Brain sonographic findings in tuberous brain sclerosis. A comparison with roentgenologic images and pathologic-anatomic findings

Ultrasound examination of a case of tuberous sclerosis is described. The results are compared to plain skull roentgenography, CT and pathological anatomical findings. Apart from the well known advantages of sonography (absence of radiation load, easy and quick practicability of control nearly without strain to the patient) the comparison shows that ultrasound offers a better chance to evaluate the structure of gliomatous masses and their relationship to the adjacent tissues. In connection with the pathological microscopical picture and the results of sonography we drew the conclusion that the paraventricular calcifications in CT so far described are most possibly gliomatous proliferations with densities around 100 HU. Using CT as a diagnostic tool alone it is not possible to distinguish between gliomatous proliferation and calcification in tuberous sclerosis.     

Inflammatory mediators, cell counts in nasal lavage and computed tomography of the paranasal sinuses in atopic children

OBJECTIVE: The aims of this study were to evaluate inflammatory cells, the profile of inflammatory mediators in nasal lavage (NL), and the involvement of the paranasal mucosa in atopic infants with no symptoms of sinusitis. METHODS: 48 atopic patients with allergic rhinitis (AR), and 33/48 patients with asthma were studied; the control group consisted of 13 nonatopic children. Those individuals with acute, chronic or recurrent sinusitis were excluded. The involvement of the paranasal mucosa was assessed by coronal computed tomography (CT) and graded by a standard protocol (0-30). A CT score greater than or equal to 12 indicated extensive involvement. Nasal lavage was used to quantify total and differential nasal cell counts. An aliquot of the supernatant was used for determining inflammatory mediators: interleukin-8 (IL-8), myeloperoxidase (MPO), and eosinophil cationic protein (ECP). Albumin was used as a marker for increased vascular permeability. These measurements were performed on all of the atopic patients and in 6/13 patients in the control group. The three groups were submitted to spirometry and complete blood cell count. RESULTS: Extensive involvement of the paranasal mucosa was observed in 7/33 (21%) of asthmatic patients (Group I) and 2/15 (13%) of those with allergic rhinitis (Group II). The highest CT score in the control group (Group III) was 7. Total cell and eosinophil count/ml and albumin concentration in nasal fluid were higher in asthmatic patients whose CT score was greater than 12. Interleukin-8 concentration, number of neutrophils and epithelial cells/ml in nasal fluid were similar in the three groups. A positive correlation between CT score, peripheral blood eosinophilia, number of eosinophils/ml and eosinophil cationic protein concentration was found in the nasal fluid of atopic children (n=48). There was an association between number of neutrophils and titers of interleukin-8 and myeloperoxidase, and between interleukin-8 and eosinophil count. CONCLUSIONS: in asthmatic patients with no symptoms of sinusitis, the extensive involvement of the paranasal mucosa is associated with blood and nasal lavage eosinophilia and cellular activation. Neutrophil infiltration and activation were not related to increased involvement of the paranasal mucosa.     

Abnormal paranasal sinuses in patients with cystic fibrosis of the pancreas

Radiographic examinations of the paranasal sinuses and chests of 187 patients with C.F. from five months to 27 years of age were reviewed. One hundred eighty-five patients consistently had opaque maxillary and ethmoidal sinuses. Forty-five patients had normal chest radiographs. These observations show that the paranasal sinuses are almost always affected in children with C.F. Although opaque paranasal sinuses do not indicate the diagnosis of C.F., clear paranasal sinuses exclude this disease with reasonable certainty.     

The kidney in children with tyrosinemia: sonographic, CT and biochemical findings

Background. Tyrosinemia relates to a deficiency of fumarylacetoacetate hydrolase and presents early in life with central nervous system and liver abnormalities. Renal function is often impaired. Little is known about the architecture and function of the kidneys. Objective. Imaging changes on US and CT are compared to the function of the kidneys in children with tyrosinemia, and followed after liver transplantation. Materials and methods. Renal sonography, CT and renal function tests in 32 children were reviewed. Renal length, volume, echogenicity and nephrocalcinosis were evaluated. Renal function was assessed by glomerular filtration rate, and the presence of aminoaciduria, acidosis and calciuria. Seventeen children had open renal biopsy during time of liver transplantation. Histology was reviewed. Statistical analyses relating renal structure to function were performed, and repeated after transplantation. Results. The kidneys were enlarged (47 %), hyperechogenic (47 %) and showed nephrocalcinosis (16 %). There was delayed excretion of contrast medium at CT in 64 %. Aminoaciduria was present in 82 % of children, hypercalciuria in 67 %, tubular acidosis in 59 %, and low GFR in 48 %. Delayed excretion of contrast was associated with low GFR (P < 0.05). Renal biopsies showed dilated tubules (81 %), interstitial fibrosis (56 %), glomerulosclerosis (56 %) and tubular atrophy (56 %). During a mean observation period of 3 years following liver transplantation, GFR improved in 50 %, tubular acidosis in 50 % and hypercalciuria in 70 %. No change was noted in renal size or sonographic architecture. Conclusion. Renal architecture and function are abnormal in the majority of children with tyrosinemia. Liver transplantation improves renal function in about 50 % of patients, but abnormal renal size and architecture persist. Received: 27 October 1997 Accepted: 4 June 1998     

Hepatic veno-occlusive disease in children undergoing bone-marrow transplantation: usefulness of sonographic findings

Background. Reports of the usefulness of ultrasonography in the diagnosis of hepatic veno-occlusive disease (HVOD) have presented conflicting results.¶Objective. To determine the usefulness of gray-scale or Doppler ultrasonographic measurements in the diagnosis of HVOD in pediatric patients undergoing BMT.¶Materials and methods. We prospectively obtained 202 serial sonograms on 48 patients and examined the association between the clinical diagnosis of HVOD (McDonald criteria) and eight ultrasound parameters, including the hepatic artery resistive index (HARI), direction and velocity of portal venous flow, and thickness of the gall bladder wall.¶Results. HVOD developed in 29 of the 48 patients. The portal venous velocity increased after BMT in the group without HVOD and decreased in the group with HVOD; this difference was significant (P = 0.01). However, there was a great deal of variability in velocity measurements for individual patients. The mean HARI was 0.64 in the group with HVOD and 0.63 in the group without HVOD, and there was no difference between the two groups in the pattern of change in HARI relative to the day of BMT (P = 0.4). There was also no significant difference in thickness of the gallbladder wall between the two groups (P = 0.6).¶Conclusion. No ultrasound parameter studied was as useful as the McDonald criteria for diagnosing HVOD.     

Mucocele of paranasal sinuses in a young infant with cystic fibrosis

We report the case of an infant who developed severe nasal obstruction as an unusual first presentation of cystic fibrosis (CF). Computed tomography (CT) showed homogeneous opacification of the symmetrically enlarged paranasal sinuses that gave the clue for the final diagnosis.     

Correlation of sonographic findings and outcome in necrotizing enterocolitis

Background There is little in the literature regarding the use of gray-scale and Doppler sonography of the bowel in necrotizing enterocolitis (NEC) and how findings depicted by this modality might assist in predicting outcome and influence management. Objective To correlate sonographic findings with outcome in NEC. Materials and methods This was a retrospective analysis of clinical and abdominal ultrasonography (AUS) findings in NEC from January 2003 to December 2005. AUS findings were evaluated for portal venous gas, free gas, peritoneal fluid, bowel wall thickness, echogenicity, perfusion and intramural gas. Patients were categorized into two groups, according to their outcome. Results A total of 40 infants were identified who had AUS for NEC prior to any surgical intervention. Group A comprised 18 neonates treated medically and recovered fully, and group B comprised 22 neonates who required surgery or died. Free gas (six patients) and focal fluid collections (three patients) were only found in group B. Increased bowel wall echogenicity, absent bowel perfusion, portal venous gas, bowel wall thinning, bowel wall thickening, free fluid with echoes and intramural gas were seen in both groups, but more frequently in group B. Anechoic free fluid was seen more frequently in group A. Increased bowel perfusion was seen equally in both groups. Conclusion An adverse outcome was associated with the sonographic findings of free gas, focal fluid collections or three or more of the following: increased bowel wall echogenicity, absent bowel perfusion, portal venous gas, bowel wall thinning, bowel wall thickening, free fluid with echoes and intramural gas. Sonographic findings are useful in predicting outcome and therefore might help guide management. This material was presented at the 5th International Pediatric Radiology Meeting in Montreal, Canada, May 2006.     

Sonographic and Doppler color sonographic findings in osteosarcoma]

Till now bone tumors are diagnosed radiologically. In this paper we describe the characteristic sonographic and colour Doppler sonographic features in 5 patients with histologically confirmed osteosarcoma. A large soft tissue tumor with echogenic osteosclerotic areas and echo-free caverns could be shown in all patients. Characteristic signs were destructions of the cortical layer and reactions of the periosteum. Compared to normal tissue an increased number of blood vessels with increased blood flow were visible by colour coded Doppler sonography in the region of the tumor. Sonography and colour coded Doppler sonography are important additions of conventional radiology to describe the structure, extension and blood supply of an osteosarcoma.     

Corrosive gastritis: sonographic findings in the acute phase and follow-up

This paper reports our experience with transabdominal ultrasound in both the acute phase and follow-up in a patient with corrosive gastritis. The case presented demonstrates that serial sonography can localise the injury, demonstrate its depth and reveal the presence of peristalsis, thereby reducing the radiation exposure resulting from barium studies. Received: 20 February 1997 Accepted: 16 April 1997     

Inflammatory diseases of the nose and nasal sinuses in children

Inflammatory diseases in childhood are quite different from those occurring in adults. The reasons are the special physiological, anatomical and immunological factors at the different stages of development. The different diagnostic possibilities (nasal swabs for virological and bacteriological examinations, X-ray, sonography, CT, endoscopy of the nose and paranasal sinuses) are discussed and the principles of the conservative and surgical therapy were demonstrated.