Biomedical subjects
Publications and source records attributed to J O Haller.
Malignant metastasis to the breast, rare in adults, has occurred in children from hematologic malignancies and from neuroblastoma and rhabdomyosarcoma. We report a case of bilateral breast metastases in a 14-year-old girl with a prior nephrectomy for renal cell carcinoma; the breast masses were the first sign of recurrence.
Simple renal cysts are very uncommon among children. Of 50 children with AIDS that underwent computed tomography at our hospital, 4 had radiographically simple cysts. The incidence of simple renal cysts in this group of children is thus approximately 45 times that seen in normal children. To our knowledge, simple renal cysts have never been reported as a manifestation of AIDS in children. It is unknown whether or not these cysts are a manifestation of HIV nephropathy (HIVN), in which microcysts are seen pathologically. We suggest that simple renal cysts may be a finding compatible with the diagnosis of HIVN.
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.
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.
PURPOSE: We studied six patients with sickle cell disease (SSD), five homozygous for sickle cell anemia and one with sickle beta-thalassemia, in whom rounded intrasplenic masses proved to be preserved functioning splenic tissue. MATERIALS AND METHODS: Available images including computed tomography, ultrasonography, bone scans (Tc-99m MDP), liver spleen scans (Tc-99m sulfur colloid), and MRI were evaluated. RESULTS: The masses were low density on CT (in an otherwise calcified spleen), hypoechoic relative to the echogenic spleen on US, and had the imaging characteristics of normal spleen on MRI. They failed to accumulate Tc-99m MDP but did demonstrate uptake of Tc-99m sulfur colloid. CONCLUSION: In a patient with SSD and intrasplenic masses, proper correlation of multiple imaging modalities will establish the diagnosis of functioning splenic tissue and avoid mistaken diagnosis of splenic abscess or infarction.
Neonatal goiter is a rare cause of a neck mass and stridor. Often, the diagnosis can be made on clinical grounds exclusively, but there may be times when a neck mass becomes a diagnostic dilemma. There are several different imaging modalities available to the clinician that are useful in the rapid diagnosis of neonatal goiter. Presently, however, there is no definite algorithm for the workup of a neonatal neck mass. The two cases presented here demonstrate the imaging findings of plain film radiography, sonography, scintigraphy, and CT in neonatal goiter.
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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.
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Explore the source record for details and available documents.
Intraspinal air has been described in patients undergoing diagnostic lumbar puncture and epidural analgesia, as a manifestation of degenerative disk disease, and after less common mechanisms, such as blunt trauma [1], strenuous exercise [2], and pelvic trauma [3]. We report a case of spinal epidural emphysema incidentally noted on CT after placement of a thoracostomy tube.
PURPOSE: To determine the clinical, pathologic, and radiologic features in pediatric patients with acquired immunodeficiency syndrome (AIDS)-related lymphoma and to compare these features with those in adult patients with AIDS-related lymphoma. MATERIALS AND METHODS: Clinical and radiologic findings were retrospectively reviewed in nine children (aged 1-15 years) with AIDS-related lymphoma. All patients had neoplastic changes that were not consistent with hyperplastic lymphoid tissue. The children underwent ultrasonography, computed tomography, magnetic resonance imaging, and plain radiography. RESULTS: Sites of involvement by malignant non-Hodgkin lymphoma at diagnosis were the liver (n = 7), spleen (n = 5), kidney (n = 4), central nervous system (n = 2), and testis and bone (n = 1). Symptoms included seizures, respiratory distress, testicular swelling, and increased abdominal girth. CONCLUSION: Children with AIDS-related lymphoma have symptoms distinct from those found in adults, but clinical, radiologic, and pathologic findings show that almost any anatomic site in these children can be involved.
Infection with the human immunodeficiency virus (HIV) can produce a broad range of illness, including opportunistic infections, lymphoproliferative diseases, and benign and malignant neoplasms. Each conditions has its own spectrum of imaging findings. This paper will highlight those findings in children suffering from HIV infection/AIDS. We will stress the findings in the more frequently involved organ systems and those that are unique to children.
Cerebral infarction is an uncommon complication of AIDS in pediatric patients. We have seen three HIV-infected children who developed acute neurological deficits due to stroke. Cerebral infarction must be considered in the work-up of a child with AIDS who presents with focal neurological deficit, seizure or mental status change. Stroke is a complication of HIV infection that occurs in approximately 1% of affected children [1]. At autopsy, evidence of cerebral infarction was documented in 10-30% of children with HIV infection [2]. We have seen three children with focal infarction who are HIV positive.
PURPOSE: To compare routine pelvic and transperineal scanning in the ultrasonographic (US) diagnosis of posterior urethral valve (PUV). MATERIALS AND METHODS: Longitudinal and transverse transperineal views were obtained in addition to routine renal and transvesicle views in the prospective US evaluation of 10 male infants (aged 2 days to 6 weeks) clinically suspected of having PUV. High-frequency (5.0- and 7.5-MHz) transducers were used. RESULTS: Five of the boys proved to have PUV. Each had urethral dilation clearly imaged at transperineal US. Only two of these boys had urethral dilatation imaged with the transvesicle approach. In three of the boys, a linear area of echogenicity, consistent with a valve, was imaged, but only with the transperineal approach. The other five boys had no urethral dilatation noted at transperineal or transvesicle US and proved to not have PUV. CONCLUSION: Transperineal imaging can aid in the diagnosis of PUV at US. Transperineal US may enable imaging of the valve itself.
The gastrointestinal manifestations of AIDS in children are related to opportunistic infections, lymphoproliferative disease, and cancer. The infections that affect the gastrointestinal tract at different sites also occur in patients without AIDS. However, in children with AIDS, the infections are more severe, often relapse, and are harder to eradicate. Candidiasis is the most common infection in the esophagus, but infections caused by herpes simplex virus and cytomegalovirus also are common. Radiologic findings include ulcerations, a cobblestone appearance, and disordered motility. Gastritis and enteritis are usually caused by cytomegalovirus. Lesions produced by this virus include ulcerations caused by ischemic necrosis as a result of vasculitis. Barium studies show increased nodularity and effacement of mucosa. Other organisms (typically found in all immunocompromised patients) include Mycobacterium avium-intracellulare, Mycobacterium tuberculosis, Campylobacter, Giardia, and Cryptosporidium. Colitis and proctitis are caused by many of the same enteric pathogens. Cytomegalovirus is the most virulent, causing necrosis, perforation, and often death. Lymphoma, smooth muscle tumors, and Kaposi's sarcoma are the most common neoplasms encountered in children with AIDS.
Progress in neurosonographic diagnosis of fetuses and neonates has continued as clinical and imaging experience has increased, technology and technique have improved, and transducers for Doppler and color Doppler imaging have become more available. This review discusses some of the advances in perinatal neurosonographic diagnosis.
Stage III Wilms tumor was diagnosed in a 9-year-old girl. Four and a half years after the treatment, which consisted of an operation, radiation therapy, and chemotherapy, the patient had a solitary metastasis in the liver, which was successfully treated with chemotherapy and surgical resection. Five years later, right lung metastases were eradicated by chemotherapy, radiation, and surgical resection. Three and a half years later, she had a metastasis in the left calf, for which she underwent surgical resection and received chemotherapy. This patient has several interesting features: (1) multiple recurrences, two in the usual sites of metastasis and one in an extremely rare site, i.e., skeletal muscle; (2) long intervals between recurrences; and (3) unusual histopathologic features, i.e., gradual evolution from a triphasic Wilms tumor at the primary site, to a predominance of differentiated mucinous epithelium in the skeletal muscle metastasis.