THE UTILITY OF CONTRAST-ENHANCED ULTRASONOGRAPHY IN DIAGNOSING CHILD’S VESICOURETERAL REFLUX – A CASE REPORT AND A REVIEW OF THE LITERATURE

Vesicoureteral reflux represents the reflow of bladder content in the ureter and pelvicalyceal system with their subsequent dilation. Most of the cases of urinary tract infections in child are associated with vesicoureteral reflux. We present the case of a 3-year-old female patient, with a history of multiple symptomatic urinary tract infections, who was admitted in our clinic for specialty investigations and establishment of an adequate therapy. The clinical exam and the laboratory tests did not point out any pathological elements. The native abdominal ultrasound was without pathological modifications, while the contrast-enhanced ultrasonography revealed bilateral vesicoureteral reflux. The renal scintigraphy with DMSA showed impaired renal function on the right side, of 39% with duplicity of the collector system and moderate dilation of the superior pelvis, and normal function of the left kidney. The recommendations consisted in long-term antibiotic prophylaxis, contrast-enhanced ultrasonography once a year and nephrologist consult every 6 months. The particularity of the case consists in diagnosing a bilateral vesicoureteral reflux by contrast-enhanced ultrasonography in a female patient with a history of multiple urinary tract infections, in whom the native renal ultrasound did not point out any pathological elements

Rapunzel Syndrome—An Extremely Rare Cause of Digestive Symptoms in Children: A Case Report and a Review of the Literature

Rapunzel syndrome is an extremely rare condition seen in adolescents or young females with psychiatric disorders consisting of a gastric trichobezoar with an extension within the small bowel. The delays in diagnosis are common since in its early stages, it is usually asymptomatic. We report the case of a 13-year-old girl admitted in our clinic for abdominal pain, anorexia, and weight loss. The clinical exam pointed out diffuse alopecia, a palpable mass in the epigastric area, and abdominal tenderness at palpation, the patient weighing 32 kg. The laboratory tests showed anemia. The abdominal ultrasound showed a gastric intraluminal mass with a superior hyperechoic arc. The upper digestive endoscopy revealed a mass formed by hair, mucus, and food occupying the gastric cavity with the extension into the duodenum confirming the diagnosis of Rapunzel syndrome. The giant trichobezoar of 511 g, measuring 17 × 7 × 6.5 cm with a tail of approximately 3 cm, was successfully removed through laparotomy. Although rare, Rapunzel syndrome must never be forgotten as a differential diagnosis for digestive symptoms since its early detection hinders the occurrence of further complications

Necrotizing fasciitis of the neck: case presentation

Necrotizing fasciitis represents a severe and rare infectious disease, which is accompanied by extended necrosis of subcutaneous tissues and fascia layers, having as a result gangrene of the teguments. To reduce mortality associated with this disease, a rapid diagnosis is necessary as well as aggressive surgical treatment, accompanied by adequate, aggressive antibiotic therapy. As a rule, etiology is teeth related, with the condition more common in immunology-depressed patients. This article presents the experience of the authors regarding a case presentation of necrotizing fasciitis with typical clinical expression and management of the disease in an immunological-depressed patient. Further data on diagnosis, microbiology, clinical manifestations, therapy principles, and prognosis are yet needed for atypical cases

The importance of SARS-CoV-2 testing in pediatric population

Pediatric population associates multiple peculiarities in terms of SARS-CoV-2 regarding the differences of symptoms in comparison to adults, but also the higher incidence of asymptomatic cases. The aim of these case reports is to underline the importance of SARS-CoV-2 testing in pediatric patients. The first case describes the case of a 2-year and nine-month-old child admitted to the Pediatrics Clinic I Targu Mures for involuntary ingestion of toxic substance. The clinical exam pointed out a mild hyperemia of pharynx and small lymph nodes under the mandibula, on the side area of the neck and above the clavicula; and the laboratory tests pointed out leukocytosis, thrombocytosis and one of the liver transaminases above the normal limit. In spite of the presentation concerns, the patient was tested for SARS-CoV-2 infection, with positive result. The evolution was favorable during the admission. The second case describes a 3-year and 8-month-old male patient brought in the emergency department with the suspicion of foreign body aspiration, but the bronchoscopy revealed only purulent secretion in the trachea and bronchia. The RTPCR test for SARS-CoV-2 infection was negative on the admission day, but due to the slowly favorable evolution, the patient was retested on the 5th day of admission, with positive result. The testing of pediatric patients independently of the symptoms and the clinical setting might carry a higher importance in limiting the viral transmission

Mycoplasma pneumoniae pneumonia – challenges related to diagnosis and treatment in children

Introduction. Pneumonia is a common infectious disease among children, very familiar to pediatricians and a major cause of hospitalization worldwide. Mycoplasma pneumoniae (M. pneumoniae) - atypical pathogen, is estimated to be responsible for approximately 30-40% of community-acquired pneumonias. The aim of the paper was to underline the diagnostic and treatment difficulties in a case of pneumonia with M. pneumoniae in a school-aged boy, with multiple presentations in the Emergency Service for respiratory difficulties. Material and method. We present the case of a 7 years and 10-month-old male patient, admitted to our clinic for wheezing, cough and dyspnea. Results. The clinical exam at admission pointed out influenced general status, wheezing, thoraco-abdominal swing, intercostal draft, sibilant and crackles, oxygen saturation 89%, tachycardia 134 beats/minute. The blood tests revealed mild leukocytosis, with neutrophilia, slightly increased inflammatory biomarkers. Considering the general status and the presence of functional respiratory syndrome, steroid and symptomatic anti-inflammatory treatment is initiated. However, the general condition remains stable, which required the widening of the spectrum of investigations with the performance of a chest CT noticing a pneumonic condensation with an air bronchogram located at the level of the right upper lobe. Considering the stationary respiratory functional syndrome and the radiological appearance of the pneumonia as well as the age, we performed serology for atypical germs and identified a positive titer of Ig M antibodies for M. pneumoniae by instituting Azithromycin po, but after 3 days, the evolution remains stationary, thus we changed the treatment with intravenous Levofloxacin, with a favorable subsequent evolution. Conclusions. Pneumonia with atypical pathogens such as M. pneumoniae is a well-defined and well-known pathology in the literature, but it still remains a condition that imposes multiple difficulties related to the diagnosis and therapeutic management of pediatric cases

ASPECTS REGARDING MUSCULOSKELETAL PAIN IN PEDIATRIC PATIENTS WITH MALIGNANCY

Introduction. Musculoskeletal pain is among the most common complaints of children and most episodes are self-limiting. However, in some cases, it is the first sign of malignancy. Objectives. Evaluation of the frequency and characteristics of musculoskeletal complaints as initial symptoms present in children with newly diagnosed cancer. Material and methods. Retrospective study that included 231 children with various malignancies diagnosed in the Pediatric Clinic I, Targu Mures, during 2000-2015. The collected data were: age at diagnosis, clinical features, laboratory findings and final diagnoses. Results. 23% of children with cancer had musculoskeletal symptoms at initial presentation. The average time between the onset and final diagnosis was 60 days. The most common complaints were arthralgia (50%) involving large joints. Juvenile rheumatoid arthritis has been the most common initial diagnosis in 7 of 54 patients (13%). Anemia was the most frequent hematological initial finding. All patients had elevated erythrocyte sedimentation rate (ESR) and lactate dehydrogenase (LDH). Malignancies diagnosed were: acute lymphoblastic leukemia and myeloid leukemia, lymphomas and solid tumors. Conclusions. Early diagnosis of cancer and adequate treatment are essential to improving the prognosis and can be done including cancer in the differential diagnosis of rheumatic diseases in children who initially accuse musculoskeletal pain

New imagistic method for assessment of liver structure in children

Introduction: Newly, acoustic radiation force impulse (ARFI) elastography has been introduced as a noninvasive technique for evaluating liver fibrosis. Matherial and methods: The present study was carried out at the Ist Pediatric Clinic Tg.-Mures, Romania, between 2010 September and 2011, April; it was a prospective study including a control group composed of 38 children with normal clinical and paraclinical findings related to the liver function and a lot of 96 children with different causes of hepatopathies. In group of patients with liver damage there were 28 overweight and obese children (considered overweight whether their weight was between the 85th and 95thpercentilefor age and sex, and obese whether their weight exceeds 95th percentile, respectively), all of them with modifications to the standard abdominal ultrasound (high echogenicity, granular liver aspect, posterior attenuation suggestive for steatosis); there were 48 patients with various malignancies under or after chemotherapy, with tumor infiltration of the liver or hepatotoxicity related to cytostatic treatment and a number of 20 patients with various etiology of hepatopathy (viral hepatitis, acute toxic hepatitis, drug hepatotoxicity).Alanine transaminase(ALT, IU) was 19,56±8,67 SD in the control group, and 37,42±31,16 in the group of children with liver diseases, while aspartate transaminase (AST, IU) was 24,88±8.67 SD in the control group, and 39,92±20,12 in the group of children with liver inury. As far as it concerns aspartate transaminase(AST, IU), in the control group it were, also, smaller levels than inthe groupofchildrenwithhepatopathies, the difference between AST mean for the two groups was, as for ALT, statistically extremely significant, with p<0.0001 We searched for correlations between global SVW and other determined parameters (AST and ALT) in each group, but we obtained no statisticaly significant correlations between the assesed parameters, except that between SWV and AST, only for the group of children with liver injury (r = 0,54 and p = 0,01),statistically significant. Conclusions: In normal conditions (children with free liver tissue), SVW was higher for the segment VIII compared to I, statistically significant, meaning that caudate lobe is “softer”, difference that does not exist in the group of liver diseases. SWV values in group of children with hepatopathies were found to increase particularly in the segment I (caudate lobe), which shows that it is first affected by any liver injury

Diagnosis of a rare case of neonatal intestinal duplication cyst isolated from the gastrointestinal tract - Case report

Duplication cysts are congenital anomalies that typically have some connection to the gastrointestinal (GI) tract, but in rare cases the cysts can be completed isolated from the GI tract. We present the case of an appropriate for gestational age male infant born at 40 weeks gestational age with neonatal intestinal duplication cyst isolated from the GI tract. Postnatal diagnostic methods included ultrasound (US) and magnetic resonance imaging (MRI) based on abnormal antenatal findings. The positive diagnosis was based on the imaging results. Duplication cysts may remain asymptomatic and that is the reason why antenatal and postnatal US screening plays an important key role in the diagnosis. Series of imaging may confirm the diagnosis, prevent future complication and help the clinician to determine the optimal operative moment