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Notes: Abstract An otherwise healthy 11-month-old boy presented with bilateral abdominal masses. Imaging findings, differential diagnosis, histological findings, and pertinent discussion are presented.

Notes: Abstract We report a rare case of bony involvement by paracoccidioidomycosis in a 4-year-old boy. Extremity radiographs show a diffuse permeative pattern of metaphyseal bony destruction. Although these findings are nonspecific, they may suggest the disease in an appropriate clinical setting. Definitive diagnosis, however, depends upon detection of Paracoccidioides braziliensis on laboratory analysis.

Notes: Abstract There are few radiologic descriptions of intrahepatic portosystemic venous shunts and all in adults. A case is reported of a newborn where the diagnosis of shunt was made with color Doppler and where the shunt resolved spontaneously at one year of age. Proposed etiologies for intrahepatic portovenous shunts are discussed.

Notes: Abstract A 9-year old girl with a large abdominal mass is presented. The clinical history, CT images, histological dindings, current classification and therapy are discussed.

Notes: Abstract The appearance of pulmonary nodules in a child with a solid malignancy undergoing chemotherapy is a clinically worrisome event. The diagnosis in such cases is not always metastatic disease, and the differential diagnosis should include granulomatous disease, atelectasis, pneumonia, inflammatory pseudotumor, hamartoma, radiation pneumonitis, and bronchiolitis obliterans with organizing pneumonia. There is no consistent radiologic feature to help distinguish benign from malignant causes of these new lesions. However, repeat chest CT 4–6 weeks after the lesions are first noted can be used to track lesion progression and may obviate the need for biopsy.

Notes: Abstract A 2-month-old infant with fever and a chest mass is presented. Imaging evaluation, differential and final pathological diagnosis are discussed.

Notes: Abstract The purpose of this report is to compare a computed tomography (CT) injury severity scale for hepatic and splenic injury with the following outcome measures: requirement for surgical hemostasis, requirement for blood transfusion and late complications. Sixty-nine children with isolated hepatic injury and 53 with isolated splenic injury were prospectively classified at CT according to extent of parenchymal involvement. Clinical records were reviewed to determine clinical outcome. Ninety-seven children (80%) were managed non-operatively without transfusion. One child with hepatic injury required surgical hemostasis, and 17 (25%) required transfusion of blood. Increasing severity of hepatic injury at CT was associated with progressively greater frequency of transfusion (P=0.002 by χ2-test). One child with splenic injury underwent surgery and eight (15%) required transfusion of blood. Splenic injury grade at CT did not correlate with frequency (P=0.41 by χ2-test) or amount (P=0.35 by factorial analysis of variance) of transfusion. There was one late complication in the nonsurgical group. A majority of children with hepatic and splenic injury were managed non-operatively without requiring blood transfusion. The severity of injury by CT scan did not correlate with need for surgery. Increasing grade of hepatic injury at CT was associated with increasing frequency of blood transfusion. CT staging was not discriminatory in predicting transfusion requirement in splenic injury.

Notes: Abstract We describe two cases of hydrocephalus in which spinal sonography revealed underlying causes responsible for the failure of therapeutic lumbar punctures.

Notes: Abstract Purpose. The role of subarachnoid blood and secondary, sterile inflammation in the pathogenesis of posthemorrhagic hydrocephalus (PHH) is not well understood. The aims of this study were to study the frequency and rate of spread of blood into the spinal subarachnoid space (SSS) and to evaluate the relationship of this finding and PHH.¶Materials and methods. Nine premature babies with major intracerebral hemorrhage (ICH, grade 3 or higher), and ten premature infants with minor ICH (grade 1) or no evidence of ICH (control group) were identified and underwent serial cranial and spinal sonography at the time of initial diagnosis, 12–24 h after the ICH and weekly thereafter for at least 9 weeks. Sagittal and axial scans of the thoracolumbar spine were obtained and evaluated for the presence of echogenic debris in the dorsal SSS. Six additional patients who had cranial and spinal sonography died within the 1st week of life and underwent post-mortem examinations.¶Results. The SSS was echo-free (normal) in all cases at the time of initial sonographic diagnosis of ICH. Within 24 h, all babies with major ICH had developed increased echogenicity of the cervical and thoracic SSS. Echogenicity of the SSS decreased gradually over several weeks. Although transient ventricular dilatation was present in every patient, only one patient had rapidly progressive PHH requiring shunt placement. Transient cysts of the cervicothoracic subarachnoid space were identified in two patients 6–7 weeks after ICH. The subarachnoid space remained echo-free in all control infants At autopsy, all four infants with echogenic spinal debris had blood or blood products in the spinal subarachnoid space, whereas two infants with echo-free spinal images did not.¶Conclusions. Spread of blood from the ventricular system into the spinal subarachnoid space after ICH is common and can be seen within 24 h of initial ICH. Subarachnoid blood is associated with post-hemorrhagic ventricular dilatation and transient spinal subarachnoid cyst formation.

Notes: Abstract Background and purpose: Microinjection into the brain with N-methyl-D-aspartate (NMDA), a synthetic analogue of glutamate, has been used as a chemical model of perinatal hypoxic-ischemic injury. Little is known about the sonographic characteristics and hemodynamic consequences of these cytotoxic lesions. An understanding of these features may be useful in the early sonographic identification of stroke in newborns.Methods: Twenty newborn lambs were anesthetized, paralyzed, and mechanically ventilated. Between 0.5 and 5 μ mole NMDA in 0.2 ml phosphate buffered salinen=18), or buffered saline only (n=2) was injected into the right putamen under sonographic guidance. Serial grey-scale and color Doppler images of the brain, Doppler spectra of the middle cerebral and thalamostriate arteries, cerebral blood flow (CBF) determinations using radiolabeled microspheres (n=9), and cerebral oxygen extraction (n=4) were obtained before, and at 15, 60, and 120 min after NMDA injection. Pathologic examination was obtained in 11 animals.Results: Homogeneous, well defined, moderately echogenic lesions surrounded by marked focal hyperemia on color Doppler were identified in every animal injected with 5 μ mole NMDA within minutes of injection. Lesions were characterized by focal areas of chromatolysis and cytoplasmic shrinkage, with scattered petechial hemorrhage. No lesions or hyperemia were observed in the animals injected with normal saline. Mean supratentorial CBF increased from 64±9 ml/min/100 g (control) to 152±30, 115±19, and 102±8 ml/min/100 g at 15, 60, and 120 min after injection respectively. The most marked increases occurred in right midbrain (467% of control), diencephalon (388%), and temporal lobe (282%), but were also observed in homotopic regions of the left hemisphere, and in pons, medulla, and cerebellum. Mean blood flow velocity in the middle cerebral artery, and thalmoperforator artery correlated well with changes in hemispheric and midbrain CBF respectively. (r=0.57–0.74,p=0.0001, andr=0.65–0.67,p=0.0001 respectively).Conclusions: Focal brain lesions may be identified by sonography within minutes after experimentally induced neuronal injury. Alterations in echotexture are primarily due to intracellular cytoplasmic changes and microscopic hemorrhage. Local intracerebral injection of NMDA in newborn lambs increases both local and global CBF.