OK-432 therapy of lymphangiomas in children

Between April 1988 and July 1995, 11 children with a lymphangioma were treated with intralesional OK-432 injection. In 7 patients it was the primary therapy and total shrinkage of the lesion was obtained in 5 of them. Two patients did not respond and the children underwent surgery. Following incomplete surgical removal or recurrence of the lymphangioma, intralesional OK-432 injection was used as secondary therapy in 4 patients. Total regression was observed in 2 cases and marked regression in the 2 others. No serious side-effects except fever lasting for 2–3 days and slight tenderness with swelling of the lymphangioma for 3–4 days after the injection was noted. Local inflammatory reaction did not cause any damage to the overlying skin and did not lead to scar formation. Depending on the size, location, and anatomical relationship to the airway, intralesional injections of the lymphangiomas were performed under general anaesthesia and the children were observed for 24 h. There was no recurrence after follow up periods ranging from 2 months to 7 years.     

Surgical procedures of mesenteric lymphangiomas in children

目的 探讨肠系膜淋巴管瘤的手术方式.方法 收集我院2006年至2011年经手术病理证实的9例小儿肠系膜淋巴管瘤的临床资料,回顾性分析其临床表现、影像学特点及手术方式.结果 9例均行手术治疗,其中2例行完整瘤体切除术,3例行劈开瘤体分块完全切除术,4例行瘤体并肠管切除肠吻合术.8例术后恢复顺利,近期并发症1例为乳糜腹,远期并发症1例为粘连性肠梗阻,经保守治疗后治愈.随访3～59个月均无瘤体复发,生长发育正常.结论 肠系膜淋巴管瘤的生长方式有两种,局限性生长和浸润性生长.手术切除为首选治疗方式,根据生长方式选择相应的手术方式,对于浸及肠系膜根部的淋巴管瘤,采用瘤体劈开,分块完全切除效果良好.     

Current therapeutic approach to cervicofacial lymphangiomas in children]

Twenty-four cases of cervicofacial lymphangioma treated between 1984 and 1991 are reported. The therapeutic approach is discussed. Because the therapeutic problem depends on whether or not the airways are involved, an endoscopic evaluation and a CT scan study should be included in the workup. In the five patients with limited lymphangiomas, complete surgical exeresis was feasible and yielded good results. Sclerosing injections are an alternative to surgery in this situation. In patients with pharyngeal or laryngeal infiltration or involvement of the mediastinum, the prognosis is extremely grim and surgery is still the mainstay of therapy despite the potential for recurrence due to the fact that only incomplete exeresis can be performed. Tracheostomy was required in two patients.     

Abdominal cystic lymphangiomas in children: presurgical evaluation with imaging.

Cystic lymphangiomas are benign vascular tumors which are most often seen in young children. They are considered to be congenital malformations stemming from sequestration of lymphatic tissue. The authors report 15 cases of abdominal location and detail the findings of imaging in the etiologic and topographic diagnosis of these lesions. The initial incidents were essentially the discovery of a palpable abdominal mass, and more rarely, an acute gastrointestinal complication. There was also one case of prenatal diagnosis. Plain films provide only indirect signs related to the displacement of neighboring organs. Ultrasonography permits the etiologic diagnosis by showing an often voluminous, septated cyst. The intra- or retroperitoneal location of the lesion is sometimes difficult to determine by sonography, in which case CT scanning is usually adequate. For abdominal locations, percutaneous sclerosis is not available, and surgical removal is the only treatment for this disorder. The topography of the lesion and the involvement of retroperitoneal structures is important to determine.     

Imaging of sinusitis in children

In most cases, sinusitis remains a clinical diagnosis. Imaging studies can be useful in diagnosing patients with atypical presentations, but plain radiographs lack sensitivity and specificity, and coronal sinus CT lacks specificity. Coronal sinus CT is generally used when complications of sinusitis are suspected or when sinus surgery is considered.     

A decade of paediatric lymphangiomas

Lymphangiomas are uncommon, benign developmental tumours of the lymphatic system. Though usually symptomless, lymphangiomas can cause problems through pressure effects and may sometimes be life-threatening, especially in newborn infants with massive lesions involving the neck and mediastinum. The literature is reviewed with 33 additional cases presented. Despite the advent of more recent and innovative treatments, surgical excision is associated with the least number of complicatons and is still the most widely used and successful method of treatment.     

Imaging of muscle disorders in children

Muscle inflammation is a relatively common pathological process in childhood. The diagnosis of the underlying cause relies on an appreciation of the pattern of clinical features, as well as the results of biochemical, histological and radiological investigations. Often the clinical and biochemical features are non-specific and insensitive. Consequently, the radiological abnormalities are very important in establishing a diagnosis and an understanding of the imaging features of muscle inflammatory disorders in childhood is needed. Some of the imaging protocols needed to investigate a variety of muscle and soft-tissue inflammatory conditions in childhood are reviewed in this article. Those features that are helpful in narrowing the differential diagnosis are indicated and a logical approach to the investigation of affected children is provided. The value of MR imaging is highlighted.     

Imaging of biliary disorders in children

Biliary atresia and related disorders of the biliary tree, such as choledochal cyst, must be considered in the differential diagnosis of prolonged conjugated hyperbilirubinemia in infants and children. Pediatric biliary tract diseases include a variety of entities with a wide range of clinical presentations. Radiology plays an important role in the diagnosis and management of these pathologies. Unrecognized causes of biliary disease, like biliary atresia, can lead to liver transplantation during the first year of life. The aim of this article is to review the imaging of pediatric biliary disorders, including the implications of interventional radiology in some biliary diseases.     

Imaging evaluation of hemoptysis in children

Hemoptysis is an uncommon but distressing symptom in children. It poses a diagnostic challenge as it is difficult to elicit a clear history and perform thorough physical examination in a child. The cause of hemoptysis in children can vary with the child’s age. It can range from infection, milk protein allergy and congenital heart disease in early childhood, to vasculitis, bronchial tumor and bronchiectasis in older children. Acute lower respiratory tract infections are the most common cause of pediatric hemoptysis. The objective of imaging is to identify the source of bleeding, underlying primary cause, and serve as a roadmap for invasive procedures. Hemoptysis originates primarily from the bronchial arteries. The imaging modalities available for the diagnostic evaluation of hemoptysis include chest radiography, multi-detector computed tomography (MDCT), magnetic resonance imaging (MRI) and catheter angiography. Chest radiography is the initial screening tool. It can help in lateralizing the bleeding with high degree of accuracy and can detect several parenchymal and pleural abnormalities. However, it may be normal in up to 30% cases. MDCT is a rapid, non-invasive multiplanar imaging modality. It aids in evaluation of hemoptysis by depiction of underlying disease, assessment of consequences of hemorrhage and provides panoramic view of the thoracic vasculature. The various structures which need to be assessed carefully include the pulmonary parenchyma, tracheobronchial tree, pulmonary arteries, bronchial arteries and non-bronchial systemic arteries. Since the use of MDCT entails radiation exposure, optimal low dose protocols should be used so as to keep radiation dose as low as reasonably achievable. MRI and catheter angiography have limited application.     

Sclerosing treatment of lymphangiomas with OK-432

Over a period of seven years, 15 patients (aged from birth to 15 years; median 22 months) with lymphangioma were treated with OK-432; they received a mean of three injections each. Ten received OK-432 as first line treatment; five were treated after surgery (three had a residual lymphangioma after incomplete removal and two had a late recurrence). OK-432 proved to be effective for primitive as well as for residual and recurrent lymphangioma. Seven cases were macrocystic; complete regression was obtained in all. Five cases were microcystic: two had more than 50% regression, and three less than 50%. Three cases were mixed, with both large and microscopic cysts: one had more than 50% regression, and two less than 50%. These last two cases underwent surgery after the sclerosing treatment. The results obtained were excellent in 100% of macrocystic cases; a shrinkage in size was obtained in all microcystic cases. OK-432 is therefore proposed as a first line option for treatment of lymphangiomas.     

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??Abstract??Cardiomyopathies are a heterogeneous group of diseases of the myocardium associated with mechanical and/or electrical dysfunction and are due to a variety of causes that frequently are genetic. The incidence of cardiomyopathy in children was 1.1 ~ 1.2/100??000. Classification of clinical and imaging examination is mainly according to the 2008 ESC ??European Society of Cardiology?? at present. Imaging modalities are mainly echocardiography and cardiac magnetic resonance imaging ??CMR??. CMR can display morphological?? tissue and functional characteristics of cardiomyopathy and is especially suitable for children in the diagnosis and follow-up.     

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.     

Massive cystic lymphangiomas of a fetus

We present a fetus with progressive massive subcutaneous lymphangiomas leading to intrauterine death. A 28-year-old woman was referred to our hospital because of a precordial cystic mass of the fetus. An ultrasound revealed lymphangiomas extending from bilateral axillae to the anterior chest wall. At 18 weeks' gestation, amniocentesis was performed and the karyotype of the fetus was found to be normal 46, XY. Thereafter the lesions increased in size gradually and spread over the body. Amniotic fluid decreased, pericardial, and pleural effusion appeared, and cardiomegaly became evident. The fetus died in utero at 25 weeks' gestation. Postmortem examination revealed a male fetus surrounded with multicystic soft masses spreading over the body, and syndactyly (left third and fourth fingers) was present. Histologically, a number of irregularly dilated lymphatics extended through subcutaneous tissues to the skeletal muscles. No communications between the cysts and the thoracic or abdominal cavity existed, and no lymphatic dilations in the viscera were confirmed. As far as we know, such conditions have rarely been reported. Considering that in previous literature, a favorable prognosis of a fetus with an atypically located (lateral cervical or non-cervical) lymphangioma with a normal karyotype has been reported, our case may be included in a distinct pathological entity. When we find a lymphangioma in a fetus, careful follow-up by ultrasound is mandatory.     

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。     

Imaging of American football injuries in children

It is estimated that 3.2 million children ages 6 to 14 years participated in organized youth football in the United States in 2007. Approximately 240,000 children play football in the nation’s largest youth football organization, with tackle divisions starting at age 5 years. The number of children playing unsupervised football is much higher, and the overall number of children participating in American football is increasing. Sports are the leading cause of injury-related emergency room visits for teenagers, and football is a leading precipitating athletic activity for these visits. Football is also the most hazardous organized sports in the United States. Though most pediatric football-related injuries are minor, such as abrasions, sprains, and strains of the extremities, football accounts for more major and catastrophic injuries than any other sport. Given football’s popularity with children in the United States, combined with the high rate of injury associated with participation in this activity, radiologists should be familiar with the imaging features and injury patterns seen in this patient population.