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Pulmonary blastoma is a rare primary malignancy of the lung, with few cases reported in children. The tumor consists of mesenchymal and epithelial components resembling the fetal lung. Seven children (aged 18 months to 5 years) with pulmonary blastoma were studied. The pulmonary radiographic patterns seen were a large, space-occupying solid mass with opacification of the hemithorax and preexisting cystic disease with a small solid tumor component. Computed tomographic images showed a low-attenuation mass with whorls of high-attenuation solid tissue. Four of the seven patients died within 2 years despite surgery and therapy; of the three surviving patients, one has recurrent disease.

The authors retrospectively evaluated 12 patients with congenital (neonatal) neuroblastoma to assess the utility of newer imaging modalities. Findings at prenatal ultrasound (US), performed in four patients, were nonspecific (hydramnios and hydrops fetalis) in two and consistent with a suprarenal mass (one solid, one cystic) in the other two. Postnatal US helped accurately detect adrenal tumors (solid or complex, with one exception) but was less accurate in the diagnosis of metastatic disease to the liver. Computed tomography accurately depicted all primary tumors and liver metastases. Magnetic resonance (MR) imaging helped establish the correct diagnosis in three patients. This study again confirmed the benign course of neonatal neuroblastoma, with 50% of the patients classified with stage IV-S disease and two deaths occurring in the series, both due to complications. Therefore, aggressive diagnostic imaging is less desirable, and US is therefore very useful, despite its limitations. The prenatal detection and solid appearance of a suprarenal mass makes the diagnosis of neuroblastoma very likely, as does the presence of liver lesions. In the absence of these characteristic findings, US should be repeated to exclude adrenal hemorrhage. MR imaging seems to be a good alternative in some instances.

Multicystic nephroblastoma is a cystic variant of the Wilms' tumor. As such, pathologic identification of blastemal elements in multilocular cystic disease is important in the long term care of patients. A case of this unusual Wilms' tumor is described.

An infant presented with congenital hemihypertrophy, hepatomegaly, and a low thoracic paraspinal mass. Liver scan showed multiple defects in the uptake of radioisotope. Surgical exploration revealed multiple infantile hemangioendotheliomas of the liver and a paraspinal hemangioendothelioma. In review of 69 reported cases of infantile hemangioendothelioma of the liver and viscera, there has been no previous note of hemihypertrophy associated with this abnormality.

Ultrasonic imaging of infants and children using an automated transducer water-path delay scanning system (Octoson) overcomes many of the technical difficulties of contact B mode ultrasound imaging and computed tomography. These disadvantages relate to small patient size, motion artifacts, hypothermia, and lack of patient cooperation. Sedation may be required for either conventional study. The automated water-path system is soothing to small children, maintains the body temperature of infants, and avoids direct transducer contact. Sedation is not necessary. Excellent resolution, shorter scan time than computed tomography, and greater flexibility of patient and transducer positioning allows much more complete imaging information. In addition, the panoramic view obtained using this modality serves to demonstrate the complete lesion and its relationship to surrounding structures.

The ability of the aza-aromatic polycyclic aromatic hydrocarbons 10-azobenz(a)pyrene and benz(a)acridine to induce the rat hepatic microsomal mixed-function oxidases was compared to that of their non-heterocyclic analogues benz(a)pyrene and benz(a)anthracene respectively. All four hydrocarbons markedly increased the O-deethylations of ethoxyresorufin and ethoxycoumarin, the non-heterocyclic analogues being the more potent. A more modest increase was seen in the O-dealkylation of pentoxyresorufin. All four hydrocarbons induced proteins recognised by antibodies to cytochrome P-450IAI but no increase was seen when antibodies to cytochrome P-450IIB1 were employed. The metabolic activation of benz(a)pyrene and Glu-P-1 to mutagenic intermediates in the Ames test was enhanced by all pretreatments. It is concluded that the aza-aromatic polycyclic hydrocarbons, like their non-heterocyclic analogues, selectively induce the cytochrome P-450I family of proteins.

Two children are described who developed an apparent cutaneous contact reaction to contrast material in urine. Both children had undergone uneventful voiding cystourethrography with diatrizoate meglumine injection USP 18% followed by intravenous urography with diatrizoate meglumine injection USP 60%. Approximately 1 hour after urography cutaneous bullae and surrounding erythema of the buttocks (one case) or foreskin (one case) were noted. This reaction resembled a superficial chemical burn.

Multicystic dysplastic kidney usually is identified easily by ultrasound examination, and treatment decisions are based upon the diagnosis and clinical status of the patient. We report on 3 newborns in whom renal ultrasound findings were strikingly similar to severe neonatal ureteropelvic junction obstruction but operation revealed multicystic dysplastic kidney.

This is a report of three cases of the oral-facial-digital (OFD) syndrome with accompanying severe cerebral abnormalities. Among 150 reported cases of this syndrome, 16 had accompanying documented cerebral anomalies including porencephalic cysts, agenesis of the corpus callosum, and cortical hypoplasia. Although mental retardation is a prominent feature of this syndrome, neuroradiologic workup is infrequent. In view of the frequency of associated cerebral abnormalities (13%) of OFD syndrome, neuroradiologic evaluation is valuable as a guide to prognosis and therapy for these children.

Three patients with leucocyte related immune deficiency developed pneumatoceles during acute bacterial pneumonia. A fourth patient with chronic granulomatous disease of childhood developed persistent lung cysts following pulmonary abscesses. The pneumatoceles persisted without significant change for one year to five years. In 25 immunologically normal patients, pneumatoceles that were associated with acute bacterial pneumonia resolved in 3 weeks to 11 months. Perhaps alterations in leukocytic function and in local inflammatory response result in fibrotic cellular reaction and sequestration of parenchymal air collections, precluding their resorption.

Ultrasound is the imaging method of choice for early diagnosis of patients with suspected splenic abscess and a good screening study in patients with fever and nonspecific abdominal symptoms.