CT urograms in pediatric patients with ureteral calculi: do adult criteria work?

BACKGROUND: Secondary signs of urinary obstruction associated with ureteral calculi are useful adjuncts to diagnosis in adults with renal colic evaluated by unenhanced helical CT. OBJECTIVE: Our purpose was to evaluate the frequency of secondary signs of obstruction in children with renal colic undergoing unenhanced helical CT. MATERIALS AND METHODS: Ureteral calculi were identified in 20 of 61 children with acute flank pain examined by unenhanced helical CT. Each imaging study was evaluated for the presence of secondary signs of urinary obstruction. The frequencies of individual signs were compared with each other by means of the McNemar test. RESULTS: Six children had no secondary sign identified. In the remaining 14 children, proximal ureteral dilatation was seen in 10, renal enlargement in 10, hydronephrosis in 9, tissue rim sign in 6, decreased kidney attenuation in 5, and perinephric stranding in 1. Comparison of the frequencies strongly suggested that perinephric stranding occurs less frequently than proximal ureteral dilatation (P = 0.004), hydronephrosis (P = 0.008), or renal enlargement (P = 0.012). CONCLUSION: Perinephric stranding, a common secondary sign in adults with ureteral calculi, occurs less frequently in children than other reported secondary signs.

Cardiopulmonary and thoracic tumors of childhood.

Cardiopulmonary and thoracic tumors in children are a diverse group of neoplasms. Unfortunately, presenting signs and symptoms are nonspecific. Imaging determines the anatomic site of origin, characterizes the mass, and defines its extent. This article reviews the appearance of cardiopulmonary and thoracic malignancies of childhood utilizing routine radiography, CT scan, MR imaging, and echocardiography.

Head injuries in children from plastic hairbeads.

BACKGROUND: Plastic hairbeads are often worn as decorative hair fasteners by children. Serious, penetrating head injuries may result from their use and have been observed in some children following a fall. OBJECTIVE: The objective of this report is to describe the imaging findings in children who have sustained head injury while wearing plastic hairbeads. MATERIALS AND METHODS: Three children with significant head injuries resulting from embedded hairbeads are described. Three additional cases of minor head injury reported to the Consumer Product Safety Commission are summarized. RESULTS: One child sustained a minimally depressed skull fracture without brain injury. The second child required surgical repair of a depressed skull fracture complicated by a parenchymal hemorrhage and dural tear. A third child required surgical evacuation of an organized, liquefied epidural hematoma 2 weeks after an initial evaluation at an outside emergency room. CONCLUSION: Children wearing plastic hairbeads are at risk for severe head injury following a fall. Caution must accompany their use.

Contrast enema findings of fibrosing colonopathy.

PURPOSE: Our objective was to describe characteristic contrast enema findings of fibrosing colonopathy. MATERIALS AND METHODS: We performed barium enemas on 18 children with cystic fibrosis who had received greater than 4500 U of lipase per kg body weight per meal and who had distal intestinal obstruction syndrome unresponsive to medical management. RESULTS: Fifteen patients had abnormal enema results. The most common findings included stricture, loss of haustra, and colonic shortening. Ten patients required surgery, nine underwent colon resection, and one had lysis of adhesions. Pathologists confirmed fibrosing colonopathy in eight of nine speci- mens. CONCLUSION: Colonic stricture, abnormal haustra, and longitudinal shortening are characteristic barium enema findings of fibrosing colonopathy.

Fibrosing colonopathy in children with cystic fibrosis.

PURPOSE: Fibrosing colonopathy is a newly described entity seen in children with cystic fibrosis. The radiological hallmarks are foreshortening of the right colon with varying degrees of stricture formation. High-dose enzyme therapy has been implicated as the cause of this process. The purpose of this study is to review the author's experience with evaluation and treatment of these patients. METHODS: There are currently 380 patients being treated at our CF center. Fifty-five of these patients have been treated with high-dose enzyme therapy (> 5,000 units of lipase/kg). The medical records of these patients, who are at risk for developing fibrosing colonopathy, were reviewed for the presence of recurrent abdominal complaints, and the work-up and treatment of these symptoms. RESULTS: Chronic complaints of abdominal pain, distension, change in bowel habits, or failure to thrive were present in 24 of the 55 patients treated with high-dose enzymes. So far, 18 of these 24 patients have been evaluated by contrast enema. Thirteen of eighteen have been found to have fibrosing colonopathy characterized by foreshortening and strictures of the colon. Additional findings included focal strictures of the right colon (7 of 13), long segment strictures (5 of 13), and total colonic involvement (1 of 13). Nine patients with the most severe symptoms have undergone colon resection, including five segmental right colectomies, three extended colectomies (ileo-sigmoid anastomosis), and one subtotal colectomy with end-ileostomy. Pathological evaluation has shown submucosal fibrosis, destruction of the muscularis mucosa, and eosinophilia. No postoperative complications or deaths occurred. All nine postoperative patients have noted marked symptomatic improvement. Contrast enema follow-up results are available for six patients, and have documented no recurrent strictures to date. Three of four nonoperative patients have less severe symptoms and are currently being treated conservatively. The other family has refused surgery and the patient is being treated symptomatically. CONCLUSION: High-dose lipase replacement has been implicated as the etiology for FC and was present in all of our patients. Our cystic fibrosis center now routinely limits lipase to 2,500 U/kg per dose. We recommend the use of the contrast enemas to evaluate at-risk patients who have chronic abdominal complaints or who present with recurrent bowel obstruction. Colon resection should be performed in those with clinically and radiographically significant strictures with the expectation of a good outcome.

Magnetic resonance imaging compared with echocardiography in the evaluation of pulmonary artery abnormalities in children with tetralogy of Fallot following palliative and corrective surgery.

BACKGROUND: Abnormalities of the pulmonary arteries following palliative or corrective surgery for tetralogy of Fallot (TOF) are common. Our purpose was to compare the usefulness of magnetic resonance imaging (MRI) and echocardiography in the post- operative evaluation of the pulmonary arteries in children with TOF. OBJECTIVE: Our hypothesis was that MRI is more sensitive than echocardiography in the detection of branch pulmonary artery abnormalities in children with TOF. MATERIALS AND METHODS: Pulmonary artery MRI and echocardiography were performed in 20 children following palliative and/or corrective surgery for TOF. MRI and echocardiography were compared in their ability to detect abnormalities of the pulmonary arteries. Angiographic or surgical correlation was available in 15 children. A perfusion scan for confirmation of pulmonary artery patency was available in one additional child. RESULTS: Abnormalities of the branch pulmonary arteries identified by MRI included: absence or occlusion (2), focal stenosis (15), hypoplasia (2), aneurysm (1), and non-confluence (1). Echocardiography could not adequately visualize the right and left branch pulmonary arteries in eight and ten children, respectively. Echocardiography missed stenosis in 13 branch pulmonary arteries, patency of hypoplastic pulmonary arteries in two children, non-confluence of the pulmonary arteries in one child, and a left pulmonary artery aneurysm in one child. Abnormalities identified by MRI were confirmed in 16 children by angiography, surgery or perfusion scan. CONCLUSION: MRI is more sensitive than echocardiography for the evaluation of branch pulmonary artery abnormalities in children following surgery for TOF.