Massive chylous ascites and transected pancreas secondary to child abuse: successful non-surgical management.

A case of massive chylous ascites associated with transection of the pancreas secondary to occult child abuse is presented. Computed tomography and ultrasound demonstrated exquisitely the location and extent of the clinically occult pancreatic injury. Also demonstrated was the complete resolution of the chylous ascites and the resolving and later completely resolved pancreatic injury following non-operative conservative treatment with total parenteral nutrition.

Burkitt's lymphoma with mandible, intra-abdominal and renal involvement--initial presentation of HIV infection in a 4-year-old child.

Burkitt's lymphoma of the jaw was first described as a jaw tumor occurring endemically in African children. We report a case of Burkitt's lymphoma in a child presenting with a painful jaw mass which proved to be Burkitt's lymphoma; renal involvement was also noted. The child was found to be HIV positive. Burkitt's may be the initial manifestation of HIV infection in the pediatric population.

Left-sided posterior mediastinal thymus--MRI findings.

Anomalous descent of the thymus may result in ectopic thymic tissue in the neck and/or the mediastinum and can mimic an abnormal mediastinal mass. We present one case of a "posterior mediastinal mass" that was diagnosed as a posterior mediastinal thymus utilizing CT plus MRI.

Febrile infants less than 3 months old: value of chest radiography.

In the febrile infant less than 3 months old, a chest radiograph is commonly obtained to identify the cause of the fever. The purpose of this study was to evaluate the necessity of obtaining chest radiographs in this population. The clinical records and chest radiographs of 192 febrile infants (greater than 100.5 degrees F, rectal) were reviewed. Nineteen patients had signs of respiratory distress; seven had positive findings on chest radiographs. Of the 173 patients without signs of respiratory distress, five had positive findings on chest radiographs. When chest radiography was considered the gold standard for the presence or absence of pneumonia, findings of respiratory distress on physical examination had a sensitivity of 58% and a specificity of 93% for the detection of pneumonia. The prevalence of positive findings on chest radiographs in febrile infants less than 3 months old was 6%. A chest radiograph should be obtained in febrile infants only when signs of respiratory distress are present.

Tuberculosis in human immunodeficiency virus-infected children. A family infection.

OBJECTIVE: To study the epidemiologic and clinical features of infection with Mycobacterium tuberculosis in human immunodeficiency virus (HIV)-infected children and their families. PATIENTS AND CLINICAL SETTING: Sixty families of children with HIV infection, children of HIV indeterminate status, and seroreverters underwent follow-up in a comprehensive multidisciplinary program for children and families. METHODS: Infection with M tuberculosis was diagnosed based on a positive Mantoux test result or a positive culture. RESULTS: Mycobacterium tuberculosis infection was diagnosed in seven children (three infected with HIV, three seroreverters, and one uninfected sibling of an infected child) from four families (6%). All infections were detected in the period from March 1990 through January 1992. Six of seven children had a history of exposure to M tuberculosis in an HIV-infected adult (parent) who was an intravenous drug user, homeless, and/or noncompliant with the medical regimen. All HIV-infected children and one seroreverter had pulmonary tuberculosis. One child died of complications of tuberculosis and HIV infection. The M tuberculosis isolated from this child was resistant to isoniazid, rifampin, and streptomycin sulfate. CONCLUSIONS: Tuberculosis is a growing problem among inner-city children born to HIV-infected parents. Children infected with HIV in this study had symptomatic and severe disease with tuberculosis, which reflected the drug susceptibility pattern of M tuberculosis seen in our community.