Comparison of computed tomography (CT) findings with RT-PCR in the diagnosis of COVID-19 in children

AIM

This study aimed to compare chest computed tomography (CT) findings with reverse-transcription polymerase chain reaction (RT-PCR) test results in children with probable or definitive diagnosis of coronavirus disease 2019 (COVID-19).

METHODS

In this retrospective archive study, pediatric patients who were followed up in the hospital with a possible or definitive diagnosis of COVID-19 and who had chest CT at presentation were included. CT scan images of the patients were reinterpreted by a pediatric radiologist and compared with their RT-PCR test results.

RESULTS

Of the total of 89 patients, 33 had negative and 56 had positive RT-PCR tests. The presence of pulmonary lesions and consolidation was statistically significantly higher in the RT-PCR negative group than in the RT-PCR positive group (p = 0.037 and 0.001, respectively). Lobe involvement of 0%-25% was higher in the RT-PCR positive group (p = 0.001), and lobe involvements of 25%-50% and 50%-75% were significantly higher in the RT-PCR negative group (p = 0.001 and 0.005, respectively). Central and perihilar involvement was found to be statistically significant in the RT-PCR negative group (p = 0.008 and 0.005, respectively).

CONCLUSION

Chest CT findings may provide some clues in predicting RT-PCR positivity in children with a probable diagnosis of COVID-19. Lobe involvement percentage of up to 25% is a finding in favor of patients with positive RT-PCR test, whereas 25%-75% lobe involvement, central and perihilar involvement, and consolidation can be interpreted in favor of patients with negative RT-PCR test.

Status dystonicus associated with CLN8 disease

BACKGROUND

Status dystonicus is an underdiagnosed condition, probably due to heterogeneous etiology, presentation and course. Herein, we report the first case of CLN8 disease in the literature presenting with status dystonicus who responded well to pharmacological intervention.

CASE

A boy aged five years and three months presented with fever, loss of appetite, intermittent excessive dystonic contractions, opisthotonus with retrocollis, and irritability for three days. His developmental milestones were reported as normal up to the age of three years and six months. At this age, he developed seizures, ataxia, and vision problems. Deterioration in developmental milestones was observed from the age of four. Laboratory tests demonstrated leukocytosis, abnormal renal function, mild metabolic acidosis, elevated creatine kinase and transaminase levels. The brain magnetic resonance imaging demonstrated cerebral and cerebellar atrophy. Homozygous missense mutation of c.709G > A (p.G237R) in the CLN8 gene was revealed. With all these clinical and laboratory findings, he was diagnosed with status dystonicus associated with CLN8 disease. Antibiotherapy, anticonvulsant drugs, and intravenous hydration with alkaline fluids were initiated. Due to irregular breathing, dysphagia, and worsening of dystonic contractions, mechanical ventilation was performed, and baclofen, haloperidol, midazolam infusion and chloral hydrate were administered, respectively. Finally, serum creatine kinase levels decreased, and dystonic contractions improved on the 15th day of hospitalization.

CONCLUSION

To the best of our knowledge, our case is the first report describing the status dystonicus in a patient with CLN8 disease. Our report suggested that neuronal ceroid lipofuscinoses should be kept in mind in the etiology of status dystonicus.

Incidental ectopic adrenal cortical tissue: Retrospective analysis of 16 patients

OBJECTIVE

To evaluate ectopic adrenal cortical tissue (EACT) and identify clinical, pathological and radiological aspects.

STUDY DESIGN

Retrospective review of pathology reports in a single tertiary institution between 2010 and 2020 was conducted. Patients diagnosed with EACT were included for analysis. Demographic characteristics, accompanying pathologies and clinicopathological and radiological findings of these patients were analyzed.

RESULTS

There was a total of 17 patients in the cohort. Fifteen were boys and 2 were adults (1 male). The mean diameter of the EACT nodule was 0.25 cm (range 0.2-0.5 cm). All EACTs were incidentally diagnosed. Seven EACTs were diagnosed during an inguinal hernia repair, 6 during orchidopexy, 1 during partial orchiectomy, 2 during orchiectomy and 1 during hysterectomy and bilateral salpingoophorectomy due to uterine prolapse.

DISCUSSION

EACT is a rare entity that is mostly found incidentally during inguinoscrotal interventions. Radiological discrimination of EACT may not be easy and thus, not detected prior to surgery. Clinical significance of EACT is not very well understood, however it tends to be a benign pathology. Although it is more commonly found in children, adults may present with EACT, as well.

CONCLUSION

A tiny yellowish nodule detected in the inguinoscrotal region should be suspected for EACT by pediatric urologists, surgeons, and pathologists.

Are urachal remnants really rare in children? An observational study

Urachal remnants are thought to have a low prevalence. However, recent studies indicate a higher rate. The aim of this study was to evaluate the prevalence of urachal remnants in children referred for imaging by abdominal/urinary/suprapubic ultrasonography in one calendar year. Files of children who underwent abdominal/urinary/suprapubic ultrasonography in one calendar year were retrospectively reviewed. Data regarding children ≤17 years that underwent ultrasonography of the ventral abdominal wall while being assessed for various reasons were collected. Anomalies detected, age, gender, reason for ultrasonography request, and diagnosis of the urachal remnant were noted. All ultrasonography assessments were performed by a single pediatric radiologist in a single institution. There were 4836 patients in the study (1919 boys). Median age of the whole cohort was 7 years. A total of 10 patients were found to have urachal remnants, which included eight urachal cysts (three boys) and two urachal diverticula (one boy).Conclusion: The prevalence of urachal remnants in our cohort was nearly 2 in every 1000 children. More specifically, the prevalence of urachal cysts was one in 600. What is Known: • Urachal remnants were believed to be rare. • Recent studies indicated a higher incidence than previous reports. What is New: • This study shows that urachal remnant may be observed in one every 500 children that undergo ultrasonography of the abdomen for various reasons. • Parental counselling and management of urachal remnants should be planned accordingly.

Risk for testicular germ cell tumors and spermatogenesis failure in post-pubertal undescended testes

PURPOSE

Cryptorchidism is a well-defined risk factor for testicular germ cell tumors, whereas the underlying mechanisms have not been fully elucidated. Surgical procedures to reposition undescended testicles into the scrotum (orchidopexy) in early childhood are recommended both to increase fertility potential and to reduce the risk of developing testicular tumors. However, treatment in the post-pubertal period is controversial. The aim of this study is to review the histopathology of orchiectomy specimens and determination of spermatogenesis in post-pubertal patients with non-treated cryptorchidism.

METHODS

Retrospective chart review was performed to assess the occurrence of TGCTs and determine spermatogenesis in post-pubertal individuals who underwent inguinal orchiectomy for undescended testis between January 2010 and December 2019. Age at the time of surgery, laterality, location of the undescended testis and pathology results were evaluated. All pathology specimens were reviewed by a blinded pathologist.

RESULTS

There were 23 patients in the cohort with a mean age of 21 years (range 13-46 years). All testes were in the inguinal canal. Our results indicated that 1 patient had seminoma. In the histological evaluation of the remaining 22 patients in whom no tumor was detected, normal spermatogenesis was not observed in any patient. Further, seminiferous tubules were not found in 19 patients. Maturation arrest was detected in the remaining 3 patients.

CONCLUSION

Testicular germ cell carcinoma was found in 4% of the patients who underwent post-pubertal orchiectomy. In addition, none of the undescended testes had normal spermatogenetic activity. Thus, orchiectomy should be considered in post-pubertal males with unilateral undescended testis that do not need the endocrinological activity of the testis.

Clinical and Radiological Profile of Nine Patients with Metachromatic Leukodystrophy

Introduction

Metachromatic leukodystrophy (MLD) is a rare, demyelinating, autosomal recessive lysosomal storage disease caused by a deficiency in the arylsulfatase A enzyme (ASA), which is encoded by ARSA gene. A lack of ASA activity results in an accumulation of sulfatides in the myelin sheaths of both the central and peripheral nervous systems, leading to developmental and neurocognitive progressive deterioration that can be observed in all age groups.

Methods

We present a total of 9 patients with MLD with an average age of 61 months, whose clinical, laboratory and cranial magnetic resonance imaging findings were evaluated, and who underwent an ARSA gene molecular analysis.

Results

Of the 9 patients, 7 had the late infantile form of the condition, 2 had the juvenile form, and 3 were identified through family screening. The median age at diagnosis was 30 months (min 3-max 73 months), the mean ASA activity value was 2 nmol/h/mgprt and the median cranial MR imaging severity score was 10 (min 5-max 18). The grey and white matter volumes of all patients, evaluated using volBrain software, were within the normal range. At an average age of 48 months, the late-infantile MLD patients were unable to control any body part.

Conclusions

Hematopoietic stem cell transplantation (HSCT), a treatment option for both the juvenile and adult forms of MLD in asymptomatic or early symptomatic patients, was performed on two of the asymptomatic and early symptomatic patients, and post-HSCT ASA activity settled within the normal range and their developmental milestones stabilized. It is important to diagnose MLD in the asymptomatic period and newborn screening can support early diagnosis.

Fibroepithelial Polyp at the Bladder Neck Presenting with Gross Hematuria in a 5-Year-Old Boy

Background: In any age group, gross hematuria is an alarming symptom. A variety of diseases, including urinary tract tumors, urinary tract infections, glomerulonephritis, urinary stone disease, and urinary trauma, can cause gross hematuria. Neoplasms of the urinary tract are definitely the most bothersome among the differential diagnoses. Fibroepithelial polyps (FEPs), in contrast, are mesodermal-originated rare and benign tumors that can be observed in the urinary tract. In this case report, we present a child with an FEP at the bladder neck that was referred because of gross hematuria. Case Presentation: A 5-year-old boy presented with intermittent gross hematuria for 2 weeks. Ultrasonography showed a 2 × 1 cm mucosal surface-borne polypoid lesion at the trigon. Patient underwent cystoscopic evaluation that revealed a polypoid mass located at the bladder neck; however, there were no signs of bladder outlet obstruction in the bladder. Transurethral resection revealed an FEP. Conclusion: Hematuria should be evaluated carefully not only in adults but also in children. FEPs in bladder can mimic bladder carcinoma clinically and radiologically. It should be kept in mind in the differential diagnosis of bladder lesions on imaging modalities in pediatric population.

Can the affected intestinal segment visualized on abdominal ultrasound predict gastrointestinal tract bleeding in immunoglobulin A vasculitis?

OBJECTIVES

The study aimed to evaluate immunoglobulin A vasculitis (IgAV) patients with gastrointestinal (GI) tract involvement and to reveal the relationship between the location and extent of the affected intestinal segment detected on the initial abdominal ultrasound and GI tract bleeding.

METHODS

This medical record review study was conducted on 117 IgAV patients with GI tract involvement between January 2016 and June 2023. Patients were divided into two groups: those with (n = 28) and without (n = 89) GI tract bleeding. Predictors of GI tract bleeding were investigated by comparing demographic, clinical characteristics, and laboratory findings.

RESULTS

Gender, age at diagnosis, symptoms at admission, rash distribution, GI tract complaints, and the elapsed time until the development of GI tract symptoms were similar in both groups. There was no difference between small intestinal, large intestinal, or small + large intestinal involvement (P = .89). The ileum was the most commonly affected intestinal segment in patients with and without GI tract bleeding (P = .37). Jejunal wall thickening (P = .04) and the number of affected intestinal segments (P = .008) were higher in patients with GI tract bleeding.

CONCLUSIONS

In IgAV patients, jejunum involvement and affected multiple intestinal segments shown by abdominal ultrasound are associated with GI tract bleeding.