Radiological Appearance Research Articles

The use of hyperbaric oxygen for avascular necrosis of the femoral head and femoral condyle: a single centre's experience over 30 years.

Avascular necrosis (AVN) is a rare progressive degenerative disease leading to bone and joint destruction. Patients often require surgical intervention. Femoral AVN is the most common anatomical location. Hyperbaric oxygen treatment (HBOT) has been shown to be effective in AVN. We present data collected from one centre over a 30-year period and compare the results with other published data. A retrospective chart review of all patients receiving HBOT for AVN at Fremantle and Fiona Stanley Hospitals since 1989 was performed. The primary outcome was radiological appearance using the Steinberg score, with secondary outcomes being subjective improvement, the need for joint replacement surgery and rates of complications. Twenty-one joints in 14 patients (14 femoral heads and seven femoral condyles) were treated with HBOT since 1989. Two patients were excluded. Within the femoral head group, nine of the 14 joints (64%) had stable or improved magnetic resonance imaging (MRI) scans post treatment and at six months (minimum); 10 joints (71%) had good outcomes subjectively, three joints required surgical intervention, and three patients developed mild aural barotrauma. Within the femoral condyle group, all five joints had stable or improved post-treatment MRI scans (four had visible improvement in oedema and/or chondral stability), four joints reported good outcomes subjectively, none of the patients required surgical intervention (follow-up > six months). This single centre retrospective study observed prevention of disease progression in femoral AVN with the use of HBOT, comparable to other published studies. This adds to the body of evidence that HBOT may have a significant role in the treatment of femoral AVN.

DIPG-80. IMAGING CHARACTERISTICS IN PEDIATRIC PATIENTS WITH DIFFUSE INTRINSIC PONTINE GLIOMA AND OUTCOME: THE MD ANDERSON CANCER CENTER EXPERIENCE

Abstract BACKGROUND Diffuse intrinsic pontine glioma (DIPG) occurs exclusively in children and, although rare, carries a poor prognosis with a median survival of approximately 10 months. Diagnosis is made on clinical and radiological appearance of the tumor. The treatment for DIPG is radiation therapy, but it is inadequate as most patients experience rapid progression and succumb to the disease. Our study sought to review radiological characteristics and survival outcomes in pediatric DIPG patients at MD Anderson Cancer Center to better understand imaging and improve current DIPG management. METHODS We performed a retrospective review of demographic and clinical data of patients with radiographic diagnosis of DIPG from 2006-2019, with IRB approval. The patients included in this study were treated at The University of Texas MD Anderson Cancer Center. Imaging findings upon diagnosis of DIPG, including the presence of hydrocephalus, intratumoral bleeding, contrast enhancement, and necrosis, were correlated with survival using Kaplan-Meier methods RESULTS This study included 25 patients diagnosed with DIPG via MRI imaging. The median OS was 13.7 months and median PFS was 10 months for this cohort. At diagnosis, if the patient had hydrocephalus or intratumoral bleeding, the median PFS were shorter compared with those who did not (8.5 and 5.4 months vs 12.2 and 10.8 months; Log-rank, P=0.019 and P=0.029, respectively). Other imaging findings, including contrast enhancement (CE) or presence of necrosis, are trending toward worse outcomes (CE vs no CE: PFS 7.9 vs 11.1 months, P=0.10; necrosis vs no necrosis: PFS 5.2 vs 10.5 months, P=0.78, respectively) CONCLUSION Imaging characteristics at diagnosis can be predictive of outcome. Hence, we propose to consider early interventions for these subgroups with worse outcomes to proceed with shunt placement and early enrollment for clinical trials as feasible. To further validate these findings, a large prospective study is required.

BIOM-08. CDKN2A --AN INDEPENDENT CYCLIN-DEPENDENT KINASE INHIBITOR VARIANT ASSOCIATED WITH MALIGNANCY AND WITH SMALL VESSEL STROKE, AS A POTENTIAL MARKER FOR RISK OF LARGE-VESSEL STROKE COMPLICATING BENIGN TERATOMA

Abstract BACKGROUND Cyclin-dependent kinase inhibitor variants, particularly those of CDKN2A are known to be associated with autosomal dominant Familial Atypical Multiple Mole/Melanoma Syndrome and pancreatic cancer predisposition. These variants are associated with risk of small vessel stroke in African/ African-American populations, and are risk factors for stroke in Nordic populations with hypertension, independent of cardiovascular risk factors. METHODS We performed a case review of a female presenting in late infancy with a central nervous system teratoma, that later was complicated by a right hemispheric middle cerebral artery (MCA)stroke, associated with a CDKN2A germline mutation. RESULTS This 14month old female presented with transient alterations of consciousness and apparent abdominal migraine events with pernicious vomiting. Neuroimaging revealed a right heterogeneous para- suprasellar mass and bilateral complex arachnoid adjacent cysts. She was observed closely for any progression, as the lesion was immediately adjacent to the optic chiasm. One year after presentation, she developed an acute ischemic right middle cerebral artery (MCA) stroke and had radiographic evidence of severe stenosis and decreased flow primarily within the right supra-clinoid internal carotid artery, the M1 segment and portion of the right A1 segment of cerebral vessels, with decreased enhancement and number of vessels in the distal right MCA territory. The vessels did not appear to be compressed by any mass effect. The radiologic appearance was consistent with vasospasm. The patient upon stoke recovery, underwent near- complete resection of the mass with no evidence of disruption of the capsule surrounding it and no vascular infiltration. Pathology revealed the expected teratoma with prominence of pancreatic acinar structures, and molecular evidence of a variant of CDKN2A, which was present in the patient and mother in the germline. CONCLUSION We propose that the imaging evidence of a vasculopathy was related to the genotype at the cyclin- dependent kinase site.

Time to re-set our thinking about airways disease: lessons from history, the resurgence of chronic bronchitis / PBB and modern concepts in microbiology.

In contrast to significant declines in deaths due to lung cancer and cardiac disease in Westernised countries, the mortality due to 'chronic obstructive pulmonary disease' (COPD) has minimally changed in recent decades while 'the incidence of bronchiectasis' is on the rise. The current focus on producing guidelines for these two airway 'diseases' has hindered progress in both treatment and prevention. The elephant in the room is that neither COPD nor bronchiectasis is a disease but rather a consequence of progressive untreated airway inflammation. To make this case, it is important to review the evolution of our understanding of airway disease and how a pathological appearance (bronchiectasis) and an arbitrary physiological marker of impaired airways (COPD) came to be labelled as 'diseases'. Valuable insights into the natural history of airway disease can be obtained from the pre-antibiotic era. The dramatic impacts of antibiotics on the prevalence of significant airway disease, especially in childhood and early adult life, have largely been forgotten and will be revisited as will the misinterpretation of trials undertaken in those with chronic (bacterial) bronchitis. In the past decades, paediatricians have observed a progressive increase in what is termed 'persistent bacterial bronchitis' (PBB). This condition shares all the same characteristics as 'chronic bronchitis', which is prevalent in young children during the pre-antibiotic era. Additionally, the radiological appearance of bronchiectasis is once again becoming more common in children and, more recently, in adults. Adult physicians remain sceptical about the existence of PBB; however, in one study aimed at assessing the efficacy of antibiotics in adults with persistent symptoms, researchers discovered that the majority of patients exhibiting symptoms of PBB were already on long-term macrolides. In recent decades, there has been a growing recognition of the importance of the respiratory microbiome and an understanding of the ability of bacteria to persist in potentially hostile environments through strategies such as biofilms, intracellular communities, and persister bacteria. This is a challenging field that will likely require new approaches to diagnosis and treatment; however, it needs to be embraced if real progress is to be made.

Incomplete partition type II in its various manifestations: isolated, in association with EVA, syndromic, and beyond; a multicentre international study.

Incomplete partition type II (IP-II) is characterized by specific histological features and radiological appearance. It may occur in isolation or in association with an enlarged vestibular aqueduct (EVA). Among those with IP-II and EVA, a subset has a diagnosis of Pendred syndrome. This study aimed to explore the prevalence of isolated IP-II, IP-II with EVA, and cases with a genetic or syndromic basis in our cohort. From a large, multicentre database of dysplastic cochleae (446 patients, 892 temporal bones), those with imaging features of IP-II were examined in detail, including whether there was a genetic or syndromic association. A total of 78 patients with IP-II were identified. Among these, 55 patients had bilateral IP-II and EVA (only 12 with typical Mondini triad), 8 with bilateral IP-II and normal VA, 2 with bilateral IP-II and unilateral EVA, and 13 with unilateral IP-II (9 with unilateral EVA). Among the group with bilateral IP-II and bilateral EVA in whom genetic analysis was available, 14 out of 29 (48%) had SLC26A4 mutations and a diagnosis of Pendred syndrome, 1 had a FOXI1 mutation, and a few other genetic abnormalities; none had KCNJ10 pathogenic variants. Bilateral IP-II-bilateral EVA may be seen in the context of Pendred syndrome (SLC26A4 or FOXI1 mutations) but, in the majority of our cohort, no genetic abnormalities were found, suggesting the possibility of unknown genetic associations. IP-II in isolation (without EVA) is favored to be genetic when bilateral, although the cause is often unknown.

Clinical and Radiological Response Following Single-Session Gamma Knife Radiosurgery in Cavernous Sinus Hemangiomas

Abstract Purpose Cavernous sinus hemangiomas (CSH) represent 2 to 3% of lesions occupying the cavernous sinus. The optimal management strategy for CSH is not established, with microsurgical resection and radiosurgery employed alone or in combination. Therefore, we aimed to analyze the efficacy and safety of gamma knife radiosurgery (GKRS) for CSH in a cohort of primary and residual CSH. Methods A retrospective analysis of 33 patients (26 primary and 7 residual CSH) that underwent single-session GKRS between 2012 and 2021 for CSH was performed. Demographic, clinical, radiological, and follow-up data were acquired, and clinicoradiological response following GKRS was assessed. Results The mean age of the cohort was 43 ± 13.5 years (range, 10–77). There were 9 males (27.3%) and 24 females (72.7%). The median lesion volume was 6.9 cc, ranging from 1.46 to 19.06 cc. The mean dose administered to the tumor margin was 13.50 ± 1.5 Gy (range, 12 to 15 Gy). The median duration of clinical follow-up was 41 months, over which period the mean reduction in tumor volume was 87.6%. Complete response, defined as absence of tumor on follow-up imaging, occurred in 23 patients (69.7%). Twenty-three patients (69.7%) showed clinical improvement following GKRS. There were no radiation-induced complications. Conclusion CSH have a distinct radiological appearance and a predictable response to radiosurgery. When used primarily in radiologically diagnosed CSH and as adjunctive therapy supplementing a subtotal excision, GKRS produces a high rate of volume reduction with the improvement of neurological function and minimal cranial nerve morbidity. Therefore, GKRS presents a viable alternative to surgery without the morbidity associated with surgical resection.

Clinical and surgical outcome in patients with cervical spondylodiscitis-a single-center retrospective case series of 24 patients.

Cervical spondylodiscitis is a rare pathology, with an incidence of 0.5-2.5 per 100,000 population, posing significant potential risks. This type of infection can lead to neurological impairment in up to 29% of patients. Radical surgical debridement of the infected segment, fusion, and an intravenous antibiotic regimen remains the gold standard in most spine centers. This study aimed to analyze the surgical outcome in a tertiary spine center based on disease severity. In this study, we retrospectively included all patients diagnosed with cervical spondylodiscitis and treated at the University Hospital Augsburg between January 2017 and May 2022. We collected and analyzed baseline parameters on clinical presentation with symptoms, laboratory parameters, radiological appearance, and surgical parameters such as type of approach and implant, as well as neurological and radiological outcomes. Descriptive statistics were performed using SPSS, and relevant correlations were examined using the t-test for independent samples and the chi-square test. Twenty-four patients (9%) with cervical spondylodiscitis were identified. Twenty-two (92%) surgically treated patients were subdivided into the complicated discitis group (n = 14, 64%) and the uncomplicated discitis group (n = 8, 36%). Seventeen patients (71%) presented with sepsis on admission, 17 patients (71%) were diagnosed with epidural abscess on primary imaging, and 5 patients (21%) had more than one discitis lesion at a distant spinal segment. The presence of epidural abscess was significantly associated with systemic sepsis (OR = 6.2; p = 0.03) and myelopathy symptoms (OR = 14.4; p = 0.00). The most frequently detected specimen was a multisensitive Staphylococcus aureus (10 patients, 42%). Six patients (25%) died after a median of 20 days despite antibiogram-accurate therapy, five of whom were diagnosed with a complicated type of discitis. The follow-up data of 15 patients (63%) revealed permanent neurological damage in 9 patients (38%). Notably, the surgical approach was a significant factor for revision surgery (p = 0.008), as three out of five (60%) ventrodorsal cases with complicated discitis were revised. Cervical spondylodiscitis represents a severe infectious disease that is often associated with permanent neurological damage or a fatal outcome, despite adequate surgical and antibiotic treatments. Complicated types of discitis may require a more challenging surgical and clinical course.

Cerebral arteriopathies of childhood and stroke - A focus on systemic arteriopathies and pediatric fibromuscular dysplasia (FMD).

Systemic vascular involvement in children with cerebral arteriopathies is increasingly recognized and often highly morbid. Fibromuscular dysplasia (FMD) represents a cerebral arteriopathy with systemic involvement, commonly affecting the renal and carotid arteries. In adults, FMD diagnosis and classification typically relies on angiographic features, like the 'string-of-beads' appearance, following exclusion of other diseases. Pediatric FMD (pFMD) is considered equivalent to adult FMD although robust evidence for similarities is lacking. We conducted a comprehensive literature review on pFMD and revealed inherent differences between pediatric and adult-onset FMD across various domains including epidemiology, natural history, histopathophysiology, clinical, and radiological features. Although focal arterial lesions are often described in children with FMD, the radiological appearance of 'string-of-beads' is highly nonspecific in children. Furthermore, children predominantly exhibit intimal-type fibroplasia, common in other childhood monogenic arteriopathies. Our findings lend support to the notion that pFMD broadly reflects an undefined heterogenous group of monogenic systemic medium-or-large vessel steno-occlusive arteriopathies rather than a single entity. Recognizing the challenges in categorizing complex morphologies of cerebral arteriopathy using current classifications, we propose a novel term for describing children with cerebral and systemic vascular involvement: 'cerebral and systemic arteriopathy of childhood' (CSA-c). This term aims to streamline patient categorization and, when coupled with advanced vascular imaging and high-throughput genomics, will enhance our comprehension of etiology, and accelerate mechanism-targeted therapeutic developments. Lastly, in light of the high morbidity in children with cerebral and systemic arteriopathies, we suggest that investigating for systemic vascular involvement is important in children with cerebral arteriopathies.

Comparing MRI and arthroscopic appearances of common knee pathologies: A pictorial review.

Knee pathology, including anterior cruciate ligament (ACL) tears, meniscal tears, articular cartilage lesions, and intra-articular masses or cysts are common clinical entities treated by orthopedic surgeons with arthroscopic surgery. Preoperatively, magnetic resonance imaging (MRI) is now standard in confirming knee pathology, particularly detecting pathology less evident with history and physical examination alone. The radiologist's MRI interpretation becomes essential in evaluating intra-articular knee structures. Typically, the radiologist that interprets the MRI does not have the opportunity to view the same pathology arthroscopically. Thus, the purpose of this article is to illustratively reconcile what the orthopedic surgeon sees arthroscopically with what the radiologist sees on magnetic resonance imaging when viewing the same pathology. Correlating virtual and actual images can help better understand pathology, resulting in more accurate MRI interpretations. In this article, we present and review a series of MR and correlating arthroscopic images of ACL tears, meniscal tears, chondral lesions, and intra-articular masses and cysts. Short teaching points are included to highlight the importance of radiological signs and pathological MRI appearance with significant clinical and arthroscopic findings.

Simulated Injuries of the Sheep Ossicular Chain: Correlations With Their Radiological Images.

Hypothesis We hypothesized that a sheep temporal bone would be a suitable model to study correlations between simulated middle ear injuries and their radiological appearances. Simulated ossicular chain injuries correlate well with their radiological images, and post-processing techniques provide optimal visualization of the sheep ossicles. Background The subtle ossicular trauma may be difficult to assess due to the small size of the structures. The precise radiological and clinical correlations of the ossicular injuries are not well documented. Methods The most common traumatic ossicular chain injuries were systematically simulated in the sheep temporal bone model. The images of the temporal bones were obtained with a high-resolution computed tomography scanner. The values of the dislocations were measured from the obtained images as well as in the temporal bones using calipers. Two observers independently evaluated the fine structures of the auditory ossicles using oblique multiplanar reconstructions (MPRs) and maximum intensity projections (MIPs). All segments of the facial nerve were also visualized. Results Optimal visualization planes of the sheep's middle ear joints have been obtained. The coincidence of simulated ossicular injuries in the specimens and MIPs was 40%. All structures of the ossicular chain were clearly distinguished except for the stapes footplate. Evaluation of the traumatic changes of the incudostapedial joint was challenging. Conclusions The sheep temporal bone is a suitable model for studying the correlations between pathological alterations in the ossicular chain and their radiological appearances. The post-processing MIP technique provides a more accurate and easier diagnosis of traumatic ossicular chain injuries than MPRs alone.

Unnecessary Explantation of IDEAL IMPLANT Structured Saline Breast Implants Prompted byRadiologic Misdiagnosis of Rupture.

The unique dual-lumen and baffle design of the IDEAL IMPLANT Structured Saline breast implant gives it specific advantages over both silicone gel-filled and the original saline-filled implants. This internal baffle structure also gives it an appearance on various radiologic imaging studies that may be misinterpreted as a rupture because of similarities to the well-known radiologic appearance of a ruptured silicone gel implant. Patients may present with various misinterpreted imaging studies, highlighting the need for plastic surgeons and radiologists to be familiar with the normal appearance of the intact IDEAL IMPLANT and be able to distinguish it from a ruptured IDEAL IMPLANT. The radiology findings must be correlated with the clinical findings, or an intact IDEAL IMPLANT misdiagnosed as ruptured, may cause unnecessary patient worry, and may prompt unnecessary surgery for removal or replacement.

Primary lung cancer in children and adolescents

PurposePrimary lung cancer is extremely rare in children and adolescents. The aim of this study is to clarify clinical features and outcomes of primary lung cancer in children and adolescents.MethodsYoung patients (aged ≤ 20 years) diagnosed as primary lung cancer between 2012 and 2023 were retrospective reviewed. According to radiological appearance of the nodules, they were divided into solid nodule (SN) group and ground glass opacity (GGO) group.ResultsA total of 74 patients were identified, with a median age at diagnosis of 18 years old (range: 11–20), including 7 patients in SN group and 67 patients in GGO group. In the GGO group, none of the nodules enlarged or changed during an average surveillance period of 10.8 months before surgery, except one. Wedge resection was the most common procedure (82.1%), followed by segmentectomy (16.4%) and lobectomy (1.5%). Histopathological analysis revealed that 64.2% of GGO nodules were adenocarcinoma in situ and minimally invasive adenocarcinomas, while the remaining 35.8% were invasive adenocarcinomas. Mutational analysis was performed in nine patients, with mutations identified in all cases. After a mean follow-up period of 1.73 ± 1.62 years, two patients in the SN group died due to multiple distant metastases, while all patients in the GGO group survived without recurrence. The overall survival (100%) of the GGO group was significantly higher than SN group (66.7%).ConclusionsPrimary lung cancer in children and adolescents are rare and histopathological heterogeneous. Persistent GGO nodules may indicate early-stage lung adenocarcinoma in children and adolescents.

Navicular bone oedema and sclerosis: current concepts on best management

Pathology associated with the navicular bone remains a common cause of forelimb lameness in horses. Since the introduction of advanced imaging modalities (particularly magnetic resonance imaging) it is now recognised that pathology of the navicular bone rarely occurs in isolation; concurrent abnormalities of the structures of the podotrochlear apparatus are often present. Different pathological processes of the navicular bone can have the same radiological appearance. Identifying the underlying disease process, as well as concurrent injuries, is essential for implementing the most appropriate management strategies in horses with navicular bone pathology. Horses with acute onset lameness or soft tissue injuries will often require a period of rest initially, whereas horses with chronic insidious lameness and no soft tissue pathology may be able to continue in work following treatment. Management should be focused on reduction of pain and inflammation which is often achieved with systemic non-steroidal anti-inflammatories, and intra-articular or intra-bursal medication in combination with reducing concussive forces acting on the navicular bone through alterations in shoeing and modification of exercise.

Right inferior rectus palsy – An unusual initial presentation of a case of disseminated fungal infection

Orbital Aspergillosis is a rare life-threatening fungal infection that is often misdiagnosed due to its nonspecific clinical and radiological appearance. In this case report, we present a case of disseminated aspergillus infection initially presenting as right inferior rectus palsy.

P079 Denosumab treatment for bone marrow oedema - a case series

Abstract Background/Aims This is a case series of patients treated with a single dose of denosumab to improve bone marrow oedema. Bone marrow oedema can cause significant pain and functional limitations. On MRI imaging, bone marrow oedema is identified as T1 hypointensities and T2 hyperintensities. Denosumab is a human monoclonal antibody that inhibits osteoclast bone absorption via binding to the cytokine RANKL [receptor activator of nuclear factor kappa-B ligand]. The exact aetiology of bone marrow oedema is unknown. It typically occurs in those aged between 40 to 60 years old. Studies have described therapeutic improvement with antiresorptive medications. Bone marrow oedema will generally resolve if left untreated. However, pharmacological treatments can curtail the clinical course. Methods This case series has emerged from Chelsea and Westminster hospital. Data was collected over a five year period for seven patients with bone marrow oedema [demonstrated on MRI] that were treated with denosumab. Six of the seven patients had a spontaneous insufficiency fracture associated with the bone marrow oedema on imaging. In our case series, two of the patients had bone marrow oedema in their hips and five in their knees. Denosumab was administered as a single 60mg subcutaneous injection. Response to treatment was ascertained by repeat MRI scan 2-4 months after denosumab treatment as well as patient reported outcomes. Results The average age of the patients was 56.4 years [age range 48-68 years]. Five of the patients [71%] reported improved symptoms at the affected site. Four patients [57%] had complete resolution of their bone marrow oedema on imaging with a further patient [14%] having an improved radiological appearance. Visual analogue scale [VAS] scores improved by 50%, although this data was only collected for some of the patients. No side-effects or complications were noted from the treatment. One of the patients who did not improve with denosumab treatment went on to have a total hip replacement due to complete loss of joint space. It is noteworthy that following further investigations, five of the seven patients were diagnosed with osteopenia on dual-energy x-ray absorptiometry [DEXA] scan, one had osteoporosis [and was subsequently commenced on alendronic acid] and one did not attend for their DEXA scan. Conclusion This series demonstrates that denosumab is an effective treatment for bone marrow oedema. Denosumab given as a single dose can be considered a safe treatment; there is not the risk of rebound worsening of bone density on treatment cessation that can be seen with prolonged treatment. Denosumab should be offered to patients who are symptomatic from bone marrow oedema to allow for quicker symptom relief and radiological improvement. Our findings are similar to that of a slightly larger case series of fourteen patients by Rolvien et al. published in 2017. Disclosure M. Galloway: None. A. Jacobs: None. M. Ismajli: None.

Uncommon suspect: A case report of a rare renal neoplasm

Primitive neuroectodermal tumors (PNETs) are a group of rare and aggressive malignancies primarily found in children and young patients. Primary renal PNETs are very much uncommon and share clinical and radiological features with renal cell carcinoma (RCC), thus posing a significant diagnostic and therapeutic challenge. This case report presents the clinical, radiological, and pathological findings of a primary renal PNET in an adult female patient, mimicking the radiological appearance of RCC.

Neonatal Head Ultrasound: Normal Findings and Common Abnormalities

Ultrasound is frequently used for the evaluation of the brain parenchyma and brain pathologies in neonates, due to its low cost, accessibility, and the absence of ionizing radiation, making it a great tool for a quick and feasible diagnosis in both term and preterm neonates. Ultrasound has a special role in the detection of germinal matrix hemorrhage, its complications, and sequelae. This article proposes a simple approach for the evaluation of the main anatomic structures of the neonate’s brain, through different approaches (anterior, posterior, and mastoid) based on diagrams and image correlation, as well as a review of the principal anatomic variants that should be considered and main pathologies. We also include the pitfalls and the most common radiologic appearance for a quick and appropriate identification to provide a correct diagnosis in the clinical setting.Learning Objective: To identify and interpret the main findings in neonatal head ultrasound, including anatomic variants and the main pathologies in both full-term and preterm neonates

An Unusual Radiologic Appearance in Pulmonary Hydatid Cyst: Diffuse Calcification

An Unusual Radiologic Appearance in Pulmonary Hydatid Cyst: Diffuse Calcification

Mycoplasma pneumoniae pneumonia – challenges related to diagnosis and treatment in children

Introduction. Pneumonia is a common infectious disease among children, very familiar to pediatricians and a major cause of hospitalization worldwide. Mycoplasma pneumoniae (M. pneumoniae) - atypical pathogen, is estimated to be responsible for approximately 30-40% of community-acquired pneumonias. The aim of the paper was to underline the diagnostic and treatment difficulties in a case of pneumonia with M. pneumoniae in a school-aged boy, with multiple presentations in the Emergency Service for respiratory difficulties. Material and method. We present the case of a 7 years and 10-month-old male patient, admitted to our clinic for wheezing, cough and dyspnea. Results. The clinical exam at admission pointed out influenced general status, wheezing, thoraco-abdominal swing, intercostal draft, sibilant and crackles, oxygen saturation 89%, tachycardia 134 beats/minute. The blood tests revealed mild leukocytosis, with neutrophilia, slightly increased inflammatory biomarkers. Considering the general status and the presence of functional respiratory syndrome, steroid and symptomatic anti-inflammatory treatment is initiated. However, the general condition remains stable, which required the widening of the spectrum of investigations with the performance of a chest CT noticing a pneumonic condensation with an air bronchogram located at the level of the right upper lobe. Considering the stationary respiratory functional syndrome and the radiological appearance of the pneumonia as well as the age, we performed serology for atypical germs and identified a positive titer of Ig M antibodies for M. pneumoniae by instituting Azithromycin po., but after 3 days, the evolution remains stationary, thus we changed the treatment with intravenous Levofloxacin, with a favorable subsequent evolution. Conclusions. Pneumonia with atypical pathogens such as M. pneumoniae is a well-defined and well-known pathology in the literature, but it still remains a condition that imposes multiple difficulties related to the diagnosis and therapeutic management of pediatric cases.

Stereotactic frame-based biopsy of infratentorial lesions via the suboccipital-transcerebellar approach with the Zamorano-Duchovny stereotactic system—a retrospective analysis of 79 consecutive cases

ObjectiveLesions of the posterior fossa (brainstem and cerebellum) are challenging in diagnosis and treatment due to the fact that they are often located eloquently and total resection is rarely possible. Therefore, frame-based stereotactic biopsies are commonly used to asservate tissue for neuropathological diagnosis and further treatment determination. The aim of our study was to assess the safety and diagnostic success rate of frame-based stereotactic biopsies for lesions in the posterior fossa via the suboccipital-transcerebellar approach.MethodsWe performed a retrospective database analysis of all frame-based stereotactic biopsy cases at our institution since 2007. The aim was to identify all surgical cases for infratentorial lesion biopsies via the suboccipital-transcerebellar approach. We collected clinical data regarding outcomes, complications, diagnostic success, radiological appearances, and stereotactic trajectories.ResultsA total of n = 79 cases of stereotactic biopsies for posterior fossa lesions via the suboccipital-transcerebellar approach (41 female and 38 male) utilizing the Zamorano-Duchovny stereotactic system were identified. The mean age at the time of surgery was 42.5 years (± 23.3; range, 1–87 years). All patients were operated with intraoperative stereotactic imaging (n = 62 MRI, n = 17 CT). The absolute diagnostic success rate was 87.3%. The most common diagnoses were glioma, lymphoma, and inflammatory disease. The overall complication rate was 8.7% (seven cases). All patients with complications showed new neurological deficits; of those, three were permanent. Hemorrhage was detected in five of the cases having complications. The 30-day mortality rate was 7.6%, and 1-year survival rate was 70%.ConclusionsOur data suggests that frame-based stereotactic biopsies with the Zamorano-Duchovny stereotactic system via the suboccipital-transcerebellar approach are safe and reliable for infratentorial lesions bearing a high diagnostic yield and an acceptable complication rate. Further research should focus on the planning of safe trajectories and a careful case selection with the goal of minimizing complications and maximizing diagnostic success.