Traumatic sternal segment dislocation in a 3‐year‐old girl: Sonographic findings

Sternal fractures are uncommon in the pediatric population, and sternal segment dislocations are even rarer with only a few cases reported in the literature. Most cases are secondary to direct trauma to the chest, but nontraumatic dislocations have been reported. The diagnosis can be difficult to establish with standard radiographs, while CT is not desirable in the pediatric population due to the associated irradiation. Ultrasound (US) can be used as the first‐line modality to evaluate the sternum. We report the US findings associated with a case of traumatic sternal segment dislocation in a 3‐year‐old girl. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45 :45–49, 2017     

Clitoromegaly as first presentation of a neurocutaneous syndrome in a 3‐year‐old girl

A rare cause of clitoral hypertrophy in a child is neurofibromatosis type 1 (NF1). Although evaluation, including karyotype and hormonal studies, is necessary to exclude ambiguous genitalia, the diagnosis of neurofibromatosis as a possible cause of clitoromegaly may help avoid lengthy and sometimes invasive interventions.     

Ambulatory blood pressure monitoring in daily clinical practice – the Spanish ABPM Registry experience

Many patients are hypertensive at the medical settings but show normal blood pressure out of the doctor's office, and are classified as white‐coat hypertensives. On the other hand, many patients with controlled hypertension at the clinic show ambulatory blood pressure levels above the thresholds considered for an adequate blood pressure control, known as having masked hypertension. Using data from the Spanish Ambulatory Blood Pressure Monitoring Registry (Spanish ABPM Registry), a national program developed to promote the use of the ambulatory technique for hypertension management in daily practice, we have reviewed the main strengths of this approach, that is the ability to detect discrepancies of blood pressure status with respect to office blood pressure measurement, and to better assess accurate rates of hypertension control. White‐coat hypertension within patients with elevated office blood pressure, and masked hypertension within office‐controlled patients affected one of three patients in each office status. On the other hand, rates of ambulatory blood pressure control (50%) doubled those of office blood pressure control (25%), still remaining half the patients uncontrolled. We think that a systematic use of ambulatory blood pressure monitoring, and strategies to improve blood pressure control constitute key priorities in hypertension management.     

Complex regional pain syndrome and dysautonomia in a 14‐year‐old girl responsive to therapeutic plasma exchange

Reflex sympathetic dystrophy, also known as complex regional pain syndrome (CRPS), has recently been shown to be associated with autoantibodies against β2‐adrenergic and muscarinic M2 receptors. In addition to pain and sudomotor/vasomotor symptoms, dysautonomia is also observed in a subset of CRPS patients. Despite its severity, there are few effective therapies for CRPS described to date. We report a case of a 14‐year‐old girl with CRPS of her right leg and dysautonomia (gastroparesis, postural tachycardia) refractory to multiple therapies, successfully treated with therapeutic plasma exchange (TPE) with albumin replacement. The patient, who has serum anti β2‐adrenergic and muscarinic M2 receptor autoantibodies in addition to nicotinic acetylcholine receptor ganglionic autoantibodies, underwent an initial course of five TPEs over a 2‐week period. She demonstrated a clinical response to TPE as manifested by a rapid improvement in her fatigue and gastroparesis, with a gradual yet significant improvement in her leg pain and sudomotor/vasomotor flares. Following the loading procedures, the patient was treated with rituximab. She continues to require periodic TPE to maintain a remission, with additional immunosuppression being considered long term. Although further studies are needed, TPE (in combination with immunosuppression) may be an appropriate therapy for CRPS patients with detectable autoantibodies, as it is for better characterized diseases with autoantibodies against neuronal surface receptors such as myasthenia gravis or Lambert Eaton myasthenic syndrome. J. Clin. Apheresis 31:368–374, 2016. © 2015 Wiley Periodicals, Inc.     

Isolated interrupted aortic arch in 42‐year‐old adult—case report

Interrupted aortic arch (IAA) is a rare congenital anomaly characterized by a complete luminal and anatomical interruption between the ascending and descending thoracic aorta. It is usually detected in the perinatal period or during infancy, but a very few cases have been reported in adults. Here, we present the case of a 42‐year‐old man who visited our hospital for arterial hypertension and in whom IAA was diagnosed with echocardiography and confirmed by computed tomography angiography. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound, 41:521–523, 2013;     

Massive vagal schwannoma in an 11‐year‐old girl

We describe an unusual case of a young girl presenting with a large vagal schwannoma necessitating a transcervical‐mandibulotomy approach for total tumor resection. The presentation is unique due to the size of the lesion, the patient’s age, the operative approach, and molecular pathology.     

Malignant peripheral nerve sheath tumor of the third eyelid in a 3‐year‐old Rhodesian Ridgeback

A 3‐year‐old Rhodesian Ridgeback was presented with conjunctivitis, enlargement of the third eyelid and a dorsotemporal deviation of the right eye. A mass within the third eyelid was detected and excised. The histopathologic examination showed a malignant peripheral nerve sheath tumor, which most likely is a neurofibrosarcoma based on immunohistochemistry.     

Reddish multilobulated mass on the scalp in a 13‐year‐old girl

Nodular hidradenoma is a rare benign adnexal tumor that occurs as a solitary nodule with a predilection for the head, face, and upper extremities. We describe the case of nodular hidradenoma presenting as an expanding nodule on the scalp. This tumor is a simulator of malignant lesions on clinical and dermoscopic examination. Our case emphasizes the importance to identify this tumor as a differential for scalp lesions.     

Laparoscopic Roux‐en‐Y duodenojejunostomy for superior mesenteric artery syndrome in a 6‐year‐old girl: A case report of a new minimally surgical technique for children

We present the first case report of laparoscopic Roux‐en‐Y duodenojejunostomy utilizing minimally invasive surgery to treat superior mesenteric artery syndrome in a child. A 6‐year‐old girl presented with a 3‐year history of intermittent postprandial epigastric pain and anorexia. An upper gastrointestinal series revealed dilatation of the first and second parts of the duodenum and an abrupt vertical cut‐off at the third portion. Despite conservative treatment for 7 weeks, there was no resolution of her symptoms, so the decision was made to proceed with a laparoscopic Roux‐en‐Y duodenojejunostomy. On follow‐up 9 months later, there had been no recurrence of her symptoms.     

Sonographic diagnosis of splenogonadal fusion in a 2‐year‐old boy

Splenogonadal fusion (SGF) is a rare congenital abnormality. It is typically identified during orchiectomy for a suspected testicular tumor or during orchiopexy. We describe the sonographic findings in a case of SGF that could help with correct diagnosis preoperatively. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45 :179–182, 2017     

Bifocal primary pancreatic Burkitt's lymphoma in a 4‐year‐old child

Pancreatic tumors are uncommon in children and rarely result in biliary obstruction. Primary pancreatic Burkitt's lymphoma is an exceptionally rare entity with only a few cases described in the literature. We present a case of a bifocal primary pancreatic Burkitt's lymphoma in a 4‐year‐old child presenting with jaundice. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45 :171–174, 2017     

Intrathyroidal thymic tissue mimicking a thyroid nodule in a 4‐year‐old child

A 4 year‐old girl was referred for CT of her neck for suspected submental lymphadenopathy and was found to have an incidental low‐attenuation thyroid mass. Subsequent thyroid ultrasound showed a heterogeneous thyroid mass with punctate areas of increased echogenicity. Cytologic examination was consistent with ectopic intrathyroidal thymic nodule. We review the presentation of ectopic thymic tissue, especially in the thyroid gland. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound, 41:319–320, 2013     

Therapeutic apheresis using a mononuclear cell program to lower the microfilaria burden of a 23‐year‐old African woman with loiasis

Apheresis has been used to lower the parasite burden of patients with Loa loa infection, but there are no reports regarding how to do this using modern, continuous flow equipment with a currently available program. A 23‐year‐old female refugee from Cameroon with known Loa loa infection presented to our Emergency Department with acute mental status changes and a picture of encephalitis. Lumbar puncture revealed Loa loa in her cerebrospinal fluid. Her midday blood microfilaria count was 15,000/mL. Because treatment with diethylcarbamazine was under consideration, we were asked to lower her parasite burden using apheresis. One single 2‐total blood volume apheresis using the mononuclear cell program (without hydroxyethyl starch) on a COBE^® Spectra Apheresis System decreased the microfilarial load from 15,000/mL to 10,666/mL, a 29% reduction. J. Clin. Apheresis 32:200–202, 2017. © 2016 Wiley Periodicals, Inc.     

Sonographic findings in a case of scrotal lymphangioma in a 68‐year‐old male

Lymphangiomas are benign tumors resulting from a congenital lymphatic malformation in infant and children. Most common sites are head, neck and axilla, and scrotal lymphangioma is very rare. Lymphangiomas are classified as capillary, cavernous, and cystic type and cystic type is most common. Complete surgical excision is definitive treatment and incomplete excision leads to local recurrence. We report a case of scrotal lymphangioma in 68‐year‐old male patient. Gray‐scale sonography revealed multiseptated, hypoechoic mass abutting the upper pole of the normal right testis. Color Doppler sonography showed no remarkable blood flow in the mass. MRI demonstrated multispetated extratesticular and extraepididymal mass in the right scrotum. Surgical excision was performed and the histopathologic diagnosis was a cystic lymphangioma. In conclusion when multiseptated cystic scrotal mass was discovered in an elderly patient, scrotal lymphangioma should be included in differential diagnosis. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound 2009