T2-based magnetic resonance genitography in children with complex anorectal malformations: experience at a tertiary pediatric hospital in Latin America.

In children with anorectal malformations (ARMs), it is essential to have a diagnostic imaging method that helps with the evaluation of the internal anatomy. In patients with a persistent cloaca, an ARM variant, in which the measurement of the urethral channel and common channel determines surgical management, there are multiple options for imaging. Magnetic resonance imaging (MRI) is an excellent method for this purpose, from which accurate measurements of channel length can be obtained. Additionally, the use of volumetric/isotropic sequences allows multiplanar reformatting. We present our experience with pelvic MRI and intracavitary non-paramagnetic contrast (MR genitography). This method uses volumetric T2-weighted images and the instillation of saline solution as a contrast agent to distinguish the common channel, length of the urethra, anatomy of the vagina, and presence and location of the rectal fistula. We believe this technique to be particularly useful for those working in settings with limited MRI resources.

MRI findings of primary intracranial sarcomas in children.

BACKGROUND: Primary intracranial sarcoma is a very rare high-grade tumor. Scant reports exist on this malignancy in children, which limit the information about its imaging characteristics. OBJECTIVE: We aimed to describe the main characteristics of primary intracranial sarcoma on MRI. MATERIALS AND METHODS: In this cross-sectional descriptive observational study, we reviewed 18 patients (aged 1-18 years) with primary intracranial sarcomas diagnosed between 2015 and 2021. RESULTS: The main findings were contrast enhancement (100%), diffusion restriction (78%), hemorrhage (89%), meningeal extension (67%), necrosis (67%), and supratentorial location (72%). CONCLUSION: Primary intracranial sarcoma are typically supratentorial in location. MRI findings of primary intracranial sarcoma are similar to other intracranial malignancies.

Congenital Toxoplasmosis: Findings in Fetal MRI.

Toxoplasma gondii infection, when acquired as an acute infection during pregnancy, can have substantial adverse effects on fetuses. We present the case of a 19-year-old pregnant woman with no previous relevant medical history. The ultrasound in the third trimester showed brain and abdominal abnormalities such as congenital hydrocephalus, volume loss of the brain parenchyma, and hepatosplenomegaly. The laboratory test showed positive IgM for Toxoplasma gondii. MRI was performed for better assessment and it shows the lesions in the central nervous system and other organs with more details.

Acute Necrotizing Encephalopathy Associated With SARS-CoV-2 Exposure in a Pediatric Patient.

We present the case of a nine-month-old male child with three days of fever, irritability, left focal seizure, and febrile focal status epilepticus. He had no history of previous comorbidities. A lumbar puncture was performed, which showed cerebrospinal fluid (CSF) leukocytosis; protein and glucose were normal, and the polymerase chain reaction (PCR) panel for 14 pathogens in CSF was negative. Immunoglobulin G (IgG) qualitative and quantitative tests were positive for coronavirus disease 2019 (COVID-19) upon arrival. An MRI performed one week after the initial onset showed findings suggestive of acute necrotizing encephalopathy (ANE). The patient required mechanical ventilation. However, his symptoms did not improve and follow-up imaging two weeks later showed progression of the disease with hemorrhagic changes. To our knowledge, this is the first reported case of ANE associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-​2) infection in a pediatric patient.

Pulmonary imaging in coronavirus disease 2019 (COVID-19): a series of 140 Latin American children.

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which resulted in the worldwide coronavirus disease 2019 (COVID-19) pandemic of 2020, has particularly affected Latin America. OBJECTIVE: The purpose of the study was to analyze the imaging findings of pulmonary COVID-19 in a large pediatric series. MATERIALS AND METHODS: Children with SARS-CoV-2 infection confirmed by either quantitative reverse transcription-polymerase chain reaction from nasopharyngeal swabs or presence of circulating immunoglobulin M (IgM) antibodies and who underwent chest radiograph or CT or both were included in this retrospective multicenter study. Three pediatric radiologists independently reviewed radiographs and CTs to identify the presence, localization, distribution and extension of pulmonary lesions. RESULTS: We included 140 children (71 female; median age 6.3 years, interquartile range 1.6-12.1 years) in the study. Peribronchial thickening (93%), ground-glass opacities (79%) and vascular engorgement (63%) were the most frequent findings on 131 radiographs. Ground-glass opacities (91%), vascular engorgement (84%) and peribronchial thickening (72%) were the most frequent findings on 32 CTs. Peribronchial thickening (100%), ground-glass opacities (83%) and pulmonary vascular engorgement (79%) were common radiograph findings in asymptomatic children (n=25). Ground-glass opacity and consolidation were significantly higher in children who needed intensive care admission or died (92% and 48%), in contrast with children with a favorable outcome (71% and 24%, respectively; P<0.05). CONCLUSION: Asymptomatic children and those with mild symptoms of COVID-19 showed mainly peribronchial thickening, ground-glass opacities and pulmonary vascular engorgement on radiographs. Ground-glass opacity and consolidation were more common in children who required intensive care admission or died.

Characterisation of computed tomography angiography findings in paediatric patients with heterotaxy.

BACKGROUND: Heterotaxy refers to the abnormal arrangement of organs across the left-right axis and is typically associated with complex cardiovascular malformations. OBJECTIVE: To characterise the range of cardiac and extracardiac CT angiography findings in children with heterotaxy using the latest nomenclature consensus and to compare the different types of isomerism. MATERIALS AND METHODS: We retrospectively analysed the data of 64 consecutive paediatric patients referred to our tertiary paediatric cardiovascular centre who underwent CT angiography for the evaluation of known or suspected heterotaxy within a 52-month period. RESULTS: Right atrial isomerism was identified in 44 (69%) children, while left atrial isomerism was identified in 18 (28%) children. Atrial appendage anatomy and situs could not be determined in 2 children (3%). Associated heart defects included complete atrioventricular canal (CAVC) in 51 (80%) children, total anomalous pulmonary venous return in 43 (67%) and pulmonary atresia in 23 (36%). The bronchial branching pattern corresponded to atrial appendage morphology in all children except in the two in whom atrial appendage morphology could not be defined. In children with right atrial isomerism, the most common associated abnormalities were CAVC (n=41, 93%) and asplenia (n=34, 77%), while in those with left atrial isomerism, the most common associated abnormalities were polysplenia (n=17, 94%) and an interrupted inferior vena cava with azygos continuation (n=15, 83%). CONCLUSION: CT angiography provides useful cardiovascular and extracardiac data on heterotaxy, which frequently involves a pattern of side-related findings but has great anatomical variability.