Imaging features of juxtacortical chondroma in children

Background

Juxtacortical chondroma is a rare benign bone lesion in children. Children usually present with a mildly painful mass, which prompts diagnostic imaging studies. The rarity of this condition often presents a diagnostic challenge. Correct diagnosis is crucial in guiding surgical management.

Objective

To describe the characteristic imaging findings of juxtacortical chondroma in children.

Materials and methods

We identified all children who were diagnosed with juxtacortical chondroma between 1998 and 2012. A single experienced pediatric radiologist reviewed all diagnostic imaging studies, including plain radiographs, CT, MR and bone scans.

Results

Seven children (5 boys and 2 girls) with juxtacortical chondroma were identified, ranging in age from 6 years to 16 years (mean 12.3 years). Mild pain and a palpable mass were present in all seven children. Plain radiographs were available in 6/7, MR in 7/7, CT in 4/7 and skeletal scintigraphy in 5/7 children. Three lesions were located in the proximal humerus, with one each in the distal radius, distal femur, proximal tibia and scapula. Radiographic and CT features deemed highly suggestive of juxtacortical chondroma included cortical scalloping, underlying cortical sclerosis and overhanging margins. MRI features consistent with juxtacortical chondroma included isointensity to skeletal muscle on T1, marked hyperintensity on T2 and peripheral rim enhancement after contrast agent administration. One of seven lesions demonstrated intramedullary extension, and 2/7 showed adjacent soft-tissue edema.

Conclusion

Juxtacortical chondroma is an uncommon benign lesion in children with characteristic features on plain radiographs, CT and MR. Recognition of these features is invaluable in guiding appropriate surgical management.     

儿童塑型性支气管炎的影像学特征

塑型性支气管炎是一种罕见的、以支气管内形成黏稠分支样铸型为特征的疾病,是一种严重的临床急症,会引起呼吸窘迫、窒息,甚至死亡,因此早期诊断、早期识别意义重大。现对塑型性支气管炎的影像学特征进行归纳总结,以期进一步提高儿科、急诊科和影像科医师对该病的认识。     

107例儿童卵巢囊性肿块的临床特征和治疗分析

目的 分析儿童卵巢囊肿的疾病特征和治疗方案.方法 采集和分析2001年1月至2010年12月间,以卵巢囊肿为首要诊断的,并在复旦大学附属儿科医院外科治疗的107例14岁以下患儿的医疗记录.结果 卵巢囊肿107例,其中左侧34例,右侧67例,双侧6例.新生儿(≤28 d)22例,婴幼儿(29 d至3岁)8例,学龄期(4～8岁)24例,青春前期(9～12岁)28例,青春期(13～14岁)25例.肿瘤发病具有与年龄相关的特征.仅1例发现影像学上垂体的轻度异常.63.8％的患儿E2激素水平高于其所在的年龄段水平.73例手术,34例保守治疗,13例术后诊断为卵巢的真性肿瘤(囊性畸胎瘤、粘液性囊腺瘤和浆液性囊腺瘤).手术保留卵巢52例(71.2％),腹腔镜手术36例,开腹手术37例.术后复发3例,均为卵巢真性肿瘤患儿.未手术患儿34例,66％由于肿块在短期随访中缩小,20％由于肿块体积小(直径1 cm)不处理,余14％为家属主观原因和发现内分泌显著异常未加干预.结论 卵巢囊肿发生率高,在各个年龄阶段均可发生,症状各异.需要与卵巢真性肿瘤鉴别.治疗多提倡保守治疗,肿块增大或扭转是干预的指征.腹腔镜手术微创、可行,建议尽可能的保留卵巢组织,剜除囊肿.功能性的卵巢囊肿复发少见.     

儿童毛细胞黏液样星形细胞瘤的影像与病理特征研究

目的　探讨儿童毛细胞黏液样星形细胞瘤（PMA）的影像特征及其与病理学改变的关系。方法　回顾性分析2010年10月至2018年6月首都医科大学附属北京天坛医院收治的20例儿童颅内PMA患者的临床资料、CT和磁共振成像（MRI）影像表现以及病理和免疫组织化学结果。结果　20例儿童PMA患者中，男15例，女5例；肿瘤位于幕下小脑半球10例，幕上大脑半球5例，视交叉-下丘脑4例，三脑室内1例。在CT图像上，PMA表现为低密度10例；在MRI图像上，肿瘤呈混杂信号11例，T1WI低信号7例，T2WI高信号7例，DWI未见弥散受限12例，MRI增强扫描表现为不均匀强化17例；肿瘤边界清楚18例，发生囊变16例，瘤周水肿11例。组织病理学检查可见双极性梭形细胞，以血管为中心生长，间质内含有大量黏液，缺乏Rosenthal纤维。结论　儿童PMA具有较为特征性的影像表现和低度恶性的肿瘤特征，肿瘤不均质性、边界清楚、边缘囊变和不均匀强化是PMA的特征性表现，CT和MRI可为儿童PMA的术前诊断、临床治疗和预后评估提供参考。     

小儿脐尿管残留畸形的超声表现（附16例报道）

小儿脐尿管残留畸形是指因胚胎期的尿囊管残余在出生后未能自行纤维化闭合而形成的一组先天性疾病,临床上非常少见,以男性患儿居多.     

Investigation and management of suspected urachal anomalies in children

Urachal anomalies occur infrequently, but may be associated with morbidity, particularly when the diagnosis has been delayed. We retrospectively reviewed our institution’s experience over a 10-year and 7-month period in the investigation and management of suspected urachal anomalies. There were 25 children between November 1995 and June 2006, who presented with a suspected urachal anomaly. The mean age was 12 months (range 3 days to 13 years); 14 were male. Presentations included granulomatous polyp (16), umbilical discharge (4), umbilical sepsis (2) and abdominal pain (2). One case was diagnosed incidentally during a renal ultrasound scan (US). The main investigative tool was US (10), followed by micturating cystourethrogram (2). Of the 25 children, 12 had a patent urachus confirmed by subsequent further imaging or surgery. Our review suggests that whilst clinical examination remains important in the management of a child presenting with a possible urachal pathology, in 36% of the cases the correct diagnosis was only made with further radiological imaging or at operation. Surgical excision was effective with no morbidity or mortality.     

6例儿童脾脏原发性孤立性肿瘤影像学表现

目的探讨儿童脾脏原发性孤立性肿瘤影像学表现。方法回顾性分析2010年1月至2015年8月间经手术、病理证实的6例儿童脾脏原发性孤立性肿瘤的影像学特征,并复习相关文献。结果 6例患儿中,2例为囊性病灶,超声表现为无回声肿物,CT平扫表现为低密度肿物,增强后无强化,病理证实为先天性囊肿;2例超声表现为实性等回声,彩色多普勒超声可探及血流信号,CT增强表现为明显低于周围脾实质的强化,病理证实为脾脏淋巴管瘤;1例超声表现为等回声肿块,血流信号丰富,MRI扫描T1WI等信号、T2WI等信号肿块,增强后稍欠均匀强化,病理证实为脾脏错构瘤;1例超声无法辨别肿块边界,CT增强扫描示向心性充填性强化,病理证实为血管瘤。结论儿童脾脏原发性孤立性肿瘤,临床缺乏特异性,影像学检查可明确肿瘤部位,并有助于鉴别诊断,但最终仍需病理确诊。     

Uncommon synovial cysts in children

Popliteal synovial cysts (Baker’s cysts) are a common occurrence in children and adults. Synovial cysts in other locations and/or with atypical extension are less common and may be confounded with tumors or other medical conditions. In this article we describe the underlying disease, clinical presentation and clinical course in six children with a sudden onset of paraarticular soft tissue masses or non-specific chronic pain. Ultrasound was the initial imaging method used in all cases; this was supplemented by MRI in three patients. Four children were diagnosed to be suffering from juvenile idiopathic arthritis (JIA), one child from Lyme Arthritis, whereas in one child no underlying disease was identified. Well-demarcated hypoechogenic lesions without signs of perfusion extending from the shoulder (two patients), elbow (one patient), hip (one patient), knee (1) or ankle (one patient) far into the adjacent musculature were detected on ultrasonography. A direct connection to the joint was demonstrated in all cases. All synovial cysts in the five arthritic patients resolved rapidly with medical treatment for arthritis, whereas the cyst persisted in the non-JIA patient. Conclusion: Uncommon synovial cysts occur in particular as a complication of arthritis. Ultrasonography is the initial and follow-up imaging method of choice, which can be supplemented by MRI in unusual cases. Apart from treatment for arthritis, no specific therapeutic interventions were required in the present cases.     

Intra-abdominal lymphatic cysts in children

Ten children with intra abdominal lymphatic cysts operated in the last 8 years are reported. They formed 0.50% of all pediatric surgical admissions and 33.3% of all intra-abdominal cystic lesions. The mean age was 5 1/2 years and the male-female ratio was 1:1. Half the cysts were in the mesentery and 30% in the omentum. The other 2 cysts were located at unusual sites. Two children having mesenteric cysts presented as abdominal emergencies. Three of them were wrongly diagnosed and treated for tuberculous ascites before laparotomy. Four mesenteric cysts were excised along with the adjoining intestinal segment, and one was drained by tube marsupialisation. All 3 omental cysts and the two cysts at unusual sites were excised in toto. There was no mortality or morbidity.     

小儿纵隔肠源性囊肿的诊断与治疗

目的：探讨纵隔肠源性囊肿病因、临床诊断及治疗。方法：回顾性分析近20年17例纵隔肠源性囊肿患儿的临床资料。结果：1例为壁内型食道囊肿，16例为纵隔肠源性囊肿，16例中2例同时合并腹腔内的肠重复畸形；临床上多数患儿以呼吸系统症状就诊，12例合并椎体畸形，12例行胸部B超检查，4例行胸部MRI检查，均为边界清晰的囊性肿物，8例行^99TmTc扫描，后纵隔内可见核素^99TmTc浓集灶。结果：分析本组临床资料，得到如下结论：第一，小儿纵隔肠源性囊肿的临床特征有①具有呼吸系统压迫症状，患侧胸廓隆起，呼吸活动度差，呼吸音减弱或消失；②后纵隔囊肿合并椎体畸形；③胸部超声、CT和/或MRI检查，后纵隔存在边缘清楚，内壁光滑的单房性含液囊肿；④^99TmTc扫描发现后纵隔囊肿内有异位的胃肠粘膜。第二，本病的根治方法是手术治疗。     

Dermoid cysts in children.

A retrospective study of dermoid cysts in children over the past 13 years at St. Christopher's Children's Hospital of Philadelphia, showed that 37% of the dermoids in the body occurred in the orbital and peri-orbital areas. An unusually high percentage of these occurred in the left eyebrow which appears to be the most frequent location for dermoid cysts in children. Dermoid cysts are a very common lesion encountered by ophthalmologists inasmuch as 3.3% of all ophthalmic surgical procedures in children were performed for dermoids. All 231 cases in this series were benign. The manner and time of presentation of these lesions are discussed as well as the treatment.     

Imaging features of Mycobacterium avium-intracellulare complex (MAC) in children with AIDS

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.     

儿童Rathke囊肿的临床特点分析

Rathke囊肿(Rathke cleft cyst)是一种垂体非腺瘤性良性病变,起源于胚胎颅咽管的残余上皮细胞。大部分Rathke囊肿是无症状的,有症状的Rathke囊肿一般有三大临床表现,即内分泌功能紊乱、头痛、视觉障碍[1]。以往儿童Rathke囊肿很少诊断,但随