The paediatric suprasellar cistern as an important CT review area

Pathology affecting the suprasellar cistern is varied in paediatric neuroradiology practice. Although MRI is the imaging modality of choice for lesions of the suprasellar cistern, abnormalities can be detected on CT with knowledge of the normal anatomy and a sound approach to the possible pathological entities. We present our approach to pathology affecting the suprasellar cistern and highlight this using various cases seen at our institution in the recent past

Computed tomography features of basal ganglia and periventricular calcifications in childhood

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Imaging findings in a patient with eosinophilic pneumonia (Lvffler's syndrome)

Löffler’s syndrome was initially described as a disorder characterised by transient pulmonary infiltrates accompanied by peripheral blood eosinophilia in asymptomatic or mildly ill patients. Abnormal chest radiographic findings are said to occur in 95% of patients but there are no descriptions of CT findings. There are many causes of this syndrome, but in developing countries the most common presentation remains secondary to the migratory larvae of common intestinal helminths. We present the clinical and radiological features of a boy with clearly defined Löffler's syndrome due to larval migration

Hypertensive encephalopathy with CT confirmation in four children with acute renal disease

Hypertensive encephalopathy (HE) is a clinical syndrome that occurs infrequently in children and is often underdiagnosed. We review four patients with HE and describe their clinical presentation and radiological findings on computed tomography (CT). Our cases demonstrate typical features on CT and correlate clinically with the syndrome of HE. Prompt recognition of the syndrome aids in earlier diagnosis and treatment, and hence proves beneficial to the patient

Magnetic resonance imaging diagnosis of causes of cerebral palsy in a developing country: A database of South African children

Background. Cerebral palsy (CP) is a common worldwide disabling disorder. However, data about prevalence and causes of CP in developing countries are deficient because of high cost and limited availability of magnetic resonance imaging (MRI), the gold standard neuro-imaging modality for evaluation and management of CP in neonates. Objectives. To determine the frequency of CP causes in children with suspected hypoxic ischaemic injury (HII) involved in medicolegal litigation in South Africa based on MRI report findings. Methods. A total of 1 620 MRI reports were categorised into HII, non-HII and normal MRI. None of the patients had prior neuro-imaging records. HII reports were sub-classified according to pattern of brain injury into basal ganglia-thalamus (BGT), watershed (WS), combined BGT-WS, periventricular leukomalacia (PVL) and multicystic encephalomalacia. Non-HII diagnoses were sub-classified into strokes, congenital malformations, kernicterus, hydrocephalus, haemorrhages, atrophies, metabolic causes and infections. Results. The median age was 6 years. HII reports (n=1 233; 76.1%) showed BGT in 447 (27.6%), WS in 266 (16.4%), combined BGT-WS in 335 (20.7%), PVL in 58 (3.6%) and multicystic in 127 (7.8%). Non-HII diagnoses (n=255; 15.7%) showed 78 (4.8%) congenital malformations, 50 (3.1%) atrophies, 35 (2.1%) kernicterus, 23 (1.4%) strokes, 12 (0.8%) haemorrhages, 14 (0.9%) hydrocephalus, 36 (2.1%) metabolic and 7 (0.5%) infections. Normal exams were 132 (8.2%). Conclusions. Despite being performed a relatively long time – median of 6 years – after the suspected perinatal HII, MRI yielded a diagnosis in 92% and showed that only 76% were due to HII, and more importantly, that there was a preterm HII pattern of injury in 15%, which when added to the 16% of non-HII cases, could potentially save on litigation in a total of 31% of cases that are unlikely to be related to malpractice. MRI should be performed wherever possible in CP cases, even if no imaging exam was performed in the perinatal period

Cognitive decline and depressed level of consciousness in AIDS: Diagnosis

Cognitive decline and depressed level of consciousness in AIDS: Diagnosi

Baseline chest radiographic features of HIV-infected children eligible for antiretroviral therapy

Background. South Africa’s HIV mortality is primarily due to pulmonary disease. No evidence exists regarding a correlation between specific chest radiographic patterns and CD4 levels of immunity in HIV-infected children.Objectives. We aimed to determine the prevalence of specific radiographic features in HIV-infected children initiating antiretroviral therapy (ART) to develop a guideline of expected baseline radiographic appearances, and the radiographic features that predominate at specific levels of immune suppression (defined by CD4 percentage ranges), which would narrow the radiological differential diagnosis.Method. Retrospective review of the baseline chest radiographs of 92 consecutive paediatric outpatients initiating ART.Results. Normal radiographs were reported in 54% of patients. Those with radiographic abnormalities had parenchymal disease (34%), mediastinal disease (22%) and pleural disease (1%). Parenchymal disease was predominantly air space (28%), and mediastinal disease was predominantly cardiomegaly (21%); lymphadenopathy was rare (1%). Radiological appearances of TB were seen in 9% of patients. A statistically significant association was shown between immune suppression and air space disease (p=0.049) with a relative risk of 0.46 (95% CI 0.24 - 0.88) for air space disease in immune-suppressed children. This association was independent of age.Conclusion. Baseline chest radiographs in paediatric outpatients presenting for initiation of ART are predominantly normal, but also demonstrate a significant number of pathological radiological features – primarily air space disease and cardiomegaly. The only statistically significant association between radiographic features and immune suppression was air space disease, which correlated with a higher level of immunity.S Afr Med J 2011;101:829-834

The hyperdense middle cerebral artery sign in a polycythaemic child

The hyperdense middle cerebral artery (HMCA) sign is known to be an early sign of intracranial arterial occlusion or infarction during unenhanced CT imaging of the brain.1 This sign has also been seen after treatment with bromide,2 in cocaine abusers3 and in adults with elevated haematocrit,4 but has not previously been reported to be a result of polycythaemia in children