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Savvas Andronikou

Publications and source records attributed to Savvas Andronikou.

At least 37 records · Page 2Linked to original sources
PubMed2004

Specificity and sensitivity of chest radiographs in the diagnosis of paediatric pulmonary tuberculosis and the value of additional high-kilovolt radiographs.

Tuberculosis (TB) remains the most common notifiable infectious disease in South Africa. The diagnosis of pulmonary TB in children is often very difficult because of the non-specific radiological signs and inter-observer variation in the interpretation of radiographs. The frontal high-kilovolt (kV) radiograph has been used to assess the effect of TB adenopathy on the tracheobronchial tree and to detect endobronchial lesions. The aims of the present study were to assess the specificity and sensitivity of chest radiographs in the diagnosis of pulmonary TB and to assess whether the addition of the high-kV radiograph affects these parameters. The study group consisted of paediatric patients suspected of having pulmonary TB over a 6-year period. These patients had clinical, bacteriological and radiographic examinations. Radiographs were examined by one experienced radiologist in two sittings separated by a 6-week interval. On the first sitting, only standard radiographs were examined and, on the second sitting, these were supplemented with high-kV radiographs. Differences in the detection of each recognized radiological feature of pulmonary TB before and after the addition of the high-kV film were analysed for statistical significance. The frequency of radiographic findings in our study compared favourably with other reports. No statistically significant differences for the detection of radiographic features consistent with pulmonary TB, or for the diagnosis of pulmonary TB, were demonstrated between the two sittings. Specificity increased from 74.4% to 86.6% with the addition of the high-kV view and sensitivity remained constant at 38.8%. The present study does not support the routine use of the frontal high-kV radiograph for the diagnosis of pulmonary TB. This paper also confirms the findings of others, that standard chest radiographs are a poor indicator of pulmonary TB in children.

Chi-Square Distribution↗
PubMed2003

Balloon dilatation in children for oesophageal strictures other than those due to primary repair of oesophageal atresia, interposition or restrictive fundoplication.

BACKGROUND: Balloon dilatation of the oesophagus in children has been performed predominantly for treating strictures, which are the result of primary repair of oesophageal atresia, interposition surgery or restrictive Nissen's fundoplication. Reports of the use of this technique for alternative causes of stricture are few. OBJECTIVE: To report our experience and success with balloon dilatation of strictures due to caustic ingestion, achalasia, oesophagitis, congenital stenosis, and epidermolysis bullosa (EB) and to make comparisons with our treatment of patients with primary repair of oesophageal atresia (OA), as well as with reports in the English language literature. MATERIALS AND METHODS: Retrospective review of fluoroscopically guided balloon oesophageal dilatation procedures in 19 patients over a 5-year period, and comparison of those performed for OA repair complications with those due to other diseases. The average radiation dose, per procedure, was calculated by a medical physicist. RESULTS: Ten patients had strictures as a result of primary repair of OA. Three patients had stricture as a result of EB, two from achalasia, two from caustic injury, one due to an oesophageal web and one from reflux oesophagitis. Our results show that the technique can also be curative for the last group and that it may be used intermittently to alleviate symptoms in ongoing diseases. We have not experienced any complications and have also calculated that, even with prolonged use of multiple procedures, the radiation exposure is comparable to other radiological techniques. CONCLUSIONS: Patients with alternative causes for oesophageal stricture may be treated to resolution within 2 years using balloon dilatation. Ongoing diseases such as EB require ongoing dilatation, but balloon dilatation of strictures has been successful in alleviating swallowing difficulty. Patients with stricture from OA repair sometimes need ongoing dilatation. Radiation exposure for multiple procedures, over an extended period, is comparable to that from a single abdominal CT, and can be considered acceptable when repeat complex surgery is the alternative treatment option, or when ongoing incurable disease is the cause of the stricture.

Adolescent↗
PubMed2003

MRI findings in acute idiopathic transverse myelopathy in children.

OBJECTIVE: To describe the clinical and MRI findings in three children with acute idiopathic myelopathy (AIM). MATERIALS AND METHODS: Retrospective review of the clinical presentation, MRI findings and outcome of three patients diagnosed with acute idiopathic transverse myelitis. RESULTS: Of note was the swift onset of symptoms in all patients, without any preceding illness or history of vaccination in two of the patients, and the rapid resolution of symptoms on steroid therapy in all the patients. MRI showed T2-weighted hyperintensity and patchy enhancement with gadolinium, but the extensive cord involvement did not correlate with the severity of presentation or outcome. CONCLUSIONS: Our findings do not support that MRI evidence alone of diffuse myelopathy is a predictor of poor outcome in childhood AIM.

Acute Disease↗
PubMed2003

Comparison of MR angiography and conventional angiography in the investigation of intracranial arteriovenous malformations and aneurysms in children.

BACKGROUND: Magnetic resonance angiography (MRA) is an attractive alternative to conventional catheter angiography (CCA) in children, especially for the detection of intracranial arteriovenous malformations (AVMs) or aneurysms in the out-of-hours setting, because it has fewer risks and complications. OBJECTIVE. To compare MRA with CCA for the detection of intracranial AVMs, aneurysms and arterial anatomy in children. MATERIALS AND METHODS: Retrospective blinded review of MRAs and CCAs by two independent paediatric radiologists, in a group of 19 children already diagnosed with AVMs, aneurysms and subarachnoid haemorrhage (SAH) and who had undergone both imaging techniques. RESULTS: Abnormalities were identified on MRA in 15 of 19 patients and by CCA in 11 of 19 patients. MRA showed one aneurysm, nine AVMs, three haemorrhages and two indeterminate lesions. CCA showed nine AVMs and two indeterminate lesions. The two modalities showed excellent correlation in the detection of AVMs in nine patients. Vascular supply to the AVMs correlated well in four cases. There was complete disagreement in the determination of vessel supply in one case, and in two cases CCA showed additional vessel supply compared to MRA, while in two further cases MRA showed an additional vessel supply compared to CCA. CCA was superior to MRA in demonstrating arterial anatomy, except with regard to the anterior and posterior communicating arteries where MRA was superior. CONCLUSIONS: The high sensitivity of MRA in the detection of AVMs when compared to CCA and the low incidence of aneurysms support the use of MRA as the initial imaging modality when intracranial haemorrhage is diagnosed on CT, especially in the out-of-hours setting.

Adolescent↗
PubMed2003

Two unusual causes of pituitary stalk thickening in children without clinical features of diabetes insipidus.

Pituitary stalk thickening has a wide differential diagnosis, but almost all infundibular diseases present with diabetes insipidus (DI). We present a child with metastatic involvement of the pituitary stalk from a primary pontine tumour and a child with tuberculous infiltration of the pituitary stalk and associated meningeal inflammation. Neither child presented with DI. Even though both metastatic disease and tuberculous infiltration of the stalk have been reported in adults, these are the first reports with accompanying cross-sectional images of pituitary stalk involvement by these diseases in children.

Adolescent↗
PubMed2003

Spinal cord involvement in pygopagus conjoined twins: case report and review of the literature.

INTRODUCTION: Pygopagus conjoined twins are joined at the rump and have union of the gastrointestinal and genitourinary systems as well occasional involvement of neural elements. CASE REPORT: We report a case where the terminal spinal cords were fused, despite which there was only a minor motor deficit in the lower limbs after separation. The pre-operative and intra-operative findings are described and issues of long-term follow-up discussed. DISCUSSION: Seven other cases reported in the literature with varying degrees of involvement of the spinal cord and cauda equina are reviewed.

Follow-Up Studies↗
PubMed2003

Neonatal nasopharyngeal teratomas: cross sectional imaging features.

BACKGROUND: Neonatal nasopharyngeal teratomas are extremely rare and there are few reports describing both CT and MRI features of these lesions. OBJECTIVE: To describe the CT and MRI appearances of neonatal nasopharyngeal teratoma. MATERIALS AND METHODS: Three neonates with nasopharyngeal teratomas and severe respiratory distress were reviewed. RESULTS: The nasopharyngeal mass resulted in severe respiratory compromise requiring urgent intervention. Characteristic mandibular and pterygoid plate abnormalities demonstrated by CT and MRI are described. CONCLUSIONS: Prenatal MRI enables the diagnosis, delineates tumour extent and allows planned delivery. CT and MRI play a key role in differentiating neonatal nasopharyngeal teratomas from other causes of a neonatal neck mass, thus optimising management.

Diagnosis, Differential↗
PubMed2003

Angiographic features of 26 children with Takayasu's arteritis.

BACKGROUND: Takayasu's arteritis (TA) is a chronic idiopathic inflammatory disease affecting primarily the aorta, its proximal branches and the pulmonary arteries. OBJECTIVES: To retrospectively review the angiograms of children with TA so as to describe the patterns of vascular involvement. PATIENTS AND METHODS: Twenty-six children with TA who differed from most other studies in that almost all of them presented with hypertension, reflecting the incidence of abdominal aortic and renal artery involvement. RESULTS: The most consistent finding was stenosis of the aorta. Marginal irregularity/undulation of the aorta was also a useful angiographic diagnostic feature in subtle disease. The incidence of aneurysms was high compared to other studies and both fusiform and saccular aneurysms were encountered. Percutaneous transluminal angioplasty (PTA) was successful in all eight patients in whom it was performed. MRI, CT angiography and US are discussed as less invasive imaging alternatives. TA is a significant cause of renovascular hypertension in children in South Africa where there is a high incidence of tuberculous infection. Knowledge of the angiographic features and pattern of aortic involvement is essential for diagnosis and initiation of early and appropriate treatment, including PTA.

Adolescent↗
PubMed2003

Skull fracture as a herald of intracranial abnormality in children with mild head injury: is there a role for skull radiographs?

The aim of the present study is to assess if skull fracture is a useful predictor of intracranial abnormality in children with minor head injury (MHI) and to evaluate the usefulness of skull radiographs. Retrospective review of CT scans and skull X-rays (SXR) of children <14 years of age with blunt head injury and correlation with the Glascow Coma Score definition of MHI (GCS > 12/15 or > 9/11) over a 1-year period was done. Three-hundred and eighty-one patients were included with a mean age of 6 years. Thirty-one percent of patients had intracranial abnormality. Forty-nine percent of all patients had fractures either on CT or SXR and 49% of these had intracranial abnormality on CT. Eighty-five percent of patients with drainable collections had associated fractures. Twenty-three percent of MHI had abnormalities on CT, of which 32% were drainable collections. All patients with MHI who had drainable collections showed a fracture. Some protocols for paediatric head injury recommend CT for all patients while others rely on clinical indicators. In developing countries, CT is neither widely available nor accessible, and preselection of patients is necessary. We demonstrated that omitting CT in MHI could result in missed intracranial abnormalities. All MHI with drainable collections had fractures. Fractures identified on SXR can be added to the clinical indications for CT in MHI and can improve detection of 'silent' drainable collections.

Adolescent↗
PubMed2003

MRI and preoperative embolization of a nasal cavity haemangioma in a child.

Haemangiomas are common benign tumours of the head and neck region in children. The nasal cavity, however, is an extremely rare site for such lesions in childhood. We present the typical MRI features of a nasal cavity haemangioma in a 12-year-old girl. Biopsy was avoided because of the MRI diagnosis and preoperative embolization of the mass was performed.

Child↗
PubMed2002

MRI features of bilateral parotid haemangiomas of infancy.

The aim of this article is to report the MRI features of bilateral parotid haemangiomas of infancy and highlight the diagnostic and prognostic value of MRI especially with regard to those lesions that may cause respiratory compromise. Retrospective review of MRI scans in six infants with bilateral parotid haemangiomas. The bilateral haemangiomas were symmetrical in all but one patient. On T1-weighted images the masses were isointense to muscle and on T2 they were hyperintense with numerous small vessels giving a septated appearance. There was vivid enhancement with gadolinium in all cases. In three patients, deep bilateral extensions were demonstrated involving the parapharyngeal spaces resulting in respiratory compromise which required tracheostomy. Bilateral parotid haemangiomas are rare, but when present may have deep extensions, which can result in respiratory compromise requiring tracheostomy.

Female↗
PubMed2002

Patterns of disease on MRI in 53 children with tuberculous spondylitis and the role of gadolinium.

BACKGROUND: Tuberculosis (TB) of the spine is the most common site of osseous involvement and has a higher prevalence in developing nations with an increasing incidence in developed nations. There are few paediatric reports of TB spondylitis (TBS) that include MRI findings. OBJECTIVE: To determine the MRI characteristics of TBS in children with special reference to gadolinium enhancement and findings on follow-up MRI. MATERIALS AND METHODS: A retrospective review of patient records and MRI scans by three readers using a consensus method of 53 patients below 13 years of age. RESULTS: Seventy-nine percent presented with kyphosis. MRI showed thoracic involvement in 83%. Eighty-five percent showed contiguous involvement of two or more vertebral bodies. An intraspinal or paraspinal soft-tissue mass or abscess was present in 98%. Subligamentous extension was noted in 64% of patients. Gadolinium was administered in 26 patients. Ring enhancement of the soft-tissue mass was shown in 65% of these. Subligamentous enhancement was shown in 35% and bone enhancement was shown in 100% of patients. Follow-up MRI performed in 16 patients showed progressive bone destruction in 10 patients, progressive kyphosis in 2 patients and progression of soft-tissue disease in 4 patients. CONCLUSIONS: We have demonstrated an advanced pattern of TBS in this childhood population, which supports other reports that describe a more aggressive process in children. Kyphosis and cord compressions were the most common complications. The use of gadolinium is promising in detecting disease earlier, as it invariably results in bone enhancement and may assist in making the diagnosis when the rim-enhancing pattern of the soft-tissue mass is demonstrated. Follow-up imaging with MRI is a suitable way of assessing resolution of cord compression and decrease in size of the soft-tissue mass. Therefore, considering the pattern of involvement in children with TBS demonstrated by this study, MRI is considered an ideal modality for making the diagnosis, demonstrating the extent of disease, identifying complications and assessing response to treatment.

Child↗
PubMed2002

Classic and unusual appearances of hydatid disease in children.

BACKGROUND: In endemic regions, hydatid disease is commoner in children than in adults. The hydatid cysts may have classic appearances, but unusual sites and appearances may cause diagnostic difficulties. OBJECTIVE: To assess the classic and unusual appearances of hydatid disease in children. MATERIALS AND METHODS: A 3-year retrospective review of available imaging of proven hydatid disease at a tertiary paediatric institution. RESULTS. Review of imaging of 21 children (9 boys, 12 girls), with a mean age of 8 years and 1 month, demonstrated cysts in the liver ( n=9), lung ( n=8), brain ( n=7), spleen ( n=2), heart ( n=1), orbit ( n=1) and soft tissues ( n=1). Multi-organ involvement occurred in eight cases with two cases that did not involve the liver. Complicated cysts were found in 13 cases and usually involved the liver ( n=8) and lung ( n=5). An unusual case of spontaneous cerebrospinal fluid (CSF) spread was also documented. CONCLUSIONS: Hydatid disease in children classically involves the liver, lung and brain but can involve almost any organ and numerous organs simultaneously. Whether hydatid disease is discovered incidentally or by intentional imaging, extended imaging is recommended to identify multifocal disease which may also display complicated cysts that may assist in the diagnostic process. All patients with one known site should undergo a minimum of an abdominal US and CT scan of the chest and brain. CT may be used instead of US of the abdomen, and MRI may be used to replace CT of the brain. Over 50% of cases in our study showed complicated cysts. Unique findings of this study include multi-organ involvement without liver cysts. Multiplicity and complications of cysts can assist diagnosis. Intraventricular and intrathecal CSF spread of a spontaneously ruptured intracerebral cyst has not, to our knowledge, been previously reported.

Child↗
PubMed2002

Anatomical considerations in the imaging of 'reduced-size' liver transplantation in children.

In liver transplantation, understanding the altered anatomical features unique to the reduced-size hepatic allografts commonly used in children is crucial in assessment of the post-surgical imaging findings. The radiologist needs to be aware of these findings because the reconstructed anatomy can lead to many imaging pitfalls if not adequately appreciated. This paper aims to evaluate the US and CT findings with regard to the anatomical features, the patency of relevant vasculature and the presence of the more commonly encountered complications in children with reduced-size liver transplants.

Child↗