The Spectrum of Myositis Ossiticans in Haemophilia

Myositis ossificans (MO) refers to non-neoplastic heterotopic soft tissue ossification that can have several aetiologies. Broadly it can be classified into three categories based on aetiology [1]. MO traumatica, the most common form occurs secondary to acute or chronic trauma. MO can also be associated with neurological disorders and in rare cases is congenital. The latter (progressive MO) is a genetic disorder in which congenital osseous abnormalities are associated with progressive soft tissue calcification. Despite an increased tendency to soft tissue bleeds, MO has been rarely reported in haemophilia. We treated three adolescents with haemophilia and MO of varying degrees of severity and outcome.

Asymptomatic childhood hypertension

A patient with asymptomatic hypertension is presented in stages (small type) to an expert clinician who responds to the information, sharing his/her reasoning with the reader (regular type). The authors’ commentary follows.

Subcutaneous fat necrosis of the newborn

We present the MRI findings in a case of subcutaneous fat necrosis of the newborn. To our knowledge, the MRI findings of this entity have not been reported. Subcutaneous fat necrosis of the newborn is an uncommon, benign process in full-term infants. Hypercalcemia may be a potentially life-threatening complication of this otherwise self-limiting process.

Adult diseases in children

The classic teaching in performance and interpretation of diagnostic studies is that "children are not small adults." The purpose of this article is to show a spectrum of "adult" disease entities that can occur, but are not usually considered in the pediatric population: cricopharyngeal achalasia, Schatzki's ring, achalasia, Helicobacter pylori, pancreatic carcinoma, adenocarcinoma of the colon, nasopharyngeal carcinoma, thyroid carcinoma, malignant melanoma, hydatidiform mole, renal cell carcinoma, leiomyosarcoma of the ovary and sarcoidosis. Radiologists interpreting pediatric imaging should recognize these entities and perform an appropriate diagnostic workup.

Long-term venous access using endogenous splenic tissue: the 'spleen-o-port'

The authors sought to determine whether endogenous splenic tissue placed in a subcutaneous pouch ("spleen-o-port") could function as a viable alternative to central venous catheters/ports for long-term venous access. A small transverse incision was made in the left upper quadrant of each puppy (n = 6) under general anesthesia. Using a stapler, the authors divided the splenic parenchyma. The superior portion was returned to its native location, and a subcutaneous pocket was created to house the inferior pole with its attached vascular supply. The fascial and muscular layers were closed with care to avoid compressing the blood supply to the spleen-o-port. Postoperatively the dogs resumed normal activity. There have been no deaths, infectious complications, splenic ruptures, or thromboses over a 6-month period. Under fluoroscopy, the dogs were imaged from postoperative day (POD) 10 to 177. Contrast agent entering the splenic parenchyma was promptly visualized in the splenic vein and then filled the portal vein. Electrolyte measurements from spleen-o-port blood samples were identical to those from peripheral venous samples. After gentamicin (mixed in a crystalloid solution) was infused through the spleen-o-port, the peak serum level corresponded to the therapeutic levels observed after standard intravenous administration. The spleen-o-port permits rapid infusion of drugs and crystalloid, and allows repetitive blood sampling while eliminating the foreign body that can promote septicemia in the immunocompromised patient.

Primary endodermal sinus tumor of the liver detected by CT

We report a case of primary endodermal sinus tumor of the liver. Endodermal sinus tumors are rare neoplasms which usually arise in the testis or ovary. Extragonadal endodermal sinus tumors are uncommon and primary tumors of the liver are very rare. The tumor was detected using CT and the diagnosis was made by percutaneous biopsy.

Evaluation of umbilical catheter and tube placement in premature infants

Umbilical arterial and venous catheters, endotracheal tubes, and nasogastric tubes are routinely used in treating premature infants, and radiologists play a critical role in evaluating proper catheter and tube placement and recognizing potential complications. Ideally, an umbilical venous catheter should be positioned in the right atrium; an umbilical arterial catheter, between T-6 and T-10 (high position) or between L-3 and L-5 (low position); an endotracheal tube, 1.5 cm above the carina, with the infant's head in a neutral position; and a nasogastric tube, in the body of the stomach. Catheters and tubes can be malpositioned in a variety of vessels and the main stem bronchi, respectively. Complications include extraluminal placement of catheters (which can result in death), thrombi in the aorta and pulmonary artery, aortic aneurysm, subglottic stenosis, intubation granuloma, and perforation of the esophagus and stomach.

Pleural lipoma in a child--CT evaluation

Lipoma is a benign neoplasm composed of adult adipose tissue and occasionally fibrous stroma. These lesions occur most often in adults and rarely in the pleura. We describe a case of a lipoma in a 3 1/2 year old child that presented as a pleural-based mass.

Plasma cell granuloma presenting as an iliopsoas mass--mimicking a rhabdomyosarcoma

Plasma cell granuloma is a rare benign tumour that can affect people of all ages. These are most commonly found in the lung but have been reported in numerous extrapulmonary sites. By gross and radiographic appearance they can mimic malignancies. We report a case of a plasma cell granuloma arising in the right pelvis contiguous with the iliopsoas mimicking a sarcoma.

The renal lesions of tuberosclerosis (cysts and angiomyolipoma)--screening with sonography and computerized tomography

The two most common sonographic abnormalities in the kidneys of 23 tuberous sclerosis (TS) patients ranging in age from newborn to 30 years are angiomyolipomas (12/23) (AML) and renal cysts (10/23). These usually both occur in the same patient with only 9 cases (39%) having sonographically normal kidneys. Of the 14 affected patients, 2 had cysts without AML and 4 others had AML without cysts. The sonographic appearance of an AML varied from a large 6 cm solid mass with little increased echogenicity (1/12) to subtle small (4 mm) extremely echogenic regions in the periphery of the kidney (11/12). The sonographic appearance of the cysts were anechoic lesions varying in size from 2 mm to 2 cm with thin uniform posterior walls and posterior enhancement. Renal lesions are found more frequently with increasing age. Sonography is the preferred screening procedure for the renal lesions of T.S.