Staging and Restaging Pediatric Abdominal and Pelvic Tumors: A Practical Guide.

The most common abdominal malignancies diagnosed in the pediatric population include neuroblastoma, Wilms tumor, hepatoblastoma, lymphoma, germ cell tumor, and rhabdomyosarcoma. There are distinctive imaging findings and patterns of spread for each of these tumors that radiologists must know for diagnosis and staging and for monitoring the patient's response to treatment. The multidisciplinary treatment group that includes oncologists, surgeons, and radiation oncologists relies heavily on imaging evaluation to identify the best treatment course and prognostication of imaging findings, such as the image-defined risk factors for neuroblastomas, the PRETreatment EXtent of Disease staging system for hepatoblastoma, and the Ann Arbor staging system for lymphomas. It is imperative for radiologists to be able to correctly indicate the best imaging methods for diagnosis, staging, and restaging of each of these most prevalent tumors to avoid inconclusive or unnecessary examinations. The authors review in a practical manner the most updated key points in diagnosing and staging disease and assessing response to treatment of the most common pediatric abdominal tumors. ©RSNA, 2024 Supplemental material is available for this article.

Abdominal symptoms as initial manifestation of COVID-19: a case series.

The COVID-19 became a pandemic in early 2020. It was found, at first, that the main manifestations of this new virus occur through respiratory and constitutional symptoms. Therefore, chest tomography was elected as the best imaging test to assess the extent of pulmonary involvement and as a good prognostic predictor for the disease. However, as new studies were produced, the gastrointestinal involvement of COVID-19 becomes more evident, with reports from patients who manifested mainly or only gastrointestinal symptoms in the course of the disease. Thus, in some cases, the initial investigation is carried out at the emergency department with an abdominal computed tomography. We report a case series of ten patients who came to the emergency department of our institution with a chief gastrointestinal complaint, and were initially submitted to an abdominal computed tomography as the first investigation. Although most of the patients did not have significant changes in the abdominal images, most reported patients had pulmonary findings visualized at the lung bases, which were later designated as typical COVID-19 pulmonary findings on chest computed tomography. Only one patient had atypical COVID-19 lung changes on chest computed tomography. All patients had a positive real-time polymerase chain reaction for COVID-19. It is imperative to alert radiologists, especially abdominal radiologists, with the possibility of COVID-19 isolated gastrointestinal symptoms. Besides, it must become a habit to radiologists to assess the pulmonary basis on abdominal scans, a site commonly affected by the new coronavirus.

Abdominal symptoms as initial manifestation of COVID-19: a case series / Sintomas abdominais como manifestação inicial da COVID-19: uma série de casos

ABSTRACT The COVID-19 became a pandemic in early 2020. It was found, at first, that the main manifestations of this new virus occur through respiratory and constitutional symptoms. Therefore, chest tomography was elected as the best imaging test to assess the extent of pulmonary involvement and as a good prognostic predictor for the disease. However, as new studies were produced, the gastrointestinal involvement of COVID-19 becomes more evident, with reports from patients who manifested mainly or only gastrointestinal symptoms in the course of the disease. Thus, in some cases, the initial investigation is carried out at the emergency department with an abdominal computed tomography. We report a case series of ten patients who came to the emergency department of our institution with a chief gastrointestinal complaint, and were initially submitted to an abdominal computed tomography as the first investigation. Although most of the patients did not have significant changes in the abdominal images, most reported patients had pulmonary findings visualized at the lung bases, which were later designated as typical COVID-19 pulmonary findings on chest computed tomography. Only one patient had atypical COVID-19 lung changes on chest computed tomography. All patients had a positive real-time polymerase chain reaction for COVID-19. It is imperative to alert radiologists, especially abdominal radiologists, with the possibility of COVID-19 isolated gastrointestinal symptoms. Besides, it must become a habit to radiologists to assess the pulmonary basis on abdominal scans, a site commonly affected by the new coronavirus.

RESUMO A COVID-19 foi declarada uma pandemia no início de 2020. Constatou-se, inicialmente, que as principais manifestações desse novo vírus ocorrem por meio de sintomas respiratórios e constitucionais. A tomografia do tórax foi eleita o exame de imagem para avaliar a extensão do comprometimento pulmonar e como um fator preditivo do prognóstico para a doença. No entanto, à medida que novos estudos são produzidos, o envolvimento gastrointestinal da COVID-19 torna-se mais evidente, com relatos de pacientes que manifestaram principalmente ou apenas sintomas gastrointestinais no decorrer da doença. Em alguns casos, a investigação inicial é realizada no pronto-socorro, com tomografia computadorizada do abdome. Relatamos uma série de casos de dez pacientes que compareceram ao serviço de emergência da instituição com uma queixa principal gastrointestinal e foram submetidos inicialmente a uma tomografia computadorizada de abdome como primeira investigação. Embora a maioria dos pacientes não tenha apresentado alterações significativas nas imagens abdominais, eles apresentaram achados pulmonares visualizados nas bases pulmonares, que depois foram caracterizadas como achados pulmonares típicos de COVID-19 nas tomografias de tórax subsequentes. Apenas um paciente apresentou achados atípicos para COVID-19 na tomografia. Todos os pacientes tiveram reação em cadeia da polimerase em tempo real positiva para o novo coronavírus. É muito importante alertar os radiologistas, principalmente os radiologistas abdominais, da possibilidade de sintomas gastrointestinais isolados no contexto da COVID-19. Além disso, deve ser um hábito para todos os radiologistas avaliar as bases pulmonares nas tomografias de abdome, local comumente afetado pela COVID-19.