Ultrasonic diagnosis of gynecologic disorders in children.

During the last five years we have applied diagnostic ultrasound to more than 350 girls under the age of 15 for suspected obstetric and gynecologic disorders. More than 60% of these patients were pregnant and were studied before elective abortion. Many other children were studied for amenorrhea or for the evaluation of a pelvic mass. Sonography has allowed us to successfully distinguish pelvic masses of ovarian origin from those of uterine origin. We have also been able to rule out functioning endocrine tumors in children with precocious puberty. In cases of intersex, sonography has been useful in the older child prior to reconstructive surgery but has played an ancillary role to more invasive procedures in the infant.

Observations on persistently dilated ureter after posterior urethral valve ablation.

The persistent ureteral dilatation frequently seen months or even years after posterior urethral valve ablation, continues to present a dilemma to the urologist. We have classified these dilated ureters into 3 types: (I) unobstructed with either an empty or filling bladder, (II) unobstructed with an empty bladder but obstructed with a filling bladder, and (III) obstructed with either an empty or filling bladder. The majority of ureters with persistent dilatation were found to be of the type II variety where appropriate treatment is not obvious. Classic ureteral tailoring and reimplantation offers little advantage since in such cases a narrower ureter is passed through a new hiatus in an otherwise unchanged bladder. When high renal pelvic pressures are found only with bladder filling, then consideration must be given to not only reconstructing the ureter but also to affecting the dynamics of the bladder and the large urinary output characteristically found in these patients.

AIDS-related malignancies in pediatrics.

This article attempts to bring the reader up to date with the latest developments concerning AIDS-related malignancies in children. As these children live longer as a result of improved therapy, malignancies of the type described will become more common and wide-spread.

The gastrointestinal manifestations of pediatric AIDS.

The manifestations of AIDS in the gastrointestinal tract in children are mainly secondary to opportunistic infections and AIDS-related neoplasms. This article reviews the radiologic and pathologic findings seen throughout the gastrointestinal tract and within the abdomen in children afflicted with AIDS. Although many radiologic findings are not specific for a particular infection or neoplasm, the radiologist can narrow the differential diagnosis with a good knowledge of the imaging findings and pathologies specific for children with AIDS.

The left aortic arch and right descending aorta.

Three patients with a left arch and a right descending aorta are described, all presenting in infancy. In one patient the abnormality was acquired, yet the radiological appearances were very similar. The place of the barium swallow in the diagnosis is discussed, and it is concluded that aortography is required for a definitive diagnosis.

Diagnostic imaging in pediatric AIDS.

The manifestations of acquired immune deficiency syndrome (AIDS) in children are mainly secondary to opportunistic infection, lymphoproliferative diseases, and AIDS-related neoplasms. This article reviews the pathologic findings of various disorders afflicting children with AIDS and emphasizes the imaging of these disorders. Although many of the radiologic findings are not specific for a particular infection or neoplasm, the differential diagnostic possibilities for an abnormality can be narrowed down significantly with proper clinical correlation and knowledge of the imaging findings and pathologies specific to children with AIDS.

Acute polyhydramnios associated with chorioangioma. A case report.

A case of acute polyhydramnios occurred at 26 weeks' gestation. Prenatal sonography demonstrated a placental chorioangioma. Acute polyhydramnios is clinically distinct from nonacute polyhydramnios and carries a high perinatal mortality rate. As in our case, fetal death often results from complications of prematurity.

Benign lesions of the mandibular and maxillary region in children: characterization by CT and MRI.

The CT criteria for classifying lesions of the mandibular and maxillary regions in adults as benign or malignant are well recognized: irregular soft tissue margins and bone destruction. We reviewed the charts of 12 pediatric patients from 3 institutions to evaluate these criteria in children. These masses were evaluated by CT and/or MRI based solely on well-recognized and published criteria. The patients' ages ranged from 4 mo to 18 yr. The histological diagnoses were ameloblastoma (4), hemangioma (2), lymphangioma, desmoplastic fibroma, hemangiopericytoma, neurofibroma, fibrous dysplasia, and juvenile angiofibroma. All but one case was surgically proven. Among the 12 cases, 5 had bone destruction and 5 showed irregular soft tissue margins. Three cases satisfied both criteria. With well-recognized CT criteria (in adult patients), characterization of these processes led to an incorrect diagnosis of a malignant lesion in 8 of the 12 cases preoperatively. Therefore, CT and MR imaging should only be a guide to the planning and extent of surgical resection. Without clearly defined distal spread of the mass, the classification of these masses in children should be made with caution.

Imaging characteristics of aggressive fibromatosis in children.

Aggressive fibromatosis (AF) is a benign, non-metastatic proliferation of fibroblasts in the musculoaponeurotic compartment that tend to infiltrate locally and recur after surgical resection. Wide local excision with adequate clear margins is the treatment of choice. Magnetic resonance imaging (MRI) and computed tomography (CT) are excellent in delineating the extent and depth of these lesions. Thus they play an important role in the surgical management of these patients. There are a few descriptions of the MRI characteristics of these lesions in children. Radiographically, our cases are typical of others described in the literature-hypointense on T1-weighted images and hyperintense on T2-weighted images.

CT findings in pediatric gastrointestinal ascariasis.

We present a case of a 9-yr-old child with gastrointestinal ascariasis. Computed tomography of the abdomen demonstrates the Ascaris roundworms as cylindrical filling defects within contrast filled bowel loops. In addition, the intestinal tract of the roundworm itself is seen as a thin thread of oral contrast within the tubular filling defect. To our knowledge, this is the first reported description of the CT findings of intestinal ascariasis in a pediatric patient.

Panner's disease: X-ray, MR imaging findings and review of the literature.

Panner's disease, avascular necrosis of the capitellum, was first described on X-ray examination of the elbow. It represents a major threat to the elbow joint integrity, and it is important to diagnose early. Panner's disease occurs most commonly in young children who play baseball, and in competitive gymnasts. Although considered a rare entity, it probably is underdiagnosed. We present the X-ray and MR imaging findings in a young boy with Panner's disease. The MR imaging findings in Panner's disease have not been previously reported.

Cryptococcal osteomyelitis. Report of a case amd a review of the literature.

A case is reported of isolated cryptococcal osteomyelitis in an 11-year-old girl without any detectable underlying disease. The patient was successfully treated for six weeks with intravenous amphotericin B and oral 5-flucytosine. There is only one other case of cryptococcal osteomyelitis reported in the English medical literature in a child. Over 50 per cent of individuals with this infection will have an underlying condition which may have predisposed them to acquiring this disease.

The role of sonography in evaluating right upper quadrant disease in children.

Since 1974, grey scale sonography has been used with increasing frequency in evaluating abdominal masses in children. Because sonography is noninvasive and does not involve ionizing radiation, it is of particular value in the evaluation of pediatric patients. This paper focuses on right upper quadrant masses in children. The liver and gallbladder have been easy to image sonographically. It should be noted that sonography cannot accurately differentiate between benign and malignant lesions. The pancreas, previously a difficult organ to appreciate radiographically, can be visualized with both ultrasound and computerized tomography. Both history and physical examination are important to the sonographic evaluation of masses in children.