Scrotal pathology in pediatrics with sonographic imaging.

Scrotal pathology in pediatrics ranges from the more benign hydrocele and varicocele to acute testicular torsion requiring emergent surgery. Malignant testicular tumors can be insidious in onset or may present acutely when trauma brings a swollen scrotum to the patient's or physician's attention. Three common conditions can present as an acute scrotum, all of which can suggest testicular torsion clinically. Epididymitis often has a less acute onset than testicular torsion, although it does not always present with a straightforward diagnosis. Although it is generally an inflammatory process affecting males from 9 to 14 years of age, it can be seen in younger males with Henoch-Schonlein purpura and Kawasaki disease. Torsion of the appendix of the testis and epididymis can present acutely and mimic acute testicular torsion and generally occurs from 6 to 12 years of age. Testicular torsion itself usually occurs from 12 to 18 years of age and usually results from the anatomical "bell-and-clapper" deformity. Infarction of the testis can occur within as early as 4 to 6 hours after torsion, depending on the duration of symptoms and degree of twist of the spermatic cord. Advances in ultrasound technology in recent years have made ultrasound the examination of choice for imaging scrotal pathology, whether acute or chronic in nature. Doppler technology has tremendously increased the radiologist's ability to assess flow within the prepubertal testicle, which allows assessment of viability in the undescended testis as well as in neonatal torsion. The ability of ultrasound to diagnose the pathogenesis of the acute scrotum is unsurpassed by any other imaging modality. Ultrasound is a readily available, noninvasive examination without radiation that provides excellent anatomic detail and serves as an important and tremendously helpful imaging modality in all types of pediatric scrotal pathology.

Hyperechoic foci in the thalamic region imaged via the posterior fontanelle: a potential mimic of thalamic pathology.

BACKGROUND: We have incidentally noted foci of increased thalamic echogenicity (FITE) on cranial sonographic images obtained via the posterior fontanelle (PF) that were not confirmed on images obtained while scanning through the anterior fontanelle (AF). Therefore, we postulated that this is a normal variant of PF imaging rather than true thalamic pathology. OBJECTIVE: The purpose of this study was to determine the incidence of FITE detected on posterior and anterior fontanelle images. MATERIALS AND METHODS: Parasagittal images were obtained bilaterally through the trigone of the lateral ventricles (including the thalami) via both the anterior and posterior fontanelles in 15 consecutive neonates (30 thalami) and evaluated independently by two pediatric radiologists for the presence or absence of FITE. Thalami were graded as grade 0 (no FITE), grade 1 (possible FITE), or grade 2 (definite FITE). Follow-up CT (n = 3) and MR (n = 1) were reviewed. RESULTS: FITE were absent in 87 % of thalami imaged via the AF, and possible FITE were present in 13 % of these cases. No cases of definite FITE were identified via the AF. However, possible FITE were identified in 33-40 % of thalami and definite FITE were seen in 33 % of thalami imaged via the PF. CONCLUSIONS: FITE seen only on images obtained through the PF on cranial sonography are a normal finding and should not be attributed to thalamic hemorrhage or ischemia.

Lymphoproliferative disorder involving the liver following transplantation: CT appearance.

OBJECTIVE: Our goal is to report the CT findings of liver involvement in lymphoproliferative disease in immunosuppressed patients. MATERIALS AND METHODS: We report CT findings in two cases of lymphoproliferative disease involving the liver. RESULTS: The findings of this disorder are nonspecific both clinically and radiographically. CONCLUSION: Nonspecific nodular pattern in the liver on CT may represent unrestricted lymphocytic infiltration in the immunosuppressed patient.

Acute chest syndrome in sickle cell disease: CT evidence of microvascular occlusion.

Patients with sickle cell disease often develop acute chest syndrome (ACS). Signs of ACS include chest pain, fever, prostration, and pulmonary opacities. Pneumonia and infarction have been implicated in the pathogenesis of this syndrome. Infarction as a result of microvascular occlusion and pneumonia are not easily differentiated with chest radiography or ventilation-perfusion scintigraphy. The authors evaluated the ability of thin section (3-mm) chest computed tomography (CT) to help diagnose microvascular occlusion in ACS and thus help differentiate two of its most likely causes. CT scans of the chest of 10 patients with moderate to severe ACS were retrospectively reviewed by two observers, who listed the number of bronchopulmonary segments showing consolidation; areas of ground-glass attenuation due to early hemorrhagic edema; and paucity or absence of small vessels, arterioles, and venules. In all patients, the degree of hypoxia was out of proportion to the extent of consolidation evident at chest radiography. The CT scans showed microvascular occlusion and areas of ground-glass attenuation in nine patients. Infection was ruled out in eight patients. High-resolution CT may play an important role in the initial evaluation and timely selection of an appropriate treatment regimen aimed at improving tissue perfusion, thus forestalling irreversible organ damage and chronic pulmonary arterial hypertension in patients with sickle cell disease.