Biomedical subjects
Publications and source records attributed to J O Haller.
Two cases of smooth muscle tumor developing in immunocompromised children are described. Both children presented after transplant surgery, one with a hepatic leiomyoma and the other with a hepatic leiomyosarcoma.
We report four sickle cell anemia patients who have received multiple blood transfusions and have been non-compliant on Desferal chelation therapy. Abdominal ultrasonography demonstrated an echogenic pancreas in all four patients. Magnetic resonance imaging in three patients revealed decreased signal intensity in all sequences in the pancreas and liver. All four patients had marked iron deposition on liver biopsy. To our knowledge, increased echogenicity of the pancreas secondary to hemosiderosis (2 degrees hemochromatosis) in sickle cell patients has not been reported in the radiologic literature.
Two children are presented with AIDS and aspergillosis. One child had pulmonary involvement while the other had invasion of the skull and brain. The rarity of aspergillosis in AIDS patients is discussed as well.
Eleven patients with sickle hemoglobinopathies undergoing sonographic examinations for reasons unrelated to renal parenchymal disease were incidentally noted to have increased echogenicity in the central portion of the renal parenchyma. This appearance was observed to be a continuum, with some cases showing focally hyperechoic medullary pyramids at one extreme and other cases showing a diffusely echogenic central parenchymal region relative to a thin band of hypoechoic cortical or peripheral parenchyma at the other extreme. The finding of hyperechoic medullae of the kidneys has been reported in patients having conditions associated with hyperuricemia, medullary nephrocalcinosis, or hypokalemia. This sign has not been commonly reported as a finding in patients with sickle syndrome. The thin hypoechoic rim of cortical parenchyma relative to a more echogenic central parenchyma has not been commented on previously.
Explore the source record for details and available documents.
Two patients with IVC and right atrial tumor thrombus associated with malignant bone tumors are described. Other tumors such as Wilms', renal cell CA, testicular adrenal and hepatic neoplasms have also been reported to invade the IVC. Ultrasound, CT and MRI are helpful in evaluating the presence of vascular thrombosis as well as its longitudinal extent, and intracardiac involvement.
Over 200 children with acquired immunodeficiency syndrome (AIDS) have been followed at our institution. We retrospectively evaluated 45 children from the above group. 26 of the 45 children had a pericardial effusion documented at echocardiography and/or at post-mortem examination. This report describes the association of pericardial effusion, myocarditis, and pericarditis in children with AIDS and the implications for imaging. Half of the children with a pericardial effusion had a normal cardiac silhouette on chest radiography. 18 children with a pericardial effusion, had associated cardiac abnormalities. These abnormalities were ventricular dilatation and/or hypertrophy, myocarditis, or pericarditis. The presence of pericardial effusion also correlated highly with pleural effusion and ascites. The presence of a pleural effusion and a pericardial effusion was almost exclusively seen in the children with cardiac abnormalities. Pericardial effusion and cardiac disease should not only be suspected in any child with radiographic signs of cardiomegaly, but be strongly suspected in any child with pleural effusions or ascites, even with a normal cardiac silhouette, especially if they are not responding to conventional medical therapy and their respiratory condition is not improving.
Hemangiopericytomas are vascular tumors of pericyte origin. Although the majority of cases have been found in adults, a small percentage have been found to be congenital, most involving the subcutaneous tissues. Gastrointestinal involvement is exceedingly rare. All of the congenital tumors were found to be benign. We report a case of congenital duodenal hemangiopericytoma in a neonate which was locally invasive.
Four cases of intrascrotal hematoma simulating testicular rupture were noted in teenagers. Careful sonographic technique allowed for the discovery of the normal testicle in a more peripheral location in the scrotum. Duplex doppler aided in confirming a normal testis in one case.
Explore the source record for details and available documents.
Previous studies of sonograms in premenarchal girls have reported the typical ovary to be homogeneous in echogenicity, with cysts an uncommon finding, particularly in children less than 6 years old. These studies found no macrocysts (cysts greater than 9 mm in greatest length) in patients less than 11 years old. This information contradicts published pathology studies and our sonographic experience. The goal of this study was to determine the prevalence of cysts in the ovaries of premenarchal girls. The pelvic sonograms of 101 consecutive premenarchal girls between 2 and 12 years old, without known gynecologic or endocrinologic disease, were prospectively studied. One hundred fifty-five ovaries were adequately imaged in three dimensions. Ovaries were evaluated for the presence or absence of cysts (as defined by sonographic criteria), and the length of the cyst or of the largest cyst, if several were noted, was measured. Cysts were identified in 106 ovaries (68%). Cysts were seen in patients of all ages, particularly in the younger children (2-6 years old). Thirteen of the cysts, noted in 11 patients between 2 and 10 years old, were macrocysts. The typical sonographic appearance of the ovary in premenarchal girls is not homogeneous. Cysts are common in premenarchal girls between 2 and 12 years old and are the cause of the typical heterogeneous image. Macrocysts can be seen in healthy girls less than 11 years old.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Torsion of the testicular appendages may simulate the clinical and physical examination findings of testicular torsion. Real-time imaging and duplex Doppler scanning aided the diagnosis of this entity in three children. The testes appear normal on sonograms and have normal vascular flow. A circular mass of increased echogenicity with a variably sized central hypoechoic region is seen adjacent to the testicle. We could not relate variations in echogenicity to time delay between clinical pain and sonographic examination.
Uterovaginal anomalies are relatively common congenital disorders whose diagnosis at a young age is important but often difficult. The various modalities currently employed for this evaluation are discussed, including MRI, the most recent available tool. The embryology of female reproductive tract anomalies is included.
Explore the source record for details and available documents.
We investigated the clinical, immunologic, and imaging features of parotid enlargement in 10 children seropositive for human immunodeficiency virus (HIV) who were infected prenatally. In seven patients, sonography revealed many small hypoechoic areas suggestive of lymphoid infiltration. In three older children, large anechoic areas suggesting lymphoepithelial cysts were present. The lesions probably represent generalized lymphoid infiltration akin to pulmonary lymphoid hyperplasia, although only two of our patients had radiologic evidence of pulmonary lymphoid hyperplasia. Four of five of the children with parotid enlargement who had immunologic studies were phenotypically HLA-DR5, an immunophenotype associated with improved immune response, occurring in less than one in four in the normal population. This suggests that painless parotid enlargement may be a good prognostic sign in HIV-seropositive children. Parotid enlargement was found in 10 HIV-positive children from 6 months to 11 years old. All except one were infected prenatally.
Diseases of the gallbladder and biliary system are particularly well suited for investigation with sonography. As such, sonography has completely supplanted oral cholecystography in the evaluation of these disorders. Because it is easy to perform and does not expose the patient to radiation or contrast agents, sonography is being used more often in children to diagnose disorders of the gallbladder and biliary tract. Many of the sonographic signs of these diseases (e.g., cholelithiasis, cholecystitis) are well established in adults and are the same in children. However, the circumstances under which these diseases occur and their different causal factors are different in children and adults. This article reviews the distinctive aspects of gallbladder-biliary tract disease in children, concentrating on the role that sonography plays in its evaluation and therapy.