Malignant hemangioendothelioma presenting as omental masses in a child

Malignant hemangioendothelioma is an uncommon lesion of the omentum in children. Multiple foci of malignant hemangioendothelioma is even more rare in the omentum. In the present case, a computed tomography scan of the abdomen showed multiple enhanced nodular lesions. To our knowledge, this is the first report of this tumor occurring in a child.

Non-surgical retrieval of intravascular foreign body: experience of 12 cases

An intravascular foreign body is an iatrogenic complication that occurs during arterial or venous catheterization or interventional procedures. The foreign body could either be a catheter fragment, a dislodged coil, or a steel guide wire. From January 1987 to December 1992, 12 cases of intravascular foreign-body removals were performed by a percutaneous method at Mackay Memorial Hospital. Of the 12 cases, five were dislodged steel guide wires, four were broken CVP catheters, two were dislodged coils, and one was Port-A fragment. The techniques we used were the loop-snare technique (two cases) and stone basket retriever (10 cases). Eleven cases of intravascular foreign bodies were removed by non-surgical percutaneous retrieval but one case was a failure due to improper extraction of a dislodged steel guide wire. The patient received surgical extraction by regional venotomy finally. No major complications were noted during or after these procedures.

Acute segmental obstructing enteritis in children

We studied a group of 15 children with acute segmental enteritis associated with intestinal obstruction. The disease is characterized by fever, leukocytosis, copious bilious vomiting, and severe abdominal pain with signs of intestinal obstruction. Exploration revealed varying degrees of segmental ischemic change in the small bowel, but surgery seemed to be unnecessary in most cases. Antibiotics were effective in nonoperative cases. The clinical illness lasted 10-14 days. The disease was self-limited, and no mortality was found in our series. To our knowledge, this is the first report of this disease entity in Chinese children.

Computed tomography of spontaneous intracranial haemorrhage due to haemostatic disorders in children

Intracranial haemorrhage is a serious problem in haemostatic disorders in children. Intracranial bleeding is sometimes more marked than suspected clinically. Computed tomography (CT) permits accurate, sensitive diagnosis of intracranial haemorrhage. We report 13 patients; 3 patients with hypoprothrombinaemia, 4 patients with thrombocytopenia or platelet dysfunction and 6 with haemophilia A, B or Von-Willebrand's disease. One patient with hypoprothrombinaemia had a subarachnoid hemorrhage (SAH), one a subdural haematoma (SDH) and the third a combination of SAH, SDH and intracerebral haematoma (ICH). One patient with thrombocytopenia or platelet dysfunction had a SDH, while the others had ICH. In the six patients with haemophilia A, B or Von-Willebrand's disease, there were four examples of ICH, five of SAH and six of SDH. A neurosurgical procedure was performed in only one patient. Three children died of serious intracranial complications with uncal herniation.

Neurofibroma: an unusual presentation

We report neurofibroma discovered incidentally in a woman who suffered trauma to her cheek. The lesion was manifest on CT as a haematoma within a parotid tumour.

Cranial computed tomography in children with acute lymphoblastic leukemia after prophylactic treatment with cranial radiation therapy and intrathecal methotrexate

BACKGROUND AND METHODS

Thirty-one children with acute lymphoblastic leukemia (ALL) who had received cranial radiation therapy (CrRT) and five concomitant doses of intrathecal methotrexate (IT MTX) for central nervous system prophylaxis (CNSP) and who had an event-free survival exceeding 5 years had cranial computed tomography (Cr CT) examination. The fractional dose for 21 of them was 1.5 Gy. The interval between the completion of CNSP and the time of Cr CT ranged from 5 to 8.5 years, with a median of 5 years 2 months.

RESULTS

Unlike the previous reports in the literature that 9-77% of children with ALL who had received Cr RT 18 Gy and IT MTX as CNSP had CT scan abnormalities, in this study no patient had CT scan abnormalities.

CONCLUSIONS

Our results might be attributable to the fractional dose of Cr RT being adequate, the IT chemotherapy being suitable, and the systemic chemotherapy not being intensive.

Is IVP necessary in children with urinary tract infection?

A prospective study was conducted to determine the role of intravenous pyelography (IVP) in detecting the associated urinary tract anomalies in children with urinary tract infection (UTI). A total of 143 cases with confirmed UTI all received renal sonography (RS), voiding cystourethrography (VCUG) and IVP, to evaluate for G-U tract anomaly. Associated G-U tract anomalies were noted in 67 cases (46.85%). No single method was adequate in detecting all abnormalities. Based on the anomalies detected, we proposed and compared two different conditions in which IVP was required. In condition A, in which IVP was performed when abnormal finding were found in RS or VCUG, 67 of 143 cases with UTI (46.85%, 67/143) were required to have IVP, among them 32 cases yielded positive results and 35 cases negative results. Two cases of duplex collecting system (DCS) were found only on IVP would be completely undetected under this proposed condition. However, when IVP was recommended and performed at the time of high grade VUR in VCUG or any abnormality in RS (condition B), 43 of 143 patients (30%, 43/143) with UTI were required to undergo IVP, yielding abnormal findings in 30 cases (70%, 30/43) and normal findings in 13. This would leave four cases of DCS undetected, including the 2 detectable only by IVP plus 2 more that showed low grade VUR on VCUG. However, these 4 cases would not result in progressive renal damage in long-term follow up.(ABSTRACT TRUNCATED AT 250 WORDS)

Unusual causes of obstructive jaundice in children: diagnosis on CT

Three cases are presented with unusual causes of obstructive jaundice diagnosed on abdominal CT in children under the age of 15 years. All the cases were initially examined by ultrasound which was inconclusive. CT studies were subsequently performed were diagnostic. These cases included hepatocellular carcinoma, a common bile duct web and duodenal hematoma. The first two cases were surgically confirmed, while the third case was proved by clinical follow-up.

Extralobar pulmonary sequestration of the left retroperitoneum

This paper presents an extralobar pulmonary sequestration in the left retroperitoneum in an eight year old girl. The clinical and diagnostic features included abdominal pain, an abdominal mass, elevated VMA, and radiological manifestations simulating a left adrenal mass. A laparatomy was performed. Extralobar pulmonary sequestration of the left retroperitoneum is fairly uncommon. An eight year old girl was admitted with abdominal pain, elevated urinary VMA and an abdominal mass. The radiological manifestations simulated a left adrenal mass. At surgery an extralobar pulmonary sequestration was detected.

[Ureteropelvic junction obstruction presenting with abdominal pain: a analysis of fourteen cases]

During the past three and half years (Jan, 1984-Jun. 1987), 14 cases of ureteropelvic junction obstruction presented with abdominal pain were encountered in the Department of Pediatrics, Mackay Memorial Hospital. Eight cases were male and six female. Their ages ranged from 4 years old to 12 years old. The duration of abdominal pain lasted for several days in 5 cases, several months in 4, and several years in another 5 cases. The abdominal pain was usually recurrent. It occurred once every 2 to 6 months. The location of pain was predominantly in the left abdomen and the periumbilical area. Cramping was the most characteristic symptom. Besides abdominal pain, several cases also had vomiting or abdominal mass. Laboratory examination showed some cases to have microscopic hematuria and others pyuria. All were proved by renal ultrasonography to have varying degrees of hydronephrosis. Intravenous pyelography or retrograde pyelography also confirmed the diagnosis of ureteropelvic junction obstruction. In 9 of the 14 cases, surgical intervention was performed to correct abnormalities. Six cases were followed up regularly; all showed improvement, however, one developed ureteropelvic junction obstruction on the contralateral kidney one year later. The remaining five cases who did not receive surgical treatment continued to have recurrent abdominal pain.

[Relationship of chest roentgenographic features and outcome in meconium aspiration syndrome]

Aspiration of meconium may produce respiratory distress of various severity and outcome. It is the purpose of this study to evaluate the relationship between roentgenographic feature of initial chest roentgenogram (less than 10 hours old) and outcome in infants with meconium aspiration syndrome (MAS). We analyzed retrospectively the clinical data and initial chest roentgenograms of 65 infants who had MAS and who were admitted to NICU of Mackay Memorial Hospital in 1987. The incidence and the mortality rate in this hospital were 0.33% and 15.4% respectively. Infiltration was seen in 52, consolidation or atelectasis in 18, hyperinflation in 17, air leak in 11, and cardiomegaly in 4. The outcome was similar between infants with the first four features. Four infants with cardiomegaly also had other types of roentgenographic feature and PH value of initial blood gas less than 7.0, which means that their poor outcome was influenced by multiple factors. From this observation we concluded that the initial chest roentgenogram is a useful aid for the diagnosis and treatment of MAS, but it is not suitable for predicting the outcome of infants with MAS.

Aneurysmal dilatation of the portal vein

In the following study, a case involving an aneurysmal dilatation of the portal vein is reported. The 5-year-old boy had a 2 month history of intermittent abdominal pain. A segmental dilatation of the portal vein was noted in the sonographic examination. The portal vein aneurysm diagnosis was later confirmed by superior mesenteric angiography and computed tomography. In our review of the literature, less than 30 cases of portal venous aneurysm have been reported. To our knowledge, this is the youngest case with such an anomaly.

[Parathyroid adenoma associated with bilateral renal calculi. A case report]

Renal calculi is an uncommon clinical presentation of parathyroid adenoma today. Only 17% of parathyroid adenoma has renal calculi in Levin's report. The association of parathyroid adenoma is often overlooked in the patients of renal calculi. We report a case whose clinical presentation is renal calculi with renal colic Parathyroid adenoma was not discovered until the second admission. The patient's clinical presentation improved after parathyroidectomy. We report this case to remind the clinical physician regarding the possibility of coexistence of parathyroid adenoma in patients of renal calculi. Excision of the parathyroid adenoma is the only treatment for these patients.