RESUMEN
Bartonella henselae, the causative agent of cat-scratch disease, has been recognized to be responsible for a broad range of clinical syndromes. We report the case of a patient with disseminated B. henselae infection mimicking Langerhans cell histiocytosis at presentation and its successful management with neurosurgery, prolonged antibacterial therapy, and observation.
Asunto(s)
Bartonella henselae , Enfermedad por Rasguño de Gato , Histiocitosis de Células de Langerhans , Enfermedad por Rasguño de Gato/diagnóstico , Enfermedad por Rasguño de Gato/terapia , Niño , Diagnóstico Diferencial , Femenino , Histiocitosis de Células de Langerhans/diagnóstico , Histiocitosis de Células de Langerhans/terapia , HumanosRESUMEN
The classification of thyroid nodules in children is often difficult, especially in pretreated patients with metastatic disease. In osteosarcoma patients, Tc-MDP SPECT/CT is used for primary and follow-up staging. Bone and soft tissue metastases can be revealed because of Tc-MDP imaging of osteoid-producing metastases. We present Tc-MDP SPECT-CT, CT, and ultrasound images of a highly suspicious calcified thyroid lesion in a 17-year-old boy with osteosarcoma. High uptake in Tc-MDP SPECT-CT provides diagnosis of thyroid metastasis of osteosarcoma, which was proven by histopathology.
Asunto(s)
Neoplasias Óseas/patología , Osteosarcoma/patología , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único , Medronato de Tecnecio Tc 99m , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/secundario , Adolescente , Humanos , Masculino , Estadificación de Neoplasias , Neoplasias de la Tiroides/patología , UltrasonografíaRESUMEN
Radiation-free imaging procedures for the purposes of forensic age diagnosis are highly desirable, especially for children. With this in mind, the stage of ossification of the olecranon was prospectively determined in 309 male and 307 female healthy volunteers aged between 10 and 25 years, based on ultrasound. A four-stage classification system was used for this purpose. This stage classification system takes into account whether an isolated secondary ossification centre, an epiphyseal cartilage or an epiphysis which is completely fused with the diaphysis can be detected. The earliest observation of stage 2 was at 10.0 years in males and 10.1 years in females. Both findings are determined by the lower age limit of the sample and are thus not representative of the minimum age for ossification stage 2. Stage 3 was first noticed at age 13.5 years in males and 10.6 years in females. Stage 4 was first reached at age 13.7 years in males and 12.3 years in females. Hence, in our sample, ossification stage 3 can be seen as evidence that females have reached the age of 10 years and males the age of 13 years. In our sample, stage 4 provides evidence that a female individual has reached the age of 12 years. It was concluded that the results of our study should be validated using other samples.
Asunto(s)
Determinación de la Edad por el Esqueleto/métodos , Olécranon/diagnóstico por imagen , Olécranon/crecimiento & desarrollo , Osteogénesis , Adolescente , Adulto , Niño , Diáfisis/diagnóstico por imagen , Diáfisis/crecimiento & desarrollo , Epífisis/diagnóstico por imagen , Epífisis/crecimiento & desarrollo , Femenino , Antropología Forense , Humanos , Masculino , Estudios Prospectivos , Caracteres Sexuales , Determinación del Sexo por el Esqueleto , Ultrasonografía , Adulto JovenRESUMEN
In order to increase the reliability of forensic age estimations in living adolescents and young adults without justification for X-ray examinations, the establishment of radiation-free imaging procedures is desirable. In this study, the ossification stage of the right-hand distal fibula epiphysis was sonographically determined prospectively in 309 male and 307 female healthy volunteers. For this purpose a four-stage classification system was used. A sonographically determined ossification stage 3 permits the proof of completion of age 13 in boys and the proof of completion of age 12 in girls. In case of an ossification stage 4 the completion of age 14 in boys and the completion of age 13 in girls can be certified. In order to increase the level of reliability of age estimates, findings should be collected by at least two independent examiners who are experienced in the sonography of skeletons, followed by consensus-building.
Asunto(s)
Determinación de la Edad por el Esqueleto/métodos , Peroné/diagnóstico por imagen , Osteogénesis/fisiología , Adolescente , Adulto , Factores de Edad , Niño , Epífisis/diagnóstico por imagen , Epífisis/fisiología , Femenino , Peroné/fisiología , Humanos , Masculino , Valores de Referencia , Factores Sexuales , Ultrasonografía , Adulto JovenRESUMEN
Establishing radiation-free imaging methods for the assessment of clavicular ossification in forensic age determination is desirable as it reduces radiation exposure in living individuals. For this purpose the stage of ossification of the right medial clavicular epiphysis was determined prospectively using sonography in 309 male and 307 female healthy volunteers. The classification of stages according to Schulz et al. was used for this purpose. Stage 2 was first noticed at the age of 14.4 years in males, and at the age of 14.1 years in females. Stage 3 was first achieved by males at the age of 17.6 years and by females at the age of 17.4 years. Stage 4 first occurred in males at the age of 19.3 years and at the age of 18.9 years in females. The mean age for stage 1 was 13.6 years. The mean age of stage 2 ranged between 17.3 and 17.6 years. For stage 3 the mean age varied from 20.7 to 21.2 years, and for stage 4 from 23.3 to 23.5 years. It was concluded that sonographically determined stage 4 clavicular ossification provides evidence for the completion of the nineteenth year of life in males and the eighteenth year of life in females. In order to increase the reliability of age determination using this method it is recommended that findings be recorded by at least two experienced independent examiners who then reach a consensus.
Asunto(s)
Determinación de la Edad por el Esqueleto/métodos , Clavícula/diagnóstico por imagen , Epífisis/diagnóstico por imagen , Patologia Forense/métodos , Osteogénesis , Adolescente , Adulto , Factores de Edad , Niño , Clavícula/crecimiento & desarrollo , Consenso , Epífisis/crecimiento & desarrollo , Femenino , Voluntarios Sanos , Humanos , Masculino , Variaciones Dependientes del Observador , Valor Predictivo de las Pruebas , Estudios Prospectivos , Reproducibilidad de los Resultados , Factores Sexuales , Ultrasonografía , Adulto JovenRESUMEN
When preparing forensic age estimates for living subjects over 18 years of age, it is crucial to evaluate the stage of ossification of the medial clavicular epiphysis. The establishment of radiation-free imaging techniques for assessment of clavicular ossification would be desirable in order to reduce the radiation exposure associated with forensic age estimations. In the present study, 84 right clavicles of test subjects 12-30 years of age were prospectively evaluated by means of ultrasound. Ossification stage classification was possible in 80 of the 84 medial clavicular epiphyses studied. In the remaining cases, stage classification was not possible due to the presence of developmental anomalies. The earliest ages at which the respective ossification stages were observed were 17.1 years for stage 2, 16.7 years for stage 3, and 22.5 years for stage 4. The age intervals observed for the ossification stages are consistent with the known data from radiological and computed tomography assessments. The present study results should be confirmed in a larger number of cases and with analysis of observer variability. Evaluation of medial clavicular epiphyseal ossification by ultrasound could ultimately be a rapid and economic non-ionizing diagnostic imaging procedure for forensic age estimation.
Asunto(s)
Determinación de la Edad por el Esqueleto/métodos , Clavícula/anatomía & histología , Clavícula/diagnóstico por imagen , Osteogénesis/fisiología , Adolescente , Adulto , Niño , Epífisis/anatomía & histología , Epífisis/diagnóstico por imagen , Femenino , Antropología Forense , Humanos , Masculino , Estudios Prospectivos , Caracteres Sexuales , UltrasonografíaRESUMEN
OBJECTIVE: We sought to evaluate the diagnostic performance of a portable indirect flat-panel detector for low-dose imaging as compared with an asymmetric film-screen system in a pediatric intensive care unit. MATERIALS AND METHODS: A total of 120 neonates underwent chest radiographs using a portable flat-panel detector (digital speed 800) and an asymmetric film-screen system (400 speed). Four readers evaluated the detection of 11 anatomic and 5 pathologic landmarks and 4 support devices. Statistical analysis was performed using repeated analysis of variance. The level of statistical significance was P = 0.05. RESULTS: The detection of 4 anatomic/4 pathologic landmarks and 2 support devices was significantly better using the flat-panel detector as compared with the asymmetric film-screen system (P < 0.05). Another 8 anatomic and one pathologic landmarks were detected equally well or slightly better with the flat-panel detector (P > 0.05). CONCLUSIONS: The portable flat-panel detector offers the potential of a 50% dose reduction with equal or significantly better detection of clinically important structures.
Asunto(s)
Radiografía Torácica/instrumentación , Pantallas Intensificadoras de Rayos X , Humanos , Recién Nacido , Recien Nacido Prematuro , Unidades de Cuidado Intensivo Pediátrico , Variaciones Dependientes del Observador , Dosis de RadiaciónRESUMEN
PURPOSE: To compare the exposure dose requirements and performance of a portable indirect flat-panel detector for pediatric use in the depiction of catheters, simulated pulmonary nodules, and simulated interstitial lung disease with those of storage phosphor radiography. MATERIALS AND METHODS: Catheters and simulated nodules and subtle interstitial lung disease (miliary, reticular, linear, and ground-glass patterns) were superimposed over an anthropomorphic chest phantom. Images were obtained with different exposures corresponding to simulated speeds of 400 and 800 with a portable flat-panel detector and printed on hard copies. These images were compared with those from storage phosphor radiography at a simulated speed of 400, which is typically used in pediatric radiology. Four independent readers recorded 7200 observations per pattern (for a total of 600 statistically independent observations), and these observations were subjected to receiver operating characteristic (ROC) analysis. Differences were considered significant at a P value of .05. RESULTS: Catheters over obscured chest areas, nodules 10 mm or smaller and larger than 10 mm over lucent lung, nodules 10 mm or smaller over obscured chest areas, and miliary and linear patterns over lucent lung showed higher areas under the ROC curve (A(z)) with the flat-panel detector at 400 and 800 digital speed compared with storage phosphor radiography. A(z) values for reticular and ground-glass patterns with the flat-panel detector were equal to or less than those with storage phosphor radiography. These differences, however, were not statistically significant. CONCLUSION: In the detection of catheters, nodules, and almost all interstitial lung disease, A(z) values were higher with the portable flat-panel detector than with storage phosphor radiography at equivalent and reduced speeds. These results suggest that the portable flat-panel detector could be used with reduced exposure dose in pediatric patients.
Asunto(s)
Enfermedades Pulmonares/diagnóstico por imagen , Pediatría/instrumentación , Fantasmas de Imagen , Radiografía Torácica/instrumentación , Pantallas Intensificadoras de Rayos X , Análisis de Varianza , Humanos , Procesamiento de Imagen Asistido por Computador , Curva ROC , Dosis de Radiación , Radiografía Intervencional/instrumentaciónRESUMEN
Malignancies from the Ewing family of tumors and acute lymphoblastic leukemia (ALL) are not known to be associated with each other. A 5-year-old girl was incidentally found to suffer from acute lymphoblastic leukemia during bone marrow staging for Ewing sarcoma of the radius. The simultaneous presence of two distinct neoplasms was confirmed by RT-PCR, with EWS/FLI1 type 1 rearrangement in the bone tumor and TEL/AML1 rearrangement in the marrow. She was treated with chemotherapy, radiotherapy, and surgery and was in remission of both diseases 31 months after diagnosis.
Asunto(s)
Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Sarcoma de Ewing/complicaciones , Preescolar , Terapia Combinada , Subunidad alfa 2 del Factor de Unión al Sitio Principal , Supervivencia sin Enfermedad , Femenino , Humanos , Proteínas de Fusión Oncogénica , Reacción en Cadena de la Polimerasa , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Proteína Proto-Oncogénica c-fli-1 , Proteína EWS de Unión a ARN , Sarcoma de Ewing/diagnóstico , Sarcoma de Ewing/terapia , Translocación GenéticaRESUMEN
Kirner's deformity is an uncommon, but characteristic volar-radial incurvature of the distal phalanx of the little finger. We report a 5-year-old girl with dystelephalangy of all fingers. Some members of the mother's family showed dystelephalangy of the little fingers; the father's family history was unaffected. Contrast-enhanced MRI showed enhancement of the soft tissues of the distal phalanges, but no bone deformities. This leads to the assumption that the radial and volar deviation of the distal phalanges is the result of a chronic inflammatory process or a vascularisation disorder of the soft tissue.