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Objective The purpose of this study was to analyze the utility of MRA-H in adolescents by comparing the results of imaging with surgical findings and/or clinical outcome. Material and methods After obtaining appropriate IRB approval, the Radiologic Information System database was queried for all patients 13–18 years of age who underwent MRA-H from 2004 through 2013. The electronic medical record was reviewed for clinical history, clinical examination findings, and operative notes. MRA-H images were reviewed for soft tissue abnormalities (labral tear, paralabral ganglion, articular cartilage loss, synovitis, ligament tears) and bony abnormalities (cam-type femoroacetabular impingement (FAI), pincer-type FAI, hip dysplasia). MRA-H findings were correlated with surgical findings and with clinical outcomes. Results Twenty-six patients with labral tears by MRA-H were included in study and grouped as follows: Group I) patients who underwent surgical management (n = 10); group II) patients managed non-surgically (medication, intra-articular injection, physical therapy) (n = 9); group III) patients lost to follow up after being advised to have surgery (n = 7). With regard to presenting symptomatology, 87.5% of patients with labral tear had groin pain. Of those patients who were diagnosed with a labral tear, 52% were categorized as idiopathic labral tears, 26% as secondary tears (secondary to abnormal bony morphology), and 22% as traumatic labral tears. The labral tears were found to be anterior in 61% and posterior in 22%. Associated articular cartilage lesions were found in 29% of patients. In group I (surgical patients), MRA-H labral findings were confirmed at surgery in 9/10. Seventy percent of labral tears in our study had some form of abnormal bony morphology. Nine of the 12 patients with bone abnormalities were derived from group I patients. Six out of 7 patients with cam-type FAI had a labral tear. Conclusion Labral tears diagnosed by MRA-H in the adolescent population correlated well with clinical examination and surgical findings. Also, MRA-H contributed by defining bony morphology that was directly applied to surgical management. Non-surgical management of labral tears diagnosed on MRA-H had a generally favorable outcome.

Sarcomas are rare connective tissue malignancies. Patients and their families often experience many challenging problems during the cancer journey. Professionals working in this complex landscape need to collaborate to optimize patient outcomes.

From a HTS campaign, a new series of pyrimidone anilides exemplified by compound 1 has been identified with good inhibitory activity for the PI3Kβ isoform. The structure of compound 1 in PI3Kγ was solved revealing a binding mode in agreement with the SAR observed on PI3Kβ. These compounds displayed inhibition in the nanomolar range in the biochemical assay and were also potent p-Akt inhibitors in a PTEN-deficient PC3 prostate cancer cell line. Optimization of in vitro pharmocokinetic properties led to compound 25 exhibiting 52% bioavailability in mice and target engagement in an acute PK/PD study.

Objectives To determine whether the size of palpable solid breast masses in adolescents at initial sonography and their growth at follow-up sonography could be used to decide between conservative management and tissue biopsy. Methods This retrospective study included 37 adolescent female patients with 45 palpable benign-appearing solid breast masses on initial sonography. They were grouped as follows: group I, masses undergoing follow-up sonography with subsequent biopsy (n = 9); group II, masses undergoing biopsy without follow-up sonography (n = 13); and group III, masses undergoing follow-up sonography without biopsy (n = 23). The largest dimension, volume, volume change per month, and change in the sonographic appearance were analyzed to predict the need for biopsy. A combination of a largest dimension greater than 3 cm and volume change per month greater than 16% was used to assess the need for biopsy. Sonograms of 22 masses were correlated with histopathologic diagnoses. Results None of the masses that underwent follow-up sonography showed changes in their sonographic appearance. All masses that underwent biopsy were benign on histopathologic analysis. There was no significant difference in the largest dimension among the groups at initial sonography or between groups I and III at follow-up sonography. The volume change was smaller for fibroadenomas (n = 7; mean, 22.67%) than benign phyllodes tumors (n = 2; mean, 45.30%) in group I, but the difference was not significant (P = .384). However, the volume change for groups I and III showed a significant difference (P = .026). Neither size greater than 3 cm nor volume change greater than 16% predicted pathologic outcomes. Conclusions If the combined criteria for assessing benignity of palpable breast masses had been used, biopsy could have been reduced by 89% in group I and deemed not necessary in 96% of group III breast masses.

Fetus in fetu is a rare congenital abnormality in which a nonviable, parasitic fetus grows within the body of its twin. A fetus in fetu is differentiated from a teratoma because it contains vertebral segmentation, organogenesis, or both.' Fewer than 100 cases of fetus in fetu have been reported, most of which have been in the abdomen. We describe a case of fetus in fetu arising in the neck. Our case is unique because, to our knowledge, a case of fetus in fetu in the neck has not been reported previously. The imaging studies presented include prenatal ultrasound imaging and magnetic resonance imaging (MRI) and postnatal computed tomography (CT).

The purpose of this study was to evaluate the utility of computed tomography (CT) renal angiogram (CTRA) in the management of childhood hypertension. This is a retrospective study of 24 children with clinical suspicion of renovascular disease who underwent CTRA examinations. CTRA demonstrated surgically correctable etiology of hypertension in 38% of the patients [5 with renal artery stenosis (RAS) and 4 with renal pathology]. In 5 patients, CTRA findings of RAS were confirmed by catheter angiogram. CTRA missed RAS in 1 patient in whom catheter angiogram showed beaded narrowing of the renal artery. All 6 patients with RAS had resolution of hypertension immediately after angioplasty or surgery. One patient with diffuse renal artery stenosis had an ipsilateral multicystic dysplastic kidney. In this patient hypertension resolved spontaneously as the dysplastic kidney shrunk in size. Seven patients had a renal etiology for hypertension. In 3 of these patients hypertension resolved after nephrectomy. Malignant hypertension in the 4th patient with reflux nephropathy was controlled medically after she underwent bilateral ureteral reimplantation. The remaining 3 patients with renal etiology were managed medically. We found that the etiology was central for hypertension in 4 patients with brain abnormalities, obesity in 1 overweight patient, essential hypertension in 4 patients, and thoracic aorta coarctation in 1 patient. Our study showed that in all except 1 instance CTRA could diagnose a surgically correctable cause for hypertension. CTRA provided useful information for the management of pediatric hypertension in all our patients.

The purpose of this study was to assess the role of sonography in the diagnosis and management of palpable solid breast masses in adolescents and to correlate the sonographic findings with the histopathologic findings and clinical outcome.A retrospective study was conducted with the breast sonograms of 20 adolescent girls 13-19 years old who presented with palpable breast masses found to be solid at breast sonography. The Stavros sonographic criteria were used to assess the benignity or malignancy of solid breast masses. All sonographic findings were correlated with histopathologic or clinical follow-up findings.Sonography showed 21 solid masses in 20 patients (one patient had bilateral solid breast masses). All but six solid masses were presumed benign according to the Stavros sonographic criteria. All solid masses were proved benign at histopathologic or clinical follow-up examination.Sonography was not useful for predicting the histologic diagnosis of all solid benign breast masses in adolescent patients. The Stavros sonographic criteria, however, were useful for predicting benignity in 65% of the breast masses on which histopathologic examination was performed. Tissue biopsy may be performed on solid breast masses that do not meet the criteria for benign masses according to the Stavros sonographic criteria.

The successful treatment of leg length discrepancy depends not only on an accurate assessment of the pattern of growth of the femur and tibia but also on thorough understanding of the various treatment methods. The radiographic features of 43 leg lengthening surgeries were studied retrospectively, and their significance in the treatment of children with leg length discrepancies was evaluated. The morbidities seen in our study include leg deformities resulting from misalignment of bone segments and excessive stretching of soft tissues, and fractures, nonunions, and delayed unions at the lengthened sites, leading to prolonged application of traction devices. The overall frequency of morbidity was 148.8%. In the orthopedic literature, morbidity rates vary with the underlying reasons for leg length discrepancy, the type of bone lengthening procedure, and the type of complications included. Timely detection of radiographic abnormalities in the lengthened leg can contribute significantly to the successful treatment of leg length discrepancy.

Department of Pathology, Loyola University Medical Center and Stritch School of Medicine,2160 S. First Ave., Maywood, IL 60153Received 20 October 2006; accepted 27 February 2007ABSTRACT: Rupture is a rare complication of ovariancysts diagnosed during the prenatal period. We pres-ent a case that focuses on the postnatal sonographicappearance of rupture of an ovarian cyst after vaginaldelivery. Histopathologic correlation is provided. Themain sonographic features include complicated asci-tes and a collapsed cystic structure in the abdomen.Ruptured ovarian cyst should be included in the dif-ferential diagnosis of unexplained ascites in a new-born girl.

Calcaneal unicameral bone cysts often contain fluid, but rarely contain fluid–fluid levels. We present a case focusing on the CT findings of a large calcaneal bone cyst with a fluid–fluid level and a review of the literature.

We report sonographic features of bladder malacoplakia (multiple polypoid solid masses) in a 16-year-old girl with Russell-Silver syndrome who presented with renal failure and urinary tract infection.

Conjoined twins are rare in the literature and parasitic conjoined twins are rarer still. To our knowledge no cases of parasitic conjoined twins have previously been reported in the radiology literature. We present a case of parasitic conjoined twins in which radiographic findings played an important role in management.

Neonatal liver abscess is a rare entity. There are no published reports of neonatal liver abscess in the radiology literature in the past 15 years. We recently encountered a premature infant in whom a hepatic abscess was diagnosed solely based on abnormal radiographic studies. We report this case to illustrate the unusual clinical and radiographic abnormalities seen with neonatal solitary hepatic abscess.

Third branchial arch anomalies are rare. The authors present a case report of a neonate with a rapidly growing neck mass due to cystic dilation of a persistent thymopharyngeal duct, which is a derivative of the third branchial arch. The presence of thyroid and thymic tissue in the cyst wall, the communication of the cyst with the piriform sinus, and the relationship of the cyst to carotid vessels and the sternomastoid muscle were consistent with the features of a thymopharyngeal duct cyst embedded in the thyroid gland.

CT, MR and bone scintigraphic findings of infiltrating chest wall lipoma are presented in this paper along with the differential diagnosis, clinical and surgical aspects of this lesion.

Intracranial lipomas are rare and usually do not have clinical expression. They are located most commonly in the interhemispheric fissure and may also be found in the quadrigeminal, ambient, chiasmatic, interpeduncular, sylvian, and perimesencephalic cisterns. Interhemispheric lipomas may be associated with choroid plexus lipomas. The ultrasonography, computed tomography, and magnetic resonance imaging findings are reported in a neonate with lateral ventricular choroid plexus lipomas and interhemispheric lipoma associated with agenesis of the corpus callosum.

MRI can yield valuable information about involvement of bone and soft tissue by aggressive bone lesions of childhood. The 18 lesions evaluated with MRI included osteosarcoma, Ewing's sarcoma, histiocytosis, osteomyelitis, osteoblastoma, giant cell tumor, aneurysmal bone cyst, ossifying fibroma, and fibrous dysplasia. In 12 children, where CT correlation was available, MRI provided equal or more information than CT. Our study shows that MRI should be the modality of choice in the evaluation of aggressive bone lesions of childhood, after conventional radiography.

Congenital histiocytosis X involving multiple organs is a rare disease that causes rapid mortality in intrauterine and neonatal life. The diagnosis of histiocytosis X (Letterer-Siwe disease) should be considered in a neonate with vesiculated crusting skin lesions. We present clinical, radiographic and histopathological findings in a neonate with congenital histiocytosis who died of respiratory failure due to diffuse infiltration of lungs with histiocytic cells.

In a retrospective review of 50 patients with known portal hypertension, uroradiologic abnormalities directly related to this entity were detected in 10 patients (20%). Unusual findings in three patients are stressed. One case of ileal conduit hemorrhage due to enterostomal varices secondary to portal hypertension, in which the imaging studies were noncontributory, is included in this discussion because of its important clinical and diagnostic implications.

Radiologic examination plays a crucial role in the evaluation of suspected gastrostomy complications. This has not been stressed adequately in the radiologic literature. In a retrospective review of 230 patients who underwent tube gastrostomy for varied clinical conditions, 70 patients who had radiologic examination for evaluation of gastrostomy-related complications were identified. Thirty complications were diagnosed radiologically. There were 11 gastric obstructions, 11 tube displacements, four gastric ulcers, two gastric perforations, one leaking gastrostomy, and one broken gastrostomy tube. Gastric torsion and gastric pneumatosis are reported for the first time as complications of gastrostomy.

Rhabdomyosarcoma is a diagnostic and therapeutic problem in the management of pediatric tumors, representing the most common malignant orbital tumor of childhood. In this discussion of the diagnosis of rhabdomyosarcoma, the role of CT is detailed through the case reports and the radiographs presented. CT can accurately define the anatomic location of the orbital mass, the involvement of various intraorbital structures, and the extension of the pathologic process into the periorbital regions such as sinuses, nasal cavity, and intracranial compartment. Thin-needle aspiration biopsies can be done under CT guidance without complications as well as follow-up monitoring of tumor regression following therapy.

Use of computerized tomography (CT) in the diagnosis of arterial calcification of infancy, including coronary obstructive disease, has not been previously reported. We were able to demonstrate by CT scan the abnormal arteries present in this disease. The calcified arteries in this infant, who died of bowel infarction at three weeks of age, were easily delineated in CT scans of the chest, abdomen, and extremities. Autopsy sections revealed intact elastic fibers in the abnormal arteries, indicating that the basic pathologic process does not primarily involve these fibers.

A pre-term baby girl presented at birth with respiratory distress and pleural effusion on the left. A soft tissue mass was found via lateral x-ray and CT scan; the mass proved to be extralobar pulmonary sequestration.

The imaging procedures utilized at presentation in the diagnostic work-up of 19 children with Burkitt lymphoma were reviewed. The distribution of disease was compared to other tumors of childhood so that the most valuable modalities could be identified. Burkitt lymphoma is a rapidly growing tumor in the child, making it essential to suggest the diagnosis as quickly as possible so that biopsy and treatment can be instigated. The primary area of involvement was abdominal (15 of 19), gastrointestinal, intraperitoneal adenopathy, hepatic and pancreatic without retroperitoneal adenopathy. Pleural effusions were common without hilar and mediastinal adenopathy. This is in contrast to other tumors of childhood where mediastinal and hilar disease in the chest and retroperitoneal node involvement in the abdomen are common. Thus sonography is an excellent imaging modality, easily identifying the extent of the disease and so suggesting the diagnosis.

The effects of pregnancy in patients with sarcoidosis is reviewed in 18 patients. During 35 pregnancies, no clinical or roentgenographic effect upon the disease process was noted in nine patients. Six of these patients demonstrated an improvement, and in three patients, a deleterious effect was noted. A relapse of the disease was not noted after delivery in 15 of the patients. In three patients, a progression of the disease continued after delivery.