Kikuchi's Disease in Children: Clinical Manifestations and Imaging Features

Previously published studies on Kikuchi disease (KD) have frequently addressed the computed tomography (CT) findings in the adult population, however, only a few studies have been reported for the pediatric age group. The purpose of this study is to analyze the clinical characteristics and imaging features of KD in children. Fifteen children (2-14 yr) who had a neck CT and pathology diagnosis of KD were included in this study. Clinical features, including the duration of lymphadenopathy and fever, prognosis, and laboratory values, were evaluated. We analyzed the sites, size, and lymph node pattern as seen on their CT scans. The median duration of fever was 10 days. Fourteen patients experienced improvement in their condition, although four of these patients experienced recurrent episodes of KD. All patients had affected cervical nodes at level V. Perinodal infiltrates were observed in the affected cervical nodes in 14 cases (93%), and non-enhancing necrosis was also noted within the affected cervical nodes in 10 cases (63%). In conclusion, the combination of imaging findings in conjunction with clinical findings of KD may help to determine whether or not to perform pathology analysis and follow-up studies

Gastrointestinal Complications Following Hematopoietic Stem Cell Transplantation in Children

Gastrointestinal system involvement is one of the principal complications seen in the recipients of hematopoietic stem cell transplantation (HSCT), and it is also a major cause of morbidity and death in these patients. The major gastrointestinal complications include typhlitis (neutropenic enterocolitis), pseudomembranous enterocolitis, viral enteritis, graft-versus-host disease, benign pneumatosis intestinalis, intestinal thrombotic microangiopathy, and post-transplantation lymphoproliferative disease. As these patients present with nonspecific abdominal symptoms, evaluation with using such imaging modalities as ultrasonography and CT is essential in order to assess the extent of gastrointestinal involvement and to diagnose these complications. We present here a pictorial review of the imaging features and other factors involved in the diagnosis of these gastrointestinal complications in pediatric HSCT recipients

High Grade Hemangioendothelioma of the Temporal Bone in a Child: A Case Report

Hemangioendothelioma is a rare vascular tumor characterized by endothelial tumor cells and variable malignant behavior, and it's not common for this lesion to involve the bone. Although there are a few reports of cranial involvement by hemangioendothelioma, only rare cases arising in temporal bone have been published. We present the radiologic findings of a 7-year-old boy who had a high grade hemangioendothelioma involving the temporal bone with intracranial extension. Evidence of flow voids on MR images suggested a tumor of vascular origin, and the ill-defined margins, cortical destruction and intracranial extension on the CT and MR images were correlated with the tumor's high histologic grade

Comparison of Clinico-Radiological Features between Congenital Cystic Neuroblastoma and Neonatal Adrenal Hemorrhagic Pseudocyst

OBJECTIVE: To evaluate the radiological and clinical findings of congenital cystic neuroblastomas as compared with those of the cystic presentation of neonatal adrenal hemorrhage. MATERIALS AND METHODS: We analyzed the US (n = 52), CT (n = 24), and MR (n = 4) images as well as the medical records of 28 patients harboring congenital cystic neuroblastomas (n = 16) and neonatal adrenal hemorrhagic pseudocysts (n = 14). The history of prenatal detection, location, size, presence of outer wall enhancement, internal septations, solid portion, calcification, turbidity, vascular flow on a Doppler examination, and evolution patterns were compared in two groups of cystic lesions, by Fischer's exact test. RESULTS: All (100%) neuroblastomas and three (21%) of the 14 hemorrhagic pseudocysts were detected prenatally. Both groups of cystic lesions occurred more frequently on the right side; 11 of 16 (69%) for neuroblastomas and 11 of 14 (79%) for hemorrhagic pseudocysts. The size, presence of solid portion, septum, enhancement, and turbidity did not differ significantly (p > 0.05) between the two groups of cystic lesions. However, tiny calcifications (n = 3) and vascular flow on color Doppler US (n = 3) were noted in only neuroblastomas. The cystic neuroblastomas became complex solid and cystic masses, and did not disappear for up to 90 days in the three following cases, whereas 11 of the 14 (79%) hemorrhagic pseudocysts disappeared completely and the three remaining (27%) evolved to calcifications only. CONCLUSION: Although the imaging findings of two groups of cystic lesions were similar, prenatal detection, the presence of calcification on initial images, vascularity on color Doppler US, and evolution to a more complex mass may all favor neuroblastomasope

Posttransplantation Lymphoproliferative Disorder in Children: Manifestations in Hematopoietic Cell Recipients in Comparison with Liver Recipients

Purpose: To compare the clinical and imaging features of posttransplantation lymphoproliferative disorder (PTLD) in pediatric patients who underwent hematopoietic cell transplantation with those in pediatric patients who underwent liver transplantation. Materials and Methods: This study was approved by the institutional review board, and the requirement to obtain informed consent was waived. The authors retrospectively reviewed the medical records and images of 552 hematopoietic cell transplant recipients and 195 liver transplant recipients. PTLD was histopathologically confirmed in 17 of the patients who underwent hematopoietic cell transplantation and 27 of the patients who underwent liver transplantation. The overall frequency, clinical course, histopathologic type, and imaging findings of PTLD were compared between the two patient groups by using the Fisher exact test. Results: The overall frequency of PTLD was 3% (17 of 552 patients) after hematopoietic cell transplantation (12% [nine of 75 patients] after umbilical cord blood transplantation) and 14% (27 of 194 patients) after liver transplantation. PTLD occurred within 6 months of transplantation in 14 of the 17 hematopoietic cell recipients (82%) and 11 of the 27 liver recipients (41%) (P = .012). Histopathologic examination revealed monomorphic disease in 11 of the 17 hematopoietic cell recipients (65%) and eight of the 27 liver recipients (30%) (P = .031). The abdomen was the most common site of involvement in both groups. Extraabdominal PTLD developed in 12 of the 17 hematopoietic cell recipients (71%) and five of the 27 liver recipients (19%) (P = .002). Although 15 of the 17 patients with hematopoietic cell transplantation-related PTLD (88%) exhibited responses after treatment, the overall mortality rate was 35% (six of 17 patients). All 27 patients with PTLD after liver transplantation improved after treatment and remain alive. Conclusion: PTLD after umbilical cord blood transplantation occurred as frequently as liver transplantation-related PTLD. Compared with liver transplantation-related PTLD, PTLD after hematopoietic cell transplantation is characterized by an earlier onset, a higher proportion of malignant monomorphic disease, and a worse outcome.Landgren O, 2009, BLOOD, V113, P4992, DOI 10.1182/blood-2008-09-178046Bradley MB, 2007, BONE MARROW TRANSPL, V40, P621, DOI 10.1038/sj.bmt.1705785Brunstein CG, 2006, BLOOD, V108, P2874, DOI 10.1182/blood-2006-03-011791Gong JZ, 2006, AM J SURG PATHOL, V30, P328Cohen J, 2005, BRIT J HAEMATOL, V129, P229, DOI 10.1111/j.1365-2141.2005.05439.xBarker JN, 2003, CRIT REV ONCOL HEMAT, V48, P35, DOI 10.1016/S1040-8428(03)00092-1Cohen Y, 2003, LEUKEMIA LYMPHOMA, V44, P1287, DOI 10.1080/1042819031000077016Juvonen E, 2003, BONE MARROW TRANSPL, V32, P97, DOI 10.1038/sj.bmt.1704089Jain A, 2002, ANN SURG, V236, P429, DOI 10.1097/01.SLA.0000033429.89429.89424.F8Lim GY, 2002, RADIOLOGY, V222, P699, DOI 10.1148/radiol.2223010456JAIN A, 2002, ANN SURG, V236, P436Wu L, 2001, ABDOM IMAGING, V26, P200Barker JN, 2001, BIOL BLOOD MARROW TR, V7, P395HARRIS NL, 2001, WHO CLASSIFICATION T, P264Pickhardt PJ, 2000, RADIOLOGY, V217, P16Loevner LA, 2000, RADIOLOGY, V216, P363Curtis RE, 1999, BLOOD, V94, P2208Pickhardt PJ, 1999, RADIOLOGY, V213, P73Pickhardt PJ, 1999, AM J ROENTGENOL, V172, P1117Pickhardt PJ, 1998, AM J ROENTGENOL, V171, P1007Donnelly LF, 1998, AM J ROENTGENOL, V171, P725MCDIARMID SV, 1998, PEDIATR TRANSPLANT, V2, P106Nalesnik MA, 1998, SPRINGER SEMIN IMMUN, V20, P325Sweet SC, 1997, AM J RESP CRIT CARE, V155, P1027Harris NL, 1997, SEMIN DIAGN PATHOL, V14, P8CECKA JM, 1997, PEDIATR TRANSPLANT, V1, P55NALESNIK MA, 1996, SEMIN THORAC CARDIOV, V8, P139DODD GD, 1992, RADIOLOGY, V184, P65NALESNIK MA, 1988, AM J PATHOL, V133, P173HO M, 1988, TRANSPLANTATION, V45, P719BRAGG DG, 1986, RADIOLOGY, V159, P291NAGINGTON J, 1980, LANCET, V1, P536MURRAY JE, 1968, ANN SURG, V168, P416