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Dell KM, Hartung EA. Approach to simple kidney cysts in children. Pediatr Nephrol 2024:10.1007/s00467-024-06386-6. [PMID: 38676761 DOI: 10.1007/s00467-024-06386-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/29/2024]
Abstract
The finding of a simple kidney cyst in a child can pose a diagnostic and management challenge for pediatric nephrologists, urologists, and primary care providers. The reported prevalence varies from 0.22 to 1% in large ultrasonography-based series of more than 10,000 children each. The true prevalence, however, may be higher or lower, as factors such as variations in referral patterns, indications for ultrasonography, or technical considerations could impact prevalence rates. For many patients, simple kidney cysts may be found incidentally when imaging is performed for another indication. Although simple cysts can occur in children, they may also represent the first sign of autosomal dominant polycystic kidney disease (ADPKD) or other less common cystic kidney diseases. Definitive guidelines regarding the evaluation and monitoring of children with simple kidney cysts have not been established. The desire on the part of the practitioner and/or parents to establish a definitive diagnosis should be balanced with the cost and inconvenience of repeated imaging and visits with specialists. The goals of this review are to (1) outline the definition, epidemiology, clinical presentation, and natural history of simple kidney cysts in childhood; (2) describe clinical features that could suggest a diagnosis other than a simple kidney cyst; and (3) present a suggested framework for evaluating and monitoring of children with one or more simple kidney cysts.
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Affiliation(s)
- Katherine M Dell
- Section On Pediatric Nephrology and Hypertension, Department of Pediatrics, Cleveland Clinic Children's, Case Western Reserve University, Cleveland, OH, USA.
| | - Erum A Hartung
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Coles V, Yardley I, Hameed S, Brennan K. Paediatric post-COVID-19 hyperinflammatory syndrome mimicking appendicitis: a case series. Ann R Coll Surg Engl 2021; 103:604-611. [PMID: 34464565 PMCID: PMC10335061 DOI: 10.1308/rcsann.2021.0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION A novel hyperinflammatory syndrome has emerged in the paediatric population: paediatric inflammatory multisystem syndrome - temporally associated with SARS-CoV-2 (PIMS-TS). Up to 50% of patients develop shock with cardiac dysfunction but presentation with acute abdominal pain is common and difficult to distinguish from appendicitis. METHOD Prospective case series of PIMS-TS patients presenting to a single UK tertiary paediatric centre. RESULTS As of 16 September 2020, 89 patients have presented with PIMS-TS to our institution; 19 (21.3%) were referred for surgical review. Pyrexia and acute abdominal pain were seen in all 19 patients. Diarrhoea was reported in 14 (73%) and vomiting in 12 (63%). On examination, eight (42%) had right abdominal tenderness, of which five had right iliac fossa (RIF) peritonism. C-reactive protein (CRP) was universally raised: median 176 (15-463)mg/l. Abdominal imaging was performed in 17 (89%), with 11 undergoing abdominal ultrasonography (65%) and 8 abdominal computed tomography (47%); two required both. Findings included nonspecific features of inflammation in the RIF. Eight patients (42%) had an abnormal echocardiogram at admission. Two (10%) patients, with classical signs and symptoms of appendicitis, underwent appendicectomy without radiological imaging and were subsequently diagnosed with PIMS-TS. During the same period, 18 patients underwent appendicectomy for histologically confirmed appendicitis. Serum CRP and ferritin levels were significantly higher in the PIMS-TS cohort compared with children with appendicitis. CONCLUSIONS PIMS-TS is a novel paediatric condition that may mimic appendicitis. It should be considered in patients presenting with abdominal pain to avoid unnecessary surgery in children at risk of cardiovascular instability.
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Affiliation(s)
- V Coles
- Evelina Children’s Hospital, UK
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Cai B, Yi H, Zhang W. Reference intervals of mesenteric lymph node size according to lymphocyte counts in asymptomatic children. PLoS One 2020; 15:e0228734. [PMID: 32040486 PMCID: PMC7010245 DOI: 10.1371/journal.pone.0228734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/21/2020] [Indexed: 12/29/2022] Open
Abstract
There is no acknowledged reference interval of mesenteric lymph node size in healthy children, and the size criterion for mesenteric lymph node enlargement (MLNE) has long been controversial. This study aimed to explore the reference intervals of mesenteric lymph node size according to lymphocyte counts in asymptomatic children and to develop a more appropriate definition of MLNE. The asymptomatic children included were divided into five age strata: 2 to 3 yr; 3 to 4 yr; 4 to 5 yr; 5 to 6 yr; and 6 to 7 yr. Correlation analyses between lymphocyte counts and the long-axis diameter, short-axis diameter, and average diameter of the largest mesenteric lymph node (LMLN) were performed. A reference interval of the short-axis diameter of LMLN was established according to this correlation analysis in each age group. We also report a reference interval of lymphocyte count in each age group. This study revealed significant correlations between the short-axis diameter of LMLN and lymphocyte count in all age groups, as well as in subdivided boy groups and girl groups. The overall reference interval of the short-axis diameter of LMLN in children was 0.54 cm—1.03 cm, with mean value of 0.75 cm. This study supports the use of the short-axis diameter greater than 8–10 mm as the diagnostic criterion for primary mesenteric lymphadenitis based on the presence of a cluster of three or more mesenteric lymph nodes and in the absence of other abnormalities.
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Affiliation(s)
- Baohuan Cai
- Department of pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, Hubei Province, China
| | - Huiming Yi
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, Hubei Province, China
| | - Wei Zhang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, Hubei Province, China
- * E-mail:
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Pediatric Intussusception: The Cinnamon Bun Sign. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2018. [DOI: 10.1177/8756479318771612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Acute abdominal pain in the pediatric patient is a common clinical symptom often resulting in uncertainty and thus often subsequently leads to a sonographic examination of the abdomen. Sonography is often the modality of choice for pediatric abdominal imaging, and consequently, sonographers should have a fundamental appreciation for the causes of acute abdominal pain in the pediatric population. Intussusception, which is the telescoping of a proximal segment of bowel into a distal segment, is one potential cause of acute abdominal pain for these patients. This review clarifies the etiology and classification of intussusception and provides an overview of the clinical manifestations, sonographic identification, and treatment of this potentially severe disorder. Also, this review provides a novel imaging sign, called the “cinnamon bun” sign, that sonographers can employ while examining patients for possible intussusception. The cinnamon bun sign is a descriptive term that may be used to illustrate a transverse sonographic plane through an intussusception.
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Benetti C, Conficconi E, Hamitaga F, Wyttenbach M, Lava SAG, Milani GP, Bianchetti MG, Simonetti GD, Helbling R. Course of acute nonspecific mesenteric lymphadenitis: single-center experience. Eur J Pediatr 2018; 177:243-246. [PMID: 28913615 DOI: 10.1007/s00431-017-3010-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/29/2017] [Accepted: 08/30/2017] [Indexed: 12/29/2022]
Abstract
UNLABELLED Available reports dealing with acute nonspecific mesenteric lymphadenitis do not address the total duration of symptoms. However, it is commonly assumed a time for recovery ≤ 4 weeks. The purpose of this report was to investigate the course of acute nonspecific mesenteric lymphadenitis in childhood. A review was made of the patients aged ≤ 16 years in whom the diagnosis of acute nonspecific mesenteric lymphadenitis was established between 2011 and 2015 at the Pediatric Emergency Unit. The records of the Pediatric Emergency Unit, those of the referring family doctors, and the results of a structured telephone interview with each family were used. Forty-four patients (25 girls and 19 boys) aged 2.5 to 16, median 8.2, years were included. A bimodal distribution in duration of symptoms was observed: symptoms persisted for ≤ 2 weeks in 22 patients and 3 to 10 weeks in 22. Clinical and laboratory characteristics were similar in children with symptoms persisting for 2 weeks or less 28 and in those with symptoms persisting for 3-10 weeks. CONCLUSION In patients affected with acute nonspecific mesenteric lymphadenitis, it is advantageous to think of the time span for recovery in terms of ≥ 4 weeks. What is Known: • Mesenteric adenitis is a self-limiting inflammatory condition with well-characterized clinical presentation and imaging features. • A total duration of symptoms of ≤ 4 weeks is usually hypothesized. What is New: • Symptoms persist for 3 to 10 weeks in half of the patients. • At presentation, clinical and laboratory characteristics are similar in children with symptoms persisting for 2 weeks or less and in those with 45 symptoms persisting for 3-10 weeks.
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Affiliation(s)
- Cecilia Benetti
- Pediatric Department of Southern Switzerland, San Giovanni Hospital, 6500, Bellinzona, Switzerland
| | - Elisa Conficconi
- Pediatric Department of Southern Switzerland, San Giovanni Hospital, 6500, Bellinzona, Switzerland
| | - Flurim Hamitaga
- Pediatric Department of Southern Switzerland, San Giovanni Hospital, 6500, Bellinzona, Switzerland
| | - Marina Wyttenbach
- Department of Diagnostic Imaging, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
| | - Sebastiano A G Lava
- University Children's Hospital Bern and University of Bern, Bern, Switzerland
| | - Gregorio P Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Mario G Bianchetti
- Pediatric Department of Southern Switzerland, San Giovanni Hospital, 6500, Bellinzona, Switzerland. .,Università della Svizzera Italiana, Lugano, Switzerland.
| | - Giacomo D Simonetti
- Pediatric Department of Southern Switzerland, San Giovanni Hospital, 6500, Bellinzona, Switzerland.,Università della Svizzera Italiana, Lugano, Switzerland
| | - Rossana Helbling
- Pediatric Department of Southern Switzerland, San Giovanni Hospital, 6500, Bellinzona, Switzerland
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Kwon H, Jung JY. Effectiveness of a radiation reduction campaign targeting children with gastrointestinal symptoms in a pediatric emergency department. Medicine (Baltimore) 2017; 96:e5907. [PMID: 28099351 PMCID: PMC5279096 DOI: 10.1097/md.0000000000005907] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Children feature more active cellular division and a smaller body area, which leads to a greater radiation dosage accumulation. We tried to reduce radiation hazards by reducing unnecessary radiological studies in a pediatric emergency department (PED) through the radiation reduction campaign.Our campaign involved a reduction from 2 (erect and supine) to 1 ordered abdominal plain radiograph (erect). This quasi-experimental, uncontrolled before-and-after study aimed to evaluate the campaign effect. We compared simple radiograph orders, length of stay (LOS) in PED, and return visit (RV) to PED between the before period (June 1, 2011-May 30, 2014) and the after period (June 1, 2014-May 30, 2015). Piecewise regression was used to assess rate differences between the periods.A total of 10,729 and 3515 patients were included before and after the campaign, respectively. During study periods, 9647 (90%) and 2710 (77%) total abdominal radiographs were ordered, respectively (rate difference = 13%; P < 0.001), and the slopes of rate changes were 0.03 and -0.71, respectively (P = 0.056). The total abdominal erect and supine film rate slope decreased from -0.19 to -2.86 (P = 0.004). The RV rate did not change (220 [2%] vs 56 [2%], respectively; P = 0.104). The slope of total RV rate changed from -0.01 to -0.05 (P = 0.132), and the slope of LOS changed from 0.001 to -0.352 (P = 0.243).The campaign to reduce abdominal radiograph orders in pediatric patients successfully reduced the abdominal plain film X-ray rate without on the RV rate and the LOS.
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Abstract
Right lower quadrant pain in children can result from various underlying conditions other than acute appendicitis. The common mimics of acute appendicitis are related to acute gastrointestinal and genitourinary diseases. Diagnosis of right lower quadrant pain in the pediatric population can be challenging, especially when the symptoms are often nonspecific. This article reviews the currently available imaging techniques for evaluating a child with right lower quadrant pain and the spectrum of differential diagnoses with a focus on imaging clues to a specific diagnosis.
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Biondi E, Macduff S, Capucilli P, Tsuboyama M, Wu S, Beck C, Lynn J, van der Jagt E, Wilson K. Using patient characteristics to predict usefulness of abdominal computed tomography in children. Hosp Pediatr 2013; 3:226-32. [PMID: 24313091 DOI: 10.1542/hpeds.2013-0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The study goal was to determine whether clinical symptoms, physical findings, or laboratory values predict the usefulness of abdominal computed tomography (CT) scans in children. METHODS We conducted a retrospective review of pediatric patients who received an abdominal CT scan between June 2009 and November 2011 at an urban medical center. A panel of pediatric hospitalists independently categorized each CT read as: (1) necessary for diagnosis; (2) unnecessary but helpful for diagnosis; or (3) neither necessary nor helpful for diagnosis. Two multiple logistic regression models examined 21 clinical variables to assess their ability to differentiate between: (1) necessary and unnecessary CT scans; and (2) helpful and unhelpful CT scans. RESULTS A total of 399 CT scans were analyzed. Seventy (18%) of these were categorized as necessary, 103 (26%) as unnecessary but helpful, and 226 (57%) as neither necessary nor helpful. Three variables were strongly correlated with necessary CT scans: leukocytosis, peritoneal signs, and male gender. The probability of a CT scan being necessary was 57% in patients with all 3 findings and 8% in those with none. Three variables were also strongly correlated with unnecessary but helpful CT scans: history of abdominal surgery, tachypnea, and leukocytosis. The probability of a CT scan being helpful was 84% in patients with all 3 findings and 35% in those with none of the 3 findings. CONCLUSIONS The majority of abdominal CT scans were unnecessary and unhelpful. Knowing which clinical variables correlate strongly with necessary or helpful abdominal CT scans may assist clinicians in deciding whether to order this test; however, the predictive power of these variables remains relatively low.
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Affiliation(s)
- Eric Biondi
- Department of Pediatrics, School of Medicine, University of Rochester, Rochester, New York 14642, USA.
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