Sonography and Magnetic Resonance Imaging Characteristics of Testicular Adrenal Rest Tumors

Summary Background: The aim of this study was to describe the gray-scale and color Doppler ultrasonography (US) and magnetic resonance (MR) imaging features of testicular adrenal rest tumors (TART) in patients with congenital adrenal hyperplasia. Material/Methods Forty-one patients with congenital adrenal hyperplasia were evaluated by gray-scale and color Doppler ultrasonography. Totally eighteen adrenal rest tumors in 9 patients were diagnosed TART on US and MR imaging. Gray-scale and color Doppler US and MR findings of the patients were documented. Results: A total of eighteen masses were evaluated in nine patients. The mean age of these patients was 14.3±4.5 (range 10.1–23.3) years. US revealed hypoechoic lesions around the mediastinum testis with hypervascularity dispersing in ten patients and hypovascularity in two patients. In six patients, the lesions were hyperechoic with poor vascularity. Lesions exhibited homogeneous (n=8) and heterogeneous (n=10). Testicular microlithiasis was present in 4 of 9 patients with TART. Doppler ultrasound showed normal testicular vessels passing through the mass which were undisturbed, not displaced and not change in caliber. MRI features were the following: all lesions were hypointense on T2- and hyperintense (n=12) and isointense (n=6) on T1-weighted images. All masses revealed homogeneous contrast enhancement on postcontrast T1-weighted images. Conclusions: Ultrasonography and MRI are good methods for detecting and monitoring TART. US is the first preferable modality because it is quick and cheap than MRI. Bilateral mostly hypoechoic lesions depicted around the mediastinum testis with no mass effect is highly suggestive for the diagnosis of testicular adrenal rest tissues on ultrasonography. Normal testicular vessels coursing through the lesions undisturbed and not change in caliber is described specific for this kind of tumors

Sağlıklı Çocuklarda Mediastinal Lenf Ganglionları; Yaşa Göre Sıklık, Boyut Aralığı Ve Dağılım

nodes (LN) is crucial. We elaborated the mediastinal LNs based on location, size and age groups. Material and Method: Contrast enhanced chest computed tomography scans of 150 children who were referred to the radiology department after trauma, were evaluated retrospectively. All participants were divided into five age groups (0-24, 25-60, 61- 120, 121-180 and 181-216 months) which included thirty children each. We documented the shortest and longest axis diameters of the largest LNs and their location along with the age and gender of the children. Kolmogorov-Smirnov test, t test, Spearman’s correlation analysis assessment and descriptive statistics were expressed using SPSS 22. Results: Mean ages were 11.53±10.1, 39.4±11.1, 84±15.9, 154.9±17.6, 190±9.3 months in consecutive age groups and 96±69.17 months in general. The most frequent locations with detectable LNs were subcarinal (n:98, 64%), right lower paratracheal (n:88, 57%), right tracheobronchial (n:82, 56%), right upper paratracheal (n:75, 49%) and left tracheobronchial (n:61, %39) lymphatic stations. Mean short and long axis diameters were 3.97±1mm (interquartile range:3.4-5.2) and 7.48±1.98mm (interquartile range:6.3-9.1) among detected 648 LNs, respectively. Both short and long axis diameters of LNs in low cervical, prevascular, subcarinal, right-left paratracheal and right-left tracheobronchial locations were correlated with the age (p<0.05). Both short and long axis diameters of subcarinal LNs (4.78±1.05mm, 9.30±1.8mm) were significantly larger than right lower paratracheal (4.03±0.9mm, 7.94±1.6mm; p:0.001), right tracheobronchial (4.42±1.26mm, 8.59±2.1mm; p:0.04) and right upper paratracheal LNs (3.64±0.79mm, 7.1±1.49mm). Conclusion: Being aware of the size range for normal mediastinal LNs according to ages and locations would facilitate management and reduce unnecessary interventions and medications.Amaç: Klinik olarak anlamlı lenf nodları (LN) hakkında karar vermek çok önemlidir. Mediastinal LNları lokasyon, boyut ve yaş gruplarına göre değerlendirdik. Gereç ve Yöntem: Travma sonrası radyoloji bölümüne yönlendirilen 150 çocuğun kontrastlı göğüs bilgisayarlı tomografi taramaları retrospektif olarak değerlendirildi. Tüm katılımcılar her biri otuz çocuğu içeren beş yaş grubuna ayrıldı (0-24, 25-60, 61-120, 121-180 ve 181-216 ay). En büyük LNlarının kısa ve uzun eksendeki çapları konumları, yaş ve cinsiyetlerine göre değerlendirildi. SPSS 22 programı ile Kolmogorov-Smirnov testi, t testi, Spearman korelasyon analizi ve tanımlayıcı istatistikler çalışıldı. Bulgular: Ortalama yaş, gruplarda sırasıyla 11,53±10,1 ay, 39,4±11,1 ay, 84±15,9 ay, 154,9±17,6 ay, 190±9,3 ay ve toplamda 96±69,17 aydı. LN’larının en sık görüldüğü lokasyonlar subkarinal (n:98, %64), sağ alt paratrakeal (n:88, %57), sağ trakeobronşiyal (n:82, %56), sağ üst paratrakeal (n:75, %49) ve sol trakeobronşiyal (n:61, % 39) lenfatik istasyonlardı. Ortalama kısa ve uzun eksen çapları sırasıyla 647 LN arasında 3.97±1mm (çeyrekler arası aralık: 3,4-5,2) ve 7,48±1,98mm (çeyrekler arası aralık: 6,3-9,1) idi. Alt servikal, prevasküler, subkarinal, sağ-sol paratrakeal ve sağ-sol trakeobronşiyal lokasyonlarda LNlarının hem kısa hem de uzun eksen çapları yaşla korele idi (p<0,05). Subkarinal LN’larının kısa ve uzun eksen çapları (4,78±1,05 mm, 9,30±1,8mm) sağ alt paratrakeal (4,03±0,9mm, 7,94±1,6mm; p:0,001), sağ trakeobronşiyal (4,42±1,26mm, 8,59±2,1mm; p:0,04) ve sağ üst paratrakeal LN’lerden (3,64±0,79mm, 7.1±1,49mm) anlamlı derecede büyüktü

Diffuse pulmonary lymphangiomatosis: imaging findings

Diffuse pulmonary lymphangiomatosis is a rare pulmonary disorder affecting the lymphatic channels from the mediastinum to the pleura. The disease usually occurs in children and young adults and frequently ends with death due to progressive course. Imaging findings of the disease are based on lymphatic involvement which appear as mediastinal soft tissue infiltration and thickening of pulmonary peribroncovascular bundles and interlobular septae. In this report, spiral and high-resolution computed tomography, and ultrasonography findings of severe form of this rare disease are presented. Furthermore, some lymphatic disorders, which are called with similar name but different appearances on imaging, are discussed

Prevalence of Testicular Microlithiasis in Males with Congenital Adrenal Hyperplasia and Its Association with Testicular Adrenal Rest Tumors

Background: Testicular microlithiasis (TM) is characterized by calcium deposits within the seminiferous tubules and is associated with benign and malign conditions. Aim: To determine TM prevalence in patients with congenital adrenal hyperplasia (CAH) and its association with testicular adrenal rest tumors (TART). Patients and Methods: Scrotal ultrasound using a high-frequency linear transducer (12 MHz) was performed in 41 patients aged 12.1 +/- 4.7 (range 3.523.3) years and 49 healthy similarly aged controls. TM was classified with respect to the number of microliths per ultrasound field as limited (LTM, = 5 microliths). CTM was graded as grade 1 (5-10 microliths), grade 2 (11-20 microliths), and grade 3 (>20 microliths). Results: TM was detected bilaterally in 9 (21.9%) patients and 2 (4.1%) control cases (1 bilateral, 1 unilateral). Four patients had LTM, one evaluated as grade 1, one as grade 2, and three as grade 3. There were 9 patients with TART. Four patients had TM and TART concomitantly. Conclusion: Because TM is frequently found in patients with CAH and may also exist concomitantly with TART, we recommend that these patients be followed annually by testicular ultrasound. Copyright (C) 2010 S. Karger AG, Base

Acute osteomyelitis of the iliac bone presenting with gluteal syndrome in a newborn

Acute osteomyelitis in neonates, although rare, represents a diagnostic and therapeutic challenge. We herein report an extremely rare case of congenital nonsyphilitic iliac bone osteomyelitis caused by methicilline-sensitive Staphylococcus aureus and presenting with gluteal syndrome in a near-term infant. To our knowledge, this represents the second report with iliac osteomyelitis and the first report with gluteal syndrome in neonatal period. A high index of suspicion is necessary to make an early diagnosis. Early diagnosis is essential to prevent catastrophic sequelae in such cases. We report this case because of its unusual clinical presentation and rarity