 1G > A was detected in DCAF17. Both parents were sequenced and identified as heterozygous for the same mutation. Conclusions We report a novel mutation detected in the DCAF17 gene and discuss the clinical findings in patients with previously reported mutations. Various manifestations of WSS, such as alopecia, endocrinological and neurological disorders, do not emerge until later in life, and therefore this situation can be challenging to diagnose particularly in pediatric cases, as in the present report. Careful attention should be paid to these additional findings, which may lead to early diagnosis and reduced genetic analysis costs, in patients with hypogonadism. In addition, there was no obvious genetic-phenotype correlation in reported cases.

Planimetry investigation of the corpus callosum in temporal lobe epilepsy patients.

OBJECTIVE: To evaluate the effects of temporal lobe epilepsy (TLE) on corpus callosum (CC) morphometry in patients with TLE. METHODS: This retrospective study was conducted at the Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey between November 2010 and December 2013. The epileptic syndrome diagnosis was based on International League Against Epilepsy criteria, and this study was conducted on the MRIs of 25 epilepsy patients and 25 control subjects. We classified the patients according to their duration of epilepsy: <10 and >/=10 years. The projection area length (PAL) of the CC was also estimated. Total brain volumes (TBV) were measured on CT images. RESULTS: The mean values of TBV for patients with TLE and the control group were not statistically different, but the CC PAL values were statistically different. The mean CC PAL values of under and over 25 years of age in patients with TLE were statistically different. The mean values of TBV of under and over 10 years duration of TLE were small statistically, but the CC PAL values were statistically different. CONCLUSION: The results indicate a clear influence of TLE on the structure of the CC rather than TBV.

Evaluation of carotid intima-media thickness and carotid arterial stiffness in children with adenotonsillar hypertrophy.

BACKGROUND: Adenotonsillar hypertrophy can produce cardiopulmonary disease in children. However, it is unclear whether adenotonsillar hypertrophy causes atherosclerosis. This study evaluated carotid intimamedia thickness and carotid arterial stiffness in children with adenotonsillar hypertrophy. METHODS: The study included 40 children with adenotonsillar hypertrophy (age: 5-10 years) and 36 healthy children with similar age and body mass index. Systolic blood pressure, diastolic blood pressure, and pulse pressure were measured in all subjects. Carotid intima-media thickness, carotid arterial systolic diameter, and carotid arterial diastolic diameter were measured using a high-resolution ultrasound device. Based on these measurements, carotid arterial strain, carotid artery distensibility, beta stiffness index, and elasticity modulus were calculated. RESULTS: Carotid intima-media thickness was greater in children with adenotonsillar hypertrophy (0.36±0.05 mm vs. 0.34±0.04 mm, P=0.02) compared to healthy controls. Beta stiffness index (3.01±1.22 vs. 2.98±0.98, P=0.85), elasticity modulus (231.39±99.23 vs. 226.46±83.20, P=0.88), carotid arterial strain (0.17±0.06 vs. 0.17±0.04, P=0.95), and carotid artery distensibility (13.14±3.88 vs. 12.92±3.84, P=0.75) were similar between children with adenotonsillar hypertrophy and the healthy controls. CONCLUSIONS: The present study revealed increased carotid intima-media thickness in children with adenotonsillar hypertrophy. The risk of subclinical atherosclerosis may be higher in children with adenotonsillar hypertrophy.

Unilateral cataract and vitreoretinopathy in a case with klippel-trenaunay syndrome.

Purpose. We present a case with Klippel-Trenaunay (KT) syndrome that had unilateral mature cataract and vitreoretinopathy. Case Report. A 17-year-old boy with KT syndrome presented to the clinic of ophthalmology for low vision in the right eye. His best corrected visual acuity (BCVA) was hand motion in the right eye and 20/20 in the left eye. Anterior segment examination revealed mature cataract in the right. During the physical examination, port-wine stains were noted over right side of his face, ankle, and toes. He had asymmetric face and his head was larger on the right side. Leg lengths were symmetrical, although he had skin hypertrophy. Cranial magnetic resonance imaging studies showed cortical atrophy discordant to his age, asymmetric vascular dilatations in the right hemisphere, hypertrophy in the right periorbital soft tissue, and choroidal plexus. The patient received an uncomplicated cataract surgery. His BCVA in the right eye improved to 20/200 after the surgery. After removing cataractous lens, we were able to examine the fundus that revealed severe vitreoretinopathy and choroidal hemangioma. Conclusion. This case emphasizes the importance of prompt ophthalmic examination in patients with KT syndrome.

Migration of ingested sewing needle from within sigmoid colon to outside of the lumen.

Foreign body ingestion is a frequently observed condition in children. However, migration of an ingested foreign body from the gastrointestinal tract toward any abdominal organ is extremely rare. We report herein a case of a 2-year-old female patient in whom an ingested sewing needle was palpable by rectal examination and was determined to have migrated from within the sigmoid colon to outside of the lumen. The needle was surgically removed. In cases of foreign body ingestion, both physical examination and radiological follow-up should be performed.

A Rare Variation of Hepatic Arteries (Michels Type IV): MDCT Angiographic Findings.

Recently, evaluation of hepatic artery variations has become increasingly important as liver transplantation from live donors gains in popular. Many diagnostic tools can be used to evaluate hepatic artery anatomy. Multi-detector computed tomography angiography (MDCTA) is one these methods. In this case report, we represent MDCTA findings of Michel type IV variation, which is a very rare condition of hepatic arteries.

Venous malformation between the external and internal jugular vein results in swelling: multidetector computed tomography imaging.

Venous malformation between the external and internal jugular vein characterized by nonfluctant, painless, and nonpulsatile swelling on the right side of his neck while the individual was singing was reported in a 45-year-old man. Interestingly, there was no skin lesion observed on his neck. The swelling increased in size when the patient was shouting (Valsalva maneuver) and diminished in size during periods of rest. Contrast enhanced multi detector computed tomography (MDCT) angiography indicated the presence of a venous malformation between the external and internal jugular vein. The patient was administered a conservative treatment strategy. Notably, only symptomatic malformations or lesions causing important aesthetic prejudice require surgical treatment. In this case, there were no symptoms or esthetic issues. Thus, we recommend diagnosis using MDCT imaging for vascular malformations at contraindicate magnetic resonance imaging (MRI).

Ectopic multinodular goiter: multidetector computed tomography findings.

The thyroid is the first endocrine gland to form during embryogenesis. At this stage, incomplete or anomalous migration of thyroid tissue causes ectopic localization of the gland. In our case, a 55-year-old woman who was evaluated via ultrasonography (USG) and multi-detector computed tomography (MDCT) had no thyroid gland at the normal location, but did have ectopic thyroid tissue in the left submandibular and submental regions.

The Multi-Detector CT findings of giant abdominal lymphangiectasis mimicking a mesenteric cystic mass in a patient with midgut volvulus.

Our purpose is to show the Multi-Detector CT (MDCT) findings of an intra-abdominal giant cystic lesion with midgut volvulus and to share our experience with giant lymphangiectasis mimicking a mesenteric cyst or a cystic mass. The pathological evaluation indicated that the cyst contained abdominal lymphatic material. Malrotation is usually detected in infants and children, but rarely in adults. In patients with chronic and recurrent volvulus, chronic venous congestion with lymphatic engorgement may occur. Interference with lymphatic drainage may result in formation of a lymphangioma or a chylous mesenteric cyst. In our case, because of the intestinal lymphatic torsion, there was a cystic lesion mimicking a mesenteric cyst or a cystic mass. To our knowledge, this is the first case of midgut volvulus and large mesenteric lymphangiectasis to be depicted by MDCT.