Intestinal ultrasound in pediatrics. / Ecografía intestinal en pediatría.

Ultrasonography is the imaging technique of choice for studying the digestive tract in pediatric patients from the neonatal period to adolescence. Its dynamic character, absence of radiation, and scant preparation required make ultrasonography preferable to contrast-enhanced fluoroscopy, computed tomography, or magnetic resonance imaging. Technical advances in ultrasound, including high-resolution multifrequency probes, panoramic studies, color Doppler, Doppler with microvascularization, elastography, and contrast agents for use in children, have increased the sensitivity and specificity of this technique. Intestinal ultrasound is indicated for conditions with diverse etiologies and pathogenesis: congenital, infectious, inflammatory, tumor-related, and vascular. Knowledge of embryological development and the normal characteristics of the digestive tract help in identifying, recognizing, and interpreting the ultrasound findings of the different conditions in pediatric patients. This paper aims to show the indications for ultrasound studies of the digestive tract in children, the findings on these studies, and the management of the most common gastrointestinal conditions in pediatric patients.

El bazo pediátrico no traumático. Valoración por imagen / Non-traumatic spleen disorders in children. Assessment by imaging

Para la mayoría de radiólogos y pediatras, el bazo es el "órgano olvidado", a pesar de estar afectado en múltiples situaciones clínicas de la infancia. Mientras que en el traumatismo abdominal pediátrico es el órgano más implicado, la patología esplénica no traumática es menos conocida. El bazo se visualiza bien mediante cualquier técnica de imagen: ecografía, tomografía computarizada, resonancia magnética, y de ellas, la primera es la más utilizada en niños. Conocer las características por imagen de las anomalías esplénicas, tanto congénitas como adquiridas, permite realizar una aproximación diagnóstica correcta, evitar procedimientos quirúrgicos o biopsias innecesarias y guiar al clínico hacia un tratamiento adecuado. Nuestro objetivo es mostrar el comportamiento del bazo en edad pediátrica con las diferentes técnicas de imagen: su anatomía normal, las principales variantes anatómicas y la patología esplénica no traumática más frecuente, correlacionando con clínica, serología o histología

The spleen is considered a "forgotten organ" by most radiologists and paediatricians despite being affected in many clinical paediatric situations. While it is the organ most often affected in paediatric abdominal trauma, non-traumatic spleen disorders are less well known. The spleen is well visualised by any imaging technique: ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI); the former is used most often in children. Using imaging techniques to determine the features of splenic anomalies, both congenital and acquired, enables a correct diagnostic approach, avoids unnecessary surgical procedures or biopsies, and helps the clinician to prescribe appropriate treatment. Our aim was to show the behaviour of the spleen in children using the different imaging techniques: its normal anatomy, the principal anatomical variants and the most common spleen disorder correlating with clinical symptoms, serology and histology

Non-traumatic spleen disorders in children. Assessment by imaging. / El bazo pediátrico no traumático. Valoración por imagen.

The spleen is considered a "forgotten organ" by most radiologists and paediatricians despite being affected in many clinical paediatric situations. While it is the organ most often affected in paediatric abdominal trauma, non-traumatic spleen disorders are less well known. The spleen is well visualised by any imaging technique: ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI); the former is used most often in children. Using imaging techniques to determine the features of splenic anomalies, both congenital and acquired, enables a correct diagnostic approach, avoids unnecessary surgical procedures or biopsies, and helps the clinician to prescribe appropriate treatment. Our aim was to show the behaviour of the spleen in children using the different imaging techniques: its normal anatomy, the principal anatomical variants and the most common spleen disorder correlating with clinical symptoms, serology and histology.

Divertículos caliciales en niños: hallazgos radiológicos y formas de presentación / Calyceal diverticula in children: imaging findings and presentations

El divertículo calicial (DC) es una eventración quística intraparenquimatosa tapizada por epitelio celular transitorio con una estrecha conexión infundibular con los cálices o pelvis del sistema colector renal, por lo que el término más exacto es divertículo pielocalicial. Muy raro en la edad pediátrica, puede ser sintomático y requerir tratamiento. Está infradiagnosticado por confundirse con quistes renales simples por ecografía; su diagnóstico se confirma con tomografía computarizada (TC) o resonancia magnética (RM) en fase excretora, para determinar su seguimiento y manejo. Nuestro objetivo es mostrar las diferentes formas de presentación de los DC en la edad pediátrica, haciendo hincapié en los criterios ecográficos que permiten una aproximación diagnóstica y en los hallazgos definitivos en TC y RM. También discutimos el diagnóstico diferencial con otras lesiones quísticas renales y su tratamiento

A calyceal diverticulum consists of a cystic eventration in the renal parenchyma that is lined with transitional cell epithelium with a narrow infundibular connection with the calyces or pelvis of the renal collector system; thus, the term pyelocalyceal diverticulum would be more accurate. Very rare in pediatric patients, calyceal diverticula can be symptomatic and require treatment. Calyceal diverticula are underdiagnosed because they can be mistaken for simple renal cysts on ultrasonography. To determine the approach to their follow-up and management, the diagnosis must be confirmed by excretory-phase computed tomography (CT) or magnetic resonance imaging (MRI). This article aims to show the different ways that calyceal diverticula can present in pediatric patients; it emphasizes the ultrasonographic findings that enable the lesion to be suspected and the definitive findings that confirm the diagnosis on CT and MRI. It also discusses the differential diagnosis with other cystic kidney lesions and their treatment

Calyceal diverticula in children: imaging findings and presentations. / Divertículos caliciales en niños: hallazgos radiológicos y formas de presentación.

A calyceal diverticulum consists of a cystic eventration in the renal parenchyma that is lined with transitional cell epithelium with a narrow infundibular connection with the calyces or pelvis of the renal collector system; thus, the term pyelocalyceal diverticulum would be more accurate. Very rare in pediatric patients, calyceal diverticula can be symptomatic and require treatment. Calyceal diverticula are underdiagnosed because they can be mistaken for simple renal cysts on ultrasonography. To determine the approach to their follow-up and management, the diagnosis must be confirmed by excretory-phase computed tomography (CT) or magnetic resonance imaging (MRI). This article aims to show the different ways that calyceal diverticula can present in pediatric patients; it emphasizes the ultrasonographic findings that enable the lesion to be suspected and the definitive findings that confirm the diagnosis on CT and MRI. It also discusses the differential diagnosis with other cystic kidney lesions and their treatment.

Torsión testicular perinatal. Valoración ecográfica y diagnóstico diferencial / Perinatal testicular torsion: ultrasound assessment and differential diagnosis

La torsión testicular perinatal constituye el 10% de las torsiones testiculares en la edad pediátrica y se produce en el periodo prenatal o neonatal durante el primer mes de vida. La mayoría son extravaginales, siendo improbable la torsión intravaginal. Su manejo es controvertido debido a la baja viabilidad del testículo y a la posibilidad de torsión bilateral. La ecografía es el método de elección para su estudio. La combinación del modo B con el Doppler color o el power Doppler facilita el diagnóstico de forma rápida y segura. Revisamos la apariencia ecográfica de la torsión testicular neonatal en cada una de sus formas de presentación, el diagnóstico diferencial con otras causas de aumento de la bolsa escrotal en el neonato, y finalmente su tratamiento (AU)

Perinatal testicular torsion, defined as torsion occurring in the prenatal period or in the first month after birth, accounts for 10% of all cases of testicular torsion in pediatric patients. Most are extravaginal, and intravaginal torsion is rare. Its management is controversial, due to the low viability of the testis and the possibility of bilateral torsion. Ultrasonography is the method of choice to study testicular torsion. Combining B-mode and power Doppler imaging facilitates a fast reliable diagnosis. We review the ultrasonographic appearance of neonatal testicular torsion for each presentation, the differential diagnosis with other causes of increased scrotal volume in neonates, and its treatment (AU)

¿Es posible el manejo ambulatorio de la invaginación intestinal? / Is it possible the outpatient management of intussusception?

Introducción: la invaginación intestinal es la causa más frecuente de obstrucción intestinal en menores de tres años. Habitualmente, tras la desinvaginación, los pacientes permanecen ingresados 24-48 horas. Recientemente se ha propuesto el manejo ambulatorio mediante observación clínica durante 12 horas. Nuestro objetivo es valorar la implementación de esta actitud terapéutica. Material y métodos: revisión retrospectiva de las invaginaciones intestinales atendidas en nuestro centro durante los últimos 12 años. Resultados: se incluye 458 pacientes, el 60,3% de ellos varones. Edad media de 24,1 meses, siendo la localización ileocólica la más frecuente (77,7%). El 2,4% presentó alguna causa secundaria. Se realizó neumoenema en 370 niños, requiriendo cirugía el 10,7%. Se registraron 78 recidivas en 56 pacientes (12,2%), 15 de ellos intrahospitalariamente. El tiempo medio para la reintroducción de la alimentación y la estancia media fueron de 28,6 y 64,4 horas respectivamente, sin diferencias significativas entre aquellos que recidivaron y los que no (60,8 frente a 69 horas; t = -0,4; p = 0,689). No se registraron diferencias entre el tiempo de evolución clínica y la tasa de éxito del neumoenema (t = 0,478; p = 0,634); aunque hubo diferencias en la necesidad de intervención quirúrgica (χ² = 5,604; p = 0,018), no hubo ninguna complicación. La reintroducción precoz de la alimentación no se relacionó con más recidivas ni diferencias entre los grupos (30,2% en el grupo que recidivó y 23,1% en el grupo sin recidiva, p = 0,608). Conclusiones: el ingreso hospitalario más allá de 12 horas no disminuye la tasa de complicaciones. Por tanto, consideramos que la observación en urgencias tras la desinvaginación durante 12 horas es una medida segura y coste-efectiva (AU)

Introduction: intussusception is the most frequent cause of bowel obstruction in children under three years. Usually, after reduction, patients remain admitted for 24-48 hours. Ambulatory management has recently been proposed, based on clinical experience of follow-up of the patient's evolution in the Emergency Department of the hospital during the following 12 hours. Our objective is to evaluate the implementation of this new therapeutic attitude. Material and methods: retrospective review of all the intussusceptions treated at our center during the last 12 years. Results: 458 patients were included, 60.3% ot them were male. Mean age was 24.1 months (SD 24.6), with the ileo-colic location being the most frequent (77.7%). 2.4% had secondary causes. A pneumoenema was performed in 370 children, requiring surgery 10.7%. There were 78 relapses in 56 patients (12.2%), 15 of them during admission. The mean time to reintroduce feeding and the mean hospital stay was 28.6 and 64.4 hours respectively, with no significant difference between those who relapsed and those who did not (60.8 vs 69 hours, t = -0.4, p = 0.689). There was no relationship between a longer clinical evolution and pneumoenema succeed rate (t = 0.478, p = 0.634). Although there were differences in the need for surgical intervention (χ² = 5.604, p = 0.018), there were no complications. Early reintroduction of feeding was not related to any recurrences or differences between groups (30.2% in the relapsed group and 23.1% in the non-recurrent group, p = 0.608). Conclusions: hospital admission beyond 12 hours does not decrease the rate of complications. Therefore, we consider that outpatient observation for 12 hours after reduction is a safe and economical measure (AU)

Quistes de ovario neonatales. Valoración ecográfica y diagnóstico diferencial / Neonatal ovarian cysts: ultrasound assessment and differential diagnosis

Los quistes de ovario son los quistes abdominales más frecuentes en fetos y neonatos de sexo femenino. La ecografía es la técnica de imagen de elección para su diagnóstico, ya que permite además distinguirlos de otras lesiones quísticas. Aunque la mayoría de quistes de ovario neonatales (QON) involucionan en el transcurso de los primeros meses de vida, pueden presentar complicaciones durante el periodo fetal o posnatal. Las manifestaciones ecográficas de los QON van a estar en función de las mismas. El manejo es controvertido, con la tendencia actual de esperar y ver. Describimos las diferentes formas de presentación de los QON con sus patrones ecográficos y complicaciones, su diagnóstico diferencial con otras lesiones abdominales quísticas y, finalmente, su manejo terapéutico (AU)

Ovarian cysts are the most common abdominal cysts in female fetuses and newborn girls. Ultrasonography is the imaging technique of choice for diagnosing ovarian cysts because it makes it possible to differentiate them from other cystic lesions. Although most neonatal ovarian cysts regress in the first few months after birth, complications can occur during gestation or after birth. The manifestations of ovarian cysts on ultrasonography will depend on the complications. The management is controversial, although the current trend favors watchful waiting. We describe the different presentations of neonatal ovarian cysts with their complications and their patterns of findings on ultrasonography. We also discuss the differential diagnosis with other cystic abdominal lesions, and finally we discuss the therapeutic management of neonatal ovarian cysts (AU)

Perinatal testicular torsion: ultrasound assessment and differential diagnosis. / Torsión testicular perinatal. Valoración ecográfica y diagnóstico diferencial.

Perinatal testicular torsion, defined as torsion occurring in the prenatal period or in the first month after birth, accounts for 10% of all cases of testicular torsion in pediatric patients. Most are extravaginal, and intravaginal torsion is rare. Its management is controversial, due to the low viability of the testis and the possibility of bilateral torsion. Ultrasonography is the method of choice to study testicular torsion. Combining B-mode and power Doppler imaging facilitates a fast reliable diagnosis. We review the ultrasonographic appearance of neonatal testicular torsion for each presentation, the differential diagnosis with other causes of increased scrotal volume in neonates, and its treatment.

Neonatal ovarian cysts: ultrasound assessment and differential diagnosis. / Quistes de ovario neonatales. Valoración ecográfica y diagnóstico diferencial.

Ovarian cysts are the most common abdominal cysts in female fetuses and newborn girls. Ultrasonography is the imaging technique of choice for diagnosing ovarian cysts because it makes it possible to differentiate them from other cystic lesions. Although most neonatal ovarian cysts regress in the first few months after birth, complications can occur during gestation or after birth. The manifestations of ovarian cysts on ultrasonography will depend on the complications. The management is controversial, although the current trend favors watchful waiting. We describe the different presentations of neonatal ovarian cysts with their complications and their patterns of findings on ultrasonography. We also discuss the differential diagnosis with other cystic abdominal lesions, and finally we discuss the therapeutic management of neonatal ovarian cysts.

Multicystic dysplastic kidney: Assessment of the need for renal scintigraphy and the safety of conservative treatment. / Displasia renal multiquística: evaluación de la necesidad de la gammagrafía renal y seguridad del tratamiento conservador.

OBJECTIVES: To assess the need for implementing renal scintigraphy in the diagnosis of the multicystic dysplastic kidney (MCDK) and the safety of its conservative treatment. MATERIAL AND METHODS: A retrospective study of patients with unilateral MCDK was conducted at our centre from January 2005 to August 2015. We calculated the positive predictive value (PPV) of ultrasonography, taking renal scintigraphy and pathology as the gold standard. We calculated a survival curve according to the Kaplan-Meier method to assess the annual probability of spontaneous resolution of the multicystic kidney. RESULTS: Fifty-six patients were identified, 48 (85.7%) of whom had a prenatal diagnosis. Thirty eight (67.9%) of the patients were males, and the left side was affected in 33 (58.9%) of the patients. We observed associated urological abnormalities in 22 (39.29%) patients, with vesicoureteral reflux the most common (8, 14.29%). Seven patients (12.5%) developed renal failure. Forty-nine (87.5%) patients developed compensatory contralateral renal hypertrophy. Of the 33 patients who underwent surgery, the pathology results confirmed the MCDK diagnosis in 32. Compared with scintigraphy and pathology, the PPV of ultrasonography was 100% and 97%, respectively. The rate of spontaneous involution was 5.4% at 3 months of life, 11.3% at 2 years and 38.4% at 5 years. CONCLUSIONS: In our experience, the conservative treatment of MCDK, until at least 5 years of age, is safe. Our data suggest that performing scintigraphy is not required for these patients, which means lower radiation exposure, as well as financial savings.

La elastografía mediante técnica Acoustic radiation force impulse es eficaz en la detección de fibrosis hepática en el niño / Acoustic radiation force impulse imaging elastography is efficacious in detecting hepatic fibrosis in children

Objetivo. Evaluar el rendimiento diagnóstico de ARFI para detectar fibrosis hepática significativa en la edad pediátrica. Material y métodos. El estudio fue aprobado por el comité de ética hospitalario, con el consentimiento informado de los pacientes o sus representantes. Estudiamos 96 niños (50 varones, 46 hembras; edad media 8 años); 16 voluntarios sin enfermedad hepática conocida y 80 con patologías que pueden evolucionar a fibrosis y cirrosis hepática. La muestra final incluyó 31 pacientes con biopsia y 16 controles sanos. En todos los casos se realizó ecografía abdominal incluyendo Doppler y elastografía con ARFI. El valor ARFI expresado como velocidad (m/s) de propagación de las ondas transversales a través del tejido se calculó promediando 16 medidas en ambos lóbulos hepáticos. Comparamos las medias con el test de ANOVA de un factor. Los tests t de Student y chi cuadrado se usaron para datos categóricos. La significación estadística se estableció para una p < 0,05. Resultados. La velocidad en niños con fibrosis ≥ F2 fue significativamente más alta (1,80 ± 0,45 m/s) que en controles y pacientes con F0-F1 (1,38 ± 0,22 m/s) (p < 0,001). La esteatosis no se relacionó con la velocidad. La actividad necroinflamatoria se relacionó muy significativamente con la velocidad (p < 0,01). Fibrosis y actividad necroinflamatoria se relacionaron muy significativamente (p < 0,0001). Conclusión. La velocidad de propagación de las ondas ARFI se relacionó significativamente en los niños con el grado de fibrosis hepática (AU)

Objective. To evaluate the diagnostic performance of acoustic radiation force impulse imaging (ARFI) in detecting significant hepatic fibrosis in children. Material and methods. Our hospital's ethics committee approved the study and all patients or their representatives provided informed written consent. We included 96 children (50 boys, 46 girls; mean age, 8 y). We also studied 16 volunteers without liver disease as controls and 80 patients with diseases that can lead to fibrosis and cirrhosis of the liver. The final sample included 31 patients with biopsies and the 16 controls. All patients underwent abdominal ultrasonography including Doppler imaging and elastography with ARFI. The ARFI value, expressed as velocity (m/s) of shear wave propagation through the tissue, was calculated by averaging 16 measurements in both liver lobes. We used one-way analysis of variance to compare means between groups; we set statistical significance at P<.05. We used Student's t-tests and chi-square tests for categorical data. Results. The ARFI value in children with fibrosis ≥ F2 was higher (1.80 ± 0.45 m/s) than in controls and higher than in patients with F0-F1 (1.38 ± 0.22 m/s). The difference was significant (P<.001) for detecting F ≥ 2. Steatosis was not related with the ARFI value (Student's t-test, P>.84). Necroinflammatory activity was strongly associated with the ARFI value (Student's t-test, P<.01). Fibrosis and necroinflammatory activity were strongly associated with each other (chi-square test, P<.0001). Conclusion. The speed of shear wave propagation is significantly associated with the degree of hepatic fibrosis in children (AU)

Lesiones hepáticas ocupantes de espacio / A hepatic space-occupying lesion

No disponible

[Acoustic radiation force impulse imaging elastography is efficacious in detecting hepatic fibrosis in children]. / La elastografía mediante técnica Acoustic radiation force impulse es eficaz en la detección de fibrosis hepática en el niño.

OBJECTIVE: To evaluate the diagnostic performance of acoustic radiation force impulse imaging (ARFI) in detecting significant hepatic fibrosis in children. MATERIAL AND METHODS: Our hospital's ethics committee approved the study and all patients or their representatives provided informed written consent. We included 96 children (50 boys, 46 girls; mean age, 8 y). We also studied 16 volunteers without liver disease as controls and 80 patients with diseases that can lead to fibrosis and cirrhosis of the liver. The final sample included 31 patients with biopsies and the 16 controls. All patients underwent abdominal ultrasonography including Doppler imaging and elastography with ARFI. The ARFI value, expressed as velocity (m/s) of shear wave propagation through the tissue, was calculated by averaging 16 measurements in both liver lobes. We used one-way analysis of variance to compare means between groups; we set statistical significance at P<.05. We used Student's t-tests and chi-square tests for categorical data. RESULTS: The ARFI value in children with fibrosis ≥ F2 was higher (1.80±0.45m/s) than in controls and higher than in patients with F0-F1 (1.38±0.22m/s). The difference was significant (P<.001) for detecting F ≥ 2. Steatosis was not related with the ARFI value (Student's t-test, P>.84). Necroinflammatory activity was strongly associated with the ARFI value (Student's t-test, P<.01). Fibrosis and necroinflammatory activity were strongly associated with each other (chi-square test, P<.0001). CONCLUSION: The speed of shear wave propagation is significantly associated with the degree of hepatic fibrosis in children.

Evaluación del grosor del complejo íntima-media de la carótida en la hipercolesterolemia familiar durante la infancia / Evaluation of carotid intima-media thickness in familial hypercholesterolemia in childhood

Introducción: en la hipercolesterolemia familiar (HF), la concentración elevada de colesterol de las lipoproteínas de baja densidad (cLDL) desde el nacimiento produce depósito lipídico en la pared arterial, que puede medirse mediante el grosor del complejo íntima-media (GIM) arterial. Sujetos y métodos: se determinaron el GIM así como las concentraciones de colesterol y sus fracciones, los triglicéridos, la apolipoproteína A-I (apo A-I), la apolipoproteína B (apo B) y los factores de riesgo endotelial (homocisteína y proteína C ultrasensible) en 89 sujetos (44 varones) de 2 a 19 años (9,54±3,91 años). El GIM se midió en ambas carótidas a 1cm del bulbo por método de alta resolución (12MHz). Se comparó el GIM medio con la edad, el sexo y los parámetros analíticos mediante análisis de regresión múltiple. Resultados: los valores medios fueron GIM de 0,334±0,088mm; colesterol total de 273,62±91,93mg/dl; cLDL de 204,21±86,16mg/dl; LDL (lipoproteínas de baja densidad) y lipoproteínas de alta densidad (HDL) de 3,83±1,45mg/dl; apo A de 134,61±26,49mg/dl; apo B de 130,59 ± 40,59mg/dl; homocisteína (mediana) de 7,16mmol/dl, y proteína C reactiva mediana de 0,3mg/l. Según el análisis de regresión múltiple, sólo la edad se asocia al GIM (p=0,049), y su incremento anual es de 0,005mm (intervalo de confianza [IC] del 95%: 0,000¿0,010); hasta los 12 años el incremento del GIM es de 0,002mm anuales (IC del 95%: −0,007-0,010) y desde esa edad el incremento es de 0,013mm anuales (IC del 95%: −0,023-0,049). Conclusiones: la medida del GIM carotídeo podría incorporarse como parámetro objetivo de valoración de la HF en la infancia. En este estudio sólo se relaciona con la edad; el aumento más marcado es a partir de los 12 años (AU)

Introduction: Familial hypercholesterolemia (FH) is characterized by exposure to severely elevated LDL-cholesterol from birth, which produces lipid deposits, which can be measured by means of intima-media thickness (IMT). Subjects and methods: The IMT and concentrations of cholesterol and its fractions, triglycerides, alipoproteins Apo-A1, Apo-B and endothelial risk factors (homocysteine and high sensitivity protein C ) were determined in 89 patients (44 males) from 2 to 19 years (9.54±3.91 years). IMT was measured by ultrasound using a 12MHz linear array transducer in both carotids to 1cm of the bulb. The IMT mean was compared with age, sex and analytical parameters using multiple regression analysis. Results: The mean values were: IMT 0.334±0.088mm, total cholesterol 273.62±91.93mg/dl, LDL-cholesterol 204.21±86.16mg/dl, LDL/HDL 3.83±1.45, apoprotein A1 134.61±26.49mg/dl, apoprotein B 130.59±40.59mg/dl, homocysteine (median) 7.16mmol/dl, Protein C (median) 0.3mg/l. Using multiple regression analysis, only age was associated with IMT (P=0.049), a mean 0.005mm (95% CI: 0.000¿0.010) being the annual increase: up to 12 years the increase in IMT was 0.002mm/year on (95% CI: −0.007-0,010) and then from that age it was 0.013mm/year (95% CI: −0.023-0.049). Conclusions: The measurement of the carotid IMT could become an objective parameter in the evaluation of the FH in childhood. In our study, it is only associated with age, the increase being most marked from 12 years onwards (AU)

[Evaluation of carotid intima-media thickness in familial hypercholesterolemia in childhood]. / Evaluación del grosor del complejo íntima-media de la carótida en la hipercolesterolemia familiar durante la infancia.

INTRODUCTION: Familial hypercholesterolemia (FH) is characterized by exposure to severely elevated LDL-cholesterol from birth, which produces lipid deposits, which can be measured by means of intima-media thickness (IMT). SUBJECTS AND METHODS: The IMT and concentrations of cholesterol and its fractions, triglycerides, alipoproteins Apo-A1, Apo-B and endothelial risk factors (homocysteine and high sensitivity protein C ) were determined in 89 patients (44 males) from 2 to 19 years (9.54+/-3.91 years). IMT was measured by ultrasound using a 12MHz linear array transducer in both carotids to 1cm of the bulb. The IMT mean was compared with age, sex and analytical parameters using multiple regression analysis. RESULTS: The mean values were: IMT 0.334+/-0.088mm, total cholesterol 273.62+/-91.93mg/dl, LDL-cholesterol 204.21+/-86.16mg/dl, LDL/HDL 3.83+/-1.45, apoprotein A1 134.61+/-26.49mg/dl, apoprotein B 130.59+/-40.59mg/dl, homocysteine (median) 7.16mmol/dl, Protein C (median) 0.3mg/l. Using multiple regression analysis, only age was associated with IMT (P=0.049), a mean 0.005mm (95% CI: 0.000-0.010) being the annual increase: up to 12 years the increase in IMT was 0.002mm/year on (95% CI: -0.007-0,010) and then from that age it was 0.013mm/year (95% CI: -0.023-0.049). CONCLUSIONS: The measurement of the carotid IMT could become an objective parameter in the evaluation of the FH in childhood. In our study, it is only associated with age, the increase being most marked from 12 years onwards.

[Pleuropulmonary blastoma in children: imaging findings and clinical patterns]. / Blastoma pleuropulmonar en niños: manifestaciones clínicas y radiológicas.

PURPOSE: To describe the imaging findings, clinical presentation and follow up of pleuropulmonary blastoma (PPB) in children. MATERIALS AND METHODS: Authors present a retrospective review of three young children with pathologically proven PPB seen from 1992 to 2006 in a pediatric hospital. The imaging findings on simple views, CT and MRI are presented. RESULTS: The first patient showed two bilateral well-defined solid lung lesions on chest X-rays, with homogeneous low attenuation on CT. Patient is free of disease following chemotherapy and surgical treatment. The second patient displayed a right tension pneumothorax. After drainage, he presented on chest X-rays and CT an underlying multicystic lesion. Following chemotherapy and surgical treatment, he presented two pulmonary metastases, which were treated with chemotherapy and surgery. The patient is now free of disease. The third patient showed a complete opacification of the left hemithorax due to a massive pleural effusion; a pleuropulmonary solid mass was seen on US, CT and MRI. The disease progressed with mediastinal, orbital and abdominal metastasis. The patient eventually died. CONCLUSION: PPB is a rare chest tumor seen in young children that can present with diverse radiological findings, and sometimes can arise in congenital cystic lung lesions. CT is the gold standard technique both for diagnosis and follow-up of these tumors.

Blastoma pleuropulmonar en niños: manifestaciones clínicas y radiológicas / Pleuropulmonary blastoma in children: imaging findings and clinical patterns

Objetivos. Describir los hallazgos por imagen del blastoma pleuropulmonar (BPP) en niños, así como su presentación clínica y evolución. Material y métodos. Estudio retrospectivo de tres pacientes consecutivos con confirmación anatomopatológica de BPP, recogidos entre 1992 y 2006 en un hospital de referencia pediátrico. Se analizan los hallazgos en la radiografía (Rx) de tórax, la tomografía computarizada (TC) y la resonancia magnética (RM). Resultados. Un paciente presentó en la Rx de tórax dos masas pulmonares sólidas bilaterales bien delimitadas, que en la TC se mostraban hipocaptantes y homogéneas. Tras tratamiento quimioterápico y cirugía, el paciente permanece libre de enfermedad. El segundo paciente comenzó con neumotórax a tensión derecho. Tras el drenaje del mismo se observó en la Rx de tórax y en la TC la presencia de una lesión multiquística subyacente. Posterior a la cirugía y al tratamiento quimioterápico presentó dos metástasis pulmonares que fueron tratadas con quimioterapia (QT) y cirugía. Actualmente está libre de enfermedad. El tercer caso presentó una opacificación completa del hemitórax izquierdo por derrame pleural masivo y masa sólida pleuropulmonar vista en la ecografía, la TC y la RM. La enfermedad progresó con extensión al mediastino, la órbita y el abdomen, y el paciente falleció. Conclusiones. El BPP es un tumor pulmonar infrecuente que se da en niños, con manifestaciones radiológicas diversas, que en ocasiones se asocia a una patología pulmonar quística congénita. La TC es la técnica de elección (patrón oro) tanto para el diagnóstico como para el seguimiento de estos tumores

Purpose. To describe the imaging findings, clinical presentation and follow up of pleuropulmonary blastoma (PPB) in children. Materials and methods. Authors present a retrospective review of three young children with pathologically proven PPB seen from 1992 to 2006 in a pediatric hospital. The imaging findings on simple views, CT and MRI are presented. Results. The first patient showed two bilateral well-defined solid lung lesions on chest X-rays, with homogeneous low attenuation on CT. Patient is free of disease followingchemotherapy and surgical treatment. The second patient displayed a right tension pneumothorax. After drainage, he presented on chest X-rays and CT an underlying multicystic lesion. Following chemotherapy andsurgical treatment, he presented two pulmonay metastases,which were treated with chemotherapy and surgery. The patient is now free of disease. The third patient showed a complete opacification of the left hemithorax due to a massive pleural effusion; a pleuropulmonary solid mass was seen on US, CT and MRI. The disease progressed with mediastinal, orbital and abdominal metastasis. The patient eventually died. Conclusion. PPB is a rare chest tumor seen in young children that can present with diverse radiological findings, and sometimes can arise in congenital cystic lung lesions. CT is the gold standard technique both for diagnosis and follow-up of these tumors (AU)

Hematoma intramural duodenal posbiopsia / Post-biopsy intramural duodenal haematoma

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