Intussusception in a child with COVID-19 in the USA.

COVID-19, caused by the novel coronavirus strain SARS-CoV-2 that emerged in late 2019, has resulted in a global pandemic. COVID-19 was initially believed to occur less frequently in children with relatively mild disease. However, severe disease and varied presentations have been reported in infected children, one of such being intussusception. There have only been three reported cases of intussusception in the pediatric population infected with COVID-19. In this paper, we will discuss the management and treatment of a novel fourth case of COVID-19-associated intussusception. This case is the first reported in the USA and suggests that COVID-19 may be implicated in the development of intussusception. Pediatricians should consider the possibility of intussusception when a child with COVID-19 presents with abdominal pain.

Persistence of müllerian duct structures in a genetic male with distal monosomy 10q.

Persistent müllerian duct syndrome (PMD) with antimüllerian hormone (AMH) deficiency is usually associated with mutations or deletions of the AMH gene, although many cases have no identified gene association. We report on a genetic male with PMD and AMH deficiency associated with distal monosomy 10q. A term 3,230 g infant was born to a healthy 27-year-old. Fetal ultrasound had shown possible genital ambiguity. Postnatal exam showed a 0.5 cm phallus with basal meatus, normal scrotum with no palpable gonads, no vaginal orifice, and a rectal fistula with an imperforate anus. Voiding cystourethrogram with ultrasound, cystoscopy, and laparoscopy showed normal bladder, urethral orifice, distal vagina, cervix, and bilateral abdominal testis. At 24 hours of life, testosterone was within normal range with low AMH level. Chromosome microarray analysis showed 46, XY, del10(10q25.3q26.13) involving an 8.2 MB interstitial deletion. Whole exome sequencing identified a NOTCH2 variant (1p11.2). AMH sequencing revealed no abnormalities. Following multidisciplinary team and parent discussion, male gender was assigned. Testosterone treatment resulted in penile length of 1.5 cm. Bilateral orchiopexy and posterior sagittal anorectoplasty were performed at 11 months of age; rudimentary müllerian structures were identified. This observation suggests an association of 10qter elements with male differentiation including AMH expression and is similar to a patient with 46, XY, del(10q26.1) in which AMH levels were not reported. Regional candidate genes include FGFR2 (10q26.13). The possible contribution of a NOTCH2 variant cannot be excluded.

Facial vein thrombophlebitis: an uncommon complication of sinusitis.

Facial vein thrombophlebitis is an uncommon complication of sinusitis. In cases where periorbital swelling complicating sinusitis is diagnosed, clinical findings of swelling and erythema extending beyond the orbital region into the cheek should alert the physician about this unusual complication and the need for further contrast-enhanced imaging and venography. The radiologist must be particularly careful in the evaluation of vascular structures of the face and neck in these children. CT and MRI with contrast material and MR venography are studies that clearly demonstrate the vascular anatomy and possible complications. However, MR venography confirms flow abnormalities within the venous system with the advantage of avoiding radiation exposure to the pediatric patient.

Non-fecalith-induced appendicitis: etiology, imaging, and pathology.

This study aims to document the imaging and pathology findings in non-fecalith-induced appendicitis. We reviewed the imaging and pathologic findings in 40 patients with histologically proven purulent appendicitis seen over a 2-year period. Findings documented were (1) total appendiceal involvement, (2) predominant appendiceal tip involvement, (3) presence of a fecalith, and (4) presence of lymphoid hyperplasia. There were a total of 40 patients, 28 males and 12 females. The age range was 2-18 years with a mean of 11.5 years. Twenty-two (55 %) patients demonstrated classic purulent appendicitis of the whole appendix, 20 (91 %) of these appendices had a fecalith. Eighteen (45 %) patients demonstrated purulent appendicitis confined to or predominately involving the tip of the appendix, and all 18 (100 %) patients demonstrated marked lymphoid hyperplasia. Only two (11 %) of these appendices had a fecalith. Overall, a fecalith was found in only 55 % of our cases, while 45 % demonstrated no fecalith, but rather marked lymphoid hyperplasia. Lymphoid hyperplasia appeared to be the underlying predisposing cause of purulent appendicitis in these cases.

Comprehensive review of the anatomy, function, and imaging of the popliteus and associated pathologic conditions.

The popliteus is a relatively small but unique muscle of the knee. It is a component of the posterolateral corner of the knee and acts as a major stabilizer of the posterolateral knee. It is important to be aware of the normal magnetic resonance (MR) imaging appearance of the popliteus musculotendinous complex and its relation to other structures of the posterolateral corner for accurate diagnosis. It is also important to be aware of the pitfalls in imaging of the popliteus. Dysfunction of the popliteus is often underappreciated and is usually secondary to direct or indirect trauma. Injuries of the popliteus can be classified as first-, second-, or third-degree strains. Injuries of the popliteus are often associated with other posterolateral corner injuries. Pathologic conditions of the popliteus may be a clue to other injuries in the knee. The site and pattern of popliteus tear can be helpful to the orthopedic surgeon in deciding whether repair is warranted and determining the approach to surgery and has prognostic implications. Undiagnosed popliteus injuries can lead to poor functional results after knee reconstructive surgery. Inflammatory pathologic conditions of the popliteus may cause knee pain and can be diagnosed with MR imaging. The popliteus is an important component of the posterolateral corner that needs closer attention for optimal diagnosis and patient care.

Tibial stress phenomena and fractures: imaging evaluation.

This study aims to evaluate the various imaging modalities used to diagnose tibial stress-fractures/phenomena and determine which of these are most useful and definitive. The plain film, computed tomography (CT), magnetic resonance (MR), and nuclear medicine findings in a 20-patient cohort, ranging from ages 10 to 21 years with an average of 16 years, were reviewed. The male to female ratio was recorded as was the incidence of right or left, or bilateral extremity involvement. Thereafter, each imaging modality was evaluated for positive findings. Twelve of the patients had pretibial swelling on plain films, 10 a thickened cortex, to a visible fracture on plain films and 13 had increased short-tau inversion recovery (STIR) signal in the post tibial (marrow) and pretibial (subperiosteum) areas on MR imaging. No CT studies were performed. One positive nuclear medicine study was available. Although there are a number of imaging modalities which can be used to evaluate the tibial stress/fracture phenomena problem, it would appear that plain films and MR studies are most useful. If plain films do not show a fracture and further information is required, an MR study is most appropriate.

What is different in children?

The bones of infants and children are soft and so they tend to buckle and bend rather than frankly break. In addition, to accommodate growth, epiphyseal plates exist. These areas represent weak zones in the long bones and shearing/twisting forces cause fractures. All of this results in fractures different than what one sees in adults and this communication deals with how to identify these fractures, how to appreciate the more subtle of these fractures, and how to utilize comparative views for the subtle cases.

Left upper quadrant pain: upside down spleen.

We present the clinical and imaging findings in a patient presenting with left upper quadrant pain. On plain films, a mass was seen in the left upper quadrant, and on computed tomography (CT), a spleen with a whorled pedicle suggesting torsion was identified. However, it was the coronal reconstruction CT study that definitely showed that the spleen had undergone a 180-degree torsion. We refer to the findings on the coronal CT reconstruction as the "upside down" spleen sign, and it was very helpful in clinching the diagnosis.

Radiographic findings in late-presenting congenital diaphragmatic hernia: helpful imaging findings.

BACKGROUND: Imaging findings in delayed presentation of congenital diaphragmatic hernia can be confusing and misleading, resulting in a delay in diagnosis. OBJECTIVE: To evaluate the often puzzling plain film findings of late-presenting CDH in an effort to determine whether any of the findings could be helpful in arriving at an early diagnosis. MATERIAL AND METHODS: We reviewed and documented the plain film findings and clinical data in eight patients seen during the last 20 years with late-presenting CDH. IRB exempt status was obtained in this study. RESULTS: There were five boys and three girls. The age range was 4 months to 12 years with a mean of 2.4 years. Five children presented with acute respiratory problems while three presented with acute abdominal pain. Two children presented with both respiratory and abdominal findings and one also presented with hematemesis. Two children had radiographic findings that were not difficult to analyze while the remaining six had findings that posed initial diagnostic problems. CONCLUSION: Although not common, late-presenting CDH can result in confusing plain film radiographic findings and a delay in diagnosis. We found that the most important finding in analyzing these radiographs is in evaluating the location and position of the gastric bubble with the more common left-side hernias.