PURPOSE: The purpose of this study was to evaluate the ultrasonographic findings of secondary appendicitis (SA) and to discuss the differential findings compared with primary appendicitis. METHODS: In this study, we analyzed the ultrasonographic findings of 94 patients under 15 years old of age treated at our institution from May 2005 to May 2014 who had bowel inflammation and an inflamed appendix with a maximal outer diameter >6 mm that improved with nonsurgical treatment (the SA group). Ninety-nine patients with pathologically proven acute appendicitis (the primary appendicitis [PA] group) from June 2013 to May 2014 and 44 patients with pathologically negative appendectomy results from May 2005 to May 2014 were also included to compare the ultrasonographic features of these conditions. A retrospective review of the ultrasonographic findings was performed by two radiologists. The clinical and laboratory findings were also reviewed. The results were statically analyzed using analysis of variance, the Pearson chi-square test, and the two-tailed Fisher exact test. RESULTS: Compared with PA, cases of SA had a smaller diameter (9.8 mm vs. 6.6 mm, P < 0.001), and were less likely to show periappendiceal fat inflammation (98% vs. 6%, P < 0.001) or an appendicolith (34% vs. 11%, P < 0.001). SA showed mural hyperemia on color Doppler ultrasonography as frequently as PA (P=0.887). CONCLUSION: The ultrasonographic features of SA included an increased diameter compared to a healthy appendix and the same level of hyperemia as in PA. However, the diameter was commonly in the equivocal range (mean diameter, 6.6 mm), and periappendiceal fat inflammation was rarely present in SA.
Appendectomy ; Appendicitis* ; Appendix ; Humans ; Hyperemia ; Inflammation ; Pediatrics ; Retrospective Studies ; Ultrasonography* ; Ultrasonography, Doppler, Color

Foreign body ingestion is a common problem in the pediatric population and the majority of such cases occur between the ages of six months and three years. Most objects pass uneventfully through the gastrointestinal tract; however, ingestion of multiple magnets can cause serious gastrointestinal complications through interaction with each other across the bowel wall. In these situations, radiologic evaluation is imperative for proper treatment. This is a case report on ingestion of 32 magnets in a 10-year-old boy. We diagnosed a small bowel fistula caused by ingestion of multiple magnets using sonography, which showed hyperechoic magnetic foreign bodies attached together penetrating the thickened neighbouring jejunum.
Child ; Eating* ; Fistula* ; Foreign Bodies ; Gastrointestinal Tract ; Humans ; Jejunum ; Male ; Ultrasonography*

Thyroid ultrasonography is widely used for diagnosis and cytologic evaluation of thyroid nodules. We encountered a case of Killian-Jamieson diverticulum, which was differentiated from a thyroid nodule using ultrasonography.

Coxsackievirus A16 (CA16), which primarily causes hand, foot, and mouth disease (HFMD), is associated with complications, such as encephalitis, acute flaccid paralysis, myocarditis, pericarditis, and shock. However, no case of pancreatitis associated with CA16 has been reported in children. We report a case of CA16-associated acute pancreatitis in a 3-year-old girl with HFMD. She was admitted because of poor oral intake and high fever for 1 day. Maculopapular rashes on both hands and feet and multiple vesicles on the soft palate were observed on physical examination. She was treated conservatively with intravenous fluids. On the fourth hospital day, she had severe abdominal pain and vomiting. The serum levels of amylase and lipase were remarkably elevated (amylase, 1,902 IU/L; reference range, 28–100 IU/L; lipase, >1,500 IU/L; reference range, 13–60 IU/L), and ultrasonography showed diffuse swelling of the pancreas with a small amount of ascites. The real-time reverse transcription polymerase chain reaction result from a stool sample was positive for CA16. CA16 can cause acute pancreatitis, and should be considered in the differential diagnosis of abdominal pain in children with HFMD.
Abdominal Pain ; Amylases ; Animals ; Ascites ; Child ; Child, Preschool ; Diagnosis, Differential ; Encephalitis ; Exanthema ; Female ; Fever ; Foot ; Foot-and-Mouth Disease ; Hand* ; Hand, Foot and Mouth Disease* ; Humans ; Lipase ; Mouth Diseases ; Myocarditis ; Palate, Soft ; Pancreas ; Pancreatitis* ; Paralysis ; Pericarditis ; Physical Examination ; Polymerase Chain Reaction ; Reference Values ; Reverse Transcription ; Shock ; Ultrasonography ; Vomiting

Primary epiploic appendagitis (PEA) is a condition that results from spontaneous torsion, ischemia, or inflammation of an epiploic appendage. This condition is manifested by localized abdominal pain and tenderness, which is often mistaken for diverticulitis or appendicitis in the adult population. PEA is a self-limiting disease, and differential diagnosis with surgical condition is important in order to prevent unnecessary surgery. Although it is commonly reported in adults, it is rarely reported in the pediatric population. We report on the radiologic findings of two cases of PEA in a 12- and a 17-year-old boy, focusing on sonographic findings.
Abdominal Pain ; Adolescent ; Adult ; Appendicitis ; Child* ; Diagnosis, Differential ; Diverticulitis ; Humans ; Inflammation ; Ischemia ; Male ; Peas ; Pediatrics ; Ultrasonography ; Unnecessary Procedures

Lemierre syndrome is a rare disease characterized by internal jugular vein thrombosis and septic emboli, and it primarily occurs in healthy young individuals; this disease usually follows an acute oropharyngeal infection. To the best of our knowledge, only a few reports about this disease have appeared in the radiologic literature. We report here the radiologic findings of a case of Lemierre syndrome in a young healthy female adolescent who had a history of acute pharyngotonsilitis. Chest radiographs showed lung nodules that displayed cavitary changes with rapid progression on the serial studies. High-resolution CT scan showed multi-focal patchy consolidations that connect with vessels, and this was suggestive of septic pulmonary embolism. Ultrasonography and CT scan of the neck revealed right internal jugular vein thrombosis.
Adolescent ; Humans ; Jugular Veins ; Lemierre Syndrome* ; Lung ; Neck ; Pulmonary Embolism ; Radiography, Thoracic ; Rare Diseases ; Thrombosis ; Tomography, X-Ray Computed ; Ultrasonography

An fistula occurring between the stomach and other abdominal internal organs or to the surface of the body is usually encountered as a complication of stomach cancer or colon cancer, peptic ulcer disease, or other variable causes. The most common type of gastric fistula is a gastro-colic fistula that is mainly found as a complication of a gastric carcinoma or of a carcinoma of the transverse colon invading each other. Sometimes, a benign gastric ulcer perforation also can cause a gastro-colic fistula. However, as far as we know, a fistula occurring between the stomach and the umbilicus has not been reported. Here we present a case report of a gastro-umbilical fistula in a young woman that manifested as a umbilical discharge.
Abdomen ; Colon, Transverse ; Colonic Neoplasms ; Female ; Fistula* ; Gastric Fistula ; Humans ; Peptic Ulcer ; Stomach ; Stomach Neoplasms ; Stomach Ulcer* ; Ultrasonography ; Umbilicus

Gynecomastia is defined as the excessive development of breast tissue in males, which can occur as unilateral or bilateral. Although the overall prevalence of gynecomastia is 40%-65%, the prepubertal unilateral gynecomastia in the absence of endocrine abnormalities is unusual, with only a few case reports in literature. Idiopathic gynecomastia in prepuberty is benign but a diagnosis of exclusion. We here report two cases of healthy prepubertal boys aged 8.8 and 9.6 years old, respectively, presented with painful palpable mass in their unilateral breast. Breast tissue with glandular proliferation was confirmed on ultrasonography. Serum levels of estradiol, testosterone, and other laboratory findings were within normal range. They seem to have the prepubertal idiopathic gynecomastia but further follow-up to see their progression is needed.
Breast ; Child ; Diagnosis ; Estradiol ; Gynecomastia* ; Humans ; Male ; Prevalence ; Reference Values ; Testosterone ; Ultrasonography

Renal artery injury is a rare complication in blunt trauma, but can cause devascularization of the kidney, leading to renal failure. It requires early diagnosis and management. The treatment of renal artery injury still remains controversial, but recent studies have reported the successful treatment outcome with endovascular stent placement. Nevertheless, there is no standard treatment strategy in cases of pediatric patients. We report a case of a 16-year-old girl with right renal artery occlusion associated with a grade IV liver laceration. She was treated with only balloon angioplasty, and the kidney showed marked improvement of parenchymal perfusion with normalized renal function. Treatment with only balloon angioplasty can be a treatment option in pediatric patients with renal artery injury.

Orbitofacial angioedema is one of the common contrast-induced adverse reactions. The symptoms are recognized, based on the patient's clinical complaints. Based on prior research findings, there were no reports about contrast-induced orbitofacial angioedema that was confirmed on image findings. The researchers herein report on contrast-induced orbitofacial angioedema presented on enhanced computed tomography, following intravenous administration of iodine contrast media.