The Value of Contrast Administration in the MRI Evaluation of Scoliosis in the Pediatric Population

2008 ◽  
Vol 21 (6) ◽  
pp. 844-847
Author(s):  
K. Abul-Kasim ◽  
D. Gomez Hassan ◽  
L. McCormick ◽  
P. Maly ◽  
P.C. Sundgren
Keyword(s):  
Pediatric Patients ◽  
Pediatric Population ◽  
Benign Lesions ◽  
Contrast Administration ◽  
Spine Imaging ◽  
Contrast Enhanced ◽  
History Of ◽  
Work Up ◽  
Spine Mri ◽  
Mri Evaluation

The aim of this study was to analyze the added utility of contrast administration for spine MRI in children with scoliosis. A retrospective review of 663 consecutive contrast-enhanced spine MRI performed in 319 patients as part of the work up of scoliosis in children 2–18 years with clinically suspected or known scoliosis over a seven year period. Those patients with known tumors (13 patients) being evaluated for scoliosis were excluded from the study. In 306 patients with scoliosis and no history of tumor pathologic contrast enhancement was seen in seven (2%) patients. Lack of enhancement helped to characterize benign lesions in 31 (10%) of the patients. Although MRI is often recommended to exclude intraspinal pathology in pediatric patients with scoliosis, the need for contrast enhanced imaging is very limited and contrast medium should not be administered unless questionable pathology is detected on noncontrast MR spine imaging.

scholarly journals Contrast-Induced Vomiting in Pediatric Patients Under Propofol Sedation: A Case Series

2019 ◽  
Vol 24 (6) ◽  
pp. 534-537
Author(s):  
Shane C. Rainey ◽  
Nadia Shaikh ◽  
Keith A. Hanson
Keyword(s):  
Magnetic Resonance Imaging ◽  
Adverse Events ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Case Series ◽  
Resonance Imaging ◽  
Imaging Studies ◽  
Contrast Administration ◽  
Contrast Enhanced ◽  
Pediatric Sedation

Gadolinium-based compounds are frequently used in contrast-enhanced magnetic resonance imaging studies. Rarely, adverse events have been reported with administration of these compounds, of which the most common are nausea and vomiting. Although well established in the adult literature, these adverse effects are less well described in the pediatric population, who often need sedation to complete imaging studies. In this case series, we present 3 children who experienced vomiting shortly after contrast administration while under sedation with propofol, which is known to have antiemetic properties. Although all 3 children recovered without complication, this case series illustrates the serious potential consequences of vomiting while sedated, and providers should be aware of these possible adverse events as pediatric sedation becomes more common outside the operating room.

Pediatric cerebellopontine angle and internal auditory canal tumors

2013 ◽  
Vol 12 (4) ◽  
pp. 317-324 ◽  
Author(s):  
Michelle A. Holman ◽  
William R. Schmitt ◽  
Matthew L. Carlson ◽  
Colin L. W. Driscoll ◽  
Charles W. Beatty ◽  
...  
Keyword(s):  
Family History ◽  
Diagnostic Criteria ◽  
Cerebellopontine Angle ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Internal Auditory Canal ◽  
Neurofibromatosis Type ◽  
History Of

Object The aim in this study was to describe the clinical presentation, differential diagnosis, and risk for neurofibromatosis Type 2 (NF2) in pediatric patients presenting with cerebellopontine angle (CPA) and internal auditory canal (IAC) tumors. Methods The authors conducted a retrospective study at a tertiary care academic referral center. All patients with an age ≤ 18 years who had presented with an extraaxial CPA or IAC tumor between 1987 and 2012 were included in the study cohort. Data regarding symptoms, diagnosis, tumor characteristics, and NF2 status were collected and analyzed. Results Sixty patients (55% female, 45% male) harboring 87 tumors were identified. The mean age at diagnosis was 12.8 years (median 14.0 years, range 0.9–18.9 years). Schwannomas were the most commonly identified lesions (57 of 87 tumors, including 52 vestibular, 3 facial, and 2 trigeminal schwannomas), followed by meningiomas (5 of 87) and epidermoid cysts (4 of 87). Six malignant tumors were diagnosed, including small-cell sarcoma, squamous cell carcinoma, malignant meningioma, atypical rhabdoid-teratoid tumor, endolymphatic sac tumor, and malignant ganglioglioma. Headache, followed by hearing loss and imbalance, was the most common presenting symptom, whereas dysphagia, otalgia, and facial pain were uncommon. Neurofibromatosis Type 2 was diagnosed in 20 (61%) of 33 patients with vestibular schwannoma (VS), while the other 13 patients (39%) had sporadic tumors. Nineteen of the 20 patients with NF2 met the diagnostic criteria for that disorder on initial presentation, and 15 of them presented with bilateral VS. At the last follow-up, 19 of the 20 patients subsequently diagnosed with NF2 demonstrated bilateral VSs, whereas 1 patient with a unilateral VS and multiple other NF2-associated tumors has yet to demonstrate a contralateral VS to date. Only 1 patient presenting with an isolated unilateral VS and no family history of NF2 demonstrated a contralateral VS on subsequent radiological screening. Conclusions Cerebellopontine angle and IAC tumors in the pediatric population are rare. There are several noteworthy differences between the adult and pediatric populations harboring these lesions. While VS is the most common pathology in both age groups, the lesion was found in only 60% of the pediatric patients in the present study. Unlike in adults, VSs in the pediatric population were associated with NF2 in over one-half of all cases. The majority of pediatric patients with NF2 fulfilled the diagnostic criteria at initial presentation; however, approximately 7% of patients presenting with a seemingly sporadic (no family history of NF2) unilateral VS will meet the criteria for NF2 later in life. Finally, malignancies account for a significantly higher percentage (10%) of cases among pediatric patients. These findings underscore the importance of early screening and close radiological follow-up and may be helpful in patient counseling.

Stroke as Presenting Feature of COVID-19 in a Pediatric Patient

2021 ◽  
Author(s):  
Shanna Swartwood ◽  
Gary R. Nelson ◽  
Audie C. Espinoza
Keyword(s):  
Pediatric Patients ◽  
Pediatric Population ◽  
Adult Population ◽  
Acute Onset ◽  
Cerebrovascular Complications ◽  
Novel Virus ◽  
Polymerase Chain ◽  
Diagnostic Work ◽  
Novel Coronavirus ◽  
Work Up

AbstractNeurologic manifestations of severe acute respiratory syndrome coronavirus 2, the virus responsible for novel coronavirus 2019 (COVID-19) infection, have been frequently reported in the adult population but remain relatively rare in pediatric patients, specifically in regard to cerebrovascular accidents (CVAs). We present the case of a previously healthy 16-year-old adolescent boy with no preceding infectious symptoms who developed acute onset of left-sided weakness and slurred speech subsequently diagnosed with acute ischemic stroke (AIS). After performing a thorough diagnostic work-up, no clear etiology for AIS was identified. He was found to be COVID-19 positive by reverse transcription polymerase chain reaction upon admission. Accumulating evidence supports a link between COVID-19 and a systemic prothrombotic state suggesting pediatric patients who present with AIS and no other risk factors should be screened for this novel virus and potentially for extracranial sources of thrombi. As the rates of positive COVID-19 infection increase in the pediatric population, pediatricians and other pediatric subspecialists should be aware of the potential neurological and cerebrovascular complications of this novel virus to avoid delays in evaluation and intervention.

scholarly journals Acquired Aplastic Anemia in Immunocompetent Pediatric Patients with Asymptomatic COVID-19 Infection: A Case Series

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 1103-1103
Author(s):  
Jordan E. Fritch ◽  
Taylor Losole ◽  
Lindsey Leyden ◽  
Jiri Bedrnicek ◽  
Deborah A. Perry ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Aplastic Anemia ◽  
Pediatric Patients ◽  
Bone Marrow Aspirate ◽  
Case Series ◽  
Exercise Intolerance ◽  
White Female ◽  
History Of ◽  
Work Up ◽  
Hispanic White

Abstract Background: In pediatrics, acquired aplastic anemia (AA) is most commonly due to infection, particularly viruses, when a cause can be identified. Coronavirus disease 2019 (COVID-19) has affected more than 197 million people worldwide, and children typically experience a less severe disease course. COVID-19 is known to cause transient hematologic abnormalities, including leukopenia, lymphopenia, anemia and thrombocytosis or thrombocytopenia in severe cases. Objectives: Describe three cases of COVID-19 associated acquired aplastic anemia in immunocompetent pediatric patients. Design/Methods: Case series established by retrospective review of the electronic medical record. Results: Case 1: An 8-year-old Hispanic male presented with a three-week history of increased bruising and a one-week history of progressive exercise intolerance, shortness of breath, pallor and fatigue. Labs showed pancytopenia. Bone marrow aspirate and biopsy was markedly hypocellular at 5-10% consistent with aplastic anemia (Figure 1). Work-up for the etiology of his aplastic anemia was only significant for positive SARS-COV-2 antibodies and a SEC23B variant of unknown significance on a comprehensive bone marrow failure (BMF)/myelodysplastic syndrome (MDS)/leukemia panel from the Children's Hospital of Philadelphia (CHOP). He was treated with eltrombopag olamine and then proceeded to immunotherapy with cyclosporine (CsA) and horse antithymocyte globulin (ATG) when a sibling match was not identified for hematopoietic stem cell transplant (HSCT). Three months later, his peripheral blood counts have improved, and he is no longer transfusion-dependent. Repeat bone marrow aspirate and biopsy continues to show markedly hypocellularity at <5%. Case 2: A 5-year-old non-Hispanic white female presented with a two-week history of easy bruising, petechial rash, fatigue and bone pain. Labs showed pancytopenia, and bone marrow aspirate and biopsy showed marked hypocellularity at 5-10% consistent with aplastic anemia (Figure 2). Her aplastic anemia work-up was significant for positive SARS-COV-2 antibodies and subclinical RBC and WBC paroxysmal nocturnal hemoglobinuria (PNH) clones. She was started on eltrombopag olamine and then proceeded to immunotherapy with CsA and ATG when a matched sibling donor was not identified. Three months later, she continues to be severely neutropenic, anemic and thrombocytopenic requiring multiple transfusions. Repeat bone marrow aspirate and biopsy showed variable cellularity with some areas 10-20% and others 70% with an overall cellularity of 50%. Case 3: An 8-year-old non-Hispanic white female presented with a 10-day history of fatigue, bilateral leg pain and pallor. Labs showed pancytopenia, elevated inflammatory markers and elevated hemoglobin F. Bone marrow aspirate and biopsy demonstrated mild-moderate hypocellularity at 40-50%, left-shifted myelopoiesis and dyspoiesis in the erythroid and megakaryocytic cell lines (Figure 3). MDS and acute lymphoblastic leukemia (ALL) fluorescence in situ hybridization (FISH) panels were negative. Additional work-up revealed positive SARS-COV-2 antibodies. Her pancytopenia resolved within two weeks of her initial hospitalization. Four months later, she presented with increased bruising and fatigue. Labs showed leukocytosis, thrombocytopenia, anemia and circulating peripheral blasts. Bone marrow aspirate and biopsy was consistent with B-cell ALL. She is receiving chemotherapy on study COG AALL1732. Conclusion: Severe aplastic anemia (SAA) has high morbidity and mortality, and timely diagnosis is needed for appropriate treatment. Multiple different viral infections have been known to cause acquired aplastic anemia. Data on all the sequelae of COVID-19 infection is still emerging, but it is plausible that COVID-19 infection may cause SAA. All three patients were found to have positive COVID-19 antibodies but did not have any evidence of previous COVID-19 infection. Further research and follow-up is needed to determine if previous COVID-19 infection is indeed a risk factor for development of SAA. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

scholarly journals A study of evaluation of chronic pain abdomen in pediatric patients by laparoscopy

2019 ◽  
Vol 6 (3) ◽  
pp. 708
Author(s):  
Ravindra G. Khasnis ◽  
Rajshankar S.
Keyword(s):  
Chronic Pain ◽  
Pediatric Patients ◽  
Diagnostic Value ◽  
Background Pain ◽  
Therapeutic Procedures ◽  
History Of ◽  
Laparoscopic Intervention ◽  
Work Up

Background: Pain in abdomen of chronic nature is common in children but being so common difficult to determine the exact cause. It has been estimated that around 2-4% of all the pediatric patients attend the outpatient department are due to pain in the abdomen that is of chronic nature in children. It has been seen that routine diagnostic and therapeutic procedures fail to make a justice of the diagnosis and management for the pain in the abdomen of chronic nature. The aim was to study the role of laparoscopy in children with chronic pain abdomen.Methods: Interventional follow up study was carried out among 19 children with pain in the abdomen of chronic nature. Detailed history pertaining to pain in the abdomen, history of surgical explorations was taken. As a part of the work up of a patient the investigations were done routinely. All children were evaluated by laparoscopy.Results: Majority of the children were in the age group of 11-12 years i.e. 42.1%. Male and female children were almost equal in distribution. USG was diagnostic in 9 patients (47.36%). Laparoscopy was diagnostic in all 18 other cases (95% cases). 73.68% had not complication after the procedure. Only four patients had fever after the surgery and only one patient had wound infection. Thus, overall the laparoscopic procedure was very successful. Laparoscopy and USG were equally effective in diagnosing inguinal hernia.Conclusions: Laparoscopy had better diagnostic value compared to ultrasonography. Laparoscopic intervention was successful with minimum complications.

Hodgkin Disease and Nephrotic Syndrome, a Rare Paraneoplastic Complication in Children with Literature Review

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4832-4832
Author(s):  
Sehba Dsilva ◽  
Gungor Karayalcin ◽  
Sharon Singh
Keyword(s):  
Nephrotic Syndrome ◽  
Renal Biopsy ◽  
Minimal Change Disease ◽  
Pediatric Population ◽  
Minimal Change ◽  
Hodgkin Disease ◽  
Humoral Factors ◽  
History Of ◽  
Work Up ◽  
Nodular Sclerosing

Abstract The association between Hodgkin Disease (HD) and paraneoplastic Nephrotic Syndrome is well documented in adults but is relatively uncommon in the pediatric population. We describe two children with HD who initially presented with Nephrotic Syndrome. Case 1: 12- year-old boy who presented with a two-week history of periorbital edema, proteinuria and hypertension and was diagnosed with Nephrotic Syndrome. The renal biopsy showed minimal change disease. Since the patient developed dyspnea, further work-up was done and he was found to have a large mediastinal mass. Core needle biopsy of the mass was consistent with HD, nodular sclerosing type. Case 2: 14-year-old boy diagnosed to have Nephrotic Syndrome with biopsy proven minimal change disease and was treated intermittently with steroids over 6 months. He subsequently developed dyspnea and was found to have a right paratracheal mass and excisinal biopsy was consistent with HD, nodular sclerosing type. Both these patients initially presented with Nephrotic Syndrome which completely resolved after the first course of chemotherapy for HD. Upon review of literature, there have been 23 pediatric cases of Nephrotic Syndrome associated with HD in patients ranging in age between 2–15 years. The renal biopsy was not done for 8 of these patients and the diagnosis was established clinically. Fifteen patients had biopsies, 9 had minimal change disease, 1 mesangial hypercellularity, 1 glomerulosclerosis, 1 undetermined histology and 3 were normal. In all cases, the Nephrotic Syndrome was refractory to steroids and resolved with treatment of the HD. Pathogenesis of the Nephrotic Syndrome associated with HD is not known, however there are speculations about T-cell involvement and production of lymphokines and humoral factors which may be responsible for the glomerular damage.

A-129 The Association between Parental Migraine History and Persistent Post Traumatic Headaches

2021 ◽  
Vol 36 (6) ◽  
pp. 1180-1180
Author(s):  
Ronnise Owens ◽  
Sherly Smith ◽  
Craig Marker
Keyword(s):  
Systematic Review ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Parental History ◽  
Pediatric Concussion ◽  
History Of ◽  
Rate Of Recovery ◽  
Post Traumatic

Abstract Objective Literature indicates persistent concussive symptoms beyond the typical recovery time of days or weeks are attributable to factors other than concussion or mild traumatic brain injury (mTBI) (Scott et al., 2020). Post traumatic headaches (PTH) are a frequent complaint of pediatric patients who have sustained a mTBI. Research have indicated that parental migraine and mTBI may put children at risk for PTH (Whitecross, 2020). This systematic review aims to further investigate the relationship between parental history of migraine and PTH in pediatric patients who have sustained a concussion. Data Selection A search was conducted using, Medline, PubMed, and Google Scholar databases with the terms “pediatric”, “concussion”, “parental”, and “headache” between 2011 and 2021. A total of 200 relevant articles were screened and 14 were selected for this review. Exclusion criteria included studies unrelated child migraines, concussion or mTBI diagnosis, and parental history. Data Synthesis A review of literature indicates a 42% heritability and earlier onset of migraine diagnosis for children with parental migraine history (Dao et al., 2018; Eidlitz-Markus et al 2015). This indicates a significant risk factor for persistent post concussive symptoms and possibly direct implications in the slower rate of recovery (Sufrinko et al., 2018). Conclusion Overall, this systematic review strongly suggests that a genetic predisposition for migraines may serve as a catalyst for onset and duration of PTH and the earlier diagnosis of pediatric migraines. Consideration of these predispositions can aid the multidisciplinary approach to improve cognitive and neurobehavioral health in the pediatric population.

scholarly journals Basal ganglia calcifications is not inconsequential in pediatric cases

2021 ◽  
Vol 19 (3) ◽  
pp. 267-269
Author(s):  
Berrin Erok ◽  
◽  
Sertaç Tatar ◽  
Tuğçe Aksu Uzunhan ◽  
Diğdem Bezen ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Pathological Finding ◽  
Pediatric Endocrinology ◽  
Basal Ganglia Calcification ◽  
Hereditary Disorders ◽  
History Of ◽  
Laboratory Investigations ◽  
First Time

Introduction. Basal ganglia calcification (BGC) in pediatric population is rare and is considered as a pathological finding. Various causes may be responsible for BGC including hypoparathyroidism, various infectious, toxicities or hereditary disorders. Aim. We aimed to present a 8 year old boy presented with generalized seizure and bilateral small amount of globus pallidum calcifications on neuroimaging studies leading to the diagnosis of idiopathic hypoparathyroidism, which is a treatable cause of seizure. Description of the case. A 8-year-old boy presented to our emergency department with generalized seizure for the first time in his life. There was no history of previous head trauma and his family history was unremarkable. Neurological examination revealed no pathological findings. Radiological imaging studies revealed only bilateral small amount of globus pallidus calcifications. He was referred to the pediatric endocrinology department for further evaluation of the hypocalcemic convulsion, where laboratory investigations revealed idiopathic hypoparathyroidism as the cause of hypocalcemic convulsion with exclusion of the other causes. Conclusion. Even a small amount of BGC in pediatric patients may be the sign of primary hypoparathyroidism and should be evaluated with serum electrolyte levels for early diagnosis and for the prevention of multisystemic complications of hypoparathyroidism.

scholarly journals Oral Investigation in Childhood Psoriasis: Correlation With Geographic Tongue and Disease Severity

2019 ◽  
Vol 5 (1) ◽  
pp. 23-27
Author(s):  
Bruna Picciani Lavinas Sayed ◽  
Thays Teixeira-Souza ◽  
Áquila Curty Almenara ◽  
Luna Azulay-Abulafia ◽  
Amanda Hertz ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Pediatric Population ◽  
Positive Family History ◽  
Severity Index ◽  
Severe Form ◽  
Oral Lesions ◽  
Healthy Controls ◽  
The World ◽  
History Of ◽  
The Mean

Background: Childhood psoriasis affects 2% of the world pediatric population. An association between psoriasis and geographic tongue (GT) in adults has been suggested, but there are no studies in children. Objective: This study aimed to compare the prevalence of oral lesions in pediatric patients with psoriasis (PP) and healthy controls and investigate the correlation between GT, severity, and age of psoriasis onset. Methods: The participants were 17 PP aged <18 years and 91 HC. The severity of vulgaris psoriasis was determined according to Psoriasis Area and Severity Index (PASI) and all patients underwent an oral examination. Results: Oral findings were present in 43% of the participants and the most common lesions were candidiasis and GT. There was a mean earlier onset in psoriasis with GT (3 years old) compared to psoriasis without GT (10 years old). The mean PASI scores in psoriasis with GT and psoriasis without GT were 9 and 3, respectively. Conclusion: Geographic tongue and candidiasis were frequently found in PP. Patients with psoriasis with GT are younger and have earlier onset of the disease, a positive family history of psoriasis, and a severe form of the disease. The present study is the first of its type to demonstrate clinical differences in pediatric PP with and without GT.

scholarly journals Use of contrast-enhanced ultrasound in pediatrics

2021 ◽  
Vol 54 (5) ◽  
pp. 321-328
Author(s):  
Marcelo Straus Takahashi ◽  
Mauricio Gustavo Ieri Yamanari ◽  
Lisa Suzuki ◽  
Ésio Fortaleza Nascimento Chaves Pedrosa ◽  
Roberto Iglesias Lopes ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Vesicoureteral Reflux ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Focal Liver Lesions ◽  
Liver Lesions ◽  
Contrast Enhanced Ultrasound ◽  
Promising Tool ◽  
Contrast Enhanced ◽  
Safe Technique

Abstract Although contrast-enhanced ultrasound has been shown to provide considerable benefits, particularly in pediatric patients, it is still used relatively rarely in Brazil. It has proven to be a safe technique, and adverse effects are rare. In this review, we address the technique and main applications of contrast-enhanced ultrasound in the pediatric population, including the evaluation of focal liver lesions, abdominal trauma, kidney grafts, liver grafts, bowel loops, and vesicoureteral reflux. It is important for pediatric radiologists to be acquainted with this promising tool, understanding its applications and limitations.

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