CT-guided hook-wire localization of pulmonary nodules in children prior to atypical resection by thoracoscopy: Practical aspects.

In the multidisciplinary treatment of pediatric oncologic patients, multiple imaging tests, biopsies, and resections are required for diagnosis, initial staging, and posterior restaging. In these patients, pulmonary nodules are not always metastases, so the correct diagnosis of these lesions affects their treatment and the patient's survival. Percutaneous localization of pulmonary nodules is key for two reasons: it enables the surgeon to resect the smallest amount of lung tissue possible and it guarantees that the nodule will be included in the resected specimen. Without percutaneous localization, it can be impossible to accomplish these two objectives in patients with very small nodules that are separated from the pleural surface and therefore impossible to see by thoracoscopy. This article reviews the technique for hook-wire localization of pulmonary nodules and the keys to ensuring the best results.

Self-limiting sternal tumors of childhood (SELSTOC): A diagnostic challenge.

INTRODUCTION: Self-limiting sternal tumors of childhood (SELSTOC) are rapidly growing sternal lesions that tend to resolve spontaneously. Patients have no history of infection, trauma, or neoplasms, and the most likely etiologyis an aseptic inflammatory reaction of unknown origin. The differential diagnosis includes a wide spectrum of lesions such as tumors, infections, malformations, or anatomic variants. MATERIAL AND METHODS: We analyzed all cases of sternal masses in pediatric patients seen between 2012 and 2019; five of these had findings compatible with SELSTOC. We retrospectively recorded patients' race, sex, age, clinical presentation, laboratory findings, imaging tests, treatment, and follow-up. RESULTS: We present five cases of rapidly growing sternal lesions whose clinical and radiological features are compatible with SELSTOC. In the absence of alarming symptoms and laboratory markers, watchful waiting could be an appropriate therapeutic approach. However, patients with some findings such as fever, elevated acute phase reactants, and/or comorbidities could require therapeutic interventions such as antibiotics or percutaneous drainage. In our series, depending on the clinical presentation and the patient's comorbidities, different therapeutic approaches were adopted (a conservative approach in two patients, antibiotics in three patients, and percutaneous drainage in one patient). In all cases, the sternal lesion was absent at discharge and/or at later follow-up visits. CONCLUSION: Radiologists and pediatricians must be aware of this entity and the different diagnostic and therapeutic approaches to rapidly growing sternal lesions in pediatricpatients because recognizing SELSTOC can avoid unnecessary diagnostic tests and/or disproportionate therapeutic strategies.

Pediatric chest X-rays during the COVID-19 pandemic. / Radiografía de tórax pediátrica en la era COVID.

BACKGROUND: An infectious disease caused by a new type of coronavirus that can manifest as an acute respiratory infection was discovered in China in mid-December 2019 and soon spread throughout the country and to the rest of the world. Although chest X-rays are the initial imaging technique of choice for low respiratory infections with or without dyspnea, few articles have reported the radiologic findings in children with COVID-19. OBJECTIVE: To describe the clinical, laboratory, and chest X-ray findings in pediatric patients with signs and symptoms of respiratory infection attended at our hospital in March 2020. To analyze the frequency of COVID-19 compared to other respiratory infections, and to describe the radiologic manifestations of COVID-19 in pediatric patients. MATERIAL AND METHODS: This cross-sectional observational study included all children with clinical manifestations of respiratory infection (fever, rhinorrhea, cough, and/or dyspnea) that required chest X-rays in our hospital between March 1 and March 31. RESULTS: A total of 231 pediatric patients (90 (39%) girls and 141 (61%) boys; mean age, 4 y, range 1 month - 16 years) underwent chest X-rays for suspected respiratory infections. Most (88.4%) had mild symptoms; 29.9% had a family member positive for COVID-19 with symptoms similar to those of the patient. Nasal and/or throat swabs were analyzed for SARS-CoV-2 with PCR in the 47 (20.3%) children who presented at the emergency department; 3 (6.3%) of these were positive. Microbiological analyses were done in 85 (36.8%) of all patients, finding infections due to pathogens other than SARS-CoV-2 in 30 (35.3%). One of the patients with a PCR positive for SARS-CoV-2 had urine infection due to E. coli and blood culture positive for S. viridans. Abnormalities were observed on X-rays in 73.2% of the patients. Peribronchial thickening was the most common abnormal finding, observed in 57% of patients. Parenchymal consolidations were observed in 38.5%, being bilateral in 29.2% and associated with pleural effusion in 3.3%. The interstitial lines were thickened in 7.3%, and 7.3% had ground-glass opacities. CONCLUSION: During March 2020, COVID-19 and other symptomatic respiratory infections were observed. The radiologic pattern of these infections is nonspecific, and chest X-rays alone are insufficient for the diagnosis. Children with clinical manifestations compatible with COVID-19 (with or without PCR confirmation of infection by SARS-CoV-2) had mild symptoms and most did not require admission or invasive mechanical ventilation. In a context of community transmission, the absence of a known epidemiological antecedent should not be a contraindication for PCR to detect SARS-CoV-2.

Practical management of pulmonary nodules in the most common pediatric tumors. / Manejo práctico de los nódulos pulmonares en las neoplasias pediátricas más frecuentes.

In pediatric patients with sarcomas, hepatoblastomas, or other types of primary tumors, lung metastases are often found at diagnosis or during follow-up. The wide variety of primary tumors and clinical situations makes management and follow-up of these patients challenging. Chest CT is the best way to detect the dissemination of disease to the lungs. Many pulmonary nodules are nonspecific, and many might not be pathological. Others have characteristics that make them suspicious. Although there are some general features that indicate that a pulmonary nodule is likely to be a metastasis, sometimes the meaning of these features depends on the primary tumor. Furthermore, metastases can develop during the course of the disease, and the protocols for follow-up are different for different primary tumors. We review the different protocols used at our hospital for the primary tumors that most often metastasize to the lungs, including the criteria for lung metastases and the follow-up for each primary tumor.

Radiografía de tórax pediátrica en la era COVID / Pediatric chest X-rays during the COVID-19 pandemic

INTRODUCCIÓN: A mediados de diciembre de 2019 se describió en China una enfermedad infecciosa causada por un nuevo tipo de coronavirus que provocaba infección respiratoria aguda y pronto se extendió por el país y por el resto del mundo. A pesar de que la radiografía de tórax es la prueba de elección inicial ante infecciones respiratorias bajas con o sin disnea, hay pocos artículos que describan los hallazgos radiológicos del niño con COVID-19. OBJETIVO: Describir las características clínicas, analíticas y los hallazgos en la radiografía de tórax de la población pediátrica atendida con clínica de infección respiratoria en nuestro hospital durante el mes de marzo. Analizar la frecuencia de COVID-19 frente a otras infecciones respiratorias y sus manifestaciones radiológicas. MATERIAL Y MÉTODOS: Estudio observacional transversal desde el 1 de marzo al 31 de marzo del 2020 de todos los niños con clínica de infección respiratoria (fiebre, rinorrea, tos y/o disnea) que han precisado radiografía de tórax en nuestro hospital. RESULTADOS: 231 niños precisaron radiografía de tórax por clínica de infección respiratoria, 90 (38,9%) niñas y 141 (61%) niños; rango de edad 1 mes-16 años, con una mediana de 4 años. La mayoría de los niños presentaron síntomas leves (88,4%). Un 29,9% de los niños presentaba ambiente epidémico familiar positivo con clínica respiratoria similar a la que presentaba el paciente. Se realizó test PCR SARS-CoV-2 a 47 de los niños que acudieron a la urgencia (20,3%), que fue positivo en 3 (6,3% de los testados). Se realizaron determinaciones microbiológicas al 36,8% (85/231), demostraron otros agentes infecciosos diferentes al SARS-CoV-2 en el 35,3% de los pacientes (30/85). Únicamente uno de los pacientes PCR positivo para SARS-CoV-2 presentó infección de orina por Escherichia coli y hemocultivo positivo para Streptococcus viridans. El 73,2% de los pacientes presentó algún tipo de alteración en la radiografía de tórax. Los engrosamientos peribronquiales fueron el hallazgo más común en el 57%. El 38,5% presentó consolidación parenquimatosa, que en un 29,2% fue bilateral y en un 3,3% asoció derrame pleural. Se demostró aumento de la trama intersticial en el 7,3%. El 7,3% se manifestó con opacidades en vidrio deslustrado. CONCLUSIÓN: Durante el mes de marzo coexistieron infecciones respiratorias sintomáticas COVID-19 y no COVID-19. El patrón radiológico de las infecciones respiratorias, incluida la COVID-19, no es específico y la radiografía en ningún caso fue suficiente para establecer el diagnóstico. Los niños con clínica respiratoria compatible con COVID-19, con o sin PCR confirmatoria, presentaron síntomas leves y en su mayoría no requirieron ingreso ni ventilación invasiva. En un entorno de transmisión comunitaria, la ausencia de antecedente epidemiológico conocido no debería ser una contraindicación para realizar estudio de PCR para SARS-CoV-2

BACKGROUND: An infectious disease caused by a new type of coronavirus that can manifest as an acute respiratory infection was discovered in China in mid-December 2019 and soon spread throughout the country and to the rest of the world. Although chest X-rays are the initial imaging technique of choice for low respiratory infections with or without dyspnea, few articles have reported the radiologic findings in children with COVID-19. OBJECTIVE: To describe the clinical, laboratory, and chest X-ray findings in pediatric patients with signs and symptoms of respiratory infection attended at our hospital in March 2020. To analyze the frequency of COVID-19 compared to other respiratory infections, and to describe the radiologic manifestations of COVID-19 in pediatric patients. MATERIAL AND METHODS: This cross-sectional observational study included all children with clinical manifestations of respiratory infection (fever, rhinorrhea, cough, and/or dyspnea) that required chest X-rays in our hospital between March 1 and March 31. RESULTS: A total of 231 pediatric patients (90 (39%) girls and 141 (61%) boys; mean age, 4 y, range 1 month - 16 years) underwent chest X-rays for suspected respiratory infections. Most (88.4%) had mild symptoms; 29.9% had a family member positive for COVID-19 with symptoms similar to those of the patient. Nasal and/or throat swabs were analyzed for SARS-CoV-2 with PCR in the 47 (20.3%) children who presented at the emergency department; 3 (6.3%) of these were positive. Microbiological analyses were done in 85 (36.8%) of all patients, finding infections due to pathogens other than SARS-CoV-2 in 30 (35.3%). One of the patients with a PCR positive for SARS-CoV-2 had urine infection due to E. coli and blood culture positive for S. viridans. Abnormalities were observed on X-rays in 73.2% of the patients. Peribronchial thickening was the most common abnormal finding, observed in 57% of patients. Parenchymal consolidations were observed in 38.5%, being bilateral in 29.2% and associated with pleural effusion in 3.3%. The interstitial lines were thickened in 7.3%, and 7.3% had ground-glass opacities. CONCLUSION: During March 2020, COVID-19 and other symptomatic respiratory infections were observed. The radiologic pattern of these infections is nonspecific, and chest X-rays alone are insufficient for the diagnosis. Children with clinical manifestations compatible with COVID-19 (with or without PCR confirmation of infection by SARS-CoV-2) had mild symptoms and most did not require admission or invasive mechanical ventilation. In a context of community transmission, the absence of a known epidemiological antecedent should not be a contraindication for PCR to detect SARS-CoV-2

Diagnóstico y tratamiento de los osteomas osteoides del retropié: un método terapéutico para cada caso / Diagnosis and treatment of hindfoot osteoid osteoma: A therapeutic method for each case

Objetivos: 1) Recordar el diagnóstico de los osteomas osteoides (OO) del pie; y 2)definir las indicaciones de su tratamiento en el retropié. Material y método: Se han revisado un total de 5 osteomas osteoides (3 localizados en el astrágalo y 2 en el calcáneo). El diagnóstico se estableció por datos clínicos y de imagen. En todos los casos se identificó un nidus calcificado en la TC, edema óseo perilesional en la RM y captación focal gammagráfica. Se realizaron 2 termoablaciones con ondas de radiofrecuencia y 3 resecciones: 2 abiertas y una artroscópica. Se evaluaron los resultados clínicos y oncológicos al final del seguimiento. Resultados: No se registró ninguna complicación. El resultado clínico fue excelente en todos los casos. Un paciente fue tratado inicialmente con cirugía abierta y, después, por fracaso del procedimiento, mediante termoablación. No hubo recidivas después de un tiempo medio de seguimiento de 4 años y 6 meses (rango: 1-12 años). Discusión: Los OO del retropié son poco frecuentes y su diagnóstico se basa en la conjunción de datos clínicos con los característicos hallazgos de imagen. El tratamiento depende del asiento del nidus y de las relaciones de este con estructuras anatómicas próximas. Conclusiones: El diagnóstico de un OO del retropié puede asegurarse cuando los datos epidemiológicos, clínicos y de imagen son compatibles con la enfermedad. La termoablación está indicada en casos intracorticales o esponjosos en los que el nidus dista más de 1cm de la piel y de estructuras neurovasculares mayores. En el resto de casos una resección abierta o artroscópica sería de elección

Objectives: 1) to set a reminder of the diagnostic approach to osteoid osteomas (OOs) of the foot; 2) to define the indications of treatment for hindfoot OOs. Material and method: 5 OOs were checked (3 cases located in the talus and two cases in calcaneus). The diagnosis was established by clinical and imaging data. In all cases, a calcified nidus was identified on CT, perilesional bone oedema on MRI and focal scintigraphic uptake. Two cases were treated with radiofrequency ablation (RFA) and 3 cases with surgical resections: two open surgeries and one arthroscopic surgery. Clinical and oncological outcomes were evaluated at the end of the follow-up. Results: No complications were reported. The clinical outcome was excellent in all cases. One patient was initially treated with open surgery and then subsequently with RFA due to failure of the procedure. There were no recurrences after an average follow-up time of 4 years and 8 months (range, 1-12 years). Discussion: Hindfoot OOs are uncommon and their diagnosis is based on clinical data in conjunction with characteristic imaging findings. Their treatment choices depend on the location of the nidus and relationships with nearby anatomical structures. Conclusions: The diagnosis of an OO of the hindfoot can be ensured when the epidemiological, clinical and imaging data are compatible with this pathological entity. RFA is indicated for intracortical or cancellous cases in which the nidus is more than 1cm off the skin and significant neurovascular structures. For all other cases an open surgical resection or arthroscopic resection would be the first choice

Diagnosis and treatment of hindfoot osteoid osteoma: A therapeutic method for each case. / Diagnóstico y tratamiento de los osteomas osteoides del retropié: un método terapéutico para cada caso.

OBJECTIVES: 1) to set a reminder of the diagnostic approach to osteoid osteomas (OOs) of the foot; 2) to define the indications of treatment for hindfoot OOs. MATERIAL AND METHOD: 5 OOs were checked (3 cases located in the talus and two cases in calcaneus). The diagnosis was established by clinical and imaging data. In all cases, a calcified nidus was identified on CT, perilesional bone oedema on MRI and focal scintigraphic uptake. Two cases were treated with radiofrequency ablation (RFA) and 3 cases with surgical resections: two open surgeries and one arthroscopic surgery. Clinical and oncological outcomes were evaluated at the end of the follow-up. RESULTS: No complications were reported. The clinical outcome was excellent in all cases. One patient was initially treated with open surgery and then subsequently with RFA due to failure of the procedure. There were no recurrences after an average follow-up time of 4 years and 8 months (range, 1-12 years). DISCUSSION: Hindfoot OOs are uncommon and their diagnosis is based on clinical data in conjunction with characteristic imaging findings. Their treatment choices depend on the location of the nidus and relationships with nearby anatomical structures. CONCLUSIONS: The diagnosis of an OO of the hindfoot can be ensured when the epidemiological, clinical and imaging data are compatible with this pathological entity. RFA is indicated for intracortical or cancellous cases in which the nidus is more than 1cm off the skin and significant neurovascular structures. For all other cases an open surgical resection or arthroscopic resection would be the first choice.

Tratamiento percutáneo de las malformaciones linfáticas en edad pediátrica: experiencia y resultados según el esclerosante empleado / Percutaneous sclerotherapy of pediatric lymphatic malformations: experience and outcomes according to the agent used

Objetivo. Estudio estadístico del éxito, el número de sesiones necesarias y la duración global del tratamiento percutáneo con esclerosantes de malformaciones linfáticas pediátricas que oriente la elección del esclerosante. Material y métodos. Estudio retrospectivo basado en los resultados obtenidos durante 14 años por Radiología Intervencionista Pediátrica en el tratamiento percutáneo de malformaciones linfáticas macroquísticas realizado en 56 pacientes. El procedimiento consiste en introducir el esclerosante bajo control ecográfico como único tratamiento, repitiendo las sesiones en ausencia de respuesta o sintomatología persistente hasta el alta. Se realiza un análisis descriptivo y estadístico del éxito, el número de sesiones y la duración del tratamiento para la obtención de conclusiones. Resultados. Se excluyen los pacientes perdidos en el seguimiento y los tratados con agentes concretos, con un número final de 52 pacientes tratados con OK432 (n=29), Ethibloc (n=5) y terapia combinada (n=18). El promedio de las sesiones y la duración (meses) del tratamiento fueron, respectivamente, de 2,38 sesiones y 8,6 meses para OK432, 1,4 sesiones y 5,6 meses para Ethibloc, y 1,83 sesiones y 2,30 meses para la terapia dual. Los resultados fueron estadísticamente significativos en la diferencia de la duración del tratamiento entre OK432 y la terapia dual. No hubo diferencias en el éxito ni en el número de sesiones, al igual que entre otras variables demográficas y anatómicas, en favor de la homogeneidad de la muestra. Conclusiones. Las diferencias entre un tratamiento más prolongado con OK432 frente a la terapia dual podrían suponer un mayor gasto sanitario y más frecuentación hospitalaria, con un mayor inconveniente para familiares y pacientes (AU)

Objective. Analyze statistically the success, number of sessions required and complete duration of treatment of agents used in pediatric percutaneous sclerotherapy of lymphatic malformations, to determine the most suitable. Material and methods. Retrospective study based on outcomes from percutaneous sclerotherapy performed on lymphatic malformations of 56 patients conducted by pediatric interventional radiologist for 14 years. As first approach, the procedure consists of ultrasound-guided introduction of sclerosing agent. Sessions were repeated until clinical resolution. Success, number of sessions and the duration of treatment were recorded and statistical treatment of the data was performed to obtain further conclusions. Results. Lost patients in follow up and other minority agents used were excluded from the data. Eventually, 52 patients treated with OK432 (n=29), Ethibloc (n=5) and combination therapy (n=18) were included. The average number of sessions and duration in months of treatment was respectively 2.38 and 8.6 for OK432, 1.4 and 5.6 for Ethibloc, and 1.83 and 2.30 for dual therapy. The results were statistically significant for the difference in duration between OK432 and dual therapy. Also, 60-80% of patients reached proper results related to success, but the difference was no significant among the agents. Other demographic and anatomical variables were analyzed, not showing any difference, which supports the homogeneity of the sample. Conclusions. Despite of no significant difference in success and number of sessions among agents, longer duration of treatment with OK432 than dual therapy could mean greater health costs and probably greater disturb for patient and family (AU)

Percutaneous sclerotherapy of pediatric lymphatic malformations: experience and outcomes according to the agent used. / Tratamiento percutáneo de las malformaciones linfáticas en edad pediátrica: experiencia y resultados según el esclerosante empleado.

OBJECTIVE: Analyze statistically the success, number of sessions required and complete duration of treatment of agents used in pediatric percutaneous sclerotherapy of lymphatic malformations, to determine the most suitable. MATERIAL AND METHODS: Retrospective study based on outcomes from percutaneous sclerotherapy performed on lymphatic malformations of 56 patients conducted by pediatric interventional radiologist for 14 years. As first approach, the procedure consists of ultrasound-guided introduction of sclerosing agent. Sessions were repeated until clinical resolution. Success, number of sessions and the duration of treatment were recorded and statistical treatment of the data was performed to obtain further conclusions. RESULTS: Lost patients in follow up and other minority agents used were excluded from the data. Eventually, 52 patients treated with OK432 (n=29), Ethibloc (n=5) and combination therapy (n=18) were included. The average number of sessions and duration in months of treatment was respectively 2.38 and 8.6 for OK432, 1.4 and 5.6 for Ethibloc, and 1.83 and 2.30 for dual therapy. The results were statistically significant for the difference in duration between OK432 and dual therapy. Also, 60-80% of patients reached proper results related to success, but the difference was no significant among the agents. Other demographic and anatomical variables were analyzed, not showing any difference, which supports the homogeneity of the sample. CONCLUSIONS: Despite of no significant difference in success and number of sessions among agents, longer duration of treatment with OK432 than dual therapy could mean greater health costs and probably greater disturb for patient and family.

Trombosis venosa renal neonatal: diagnóstico precoz con ecografía Doppler y secuelas a largo plazo / Neonatal renal vein thrombosis: early diagnosis using Doppler ultrasonography and long-term sequelae

Objetivo: Describir los mecanismos fisiopatológicos de las trombosis venosas renales perinatales y los factores de riesgo asociados, haciendo hincapié en las características clínico rradiológicas y en su evolución a largo plazo. Material y métodos: Se han estudiado retrospectivamente un total de 11 casos de trombosis venosa renal neonatal, con una edad media al diagnóstico de 3 días. Se analizaron la forma de presentación, las manifestaciones clínicas, los hallazgos de imagen obtenidos mediante ecografía (modos B y Doppler), el tratamiento instaurado y las secuelas a largo plazo. Resultados: En el momento del diagnóstico, la tríada de masa palpable, hematuria franca y trombocitopenia estaba presente únicamente en el 63,63% de los pacientes. Resultados: En el 45,45% de los casos pudo identificarse un factor de riesgo protrombótico en los recién nacidos o en sus madres. Todos los recién nacidos mostraron aumento del tamaño renal y pérdida de la diferenciación corticomedular en el estudio ecográfico. En 4 de los 11 casos se identificaron imágenes lineales hiperecogénicas intramedulares, características del estadio inicial de la trombosis. Los estudios funcionales de seguimiento con ácido dimercaptosuccínico (DMSA) y ácido mercapto-acetil-triglicina (MAG-3) revelaron anomalías morfológicas en todos los pacientes, con un riñón no funcionante en 7 casos. Conclusiones: Visualizar bandas ecogénicas intramedulares alerta de la fase inicial de una trombosis venosa renal, por lo que debe instaurarse precozmente un tratamiento adecuado. Exceptuando los casos acontecidos intraútero, la trombosis de la vena renal conlleva un mal pronóstico, con atrofia y fallo renal a largo plazo (AU)

Objective: To describe the physiopathological mechanisms in perinatal renal vein thrombosis and the associated risk factors, with emphasis on the clinical and radiological characteristics and on the long-term evolution. Material and methods: We retrospectively studied a total of 11 cases of neonatal renal vein thrombosis; the mean age of patients at diagnosis was 3 days. We analyzed the type of presentation, the clinical manifestations, and the findings at B-mode and Doppler ultrasonography, as well as the treatment undertaken and the long-term sequelae. Results: At the time of diagnosis, the triad of a palpable mass, unequivocal hematuria, and thrombocytopenia was present in only 63.63% of patients. Results: A prothrombotic risk factor was identified in the newborn or mother in 45.45% of cases. At ultrasonographic examination, all newborns had enlarged kidneys and in all cases it was impossible to differentiate between the renal cortex and the renal medulla. In 4 of the 11 cases, hyperechogenic intramedullary linear images characteristic of the initial stage of thrombosis were identified. Functional follow-up studies using DMSA (dimercaptosuccinic acid) and MAG-3 (mercaptoacetyl triglycine acid) revealed morphological abnormalities in all patients; 7 patients had a nonfunctioning kidney. Conclusions: Visualizing echogenic bands within the medulla should alert radiologists to the initial phase of renal vein thrombosis and enable the appropriate treatment to be administered. With the exception of cases discovered before birth, renal vein thrombosis has a poor prognosis, with atrophy and renal failure in the long term (AU)

[Neonatal renal vein thrombosis: early diagnosis using Doppler ultrasonography and long-term sequelae]. / Trombosis venosa renal neonatal: diagnóstico precoz con ecografía Doppler y secuelas a largo plazo.

OBJECTIVE: To describe the physiopathological mechanisms in perinatal renal vein thrombosis and the associated risk factors, with emphasis on the clinical and radiological characteristics and on the long-term evolution. MATERIAL AND METHODS: We retrospectively studied a total of 11 cases of neonatal renal vein thrombosis; the mean age of patients at diagnosis was 3 days. We analyzed the type of presentation, the clinical manifestations, and the findings at B-mode and Doppler ultrasonography, as well as the treatment undertaken and the long-term sequelae. RESULTS: At the time of diagnosis, the triad of a palpable mass, unequivocal hematuria, and thrombocytopenia was present in only 63.63% of patients. A prothrombotic risk factor was identified in the newborn or mother in 45.45% of cases. At ultrasonographic examination, all newborns had enlarged kidneys and in all cases it was impossible to differentiate between the renal cortex and the renal medulla. In 4 of the 11 cases, hyperechogenic intramedullary linear images characteristic of the initial stage of thrombosis were identified. Functional follow-up studies using DMSA (dimercaptosuccinic acid) and MAG-3 (mercaptoacetyltriglycine acid) revealed morphological abnormalities in all patients; 7 patients had a nonfunctioning kidney. CONCLUSIONS: Visualizing echogenic bands within the medulla should alert radiologists to the initial phase of renal vein thrombosis and enable the appropriate treatment to be administered. With the exception of cases discovered before birth, renal vein thrombosis has a poor prognosis, with atrophy and renal failure in the long term.

Torsion of a Meckel's diverticulum: sonographic findings.

There are few reports of the sonographic appearance of Meckel's diverticulum. We present a case of torsion of a Meckel's diverticulum that was suggested by sonography and confirmed pathologically. We discuss the sonographic differential diagnosis, which includes acute appendicitis, enteric duplication cyst and intestinal volvulus.

[Radiographic findings in Pneumocystis carinii pneumonia and its complications in HIV patients]. / Hallazgos radiológicos de la neumonía por Pneumocystis carinii y sus complicaciones en enfermos VIH.

We have performed a retrospective study of 61 cases of Pneumocystis carinii pneumonia (PCP) among the Human Immunodeficiency Virus (HIV) seropositive population at the 11th Health Area of the Comunidad de Madrid with microbiological diagnosis until January 1994. We made an Epidemiologic analysis of this PCP group and compared it with the Epidemiologic data of the general HIV population in Madrid. Besides, we studied the radiologic manifestations and their possible associations with several factors (sex, HIV risk factor, time of HIV risk practice, time of HIV infection, associated infections, number of CD4 lymphocytes, radiologic secuelae, time of healing, mortality, number of PCP episodes, time interval from primoinfection to death). The goal of our study is to show the Statistical associations between these variables.