Various Ultrasonographic Manifestations of Bacille Calmette-Guerin (BCG) Lymphadenitis in Infants after BCG Vaccination

PURPOSE: To evaluate the various ultrasonographic manifestations of BCG lymphadenitis complicated by BCG vaccination in infantsMATERIALS and METHODS:Among a total of 59 patients of BCG lymphadenitis, we retrospectively evaluated the ultrasonographic findings of five patients (seven involved areas), who were operated and confirmed by histopathology. Three cases were male and two were female and the age range is from 3 months to 9 months (mean: 5.5 months).RESULTS: Among five cases two had only a single lesion and three had multiple lesions, and two of those had multiple lesions at 2 separate locations. All five cases had ipsilateral supraclavicular lesions with same BCG vaccination site and two also had ipsilateral axillary lesions. Ultrasonography showed enlarged lymph nodes and heterogeneous hypoechoic changes suggesting internal necrosis or suppurative changes in three cases, but 1 had cystic necrotic change with fluid-fluid level and another had conglomerated mass with intermingled hyper and hypoechoic areas, which were initially suspected to be a tumorous condition but revealed conglomerated lymph nodes on follow-up ultrasonography and MRI. CONCLUSION: BCG lymphadenitis is usually located adjacent to a BCG vaccination site, but ultra-sonography can show single or multiple lymph node enlargement and various manifestations from homogeneous lymphadenitis to cystic abscess changes and even a mass-like appearance , demonstrating that the evaluation of ultrasonography should be done very carefully.ope

A Comparison of Accuracy between MRI and Arthroscopic Finding in the Diagnosis of Acute ACL Tear

Purpose: The purpose of this study is to evaluate the accuracy of magnetic resonance imaging (MRI) in the diagnosis of acute anterior cruciate ligament (ACL) injury and its tear pattern in comparison with arthroscopic finding. Materials and Methods: Sixty consecutive patients with acute ACL injury were taken NRI followed by arthroscopic examination between January 2002 and June 2004. MRI findings were reviewed according to the presence of ACL discontinuity, diffuse swelling or thickening, focal edema, collapse on distal end, and any combined tear. The pathologic findings were then confirmed arthroscopically. The diagnostic accuracy of MRI on ACL tear pattern was analyzed by obtaining its positive predictive value. Results: All fifty two cases with presence of discontinuity on MRI showed ACL rupture arthroscopically. The location of ACL tear, diffuse swelling and focal edema on MRI also corresponded with arthroscopic findings respectively. However, the diagnostic accuracy of MRI was relatively lower in the presence of other ACL patterns such as collapses and combined tear. Conclusion: Preoperative MRI findings seem to be in accordance with arthroscopic findings and is significantly accurate in detection of location and diffuse swelling and focal edema of ACL tear.ope

Prenatal diagnosis of an inguinoscrotal hernia: Sonographic and magnetic resonance imaging findings

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Ultrasound measurement of pediatric visceral fat thickness: correlations with metabolic and liver profiles

PURPOSE: Abdominal obesity is a fundamental factor underlying the development of metabolic syndrome. Because of radiation exposure and cost, computed tomography or dual-energy X-ray absorptiometry to evaluate abdominal adiposity are not appropriate in children. Authors evaluated whether ultrasound results could be an indicator of insulin resistance and nonalcoholic fatty liver disease (NAFLD). METHODS: We enrolled 73 subjects (aged 6-16 years) who were evaluated abdominal adiposity by ultrasound. Subcutaneous fat thickness was defined as the measurement from the skin-fat interface to the linea alba, and visceral fat thickness (VFT) was defined as the thickness from the linea alba to the aorta. Anthropometric and biochemical metabolic parameters were also collected and compared. The subjects who met 2 criteria, radiologic confirmed fatty liver and alanine aminotransferase >40, were diagnosed with NAFLD. RESULTS: There was a strong positive correlation between VFT and obesity. VFT was highly correlated with the homeostasis model assessment for insulin resistance score (r=0.403, P<0.001). The area under the curve for VFT as a predictor of NAFLD was 0.875 (95% confidence interval [CI], 0.787-0.964). VFT of 34.3 mm was found to be the discriminating cutoff for NAFLD (sensitivity, 84.6%; specificity, 71.2%, respectively). CONCLUSION: Ultrasound could be useful in measuring VFT and assessing abdominal adiposity in children. Moreover, increased VFT might be an appropriate prognostic factor for insulin resistance and NAFLD.ope

Percutaneous Transhepatic Biliary Drainage in a Two-Month-Old Infant with Inspissated Bile Syndrome

Inspissated bile syndrome (IBS) is a relatively rare condition. Many treatment options are available, including medication, surgery, and surgical interventions, such as insertion of cholecystostomy drain, endoscopic retrograde cholangiopancreatography, internal biliary drainage, and percutaneous transhepatic biliary drainage (PTBD). We herein report the first case of IBS that was successfully treated with PTBD in a two-month-old infant in Korea. PTBD was initiated on postnatal day 72. On postnatal day 105, we confirmed complete improvement and successfully removed the catheters. This report suggests that PTBD is a viable and safe treatment option for obstructive jaundice in very young infants.ope

Visceral fat thickness and its associations with pubertal and metabolic parameters among girls with precocious puberty.

PURPOSE: This study aimed to investigate associations of central obesity with sexual maturation and metabolic parameters in Korean girls with precocious puberty. METHODS: This retrospective study evaluated data from 72 girls under 8 years of age with a chief complaint of early breast development. The patients were categorized as central precocious puberty (CPP) subjects or non-CPP subjects based on their gonadotropin-releasing hormone stimulation test results. Visceral fat thickness (VFT) was measured using ultrasonography and defined as the distance from the linea alba to the aorta. Patient anthropometric, metabolic, and hormonal parameters were also evaluated. RESULTS: Increased VFT was correlated with an earlier onset of thelarche among all study subjects (r=-0.307, P=0.034). Overweight CPP subjects showed higher insulin resistance than normal weight CPP subjects. Insulin resistance was not significantly different between overweight and normal weight non-CPP subjects. VFT was not significantly different between CPP and non-CPP subjects (2.22±0.79 cm vs. 2.74±1.47 cm, P=0.169). However, overweight and obese CPP subjects (body mass index percentile>85%) had lower VFT than non-CPP obese subjects. CONCLUSION: Central obesity, defined using ultrasonography-measured VFT, might be associated with early pubertal development in Korean girls. However, VFT was not higher in CPP than non-CPP patients and was not significantly correlated with insulin resistance. Further longitudinal studies with a larger cohort are needed.ope

Brain Magnetic Resonance Angiography in Children with Chronic Headache

Purpose : Headaches occur frequently in the pediatric population and have a significant impact on their quality of life. Several mechanisms are currently thought to contribute to headache pathogenesis. Our aim was to investigate the association of chronic headache in children and cerebral vascular anomaly by performing brain magnetic resonance angiography(MRA). Methods : We retrospectively reviewed medical records and MRA of 44 patients with chronic headache who visited the pediatric clinic of Young Dong Severance hospital from January 2006 to April 2008. Results : The number of enrolled patients was 44. Eight(18.2%) of them showed abnormal brain MRA findings. Abnormal findings included 5 cases of unilateral A1 hypoplasia, 1 case of unilateral vertebral artery hypoplasia, 1 case of unilateral A1 and P1 hypoplasia, 1 case of Moyamoya disease. Among the 44 patients, 21 had complained only headache and 23 had complained other neurological symptoms with headache. The ratio of abnormal MRA between the two groups showed no statistical difference. Conclusion : Vascular anomaly could be a possible pathogenesis and risk factor in chronic headache in children. Further investigation and long term follow up is neededope

Imaging of primary chest wall tumors with radiologic-pathologic correlation

Neoplasms and tumorlike lesions that originate from chest wall tissues are uncommon compared with tumors in other parts of the body, and unfamiliarity with these disease entities can cause diagnostic difficulties for radiologists. Furthermore, the imaging features of many of these tumors are nonspecific, particularly those that are locally aggressive. However, a systematic approach based on patient age, clinical history, lesion location, and characteristic imaging findings often helps limit the differential diagnosis. Primary chest wall tumors can be classified as bone or soft-tissue tumors, with the latter being further classified into adipocytic tumors, vascular tumors, peripheral nerve sheath tumors, cutaneous lesions, fibroblastic-myofibroblastic tumors, and so-called fibrohistiocytic tumors, largely based on the 2002 World Health Organization classification. Within each category, it is possible to further limit the differential diagnosis with cross-sectional imaging. Information on specific features (eg, mineralization, fibrosis, hemosiderin deposits) and imaging patterns (eg, the "target sign" and "fascicular sign" seen in neurogenic tumors) can aid in making the diagnosis. Radiologists can achieve a sufficiently specific diagnosis of bone tumors and soft-tissue tumors if typical findings are present.ope

A case of eosinophilic fasciitis presenting as pitting edema of the lower extremities

Eosinophilic fasciitis is a rare disease characterized by diffuse fasciitis with peripheral eosinophilia and progressive induration and thickening of the skin and soft tissues. We report a 19-year-old female who presented with pitting edema in both lower extremities. She had a history of excessive physical activity before her symptoms developed. Physical examination revealed 2+ pitting edema in both lower legs. She complained of mild pain in both knee joints and feet, with no tenderness or heating sensations. Laboratory results were unremarkable except for severe eosinophilia. Parasite infection, venous thrombosis, and cardiac and renal problems were excluded. A magnetic resonance imaging study of both lower extremities revealed increased signal intensity in the subcutaneous lesions, consistent with superficial inflammation of the fascia. Mixed perivenular lymphoplasmacytic and eosinophilic infiltration in the subcutaneous lesion were observed on biopsy. The patient was treated with corticosteroids, resulting in remarkable improvement in both edema and eosinophilia.ope

Ultrasound Feature-Based Diagnostic Model Focusing on the "Submarine Sign" for Epidermal Cysts among Superficial Soft Tissue Lesions

OBJECTIVE: To develop a diagnostic model for superficial soft tissue lesions to differentiate epidermal cyst (EC) from other lesions based on ultrasound (US) features. MATERIALS AND METHODS: This retrospective study included 205 patients who had undergone US examinations for superficial soft tissue lesions and subsequent surgical excision. The study population was divided into the derivation set (n = 112) and validation set (n = 93) according to the imaging date. The following US features were analyzed to determine those that could discriminate EC from other lesions: more-than-half-depth involvement of the dermal layer, "submarine sign" (focal projection of the hypoechoic portion to the epidermis), posterior acoustic enhancement, posterior wall enhancement, morphology, shape, echogenicity, vascularity, and perilesional fat change. Using multivariable logistic regression, a diagnostic model was constructed and visualized as a nomogram. The performance of the diagnostic model was assessed by calculating the area under the curve (AUC) of the receiver operating characteristic curve and calibration plot in both the derivation and validation sets. RESULTS: More-than-half-depth involvement of the dermal layer (odds ratio [OR] = 3.35; p = 0.051), "submarine sign" (OR = 12.2; p < 0.001), and morphology (OR = 5.44; p = 0.002) were features that outweighed the others when diagnosing EC. The diagnostic model based on these features showed good discrimination ability in both the derivation set (AUC = 0.888, 95% confidence interval [95% CI] = 0.825-0.950) and validation set (AUC = 0.902, 95% CI = 0.832-0.972). CONCLUSION: More-than-half-depth of involvement of the dermal layer, "submarine sign," and morphology are relatively better US features than the others for diagnosing EC.ope