Faculty Bibliography

The clinical courses of children with acquired immunodeficiency syndrome (AIDS) who underwent diagnostic flexible bronchoscopy at Bellevue Hospital from 1987-1992 were reviewed to determine the value of the procedure in patient management. Twenty-eight children (age 13 days to 12 years) underwent 31 bronchoscopies for indications including respiratory distress, fever and abnormal chest radiograph. Procedures were well tolerated. Complications were limited to transient hypoxia and epistaxis. Although 58% of bronchoscopies yielded a diagnosis (Pneumocystis carinii, Streptococcus viridans, Pseudomonas aeruginosa, Cytomegalovirus, atypical mycobacterium, giant cell pneumonia, and mechanical obstruction), empiric medical therapy was altered in only 16% of cases. Bronchoscopic diagnoses are correlated with Centers for Disease Control (CDC) classification, immune status, treatment and outcome

The contrast-enhanced preoperative computed tomographic (CT) scans and microscopic slides of 94 patients with 100 surgically resected renal cell carcinomas (RCCs) were retrospectively and independently reviewed in order to correlate the CT imaging findings of RCC with nuclear grading. As nuclear grade increased, RCCs were more likely to be of higher stage and greater size at presentation, and appeared more heterogeneous and less marginated. Of the features analyzed, tumor margination most closely correlated with nuclear grade. Overlap in the CT appearance of individual tumors limited the potential of CT to differentiate RCCs of varying grade. Small, well-marginated, homogeneous tumors, however, were either grade I or II, and were distinguishable from the more aggressive grade III lesions, which generally displayed irregular margins and greater inhomogeneity

Thin-section, high-resolution (1.0/1.5 mm thick slices), low-dose chest CT scans were performed in 55 infants and children. The studies were carried out with 1- and 2-s scan (data acquisition) times using a high-resolution (bone) algorithm. Although there was some motion artifact, the studies provided valuable information for evaluating diffuse parenchymal lung disease. The thin slices provided finer detail and more diagnostic information than images representing thicker sections. Most studies were performed using between 40 and 80 mAs. It is estimated that the patients' radiation exposure was 20% that of conventional high-resolution CT (HRCT) and 57% that of routine chest CT. Diagnostic HRCT scans can be obtained in infants and young children without the need for suspended respiration or specialized ultrafast CT scanners

HIV infection is responsible for a major proportion of the immunodeficiency disease seen in the pediatric population. The radiologic findings are varied and generally non-specific. The development of secondary neoplasms may present new diagnostic and therapeutic challenges as therapy for superimposed infections becomes more successful

We describe a case of fibrous histiocytoma of the trachea diagnosed in a 17-year-old female who presented with symptoms of 'asthma'. Management included rigid bronchoscopy with biopsy and debulking of this obstructing tumor, later excised with partial tracheal resection. Although tracheal tumors are quite rare in children, the majority (6/9) of reported cases of fibrous histiocytoma of the trachea have been described in the pediatric age group. The possibility of a tracheal neoplasm as a cause of wheezing, stridor or hemoptysis in children should be recognized. Control of the airway without tracheotomy may facilitate surgical cure via tracheal resection in such cases.

Patients suspected of having derangement of solitus asymmetry should be evaluated individually to determine abdominal visceral and vascular arrangement and to investigate associated problems. This evaluation should begin with plain films to assess cardiac and gastric positions and pulmonary vascularity. Assessment of the bronchial branching patterns should be attempted in all cases. Sonography will delineate the presence or absence of splenic tissue and the anatomy and relationships of the cava and the portal vein. When no spleen is found and the pulmonary vascularity appears congested, a subdiaphragmatic total anomalous pulmonary venous connection should be suspected and verified. If there are splenuli in the retrogastric area, particular attention should be paid to the status of the gallbladder, especially in children who do not have congenital heart disease. Selective spleen scans can confirm the presence of splenic tissue. The high cost and sedation requirement of MR would suggest that it be reserved for cases in which sonography is unable to answer the pertinent questions

Chronic granulomatous disease (CGD) is a genetically inherited disease of childhood, which is characterized by repeated bacterial and/or fungal infections. The genitourinary tract is rarely involved. We report a case of CGD with involvement of the urinary bladder. Pertinent clinical and sonographic findings of this disease are described

Sonographic examination of the abdomen was performed in 155 patients with clinical diagnosis of AIDS. Approximately one half of the patients had hyperechoic (fatty) liver and splenomegaly. About one third of the patients had lymphadenopathy and hyperechoic kidneys. Intravenous drug abusers were more likely to have renal parenchymal changes, whereas patients with sexually transmitted AIDS have a greater incidence of splenomegaly. Lymphadenopathy is the most consistent finding that would question the immune competency of a patient in the appropriate clinical setting. The usefulness of sonography lies in the detection or exclusion of potentially treatable complications in AIDS