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Berdon WE, Baker DH. Azygos vein dilatation in acquired obstruction of the inferior vena cava (examples following calcified caval thrombosis and following mesocaval shunt for portal hypertension). Pediatr Radiol 2005; 2:221-4. [PMID: 15822886 DOI: 10.1007/bf00972693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Leonidas J, Berdon WE, Baker DH, Amoury R. Perforation of the gastrointestinal tract and pneumoperitoneum in newborns treated with continuous lung distending pressures. Pediatr Radiol 2005; 2:241-5. [PMID: 15822890 DOI: 10.1007/bf00972697] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Gallagher MP, Schachner HC, Levine LS, Fisher DA, Berdon WE, Oberfield SE. Neonatal thyroid enlargement associated with propylthiouracil therapy of Graves' disease during pregnancy: a problem revisited. J Pediatr 2001; 139:896-900. [PMID: 11743522 DOI: 10.1067/mpd.2001.119447] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- M P Gallagher
- Department of Pediatrics, Columbia University, New York, NY, USA
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Haller JO, Berdon WE, Franke H. Sickle cell anemia: the legacy of the patient (Walter Clement Noel), the interne (Ernest Irons), and the attending physician (James Herrick) and the facts of its discovery. Pediatr Radiol 2001; 31:889-90. [PMID: 11727028 DOI: 10.1007/s002470100014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- J O Haller
- Department of Radiology, Beth Israel Medical Center, First Avenue and 16th Street, New York, NY 10003, USA
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Affiliation(s)
- W E Berdon
- Columbia Presbyterian Medical Center, Babies and Children's Hospital of New York, 3959 Broadway, New, York NY 10032, USA
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Brenner DJ, Elliston CD, Hall EJ, Berdon WE. Estimates of the cancer risks from pediatric CT radiation are not merely theoretical: comment on "point/counterpoint: in x-ray computed tomography, technique factors should be selected appropriate to patient size. against the proposition". Med Phys 2001; 28:2387-8. [PMID: 11764047 DOI: 10.1118/1.1415074] [Citation(s) in RCA: 115] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Comerci SC, Berdon WE, Ruzal-Shapiro C, Levin TL, Krongrad E, Bisset GS, Strife JL. Systemic arterial collateral esophageal indentations in pseudotruncus arteriosus. Pediatr Radiol 2001; 25:192-4. [PMID: 7644300 DOI: 10.1007/bf02021532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Barium esophagrams were obtained in two patients with respiratory problems whose underlying congenital heart disease was pseudotruncus arteriosus type I. The esophagrams revealed vascular indentations on the esophagus, one posteriorly, and the other anteriorly. Both types of indentations were secondary to aorto-pulmonary communicating arteries from the descending aorta.
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Affiliation(s)
- S C Comerci
- Department of Radiology, Columbia Presbyterian Medical Center, Babies & Children's Hospital, New York, NY 10032, USA
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Abstract
Pooling of blood in the spleen is a frequent occurrence in children with sickle cell diseases, particularly in the first few years of life, resulting in what is termed "splenic sequestration crisis." The spectrum of severity in this syndrome is wide, ranging from mild splenomegaly to massive enlargement, circulatory collapse, and even death. The diagnosis is usually clinical, based on the enlargement of the spleen with a drop in hemoglobin level by > 2 g/dl, and it is rare that imaging studies are ordered. However, in the patient who presents to the emergency department with non-specific findings of an acute abdomen, it is important to recognize the appearance of sequestration on imaging studies. We studied seven patients utilizing contrast-enhanced CT scans and found two distinct patterns--multiple, peripheral, non-enhancing low-density areas or large, diffuse areas of low density in the majority of the splenic tissue. Although radiological imaging is not always necessary to diagnose splenic sequestration, in those situations where this diagnosis is not immediately obvious, it makes an important clarifying contribution.
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Affiliation(s)
- S Sheth
- Division of Pediatric Hematology, Department of Pediatrics, Division of Hematology, College of Physicians and Surgeons of Columbia University, 622 West 168th Street, New York, NY 10032, USA.
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Berdon WE. Rings, slings, and other things: vascular compression of the infant trachea updated from the midcentury to the millennium--the legacy of Robert E. Gross, MD, and Edward B. D. Neuhauser, MD. Radiology 2000; 216:624-32. [PMID: 10966687 DOI: 10.1148/radiology.216.3.r00se40624] [Citation(s) in RCA: 115] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In the first half of the 20th century, pediatric chest imaging was limited mainly to the performance of conventional radiography, including barium esophagography and occasionally bronchography and angiography. Despite this limited imaging approach, by 1950 the diagnosis and treatment of vascular "rings" compressing infant airways had been accomplished with the pioneering efforts of Robert E. Gross, MD, in the field of surgery, and Edward B. D. Neuhauser, MD, in the field of radiology. The next two decades brought the recognition of pulmonary arterial "sling," or anomalous left pulmonary artery, in diagnosis and treatment. Recognition of still another vascular compressive syndrome in infants was identified as that due to the absence of the pulmonary valve. These "rings, slings, and other things" are now evaluated with magnetic resonance (MR) imaging, including MR angiography, and computed tomography (CT), including CT angiography, with the added use of three-dimensional reconstruction. These are the legacies of Drs Gross and Neuhauser.
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Affiliation(s)
- W E Berdon
- Department of Radiology, Babies & Children's Hospital of New York, New York, NY 10032, USA.
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Joshi A, Berdon WE, Ruzal-Shapiro C, Barst RJ. CT detection of tracheobronchial calcification in an 18-year-old on maintenance warfarin sodium therapy: cause and effect? AJR Am J Roentgenol 2000; 175:921-2. [PMID: 10954513 DOI: 10.2214/ajr.175.3.1750921] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- A Joshi
- Babies and Children's Hospital of New York Columbia-Presbyterian Medical Center New York, NY 10032, USA
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Abstract
PURPOSE The purpose of this paper was to review the imaging features of Mycobacterium avium-intracellulare complex (MAC) in 16 pediatric patients with human immunodeficiency virus (HIV). MATERIALS AND METHODS We reviewed the pertinent clinical records of 16 children diagnosed with MAC between January 1990 and June 1998. These 16 cases were blood- or biopsy-proven to have MAC infection. Their plain films, abdominal, and chest CT scans were then reviewed and the findings were analyzed with reference to the few reported cases of children with MAC. RESULTS Abdominal findings: all but one had retroperitoneal adenopathy, mesenteric adenopathy or both. Ten patients had hepatomegaly, while nine patients were found to have splenomegaly. Four patients had nonspecific thickened gallbladder wall, while intestinal wall thickening and thickened stomach folds were identified in six of ten patients. Necrotic, fluid-filled nodes were also found. Chest findings included mediastinal adenopathy, cystic/cavitary lesions and bronchiectasis. One patient developed a fistula between the mediastinal lymph nodes, esophagus, and bronchial tree. CONCLUSION Pediatric patients with HIV who develop MAC infection may present with massive lymph node enlargement. This can occur not only in mesenteric and retroperitoneal nodes but also in hilar and posterior mediastinal nodes as well. As in MTB infection, these nodes can break down with development of fistulous tracts to both esophagus and adjacent lung. The major differential diagnostic consideration besides MTB is lymphoma.
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Affiliation(s)
- M Pursner
- State University of New York, Health Science Center at Brooklyn, USA
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Abstract
OBJECTIVE This report discusses the relationship of supradiaphragmatic hepatic tissue that is fused to the lung (through a diaphragmatic defect) with pulmonary hypoplasia-a new constellation of findings. CONCLUSION Hepatic pulmonary fusion should be suspected in instances of apparent diaphragmatic hernia characterized by mediastinal shift towards the hypoplastic lung or when the mediastinum does not shift away from the mass.
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Affiliation(s)
- T L Slovis
- Department of Pediatric Imaging, Children's Hospital of Michigan, Detroit 48201, USA
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Heller GD, Haller JO, Berdon WE, Sane S, Kleinman PK. Punctate thymic calcification in infants with untreated Langerhans' cell histiocytosis: report of four new cases. Pediatr Radiol 1999; 29:813-5. [PMID: 10552058 DOI: 10.1007/s002470050702] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Four new cases of punctate thymic calcification in infants with untreated Langerhans' cell histiocytosis (LCH) are added to the four previously reported cases. All cases were shown on CT scans; plain films were rarely diagnostic. Pathologic correlation remains elusive since the usual biopsies of the LCH have been on skin or bone biopsies. A single prior pathologic study of the thymus in untreated LCH showed microscopic calcospherites. The thymic punctate calcific densities in patients with LCH may represent further accretion so that the calcospherites become macroscopic. The finding of such punctate calcific densities in an enlarged thymus of an infant with skin or bone or lung disease is strongly suggestive of LCH.
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Affiliation(s)
- G D Heller
- Department of Radiology, SUNY Health Science Center at Brooklyn, Box 1208, Brooklyn, NY 11203, USA
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Berdon WE, Stylianos S, Ruzal-Shapiro C, Hoffer F, Cohen M. Neuroblastoma arising from the organ of Zuckerkandl: an unusual site with a favorable biologic outcome. Pediatr Radiol 1999; 29:497-502. [PMID: 10398782 DOI: 10.1007/s002470050629] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Prognosis in neuroblastoma has been shown to correlate with age and stage at diagnosis and site of origin. Extra-abdominal tumors (chest, neck, pelvis) do better in terms of survival than tumors arising from the upper abdomen. OBJECTIVE We evaluated a subgroup of abdominal neuroblastomas arising near to the aortic bifurcation (commonly called organ of Zuckerkandl, O. Z.) to assess their biologic outcome and problems in diagnosis and therapy. MATERIALS AND METHODS Sixteen O. Z. primary tumors were seen at three children's hospitals. Their clinical records and imaging studies were reviewed, including the sonographic, CT, and MRI findings. When available, MYCN amplification was noted (MYCN is the current term previously called N-MYC). RESULTS Despite more than half of the tumors being very large, survival was the rule, with only one fatality (following multiple local recurrences). Only one patient (who survived) had bone metastases. The larger masses were usually palpated in otherwise well children, while the smaller ones were found in the course of evaluation for unrelated problems such as urinary tract infection. Intraspinal extension was common, though usually asymptomatic. MYCN amplification was absent in the four patients studied. CONCLUSIONS Lower abdominal (O. Z.) neuroblastomas present technical problems of surgical removal, but form a group with a favorable outcome similar to cervical and thoracic primary sites. MRI was useful in delineating intraspinal extension.
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Affiliation(s)
- W E Berdon
- Department of Radiology, Division of Pediatric Radiology, Babies & Children's Hospital of New York, 3959 Broadway, BHN 3-318, New York, NY 10032, USA
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Abstract
BACKGROUND Patients with ataxia telangiectasia (AT), known to have an inherent increased susceptibility to the development of cancer, may present with malignancies that are unusual for the patient's age, are often difficult to diagnose clinically and radiographically and respond poorly to conventional therapy. MATERIALS AND METHODS We reviewed the clinical presentation and imaging studies of 12 AT patients who developed malignancies. RESULTS Eight of the twelve patients developed non-Hodgkin's lymphoma (CNS, thorax, bone), two developed Hodgkin's disease, and two were diagnosed with gastrointestinal mucinous adenocarcinoma. CONCLUSION The lymphomas were commonly extra nodal, and infiltrative rather than mass-like. The recognition of the tumors was often delayed due to confusion with the known infectious complications in AT patients.
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Affiliation(s)
- R C Murphy
- Babies & Children's Hospital of New York, Department of Radiology, Division of Pediatric Radiology, 3959 Broadway, BHN 3-318, New York, NY 10032, USA
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Abstract
OBJECTIVE To perform preoperative airway evaluations, using radiographic analysis, to review the tracheal anatomy in children with congenital cardiac disease. DESIGN Prospective. SETTING A university children's hospital. PARTICIPANTS One hundred patients. MEASUREMENTS AND MAIN RESULTS One magnified airway film (high kilovoltage filtered) was performed preoperatively on 100 consecutive children presenting for repair of congenital cardiac disease. Events at intubation, with respect to endotracheal tube size (internal diameter in millimeters) and difficulties with placement of the tube, were recorded. Postoperative morbidity, specifically related to underlying airway anomaly, was documented. Eleven children had positive radiographic findings after review of magnified airway films. Six of 11 patients had evidence of tracheobronchial pathology, and five patients had no tracheal pathology. Difficulties with intubation were noted in two children. No perioperative morbidity was noted in any patient. CONCLUSION The use of preoperative magnified airway films for tracheal evaluations in children with cardiac disease should be considered.
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Affiliation(s)
- R Kazim
- Department of Anesthesiology, Columbia University, College of Physicians and Surgeons, New York, NY, USA
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Abstract
Malpositioning of the percutaneously placed central venous line (PCVL) or percutaneously inserted central catheter (PICC) in infants is not a rare occurrence. It has been occasionally observed that these lines spontaneously correct themselves. This prospective study was done to study the incidence of malposition and spontaneous correction. Using a modification of the standard method, 187 catheters were placed with 98.9 % success. Seven of these were initially malpositioned. All seven corrected themselves within a day when left in and used as a peripheral intravenous line. In many centers malpositioned catheters are taken out and replaced, which imposes great stress on the critically ill infant. Our study suggests that to avoid this stress the catheter should be left in place, since spontaneous correction may occur.
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Affiliation(s)
- S Rastogi
- Division of Neonatal Medicine, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, 3959 Broadway BH-12N, Rm 1201, New York, NY 10032, USA
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Abstract
Indinavir sulfate is a protease inhibitor used in the treatment of the human immunodeficiency virus (HIV). This case report describes the radiographic and urologic manifestations of indinavir urolithiasis in two pediatric patients with acquired immunodeficiency syndrome (AIDS). Management involves aggressive hydration and surgical intervention when indicated.
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Affiliation(s)
- C B Noble
- Department of Radiology, Babies & Children's Hospital of New York, 3959 Broadway, BHN 3-318, New York, NY 10032, USA
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Sheth S, Ruzal-Shapiro C, Hurlet-Jensen A, Piomelli S, Berdon WE. Pulmonary embolism developing in patients with sickle cell disease on hypertransfusion and IV deferoxamine chelation therapy. Pediatr Radiol 1997; 27:926-8. [PMID: 9388284 DOI: 10.1007/s002470050273] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Pulmonary disease, including thromboembolic problems, accounts for a large portion of the morbidity of sickle cell disease. Chronic transfusion therapy is now a part of long-term treatment of sickle cell patients with stroke and chest syndrome. The resultant iron overload must be treated with chelation therapy using deferoxamine. Poor compliance with subcutaneous chelation therapy has necessitated intravenous deferoxamine treatment. We describe two patients with sickle cell disease on such a regimen, who became hypoxic as a result of pulmonary thromboembolism, secondary to venous thrombophlebitis. The thrombophlebitis and subsequent pulmonary embolism probably reflect the hypercoagulable state seen in sickle cell and are not due to the deferoxamine therapy.
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Affiliation(s)
- S Sheth
- Division of Pediatric Hematology, 180 Fort Washington Avenue, HP 5-554, New York, NY 10032, USA
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Abstract
The most common form of Gaucher's disease, type 1 (chronic non-neuronopathic), results in accumulation of glucocerebroside in reticuloendothelial cells of the spleen, liver and bone marrow, with frequent occurrence of bone pain due to vaso-occlusive crisis. We report the finding of a "cold" vertebral body on bone scan in two patients with Gaucher's disease and bone crisis. Photopenia was so striking as to give the appearance of a "missing" vertebra. Concurrent plain films appeared normal. In one patient Gaucher's disease had not previously been diagnosed.
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Affiliation(s)
- E G Dolen
- Department of Radiology, Columbia-Presbyterian Medical Center, 177 Fort Washington Avenue, New York, NY 10032, USA
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Abstract
OBJECTIVE The objective of this study was to review the problem of lumbar gibbus in children with storage diseases and bone dysplasias utilizing plain films and MR imaging. MATERIALS AND METHODS Clinical histories and radiographic images in five patients with storage diseases [four mucopolysaccharidosis (MPS) and one mucolipidosis] and two with achondroplasia were reviewed. The International Skeletal Dysplasia Registry (Los Angeles, Calif.), surveyed for all patients with lumbar gibbus and skeletal dysplasias, provided 12 additional cases. RESULTS All patients had localized gibbus of the upper lumbar spine, characterized by anterior wedging and posterior displacement of the vertebrae at the apex of the curve, producing a beaked appearance. The curve, exaggerated in the sitting or standing position, was most severe in the two patients with MPS-IV (one of whom died). Both developed severe neurologic signs and symptoms requiring surgical intervention. In four patients, MR images demonstrated the apex of the curve to be at or below the conus. Two patients demonstrated anterior herniation of the intervertebral discs at the apex of the curve, though the signal intensity of the intervertebral discs was normal. CONCLUSION Lumbar gibbus has important neurologic and orthopedic implications, and is most severe in patients with MPS. The etiology of the gibbus with vertebral beaking is multifactorial and includes poor truncal muscle tone, weight-bearing forces, growth disturbance and anterior disc herniation. The curve is generally at or below the conus. Neurologic complications are unusual, although orthopedic problems can arise. Due to their longer survival, patients with achondroplasia or Morquio's disease are more vulnerable to eventual gibbus-related musculoskeletal complications.
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Affiliation(s)
- T L Levin
- Department of Radiology, Division of Pediatric Radiology, Columbia-Presbyterian Medical Center, New York, NY 10032, USA
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Emy PY, Levin TL, Sheth SS, Ruzal-Shapiro C, Garvin J, Berdon WE. Iron overload in reticuloendothelial systems of pediatric oncology patients who have undergone transfusions: MR observations. AJR Am J Roentgenol 1997; 168:1011-5. [PMID: 9124106 DOI: 10.2214/ajr.168.4.9124106] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Pediatric oncology patients who undergo intensive chemotherapy develop anemia caused by myeloid suppression that necessitates transfusions that, in turn, cause iron deposition in the reticuloendothelial system. We describe MR imaging of iron overload in pediatric patients who underwent such chemotherapy and who have solid and hematologic tumors. MATERIALS AND METHODS The MR appearance of the liver, spleen, and bone marrow was evaluated in 13 children with both solid (n = 10) and hematologic (n = 3) malignant lesions using known criteria for the presence of iron deposition. Findings were correlated with transfusional history, chemotherapeutic regimens, and ferritin levels. RESULTS MR imaging obtained after chemotherapy and transfusional therapy revealed signs of iron deposition in the liver and spleen, particularly on T2-weighted images. Bone marrow signal intensity varied among patients. Pancreatic signal intensity was normal. Ferritin levels were elevated in all patients. CONCLUSION Reticuloendothelial system iron deposition present in follow-up MR imaging of pediatric solid and hematologic malignant lesions reflected the intensity of the chemotherapeutic regimen, the degree of myeloid suppression, and the resultant transfusional requirements. Such iron deposition appeared to have no effect on cardiac, liver, or pancreatic function.
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Affiliation(s)
- P Y Emy
- Department of Pediatric Radiology, Columbia-Presbyterian Medical Center, Babies and Children's Hospital, New York, NY 10032, USA
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Abstract
Dideoxyinosine (ddI) is a widely used antiretroviral agent in treatment of HIV infection. Pancreatitis is a serious side effect. Two cases are reported, one with rapid development of a pseudocyst.
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Affiliation(s)
- T L Levin
- Department of Radiology, Division of Pediatric Radiology, Babies and Children's Hospital of New York-Columbia Presbyterian Medical Center, 3959 Broadway, BHN 3-318, New York, NY 10032, USA
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Cleveland RH, Schluchter M, Wood BP, Berdon WE, Boechat MI, Easley KA, Meziane M, Mellins RB, Norton KI, Singleton E, Trautwein L. Chest radiographic data acquisition and quality assurance in multicenter studies. Pediatr Radiol 1997; 27:880-7. [PMID: 9361051 PMCID: PMC4358845 DOI: 10.1007/s002470050262] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Multicenter studies rely on data derived from different institutions. Forms can be designed to standardize the reporting process allowing reliable comparison of data. OBJECTIVE The purpose of the report is to provide a standardized method, developed as a part of a multicenter study of vertically transmitted HIV, for assessing chest radiographic results. MATERIALS AND METHODS Eight hundred and five infants and children were studied at five centers; 3057 chest radiographs were scored. Data were entered using a forced-choice, graded response for 12 findings. Quality assurance measures and inter-rater agreement statistics are reported. RESULTS The form used for reporting chest radiographic results is presented. Inter-rater agreement was moderate to high for most findings, with the best correlation reported for the presence of bronchovascular markings and/or reticular densities addressed as a composite question (kappa = 0.71). The presence of nodular densities (kappa = 0.56) and parenchymal consolidation (kappa = 0.57) had moderate agreement. Agreement for lung volume was low. CONCLUSION The current tool, developed for use in the pediatric population, is applicable to any study involving the assessment of pediatric chest radiographs for a large population, whether at one or many centers.
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Affiliation(s)
- R H Cleveland
- Department of Radiology, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
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Abstract
Stage IV neuroblastoma is associated with high mortality; an exception are patients whose stage IV status includes distant positive nodes, but no skeletal metastases-stage IVN neuroblastoma. We describe our experience with preoperative MRI in three patients with extensive abdominal neuroblastoma without cortical bony involvement but with unsuspected metastatic involvement to the left supraclavicular (Virchow's) node. We review findings of left supraclavicular nodal spread in five earlier cases of IVN neuroblastoma.
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Affiliation(s)
- S J Abramson
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Berdon WE. Lateral cervical spine films in Down syndrome. Pediatr Radiol 1996; 26:748. [PMID: 9027297 DOI: 10.1007/bf01383397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Levin TL, Berdon WE, Haller JO, Ruzal-Shapiro C, Hurlet-Jenson A. Intrasplenic masses of "preserved" functioning splenic tissue in sickle cell disease: correlation of imaging findings (CT, ultrasound, MRI, and nuclear scintigraphy). Pediatr Radiol 1996; 26:646-9. [PMID: 8781104 DOI: 10.1007/bf01356826] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE We studied six patients with sickle cell disease (SSD), five homozygous for sickle cell anemia and one with sickle beta-thalassemia, in whom rounded intrasplenic masses proved to be preserved functioning splenic tissue. MATERIALS AND METHODS Available images including computed tomography, ultrasonography, bone scans (Tc-99m MDP), liver spleen scans (Tc-99m sulfur colloid), and MRI were evaluated. RESULTS The masses were low density on CT (in an otherwise calcified spleen), hypoechoic relative to the echogenic spleen on US, and had the imaging characteristics of normal spleen on MRI. They failed to accumulate Tc-99m MDP but did demonstrate uptake of Tc-99m sulfur colloid. CONCLUSION In a patient with SSD and intrasplenic masses, proper correlation of multiple imaging modalities will establish the diagnosis of functioning splenic tissue and avoid mistaken diagnosis of splenic abscess or infarction.
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Affiliation(s)
- T L Levin
- Department of Radiology, Columbia-Presbyterian Medical Center, Babies & Children's Hospital of New York, 3959 Broadway, BHN 3-318, New York, NY 10032, USA
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Leonidas JC, Berdon WE, Valderrama E, Neveling U, Schuval S, Weiss SJ, Hilfer C, Godine L. Human immunodeficiency virus infection and multilocular thymic cysts. Radiology 1996; 198:377-9. [PMID: 8596835 DOI: 10.1148/radiology.198.2.8596835] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE Pathologic changes of the thymus, often seen in children with the human immunodeficiency virus (HIV), reflect direct invasion by the virus, followed by involution of the gland. A previously unknown form of thymic response to HIV infection, that of a multilocular thymic cyst, is reported. MATERIALS AND METHODS Findings were examined in three HIV-positive patients, two children and one adult first seen with large thymic masses. RESULTS All three had large, septate low-attenuation areas at computed tomography consistent with multilocular thymic cysts. The cystic nature of the lesions was confirmed with magnetic resonance imaging in two. Histopathologic examination, performed in two instances, helped establish the diagnosis. All patients remained in clinically stable condition. They all had parotid gland enlargement and lymphocytic interstitial pneumonia. CONCLUSION Multilocular thymic cysts are probably another manifestation of the diffuse infiltrative lymphocytosis syndrome, usually associated with a milder course of acquired immunodeficiency syndrome.
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Affiliation(s)
- J C Leonidas
- Department of Radiology, Schneider Children's Hospital of Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, NY 11040, USA
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34
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Solomon KS, Levin TL, Berdon WE, Romney B, Ruzal-Shapiro C, Bye MR. Pneumothorax as the presenting sign of Pneumocystis carinii infection in an HIV-positive child with prior lymphocytic interstitial pneumonitis. Pediatr Radiol 1996; 26:559-62. [PMID: 8753672 DOI: 10.1007/bf01372242] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
An HIV-positive child presented with a pneumothorax secondary to cavitary Pneumocystis carinii pneumonia (PCP). Lymphocytic interstitial pneumonitis had been evident on earlier radiographs but had resolved, concurrent with a decrease in her CD4 counts, before the radiographic changes of PCP became evident. As immune function declines in HIV-positive children, the chest radiograph may paradoxically clear. In such a setting, development of focal lung disease, including pneumothorax, may herald Pneumocystis carinii infection.
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Affiliation(s)
- K S Solomon
- Department of Radiology, Division of Pediatric Radiology, Babies & Children's Hospital of New York, Columbia-Presbyterian Medical Center, 3959 Broadway, BHN 3-318, New York, NY 10032, USA
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35
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Comerci SC, Levin TL, Ruzal-Shapiro C, Berdon WE, Beckwith JB, Hibshoosh H, Hurlet-Jensen A, Sitarz AL. Benign adenomatous kidney neoplasms in children with polycythemia: imaging findings. Radiology 1996; 198:265-8. [PMID: 8539391 DOI: 10.1148/radiology.198.1.8539391] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE To correlate pathologic, computed tomographic (CT), and ultrasound (US) characteristics of nephrogenic adenofibromas and embryonal adenomas (uncommon pediatric renal tumors) in children. MATERIALS AND METHODS Medical records and imaging and pathologic findings were reviewed in three children (aged 6 1/2, 7, and 11 years) with adenomatous renal tumors and polycythemia. Specimens were reviewed at the National Wilms Tumor Study Pathology Center (Loma Linda, Calif). RESULTS All tumors were smaller than 3 cm in greatest dimension. They were hyperechoic on US scans and had high attenuation on unenhanced CT scans. Two patients underwent nephrectomy for initial diagnosis of Wilms tumor. The third underwent local excision. At pathologic examination, embryonal-appearing adenomatous epithelial cells were found to form tubules and papillae with abundant psammomatous calcifications. Two masses were classified as embryonal adenomas and one as nephrogenic adenofibroma. CONCLUSION Increased attenuation on CT scans and increased echogenicity on US scans of renal adenomatous tumors are distinctive findings that may reflect the presence of tubulopapillary structures and psammomatous calcifications.
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Affiliation(s)
- S C Comerci
- Department of Radiology, Columbia Presbyterian Medical Center, Babies' and Children's Hospital of New York, New York, NY 10032, USA
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Abstract
Panner's disease, avascular necrosis of the capitellum, was first described on X-ray examination of the elbow. It represents a major threat to the elbow joint integrity, and it is important to diagnose early. Panner's disease occurs most commonly in young children who play baseball, and in competitive gymnasts. Although considered a rare entity, it probably is underdiagnosed. We present the X-ray and MR imaging findings in a young boy with Panner's disease. The MR imaging findings in Panner's disease have not been previously reported.
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Affiliation(s)
- J M Stoane
- Department of Radiology, State University of New York Health Center at Brooklyn 11203, USA
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37
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Berdon WE. Tracheal anomalies, vascular compression and respiratory distress: the soft and hard and long and short of it. Pediatr Radiol 1995; 25 Suppl 1:S197-8. [PMID: 8577525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- W E Berdon
- Department of Radiology, Columbia Presbyterian Medical Center, Babies' & Children's Hospital, 3959 Broadway, BHN 3-318, New York, NY 10032, USA
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38
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Comerci SC, Berdon WE, Levin TL, Ruzal-Shapiro C. Congenitally short trachea and high carina with left mainstem bronchus compression by the ligamentum arteriosum. Pediatr Radiol 1995; 25 Suppl 1:S194-6. [PMID: 8577524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We report a patient with congenitally short trachea (CST), defined as a decreased number of tracheal rings and high carina, who had respiratory distress and overaeration of the left lung secondary to extrinsic narrowing of the distal mainstem bronchus by ligamentum arteriosum compression.
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Affiliation(s)
- S C Comerci
- Department of Radiology, Columbia Presbyterian Medical Center, Babies' & Children's Hospital, 3959 Broadway, BHN 3-318, New York, NY 10032, USA
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Levin TL, Sheth S, Berdon WE, Ruzal-Shapiro C, Piomelli S. Deferoxamine-induced platyspondyly in hypertransfused thalassemic patients. Pediatr Radiol 1995; 25 Suppl 1:S122-4. [PMID: 8577502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Deferoxamine chelation therapy (widely used to reduce iron overload in hypertransfused thalassemic patients) has been implicated in causing skeletal growth abnormalities (rachitic-like changes in the long bones and vertebral body flattening), particularly when used in early infancy and at high dose levels. Radiographs of seven hypertransfused and well-chelated patients with thalassemia were reviewed. For two patients, serial films of the spine from the early 1970s to the present revealed a sequence of changes in the vertebral bodies, beginning with normal bodies that became bulbous and subsequently flattened. These two patients had begun deferoxamine chelation therapy early in infancy. The bone changes, though slightly reminiscent of post-radiation changes, are milder and result in a final Scheuermann-like picture.
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Affiliation(s)
- T L Levin
- Department of Radiology, Columbia-Presbyterian Medical Center, Babies & Children's Hospital, 3959 Broadway, BHN 3-318, New York, NY 10032, USA
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40
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Shao W, Chung T, Berdon WE, Mellins RB, Griscom NT, Ruzal-Shapiro C, Schneider P. Fluoroscopic diagnosis of laryngeal asthma (paradoxical vocal cord motion). AJR Am J Roentgenol 1995; 165:1229-31. [PMID: 7572509 DOI: 10.2214/ajr.165.5.7572509] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- W Shao
- Department of Radiology, Babies and Children's Hospital of New York, Columbia-Presbyterian Medical Center, NY 10032, USA
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41
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Mullen LA, Berdon WE, Ruzal-Shapiro C, Levin TL, Fountain KS, Garvin JH. Soft-tissue sarcomas: MR imaging findings after treatment in three pediatric patients. Radiology 1995; 195:413-7. [PMID: 7724759 DOI: 10.1148/radiology.195.2.7724759] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE To characterize the skeletal and bone marrow magnetic resonance (MR) imaging changes during and after treatment of childhood soft-tissue tumors. MATERIALS AND METHODS Three boys with soft-tissue sarcomas of the popliteal fossa underwent surgery, radiation therapy, and chemotherapy. Plain radiographic and MR imaging findings were correlated with the effect of treatment. RESULTS After radiation therapy, MR images revealed findings that resembled those of rickets at sites of irradiation in the three patients. These findings included metaphyseal sclerosis, metaphyseal fraying, and epiphyseal plate widening. Bone marrow imaging changes were temporally related to therapy. During chemotherapy, reconversion to hematopoietic marrow was noted in nonirradiated areas in two patients, but after cessation of all treatment, these areas converted back to fatty marrow. Irradiated areas of bone marrow remained fatty throughout therapy in the three patients. CONCLUSION Awareness of the MR imaging findings related to antineoplastic treatment of soft-tissue tumors is important to distinguish these changes from progression of primary disease.
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Affiliation(s)
- L A Mullen
- Department of Radiology, Babies Hospital, Columbia Presbyterian Medical Center, New York, NY 10032, USA
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Affiliation(s)
- W E Berdon
- Department of Radiology, Columbia-Presbyterian Medical Center, New York, NY 10032, USA
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43
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Levin TL, Sheth SS, Ruzal-Shapiro C, Abramson S, Piomelli S, Berdon WE. MRI marrow observations in thalassemia: the effects of the primary disease, transfusional therapy, and chelation. Pediatr Radiol 1995; 25:607-13. [PMID: 8570313 DOI: 10.1007/bf02011827] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The magnetic resonance bone marrow patterns in thalassemia were evaluated to determine changes produced by transfusion and chelation therapy. Thirteen patients had T1- and T2-weighted images of the spine, pelvis and femurs. Three received no therapy (age range 2.5-3 years). Three were hypertransfused (transfused to maintain a hemoglobin greater than 10 g/dl) and not chelated because of age (age range 6 months-8 years). Seven were hypertransfused and chelated (age range 12-35 years). Signal characteristics of marrow were compared with those of surrounding muscle and fat. Fatty marrow (isointense with subcutaneous fat) was compared with red marrow (hypointense to fat and slightly hyperintense to muscle). Marrow hypointense to muscle was identified as iron deposition within red marrow. The untreated group demonstrated signal consistent with red marrow throughout the central and peripheral skeleton. Hypertransfused but not chelated patients demonstrated marked iron deposition in the central and peripheral skeleton. Hypertransfused and chelated patients demonstrated iron deposition in the central skeleton and a mixed appearance of marrow in the peripheral skeleton. The MR appearance of marrow in thalassemia is a reflection of the patient s transfusion and chelation therapy. Iron deposition occurs despite chelation therapy in sites of active red marrow. As red marrow retreats centrally with age, so does the pattern of iron deposition. The long-term biological effects of this iron deposition are unknown.
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Affiliation(s)
- T L Levin
- Department of Pediatric Radiology, Columbia-Presbyterian Medical Center, Babies and Children's Hospital, 3959 Broadway, New York, NY 10032, USA
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Liebling MS, Berdon WE, Ruzal-Shapiro C, Levin TL, Roye D, Wilkinson R. Gymnast's wrist (pseudorickets growth plate abnormality) in adolescent athletes: findings on plain films and MR imaging. AJR Am J Roentgenol 1995; 164:157-9. [PMID: 7998530 DOI: 10.2214/ajr.164.1.7998530] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- M S Liebling
- Babies Hospital, Department of Radiology, Columbia-Presbyterian Medical Center, New York, NY 10032
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45
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Levin TL, Liebling MS, Ruzal-Shapiro C, Berdon WE, Stolar CJ. Midgut malfixation in patients with congenital diaphragmatic hernia: what is the risk of midgut volvulus? Pediatr Radiol 1995; 25:259-61. [PMID: 7567230 DOI: 10.1007/bf02011092] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Twenty-four patients with repaired diaphragmatic hernia had upper gastrointestinal series to assess the rotation and fixation of the bowel. A spectrum of rotational abnormalities was present in almost all patients, although those with repaired right-sided hernias demonstrated a more obvious anomaly of rotation than those with repaired left-sided hernias. No patient developed a midgut volvulus despite the presence of malfixation. Postoperative adhesions likely limit the occurrence of volvulus.
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Affiliation(s)
- T L Levin
- Department of Pediatric Radiology, Columbia-Presbyterian Medical Center, Babies and Children's Hospital, New York, NY 10032, USA
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46
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Forese LL, Berdon WE, Harcke HT, Wagner ML, Lachman R, Chorney GS, Roye DP. Severe mid-cervical kyphosis with cord compression in Larsen's syndrome and diastrophic dysplasia: unrelated syndromes with similar radiologic findings and neurosurgical implications. Pediatr Radiol 1995; 25:136-9. [PMID: 7596660 DOI: 10.1007/bf02010328] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Mid-cervical kyphosis in diastrophic dysplasia (DD) with cord compression and weakness has been recognized for the last three decades. A strikingly similar situation exists in Larsen's syndrome (LS), an otherwise unrelated problem of weakness with lay joints and dislocations with typical facies. Forty patients with DD were studied of whom seven had cervical spine kyphosis: one patient had spontaneous correction over the ensuing two decades. Seven patients with LS were studied of whom four had cervical spine changes with cord compression. There was one sudden death among the patients with LS and no cases of spontaneous correction. Muscle weakness in DD and LS should lead to evaluation of cervical spine kyphosis with cord compression. Plain films, CT and recently MRI are useful.
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Affiliation(s)
- L L Forese
- Department of Orthopaedic Surgery, Columbia-Presbyterian Medical Center, New York, USA
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47
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Levin TL, Sheth SS, Hurlet A, Comerci SC, Ruzal-Shapiro C, Piomelli S, Berdon WE. MR marrow signs of iron overload in transfusion-dependent patients with sickle cell disease. Pediatr Radiol 1995; 25:614-9. [PMID: 8570314 DOI: 10.1007/bf02011829] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Magnetic resonance (MR) marrow signal in the axial and appendicular skeleton of 13 transfusion-dependent and chelated pediatric patients with sickle cell anemia (SSD) was compared with marrow signal in six non-transfusion-dependent patients with SSD. Hepatic, pancreatic, and renal MR signal were also evaluated. Indication for hypertransfusion therapy was primarily prior history of stroke. Transfusion-dependent patients had evidence of iron deposition throughout the imaged marrow and the liver, despite deferoxamine chelation therapy. Non-transfusion-dependent patients did not demonstrate grossly apparent signs of iron overload. Red marrow restoration was present in the spine, pelvis, and long bones and, in some patients, within the epiphyses. Marrow edema secondary to vaso-occlusive crises was evident in the metaphyses and diaphyses of long bones in areas of both red and fatty marrow and was best seen using fat-saturated T2-weighted imaging techniques.
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Affiliation(s)
- T L Levin
- Department of Pediatric Radiology, Babies & Children's Hospital, Columbia-Presbyterian Medical Center, 3959 Broadway, New York, NY 10032, USA
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48
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Stylianos S, Berdon WE, Hicks BA, Weiswasser J, Perzin KH. Complex colon duplication mimicking an obstructed, non-functioning kidney in a newborn with imperforate anus and spinal dysraphism. Pediatr Radiol 1995; 25:269-71. [PMID: 7567234 DOI: 10.1007/bf02011097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Gastrointestinal (GI) duplications contain tissue resembling several portions of the GI tract and are associated with vertebral and genitourinary (GU) abnormalities [1-4]. We report a newborn with low, imperforate anus and lumbosacral dysraphism, who presented with a large cystic mass in the left renal fossa and pelvis. The flank mass (felt initially to be a dysplastic kidney and ureter) proved to be a complex GI duplication with histologic evidence of gastric, small bowel, and colonic mucosa, as well as respiratory epithelium and pancreatic tissue.
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Affiliation(s)
- S Stylianos
- Department of Pediatric Surgery, Babies Hospital-207N, New York, NY 10032, USA
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Abstract
We report on an 8-year-old boy with a unilateral testicular mass and bilateral diffusely echogenic testes on sonography. At inguinal exploration torsion of an appendix testis with a reactive phlegmon was found and testis biopsy revealed significant testicular microlithiasis. To our knowledge our case demonstrates a previously undescribed presentation of testicular microlithiasis. The literature is reviewed and this disease entity is discussed.
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Affiliation(s)
- D J Kwan
- Department of Pediatric Urology, Columbia University College of Physicians and Surgeons, New York, New York
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50
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Levin TL, Miller TT, Panicek DM, Rosenfield N, Ruzal-Shapiro C, Dick HS, Berdon WE. MR signal characteristics of cadaveric bone allografts in three children with primary bone tumors treated with limb salvage therapy. Pediatr Radiol 1994; 24:488-90. [PMID: 7885780 DOI: 10.1007/bf02015006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Three children with adult cadaveric bone allografts for the treatment of bone malignancies are presented. Follow-up magnetic resonance (MR) imaging demonstrated decreased signal on T1-weighted imaging and increased signal on T2-weighted imaging in the allograft without clinical evidence of recurrent disease. These signal characteristics appear to be a normal finding in cadaveric bone allografts and should not be mistaken for recurrence. The finding may reflect persistent marrow necrosis within the allograft marrow cavity.
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Affiliation(s)
- T L Levin
- Babies Hospital, Department of Radiology, Columbia-Presbyterian Medical Center, New York, NY 10032
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