Brain death in children: is computed tomography angiography reliable as an ancillary test?

BACKGROUND: The diagnosis of brain death is primarily clinical. Sometimes ancillary tests are needed. OBJECTIVE: This study compared sensitivity and interobserver agreement of the 10-, 7- and 4-point CT angiography scoring systems for the diagnosis of brain death in children. MATERIALS AND METHODS: CT angiography examinations of 50 pediatric patients with a clinical diagnosis of brain death were evaluated according to 10-, 7- and 4-point scoring systems. Images were evaluated by two radiologists who considered the vessel opacification first in the arterial phase (A0-V50) and then in the venous phase (A0-V50). We evaluated interobserver agreement for the assessment of vessel opacification and diagnosis of brain death. We compared the differences among brain death diagnoses between children with craniotomy-craniectomy defects, open fontanelles and preserved bone integrity. We subdivided children into two groups according to age: ≤ 2 years and > 2 years. We calculated sensitivities according to age groups. RESULTS: Using the clinical exam as the reference standard, we found sensitivities for 10-, 7- and 4-point scoring systems to be 70%, 88% and 92% in the A0-V50 method and 40%, 82% and 82% in the A50-V50 method, respectively. Percentage agreement between readers was 78% for the 7-point scale using the A0-V50 method and more than 90% for other scoring systems for both the A0-V50 method and the A50-V50 method. The sensitivity was much lower in children with open anterior fontanelles compared to the groups with preserved bone integrity and with a craniotomy-craniectomy defect. CONCLUSION: Just as in adult age groups, in children the 4-point scale appears to be more sensitive than the 10- and 7-point scales for CT angiography-based assessment of brain death. Because the scoring systems have similar sensitivities, they could be used as ancillary tests in pediatric cases.

Non-hormonal Clitoromegaly due to Clitoral Priapism Caused by Appendicitis/Appendectomy

Clitoromegaly usually develops due to hyperandrogenism. There are a few cases of clitoromegaly described without clinical and biochemical hyperandrogenism. Clitoromegaly due to clitoral priapism and clitoral priapism after appendectomy have not been reported previously. A 7-year-old girl was referred for enlargement of the clitoris. She reported having a mild, pulsating clitoral pain starting three days after an appendectomy operation. Subsequently, painful swelling and an increase in the size of the clitoris was observed. Her growth and physical examination were otherwise normal. Causes of the clitoromegaly due to androgen excess were excluded after a comprehensive work-up. Color Doppler ultrasound revealed a high peak systolic velocity and resistance in the cavernosal artery, consistent with clitoral priapism. The clitoromegaly and associated symptoms improved significantly with oral pseudoephedrine and intracavernosal aspiration. This unique case illustrates that clitoral priapism is a rare, non-hormonal cause of clitoromegaly and may occur after appendectomy. Pseudoephedrine treatment is helpful in alleviating the symptoms.

Orbital structures in the pediatric age group: A normative assessment using magnetic resonance imaging.

PURPOSE: Many diseases of traumatic, infectious, endocrinologic and neoplastic origin can lead to orbital involvement and related morphological changes. In the present study, we aimed to determine the age-based normal orbital measurements using magnetic resonance imaging (MRI) in pediatric patients. METHODS: Our retrospective study included 186 patients with normal orbital MRI findings. The patients were divided into the following five groups based on their age. Group 1: 1-24 months; Group 2: 25-60 months; Group 3: 61-120 months; Group 4: 121-168 months; and Group 5: 169-216 months. Globe position relative to interzygomatic line (IZL) and orbital rim, optic nerve-sheath complex, extraocular muscle diameters, were measured. RESULTS: The differences among the age groups for the distances between cornea and sclera in relation to IZL, for the distances between cornea and sclera relative to orbital rim, and for the extraocular muscle diameters were statistically significant. In terms of the extraocular muscle diameter, it was found that the thinnest muscle of all groups was the lateral rectus muscle while the thickest was the medial rectus muscle. CONCLUSION: In pediatric patients who were divided into five groups based on their age, the positions of bulbus oculi relative to IZL or orbital rim and the normal diameter ranges of extraocular muscles and of the optic nerve-sheath complex in orbital MRI were determined. We are of the opinion that the presence of such a scale could be a guide in the evaluation of orbital MRI in pediatric patients.

Giant intracardiac blood cyst of the mitral valve in a pediatric patient: A case report.

Intracardiac blood cysts are rare congenital malformations most commonly located in the endocardium of semilunar or atrioventricular valves. They are predominantly seen in infants, especially below 2 months of age, and disappear spontaneously in the first 6 months of life making the detection of blood cysts a rare finding in the adult population. Although most patients are asymptomatic, they may occasionally present with obstruction, valvular dysfunction, or embolism. Herein, we present a 2.5-year-old female patient, who was successfully treated with surgical excision of an intracardiac blood cyst causing mild-to-moderate mitral regurgitation and obstruction.

Ultrasound measurement of liver longitudinal length in a North Anatolian population: A community-based study.

BACKGROUND: Liver size can be influenced by various factors, including malignant diseases, infective processes, and anthropometric variations among individuals from different geographical locations and races. Therefore, the exact definition of hepatomegaly in the ultrasonographic measurement of liver size is controversial. Moreover, the majority of studies regarding the study of liver size are not community-based. AIMS: The aim of this study is to establish a range of normal liver sizes by ultrasonography with respect to age and sex in healthy individuals and to identify factors affecting liver size. STUDY DESIGN: This was a prospective, community-based study. METHODS: Liver size was measured ultrasonographically from the midclavicular line in 822 individuals, of which 49.3% (n = 405) were male and 51.7% (n = 417) were female. Following physical examination, all participants provided blood samples. Height, weight, and waist circumference were recorded. The mean liver length was calculated for males, females, and for the whole study group. It was also determined whether there was an association between liver size and age, weight, height, body mass index (BMI), body surface area, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) enzyme levels. Results: The mean liver length was significantly different between males (150.04 ± 14.84) and females (147.57 ± 18.32, P = 0.034). Weight and BMI were the most strongly associated with liver size. There was a significant difference between liver size in individuals with normal and elevated levels of AST and ALT enzymes (P < 0.01). CONCLUSION: In a northern Anatolian Turkish population, liver size was greater among males than females. In light of these data, we believe our study may serve as a reference source for the evaluation of liver size.

Pulmonary involvement in ankylosing spondylitis assessed by multidetector computed tomography.

BACKGROUND: Ankylosing spondylitis (AS) may present with extra-articular involvement in the lungs. We aimed to evaluate the abnormal pulmonary multidetector computed tomography findings of patients with AS and compare them with the clinical symptoms, duration of illness, laboratory results and pulmonary function tests (PFT). MATERIAL/METHODS: We evaluated the chest multidetector computed tomography (MDCT) findings of 41 patients with ankylosing spondylitis (AS) and compared them with pulmonary function test (PFT) results, demographic characteristics, duration of illness and laboratory findings that we were able to obtain. RESULTS: The most common abnormalities were nodules, peribronchial thickening, pleural thickening and bronchiectasis. Abnormalities occurred in 96.87% of patients in the early AS group and 77.8% of patients in the late AS group. Patients with early AS included asymptomatic individuals with normal PFT results and abnormal MDCT findings. CONCLUSIONS: The use of MDCT in AS patients may be beneficial for the evaluation of pulmonary disease, even in asymptomatic patients without any PFT abnormalities and those in the early stages of the disease.