Background: Magnetic resonance coronary angiography (MRCA) is a minimally invasive and radiation-free technique that enables evaluation of the coronary arteries in patients being followed-up for Kawasaki disease (KD). However, during MRCA scanning it is mandatory that patients lie still in bed for a long time. This is a major obstacle to the application of MRCA in pediatric patients.
Aims: We aimed to determine the utility of MRCA without using sedatives in pediatric patients using preparation.
Methods: Our study included 7 consecutive pediatric KD patients who underwent an MRCA to evaluate coronary artery lesions between 2010 and 2016 at the Itabashi Medical Association Hospital. The preparation for MRCA was performed in all patients, including a field trip and detailed explanation. The MRCA was conducted without sedatives. We compared the findings of MRCA and ultrasound cardiography (UCG) and investigated their correlation.
Results: The mean age of patients was 8.3 ± 4.1 years (range 4–15 years, 6 boys and 1 girl). The mean time from disease onset to the MRCA procedure was 2.7 ± 2.8 years. Scanning could be successfully completed in all patients without sedatives because pediatricians had prepared themselves adequately prior to scanning. The measurements of coronary artery in MRCA were significantly larger than those of UCG and showed a strong positive correlation.
Conclusion: An MRCA procedure can be performed without sedatives in pediatric KD patients, including children as young as 4 years (the youngest patient we experienced). Adequate preparations by physicians prior to scanning can reduce avoidable and unnecessary sedation in these patients.
When multiple magnets are ingested, they can attract each other through the intestinal wall and cause complications such as an obstruction, perforation, or fistula. In general, determining the magnet’s adsorption on an X-ray image is not difficult. However, the present case displayed an atypical appearance due to the unusual manner of their attachment.
A one-year-old boy visited our emergency outpatient department about 10 hours after ingesting two magnets. The presence of the magnets was confirmed by abdominal X-ray, but a space of about 4 mm between the magnets indicated an apparent lack of attachment. After admission, his general state was stable with no abdominal symptoms. Repeated X-ray imaging showed the movement of the magnets. On the next morning the patient excreted the magnets. Examination of the magnets after their excretion showed that they had indeed been attached during their passage through the digestive system.
Fortunately, the magnets in this case were excreted without complication. Even if there is a gap between the magnets, it may be due to the radiolucent parts attached to the magnets. In such cases removal of magnets should be considered because the possibility of attachment through the intestinal wall cannot be denied.
Although it is well known that respiratory complications are associated in patients with Down syndrome (DS), airway anomalies are relatively uncommon. We herein report a case of an 11-month-old infant with DS in whom recurrent respiratory symptoms were present after birth and tracheal bronchus was detected by chest CT. The present case was a boy who was born weighing 2,344 g at 36 weeks of gestational age, whose APGAR score (5 minutes) was 9 points without newborn asphyxia. Congenital facial anomalies were recognized and 21-trisomy was confirmed by G-staining method. Due to increased respiratory rate (60–70/min) and decreased SpO2 (65%) at age 11 days, chest CT was performed and showed diffuse ground-glass opacities in both lungs. Pulmonary edema or neonatal pneumonia was suspected. Pneumonia was improved by antibiotic therapy. However, wheezing was sustained. Chest CT was performed at 11 months after birth and revealed consolidation in the right upper lobe and mild, diffuse ground-glass opacities in both lungs. In addition, it showed that the right upper bronchus originated directly from the supracarinal trachea. Therefore, the diagnosis of tracheal bronchus (displaced type) was made. Pulmonary edema from DS was considered for diffuse ground-glass opacities in both lungs.
Foreign body ingestion in small children is common. Because most foreign bodies pass innocuously through the gastrointestinal tract, it is not so often for them to require endoscopic removal or emergency surgery. We herein report a case in which emergency surgery was required after the ingestion of multiple magnets. A 1 year old boy was referred to our hospital for vomiting and drowsiness. An X-ray revealed 5 small magnetic balls in the right abdomen, in addition, CT revealed free air in the abdominal cavity. We diagnosed the patient with gastrointestinal perforation caused by the ingestion of multiple magnets and he was quickly transferred to the children’s hospital for surgery. During the operation, one magnet was found in the stomach in apposition to 4 magnets in the abdominal cavity. These 4 magnets had caused multiple perforations associated with pressure bowel necrosis in the intestine wall. In the present case, the boy had ingested neodymium magnets, which are small and powerful. Recently, the incidence of magnet-related injuries has increased with the spread of neodymium magnets. Because such magnets can be easily obtained, the restriction of their use and sale is desired, and appropriate education must be provided for people including health-care workers.
Neonatal bacterial meningitis is a serious disease that is associated with significant morbidity and mortality. Moreover, early diagnosis and evaluation of its response to treatment can be challenging. Spinal ultrasonography (US) can detect inflammatory changes in meningitis. However, data on its usefulness are scarce. This prompted us to evaluate the relationship between spinal US findings and cerebrospinal fluid (CSF) cell count in a newborn with Group B streptococcus meningitis. Echogenicity and trabeculations in the posterior subarachnoid space and absence of spinal cord pulsations on spinal US were observed on admission and improved with reduction in the CSF cell count. Spinal US may be useful to evaluate the efficacy of treatment for neonatal bacterial meningitis, which may lead to a reduction in the need for lumbar punctures.
Neonatal herpes simplex encephalitis (HSE) is a devastating disorder, although it can be treated. Early diagnosis and antiviral therapy are essential. In this study, we report on a female neonate with HSE, whose brain MRI was of diagnostic value. She exhibited lethargy, poor suckling, seizure, and central apnea on day 13 after birth (day 1). An examination of her cerebrospinal fluid (CSF) on day 2 showed mild pleocytosis with lymphocytic predominance. On day 3, multiple high signal lesions were found on diffusion-weighted images (DWI) in brain MRI in the bilateral corticospinal tracts, bilateral frontal and right parietal cortices, bilateral thalami and pallidums, left cerebellar white matter, and pons. Although a traditional polymerase chain reaction (PCR) did not detect herpes simplex virus (HSV) in the CSF on day 2, acyclovir administration was not discontinued, because MRI showed corticospinal tract lesions, which have recently been reported to be preferentially affected in neonatal HSE. Real-time PCR thereafter detected HSV from the CSF on day 2. It is important to recognize that the negative results of the first HSV–PCR do not exclude neonatal HSE, if DWI shows a characteristic lesion distribution in early stages of the illness.
This case report presents a case of acute encephalopathy found in a one-year-old boy, which was caused by secondary carnitine deficiency due to cefteram pivoxil. Prolonged comatose state developed after convulsions associated with fever. He had lost his appetite and taken oral cefteram pivoxil for six days. On admission, he was poorly nourished and showed sluggish light reflexes as well as positive Babinski reflexes. Laboratory studies showed hypoglycemia and hyperammonemia as well as metabolic acidosis. Serum free carnitine was decreased, whereas pivaloyl carnitine level was elevated. Diffusion-weighted MRI on the 8th day of admission exhibited high signal intensity with decreased apparent diffusion coefficient in the cerebral cortex of the bilateral frontal, parietal and occipital lobes, whereas T2-weighted MRI showed no signal intensity. Follow up MRI on the 30th day exhibited cerebral atrophic changes. 99mTc-ethylcysteinate dimer SPECT exhibited decreased cerebral blood flow in the bilateral frontal lobes as well as left parietal lobe on the 10th day. He suffered severe neurological sequelae with spastic quadriplegia. We conclude that careful use of pivalic acid-containing antibiotics is necessary for the prevention of secondary carnitine deficiency especially in poorly nourished pediatric patients. Prophylactic administration of L-carnitine may be taken into consideration to prevent the provocation in such conditions.
Cat scratch disease (CSD) is a disease caused by Bartonella henselae infection which presents fever, lymphadenopathy with pain, physical weariness after bite or scratch by a cat. Few case reports have described patients with CSD with multiple granulomas in liver and spleen.
The patient was an 8-year-old boy who presented prolonged fever without other symptoms. His abdominal Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) showed multiple round lesions in liver and spleen. By these findings and elevated serum IgG of Bartonella henselae, he was diagnosed with CSD.
Abdominal CT and MRI were useful for diagnosing this atypical CSD.
Linear skull fractures without intracranial injuries in children usually resolve without complications, and rarely cause intracranial hypertension or hydrocephalus. We present a case of intracranial hypertension with expansion of the subarachnoid space subsequent to a linear skull fracture. A 15-month-old girl developed vomiting and irritability 28 days after an occipital linear skull fracture due to an accidental fall. It was not possible to give an accurate diagnosis despite her frequent emergency room visits. On day 40 after the injury, a follow-up head computed tomography scan after the skull fracture showed dilatation of the cerebral sulci and cranial sutures, while fundoscopy showed bilateral papilledema. She was hospitalized because of suspected intracranial hypertension. Head magnetic resonance imaging showed ﬂattening of the posterior sclera, distension of the perioptic subarachnoid space, and an empty sella with a flattened pituitary gland. She was diagnosed with intracranial hypertension and received an Ommaya reservoir. On day 62 after the injury, she was discharged with symptomatic improvement. Head trauma, including that caused by linear skull fractures without intracranial injuries, causes intracranial hypertension or hydrocephalus in children. Thus, prolonged atypical symptoms such as vomiting or irritability after head trauma necessitate consideration of additional examinations including head computed tomography.