Disseminated hepatic and splenic calcifications following cat-scratch disease.

Patients with cat-scratch disease (CSD) may develop visceral manifestations such as hepatic and splenic granulomas. Normally, the granulomas disappear within 1-5 months. Two previous reports have described the evolution of splenic lesions into small calcifications. We report a case of cat-scratch disease in which long lasting multiple and disseminated hepatic and splenic granulomas evolved into coarse calcifications.

Unusual, benign asymptomatic scrotal masses in children: case reports and review of the literature.

Asymptomatic scrotal masses (ASM) in children constitute an entity of pathologies, ranging from congenital anomalies to neoplasms. Testicular ultrasound is the imaging modality of choice in the evaluation of ASM, although there is extensive overlap between benign and malignant lesions. Five children with ASM of benign origin are presented: 2 boys had extratesticular mass (one paratesticular lipoma and one voluminous sebaceous scrotal cyst); the remaining 3 patients had testicular mass (one supernumerary testis, one intratesticular cyst and one unilateral testicular hypertrophy). Basing on the ultrasonographic appearance, a certain diagnosis of benign lesion was made only in the last 2 cases; the remaining patients underwent explorative inguinotomy in order to rule out any malignancy. Some guidelines for proper diagnosis of ASM in childhood are proposed by the authors. However, at least in children, testicular preservation should not be based only on the sonographic findings, and surgical exploration is mandatory whenever the nature of the lesion remains unclear.

Imaging of aldosterone-secreting adenomas: a prospective comparison of computed tomography and magnetic resonance imaging in 27 patients with suspected primary aldosteronism.

We have compared prospectively the sensitivity, specificity and accuracy of CT and MRI in a series of 27 consecutive patients (age 23-76 yrs, 17 females, 10 males) with clinically suspected primary aldosteronism. We found 13 patients with a unilateral aldosterone-producing adenoma (11 on the left and 2 on the right side), 6 with idiopathic hyper-aldosteronism and 8 with primary hypertension, which in two cases was associated with a nonfunctioning adrenal adenoma. The diagnosis of aldosterone-producing adenoma was confirmed at surgery and pathology in all cases. Idiopathic hyper-aldosteronism was diagnosed on the basis of the results of dexamethasone-suppressed adrenal scintigraphy and/or selective adrenal vein sampling. MRI correctly identified all cases of aldosterone-producing adenoma, but gave false positive results in five cases: one had idiopathic hyper-aldosteronism with bilateral nodular hyperplasia and four primary hypertension, which in two patients was associated with a nonfunctioning adrenal adenoma. Therefore, the sensitivity of MRI was 100%, its specificity 64% and overall diagnostic accuracy 81%. In comparison, CT correctly recognized only eight of the 13 patients with aldosterone-producing adenoma and gave false positive results in three primary hypertensives, including the two patients with a nonfunctioning adrenal adenoma. Therefore, its sensitivity, specificity and accuracy were 62, 77 and 69%, respectively. Based on these results, it could be anticipated that about four of every ten patients with aldosterone-producing adenoma would not be correctly diagnosed by CT.(ABSTRACT TRUNCATED AT 250 WORDS)

[Inflammation of the anterior chest wall: its assessment by magnetic resonance]. / Flogosi della parete toracica anteriore: valutazione con Risonanza Magnetica.

Magnetic resonance (MR) is the imaging method used to assess primary and secondary inflammatory lesions of the chest wall. Five patients with inflammatory lesions of the anterior chest wall were submitted to MR examinations in order to define the role of this method in both identification and assessment of the extent of tissue involvement. In all the examined patients MR Imaging accurately showed the involved muscle groups and the presence/absence of mediastinitis. MR Imaging easily detected sternal and clavicular osteomyelitis; in one patient only MR failed to detect osteomyelitis of the first rib. The accurate assessment of soft tissue infections enabled us to select the most suitable surgical therapy to reduce esthetic damage. Two cases were restudied after chest wall reconstruction by means of rotated pectoral flaps. In the 2 patients in whom the differential diagnosis between inflammatory lesion and recurrent tumor could not be made by means of MR Imaging, CT-guided needle biopsy was performed.

[Comparison of radiology and 24-hour esophageal pH-monitoring in the diagnosis of gastro-esophageal reflux in various pediatric age groups]. / Confronto tra radiologia e pH-metria esofagea di 24 ore nella diagnosi della malattia da reflusso gastro-esofageo in diverse età pediatriche.

We retrospectively examined the 24 hour oesophageal pH study and the upper gastrointestinal (UGI) series of 67 children aged 5 weeks to 15 years. Thirty-seven were suffering from gastro-oesophageal reflux (GER) and 27 from other diseases. Nineteen of them were younger than 6 months, 22 older than 18 months and the remaining 26 ranged from 6 to 18 month old. We found a high incidence of false positive and false negative results of the UGI series in all age groups. The number of false positive results was much higher in infants younger than 6 months (67%) than in the older children studied (27% between 6 and 18 months and 14% after 18 months). On the contrary, false negative results were absent in the first 6 months of life, but their number increased with age, up to 40% in children older than 18 months. Moreover, the 24 hour ph monitoring was found to have a high sensitivity (100%) and specificity (82-100%) in all age groups. For this reason, we believe than this examination could be used as the first line of investigation for the diagnosis of GER in all children, independently of their age.

[Diagnostic role of echography in acute appendicitis in children]. / Ruolo diagnostico dell'ecografia nell'appendicite acuta del bambino.

Eighty-seven pediatric patients with suspected acute appendicitis underwent high-resolution US with graded abdominal compression. The study was limited to the patients with a questionable clinical diagnosis, accounting for about 40% of the patients examined for acute appendicitis in our Institution. US had 87.3% accuracy, 81.5% sensitivity, and 90% specificity. The main US findings in the positive cases were: visualization of the appendix as a tubular non-compressible structure, with a diameter of 5 mm or more, symmetric/asymmetric wall thickening, possible presence of appendicoliths and variable appearance of the central echogenic layer (preserved, doubled for lumen dilatation, partially/totally lost). The above US findings were grouped in 3 basic patterns: type I (thickened appendix with no structural abnormalities) appeared to be related to non-suppurative and phlegmonous acute appendicitis; type II (detectable appendiceal abnormalities) was observed both in phlegmonous and in suppurative acute appendicitis; type III (pericecal complex mass, frequently with appendicoliths) was found in all cases of periappendiceal abscess. In our experience, the use of US in the diagnosis of acute appendicitis in children allowed a reduction by about 2/3 in the rate of unnecessary laparotomies. Such a finding emerges from the comparison with the results obtained in the 2 years prior to the use of US. The technique also allowed an unquestionable diagnosis of acute appendicitis or periappendiceal abscess to be made in a number of clinically equivocal cases, thus avoiding potentially harmful delays in diagnosis. On the other hand, the incidence of false-negatives on US is not negligible, which calls for a cautious clinical and US evaluation of all equivocal cases following no typical US pattern.

Agenesis of the bladder: a case report and review of the literature.

Agenesis of the bladder is a rare congenital anomaly, recorded most often in stillborn infants. Renal agenesis and other severe malformations are frequently associated. An apparent failure of the infraureteral tissue of the mesonephric duct to develop into trigone and proximal urethra seems to be the cause of this anomaly. We report a case of bladder agenesis with anal atresia, left renal dysplasia, and bicornuate uterus.

Diagnostic value of ultrasonography in neonatal liver rupture.

A case of neonatal liver rupture is described. The capability of ultrasonography in revealing both the parenchymal lesions and the subcapsular hematoma is emphasised.

Upper urinary tract obstruction in children caused by Candida fungus balls.

2 children with upper urinary tract obstruction from Candida fungus balls are reported. A presumptive diagnosis, made on the basis of clinical and radiological findings, was confirmed by microscopic examination of urinary sediment. Medical treatment was successful in both patients. Since Candida infections can occur in patients with altered host resistance, this should alert clinicians to the possibility of fungal involvement when radiolucent filling defects are found in the renal pelvis. Such a presumptive diagnosis can then lead to a correct approach with conservation of renal function.

Esophageal perforation in the newborn.

Two cases of esophageal perforation in the newborn are reported. The first case underwent surgery after suspected diagnosis of a traumatic perforation of a superior atresic esophageal stump. The second case was treated with supportive therapy. Both cases were cured and discharged in good health. The possible mechanisms of spontaneous and iatrogenic perforation are discussed.