Tracy Kilborn - Academia.edu (original) (raw)

Papers by Tracy Kilborn

Research paper thumbnail of Imaging Features of the Brain, Cerebral Vessels and Spine in Pediatric Tuberculous Meningitis With Associated Hydrocephalus

Pediatric Infectious Disease Journal, 2016

Background-Pediatric tuberculous meningitis leads to high rates of mortality and morbidity. Promp... more Background-Pediatric tuberculous meningitis leads to high rates of mortality and morbidity. Prompt diagnosis and initiation of treatment are challenging; imaging findings play a key role in establishing the presumptive diagnosis. General brain imaging findings are well reported; however, specific data on cerebral vascular and spinal involvement in children are sparse. Methods-This prospective cohort study examined admission and follow up computed tomography brain scans and magnetic resonance imaging scans of the brain, cerebral vessels (magnetic resonance angiogram) and spine at 3 weeks in children treated for tuberculous meningitis with hydrocephalus (inclusion criteria). Exclusion criteria were no hydrocephalus on admission, treatment of hydrocephalus or commencement of anti-TB treatment before study enrolment. Imaging findings were examined in association with outcome at 6 months. Results-Forty-four patients (median age 3.3 [0.3-13.1] years) with definite (54%) or probable tuberculous meningitis were enrolled. Good clinical outcome was reported in 72%; the mortality rate was 16%. Infarcts were reported in 66% of patients and were predictive of poor outcome. Magnetic resonance angiogram abnormalities were reported in 55% of patients. Delayed tuberculomas developed in 11% of patients (after starting treatment). Spinal pathology was more common than expected, occurring in 76% of patients. Exudate in the spinal canal increased the difficulty of lumbar puncture and correlated with high cerebrospinal fluid protein content. Conclusion-Tuberculous meningitis involves extensive pathology in the central nervous system. Severe infarction was predictive of poor outcome although this was not the case for angiographic abnormalities.

Research paper thumbnail of A case-based approach to UTI imaging – making sense of the guidelines

South African Journal of Radiology, 2015

Urinary tract infections (UTIs) are common amongst children and invariably result in imaging test... more Urinary tract infections (UTIs) are common amongst children and invariably result in imaging tests to look for correctable causes that may predispose the child to infection. The objective of imaging is to identify those children at risk of long-term renal damage. The ideal imaging algorithm is extensively debated in the literature owing to the lack of evidence-based data, evolving theories on the pathophysiology of UTI and vesicoureteric reflux (VUR). The present article provides a case-based approach to the imaging of UTIs and proposes guidelines relevant to the South African setting.

Research paper thumbnail of Perceived Impact of COVID-19 on Pediatric Radiology Departments Around the World: WFPI COVID-19 Task Force Survey Results from 6 Continents

Radiology: Cardiothoracic Imaging, 2020

Purpose To investigate how COVID-19 has impacted pediatric radiology practice around the world at... more Purpose To investigate how COVID-19 has impacted pediatric radiology practice around the world at the present time. Materials and Methods This study was based on a survey conducted by the World Federation of Pediatric Imaging (WFPI) COVID-19 task force. Pediatric radiology representatives from countries around the world were identified and asked to complete an electronic survey consisting of 17 questions related to the impact of, concerns surrounding, and education related to COVID-19 on pediatric radiology. For each outcome variable, a pair of 2-way frequency tables was constructed: one against COVID-19 prevalence, and another against region. Tests of independence of the tables’ row and column factors were performed based on Fisher’s exact test and odds ratios (OR) were estimated via logistic regression models corresponding to these 2-way tables. Results The survey (response rate 87%, 72/83) comprised representatives from 71 countries and Hong Kong across 6 continents. 66/72 respon...

Research paper thumbnail of Tuberculosis during early antiretroviral-induced immune reconstitution in HIV-infected children

The International Journal of Tuberculosis and Lung Disease

Referral paediatric hospital, Cape Town, South Africa. To describe the clinical manifestations of... more Referral paediatric hospital, Cape Town, South Africa. To describe the clinical manifestations of Mycobacterium tuberculosis (TB) associated disease in human immunodeficiency virus (HIV) infected children during early antiretroviral-induced immune reconstitution. Case series. Eleven patients with probable or culture confirmed TB were identified. Seven presented after a median 25 (range 8-54) days on highly active antiretroviral therapy (HAART) with pulmonary TB and one also had extra-pulmonary disease. Three of the patients had a prior history of TB and presented with relapse or recurrent disease. Four patients with TB developed a tuberculous paradoxical reaction; one died of suspected tuberculous immune reconstitution pneumonitis. The duration of pre-HAART anti-tuberculosis treatment and antiretroviral treatment ranged from 21 to 59 and 6 to 105 days, respectively, when they presented with a paradoxical reaction. Drug-resistant (isoniazid and rifampicin) TB was cultured from one pa...

Research paper thumbnail of Pediatric and Adult Spinal Tuberculosis

Neuroimaging Clinics of North America, 2015

The prevalence of tuberculosis (TB) has increased in developing and developed countries as a cons... more The prevalence of tuberculosis (TB) has increased in developing and developed countries as a consequence of the AIDS epidemic, immigration, social deprivation, and inadequate TB control and screening programs. Spinal TB may be osseous or nonosseous. Classic findings of multiple contiguous vertebral body involvement, gibbus formation, and subligamentous spread with paravertebral abscesses are optimally evaluated with MR imaging. Nonspondylitic spinal TB is less well described in the literature, may develop in the absence of TB meningitis, and is often associated with meningovascular cord ischemia. Radiologists should be familiar with the spectrum of imaging findings, allowing early diagnosis and treatment of this serious condition.

Research paper thumbnail of Change in optic nerve sheath diameter as a radiological marker of outcome from endoscopic third ventriculostomy in children

Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery, Jan 4, 2015

The purpose of this study was to investigate the value of the change in optic nerve sheath diamet... more The purpose of this study was to investigate the value of the change in optic nerve sheath diameter (ONSD) as a radiological marker of endoscopic third ventriculostomy (ETV) outcome in children. Magnetic resonance imaging (MRI) scans of patients on whom ETVs were performed between the periods of January 2009 and June 2013 were reviewed. ONSD measurements on pre- and post-operative images were performed by two blinded observers, and the relationship between the change in these measurements and outcome from ETV were investigated. These findings were then also compared to conventional imaging features associated with ETV outcome. MRI scans of 24 patients were adequate to measure the ONSD pre- and post-operatively. In patients with successful ETV (n = 19), the mean change in ONSD was 0.73 mm and in patients with a failed ETV (n = 5), the mean change in ONSD was 0.18 mm (p = 0.0007). A change in ONSD of 7.5 % of the initial measurement demonstrated a sensitivity of 92.9 % and a sensitivi...

Research paper thumbnail of Imaging features of tuberous sclerosis complex with autosomal-dominant polycystic kidney disease: a contiguous gene syndrome

Pediatric Radiology, 2014

Genes for tuberous sclerosis complex (TSC) type 2 and autosomal-dominant polycystic kidney diseas... more Genes for tuberous sclerosis complex (TSC) type 2 and autosomal-dominant polycystic kidney disease (ADPKD) type 1 are both encoded over a short segment of chromosome 16. When deletions involve both genes, an entity known as the TSC2/ADPKD1 contiguous gene syndrome, variable phenotypes of TSC and ADPKD are exhibited. This syndrome has not been reviewed in the radiology literature. Unlike renal cysts in TSC, cystic disease in TSC2/ADPKD1 contiguous gene syndrome results in hypertension and renal failure. A radiologist might demonstrate polycystic kidney disease before the patient develops other stigmata of TSC. Conversely, in patients with known TSC, enlarged and polycystic kidneys should signal the possibility of the TSC2/ADPKD1 contiguous gene syndrome and not simply TSC. Distinguishing these diagnoses has implications in prognosis, treatment and genetic counseling. To describe the clinical and imaging findings of tuberous sclerosis complex and polycystic kidney disease in seven pediatric patients. We retrospectively reviewed renal and brain imaging of children and young adults with genetically proven or high clinical suspicion for TSC2/ADPKD1 contiguous gene syndrome. We included seven pediatric patients from two referral institutions. Ages ranged from birth to 21 years over the course of imaging. The mean follow-up period was 9 years 8 months (4 years 6 months to 20 years 6 months). No child progressed to end-stage renal disease during this period. Three patients were initially imaged for stigmata of TSC, three for abdominal distension and one for elevated serum creatinine concentration. All patients developed enlarged, polycystic kidneys. The latest available imaging studies demonstrated that in 12 of the 14 kidneys 50% or more of the parenchyma was ultimately replaced by >15 cysts, resulting in significant cortical thinning. The largest cysts in each kidney ranged from 2.4 cm to 9.3 cm. Echogenic lesions were present in 13 of the 14 kidneys, in keeping with angiomyolipomas (ranging from 0.4 cm to 7.8 cm). Compared to the latest imaging studies, the initial studies only demonstrated 64% of kidneys to be borderline or enlarged; the majority had 10 or more cysts and 0-5 echogenic foci in each kidney, measuring 0.8 cm maximally, which were possible angiomyolipomas. Increased cortical echogenicity was observed in eight kidneys, and decreased corticomedullary differentiation was demonstrated in six kidneys. Cortical thinning varied with size and number of cysts. The sonographic renal findings in TSC2/ADPKD1 contiguous gene syndrome progress over time and demonstrate a specific pattern of renal disease different from typical tuberous sclerosis complex. There are multiple cysts at presentation and there is progressive enlargement of the kidneys and of the renal cysts. Because clinical or imaging findings of TSC may not manifest in the young child, the radiologist can be the first to suggest a diagnosis of TSC2/ADPKD1 contiguous gene syndrome and recommend thorough skin examination and imaging in search of TSC findings. The radiologist should be able to suggest the diagnosis of TSC2/ADPKD1 contiguous gene syndrome in children with TSC who have large cysts occupying a large portion of an enlarged kidney. This should not be dismissed as renal cystic disease of TSC or as ADPKD because the diagnosis of TSC2/ADPKD1 contiguous gene syndrome has implications for patient management and prognosis.

Research paper thumbnail of HIV Encephalopathy: pediatric case series description and insights from the clinic coalface

AIDS research and therapy, 2015

The Human Immune Deficiency Virus (HIV) can manifest neurologically in both adults and children. ... more The Human Immune Deficiency Virus (HIV) can manifest neurologically in both adults and children. Early invasion of the central nervous system by the virus, affecting the developing brain, is believed to result in the most common primary HIV-related neurological complication, HIV Encephalopathy (HIVE). In countries such as South Africa where many children have not been initiated on antiretroviral treatment early, HIVE remains a significant clinical problem. Children were selected from a clinic for children with neurologic complications of HIV, located at the Red Cross War Memorial Children's Hospital, South Africa 2008-2012. Eligible subjects fulfilled the following inclusion criteria: aged 6 months-13 years; positive diagnosis of HIV infection, vertically infected and HIVE as defined by CDC criteria. Each participant was prospectively assessed by a Pediatric Neurologist using a standardized proforma which collated relevant details of background, clinical and immunological status...

Research paper thumbnail of Orbital lymphomatoid granulomatosis – a rare cause of proptosis

Pediatric Radiology, 2014

A 1-year-old girl with unilateral proptosis was found to have primary orbital lymphomatoid granul... more A 1-year-old girl with unilateral proptosis was found to have primary orbital lymphomatoid granulomatosis - a condition rarely occurring in children. This multisystem angiocentric, angiodestructive, lymphoproliferative disease typically involves the lungs, with ocular involvement being extremely uncommon. Our case serves to illustrate the imaging findings of this unusual condition and highlight a rare cause of proptosis.

Research paper thumbnail of Immune reconstitution inflammatory syndrome after initiating highly active antiretroviral therapy in HIV-infected children

Pediatric Radiology, 2009

The outcome of HIV infection has improved since the widespread availability of highly active anti... more The outcome of HIV infection has improved since the widespread availability of highly active antiretroviral therapy (HAART). Some patients, however, develop a clinical and radiological deterioration following initiation of HAART due to either the unmasking of occult subclinical infection or an enhanced inflammatory response to a treated infection. This phenomenon is believed to result from the restored ability to mount

Research paper thumbnail of Accuracy of radiographer reporting of paediatric brain CT

Pediatric Radiology, 2007

Background Radiographer reporting has been studied for plain films and for ultrasonography, but n... more Background Radiographer reporting has been studied for plain films and for ultrasonography, but not in paediatric brain CT in the emergency setting. Objective To study the accuracy of radiographer reporting in paediatric brain CT. Materials and methods We prospectively collected 100 paediatric brain CT examinations. Films were read from hard copies using a prescribed tick sheet. Radiographers with 12 years' and 3 years' experience, respectively, were blinded to the history and were not trained in diagnostic film interpretation. The radiographers' results were compared with those of a consultant radiologist. Three categories were defined: abnormal scans, significant abnormalities and insignificant abnormalities. Results Both radiographers had an accuracy of 89.5% in reading a scan correctly as abnormal, and radiographer 1 had a sensitivity of 87.8% and radiographer 2 a sensitivity of 96%. Radiographer 1 had an accuracy in detecting a significant abnormality of 75% and radiographer 2 an accuracy of 48.6%, and the sensitivities for this category were 61.6% and 52.9%, respectively. Results for detecting the insignificant abnormalities were poorer. Conclusions Selected radiographers could play an effective screening role, but lacking the sensitivity required for detecting significant abnormality, they could not be the final diagnostician. We recommend that the study be repeated after both radiographers have received formal training in interpretation of paediatric brain CT.

Research paper thumbnail of Significant airway compromise in a child with a posterior mediastinal mass due to tuberculous spondylitis

Pediatric Radiology, 2005

Research paper thumbnail of Tuberculous iliac artery aneurysm in a pediatric patient

Journal of Vascular Surgery, 2013

Vascular complications of tuberculous infections are rare and occur even less frequently in the p... more Vascular complications of tuberculous infections are rare and occur even less frequently in the pediatric population. Tuberculous pseudoaneurysms can occur either as a result of contiguous spread from a neighboring focus-invariably infected lymph nodes-or by hematogenous spread and seeding of acid-fast bacilli that lodge in the adventitia or media via the vasa vasorum. We report a case of turberculous right common iliac artery pseudoaneurysm in a 12-year-old and review the relevant literature.

Research paper thumbnail of Multiple injuries diagnosed using full-body digital x-ray

Journal of Pediatric Surgery, 2006

Missed injuries in patients with multiple trauma are primarily attributable to inadequate radiogr... more Missed injuries in patients with multiple trauma are primarily attributable to inadequate radiography. A case is presented that demonstrates the value of a full-body digital radiography system in diagnosing pathology in pediatric multiple trauma patients. Full-body imaging allowed the identification of a ruptured diaphragm, a pelvic fracture, and a femoral fracture on a single radiographic projection in the resuscitation room, facilitating immediate intervention.

Research paper thumbnail of Magnetic Resonance Imaging Versus Histopathology in Wilms Tumor and Nephroblastomatosis

Journal of Pediatric Hematology/Oncology, 2014

Magnetic resonance imaging (MRI) has become the principal tool for Wilms tumor (WT) assessment an... more Magnetic resonance imaging (MRI) has become the principal tool for Wilms tumor (WT) assessment and follow-up. MRI and histopathologic findings were not congruent in 2 of the q30 scanned patients with renal masses (2008 to 2011). Three lesions thought to be WT on MRI were found to be a sclerotic nephrogenic rest (1), cystic renal dysplasia (1), and focal chronic pyelonephritis (1). The "typical" features suggesting nephroblastomatosis and WT on MRI are unreliable and such lesions require biopsy for histopathologic diagnosis, especially when nephron-sparing surgery is necessary to preserve renal function.

Research paper thumbnail of Skull fracture as a herald of intracranial abnormality in children with mild head injury: Is there a role for skull radiographs?

Australasian Radiology, 2003

The aim of the present study is to assess if skull fracture is a useful predictor of intracranial... more The aim of the present study is to assess if skull fracture is a useful predictor of intracranial abnormality in children with minor head injury (MHI) and to evaluate the usefulness of skull radiographs. Retrospective review of CT scans and skull X-rays (SXR) of children <14 years of age with blunt head injury and correlation with the Glascow Coma Score definition of MHI (GCS > 12/15 or > 9/11) over a 1-year period was done. Three-hundred and eighty-one patients were included with a mean age of 6 years. Thirty-one percent of patients had intracranial abnormality. Forty-nine percent of all patients had fractures either on CT or SXR and 49% of these had intracranial abnormality on CT. Eighty-five percent of patients with drainable collections had associated fractures. Twenty-three percent of MHI had abnormalities on CT, of which 32% were drainable collections. All patients with MHI who had drainable collections showed a fracture. Some protocols for paediatric head injury recommend CT for all patients while others rely on clinical indicators. In developing countries, CT is neither widely available nor accessible, and preselection of patients is necessary. We demonstrated that omitting CT in MHI could result in missed intracranial abnormalities. All MHI with drainable collections had fractures. Fractures identified on SXR can be added to the clinical indications for CT in MHI and can improve detection of 'silent' drainable collections.

Research paper thumbnail of Overnight oximetry in African children with human immunodeficiency virus

Archives of Disease in Childhood, 2012

Research paper thumbnail of A pilot study evaluating the “STATSCAN” digital X-ray machine in paediatric polytrauma

Emergency Radiology, 2007

A pilot study evaluating the use in paediatric polytrauma of the STATSCAN, a low-radiation dose, ... more A pilot study evaluating the use in paediatric polytrauma of the STATSCAN, a low-radiation dose, fanbeam digital radiography unit (Lodox Systems, Sandton, South Africa). Over 3 months, 23 polytrauma patients treated at the Emergency Unit of the Red Cross Children's Hospital in Cape Town, South Africa, were imaged on the STATSCAN. Image quality, diagnostic equivalence and clinical efficiency were compared with a computed radiog-raphy (CR) system (Fuji FCR 5000, Fuji Photo Film, Tokyo, Japan). The STATSCAN antero-posterior bodygram correlated well technically and diagnostically with CR, showing 96% of the fractures in the cohort. It allowed superior visualisation of the trachea and main bronchi and imaging was, on average, 13% faster than CR. The STATSCAN could play an important role in paediatric polytrauma. The clinical significance of its superior demonstration of the trachea and main bronchi requires further evaluation.

Research paper thumbnail of Imaging Features of the Brain, Cerebral Vessels and Spine in Pediatric Tuberculous Meningitis With Associated Hydrocephalus

Pediatric Infectious Disease Journal, 2016

Background-Pediatric tuberculous meningitis leads to high rates of mortality and morbidity. Promp... more Background-Pediatric tuberculous meningitis leads to high rates of mortality and morbidity. Prompt diagnosis and initiation of treatment are challenging; imaging findings play a key role in establishing the presumptive diagnosis. General brain imaging findings are well reported; however, specific data on cerebral vascular and spinal involvement in children are sparse. Methods-This prospective cohort study examined admission and follow up computed tomography brain scans and magnetic resonance imaging scans of the brain, cerebral vessels (magnetic resonance angiogram) and spine at 3 weeks in children treated for tuberculous meningitis with hydrocephalus (inclusion criteria). Exclusion criteria were no hydrocephalus on admission, treatment of hydrocephalus or commencement of anti-TB treatment before study enrolment. Imaging findings were examined in association with outcome at 6 months. Results-Forty-four patients (median age 3.3 [0.3-13.1] years) with definite (54%) or probable tuberculous meningitis were enrolled. Good clinical outcome was reported in 72%; the mortality rate was 16%. Infarcts were reported in 66% of patients and were predictive of poor outcome. Magnetic resonance angiogram abnormalities were reported in 55% of patients. Delayed tuberculomas developed in 11% of patients (after starting treatment). Spinal pathology was more common than expected, occurring in 76% of patients. Exudate in the spinal canal increased the difficulty of lumbar puncture and correlated with high cerebrospinal fluid protein content. Conclusion-Tuberculous meningitis involves extensive pathology in the central nervous system. Severe infarction was predictive of poor outcome although this was not the case for angiographic abnormalities.

Research paper thumbnail of A case-based approach to UTI imaging – making sense of the guidelines

South African Journal of Radiology, 2015

Urinary tract infections (UTIs) are common amongst children and invariably result in imaging test... more Urinary tract infections (UTIs) are common amongst children and invariably result in imaging tests to look for correctable causes that may predispose the child to infection. The objective of imaging is to identify those children at risk of long-term renal damage. The ideal imaging algorithm is extensively debated in the literature owing to the lack of evidence-based data, evolving theories on the pathophysiology of UTI and vesicoureteric reflux (VUR). The present article provides a case-based approach to the imaging of UTIs and proposes guidelines relevant to the South African setting.

Research paper thumbnail of Perceived Impact of COVID-19 on Pediatric Radiology Departments Around the World: WFPI COVID-19 Task Force Survey Results from 6 Continents

Radiology: Cardiothoracic Imaging, 2020

Purpose To investigate how COVID-19 has impacted pediatric radiology practice around the world at... more Purpose To investigate how COVID-19 has impacted pediatric radiology practice around the world at the present time. Materials and Methods This study was based on a survey conducted by the World Federation of Pediatric Imaging (WFPI) COVID-19 task force. Pediatric radiology representatives from countries around the world were identified and asked to complete an electronic survey consisting of 17 questions related to the impact of, concerns surrounding, and education related to COVID-19 on pediatric radiology. For each outcome variable, a pair of 2-way frequency tables was constructed: one against COVID-19 prevalence, and another against region. Tests of independence of the tables’ row and column factors were performed based on Fisher’s exact test and odds ratios (OR) were estimated via logistic regression models corresponding to these 2-way tables. Results The survey (response rate 87%, 72/83) comprised representatives from 71 countries and Hong Kong across 6 continents. 66/72 respon...

Research paper thumbnail of Tuberculosis during early antiretroviral-induced immune reconstitution in HIV-infected children

The International Journal of Tuberculosis and Lung Disease

Referral paediatric hospital, Cape Town, South Africa. To describe the clinical manifestations of... more Referral paediatric hospital, Cape Town, South Africa. To describe the clinical manifestations of Mycobacterium tuberculosis (TB) associated disease in human immunodeficiency virus (HIV) infected children during early antiretroviral-induced immune reconstitution. Case series. Eleven patients with probable or culture confirmed TB were identified. Seven presented after a median 25 (range 8-54) days on highly active antiretroviral therapy (HAART) with pulmonary TB and one also had extra-pulmonary disease. Three of the patients had a prior history of TB and presented with relapse or recurrent disease. Four patients with TB developed a tuberculous paradoxical reaction; one died of suspected tuberculous immune reconstitution pneumonitis. The duration of pre-HAART anti-tuberculosis treatment and antiretroviral treatment ranged from 21 to 59 and 6 to 105 days, respectively, when they presented with a paradoxical reaction. Drug-resistant (isoniazid and rifampicin) TB was cultured from one pa...

Research paper thumbnail of Pediatric and Adult Spinal Tuberculosis

Neuroimaging Clinics of North America, 2015

The prevalence of tuberculosis (TB) has increased in developing and developed countries as a cons... more The prevalence of tuberculosis (TB) has increased in developing and developed countries as a consequence of the AIDS epidemic, immigration, social deprivation, and inadequate TB control and screening programs. Spinal TB may be osseous or nonosseous. Classic findings of multiple contiguous vertebral body involvement, gibbus formation, and subligamentous spread with paravertebral abscesses are optimally evaluated with MR imaging. Nonspondylitic spinal TB is less well described in the literature, may develop in the absence of TB meningitis, and is often associated with meningovascular cord ischemia. Radiologists should be familiar with the spectrum of imaging findings, allowing early diagnosis and treatment of this serious condition.

Research paper thumbnail of Change in optic nerve sheath diameter as a radiological marker of outcome from endoscopic third ventriculostomy in children

Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery, Jan 4, 2015

The purpose of this study was to investigate the value of the change in optic nerve sheath diamet... more The purpose of this study was to investigate the value of the change in optic nerve sheath diameter (ONSD) as a radiological marker of endoscopic third ventriculostomy (ETV) outcome in children. Magnetic resonance imaging (MRI) scans of patients on whom ETVs were performed between the periods of January 2009 and June 2013 were reviewed. ONSD measurements on pre- and post-operative images were performed by two blinded observers, and the relationship between the change in these measurements and outcome from ETV were investigated. These findings were then also compared to conventional imaging features associated with ETV outcome. MRI scans of 24 patients were adequate to measure the ONSD pre- and post-operatively. In patients with successful ETV (n = 19), the mean change in ONSD was 0.73 mm and in patients with a failed ETV (n = 5), the mean change in ONSD was 0.18 mm (p = 0.0007). A change in ONSD of 7.5 % of the initial measurement demonstrated a sensitivity of 92.9 % and a sensitivi...

Research paper thumbnail of Imaging features of tuberous sclerosis complex with autosomal-dominant polycystic kidney disease: a contiguous gene syndrome

Pediatric Radiology, 2014

Genes for tuberous sclerosis complex (TSC) type 2 and autosomal-dominant polycystic kidney diseas... more Genes for tuberous sclerosis complex (TSC) type 2 and autosomal-dominant polycystic kidney disease (ADPKD) type 1 are both encoded over a short segment of chromosome 16. When deletions involve both genes, an entity known as the TSC2/ADPKD1 contiguous gene syndrome, variable phenotypes of TSC and ADPKD are exhibited. This syndrome has not been reviewed in the radiology literature. Unlike renal cysts in TSC, cystic disease in TSC2/ADPKD1 contiguous gene syndrome results in hypertension and renal failure. A radiologist might demonstrate polycystic kidney disease before the patient develops other stigmata of TSC. Conversely, in patients with known TSC, enlarged and polycystic kidneys should signal the possibility of the TSC2/ADPKD1 contiguous gene syndrome and not simply TSC. Distinguishing these diagnoses has implications in prognosis, treatment and genetic counseling. To describe the clinical and imaging findings of tuberous sclerosis complex and polycystic kidney disease in seven pediatric patients. We retrospectively reviewed renal and brain imaging of children and young adults with genetically proven or high clinical suspicion for TSC2/ADPKD1 contiguous gene syndrome. We included seven pediatric patients from two referral institutions. Ages ranged from birth to 21 years over the course of imaging. The mean follow-up period was 9 years 8 months (4 years 6 months to 20 years 6 months). No child progressed to end-stage renal disease during this period. Three patients were initially imaged for stigmata of TSC, three for abdominal distension and one for elevated serum creatinine concentration. All patients developed enlarged, polycystic kidneys. The latest available imaging studies demonstrated that in 12 of the 14 kidneys 50% or more of the parenchyma was ultimately replaced by >15 cysts, resulting in significant cortical thinning. The largest cysts in each kidney ranged from 2.4 cm to 9.3 cm. Echogenic lesions were present in 13 of the 14 kidneys, in keeping with angiomyolipomas (ranging from 0.4 cm to 7.8 cm). Compared to the latest imaging studies, the initial studies only demonstrated 64% of kidneys to be borderline or enlarged; the majority had 10 or more cysts and 0-5 echogenic foci in each kidney, measuring 0.8 cm maximally, which were possible angiomyolipomas. Increased cortical echogenicity was observed in eight kidneys, and decreased corticomedullary differentiation was demonstrated in six kidneys. Cortical thinning varied with size and number of cysts. The sonographic renal findings in TSC2/ADPKD1 contiguous gene syndrome progress over time and demonstrate a specific pattern of renal disease different from typical tuberous sclerosis complex. There are multiple cysts at presentation and there is progressive enlargement of the kidneys and of the renal cysts. Because clinical or imaging findings of TSC may not manifest in the young child, the radiologist can be the first to suggest a diagnosis of TSC2/ADPKD1 contiguous gene syndrome and recommend thorough skin examination and imaging in search of TSC findings. The radiologist should be able to suggest the diagnosis of TSC2/ADPKD1 contiguous gene syndrome in children with TSC who have large cysts occupying a large portion of an enlarged kidney. This should not be dismissed as renal cystic disease of TSC or as ADPKD because the diagnosis of TSC2/ADPKD1 contiguous gene syndrome has implications for patient management and prognosis.

Research paper thumbnail of HIV Encephalopathy: pediatric case series description and insights from the clinic coalface

AIDS research and therapy, 2015

The Human Immune Deficiency Virus (HIV) can manifest neurologically in both adults and children. ... more The Human Immune Deficiency Virus (HIV) can manifest neurologically in both adults and children. Early invasion of the central nervous system by the virus, affecting the developing brain, is believed to result in the most common primary HIV-related neurological complication, HIV Encephalopathy (HIVE). In countries such as South Africa where many children have not been initiated on antiretroviral treatment early, HIVE remains a significant clinical problem. Children were selected from a clinic for children with neurologic complications of HIV, located at the Red Cross War Memorial Children's Hospital, South Africa 2008-2012. Eligible subjects fulfilled the following inclusion criteria: aged 6 months-13 years; positive diagnosis of HIV infection, vertically infected and HIVE as defined by CDC criteria. Each participant was prospectively assessed by a Pediatric Neurologist using a standardized proforma which collated relevant details of background, clinical and immunological status...

Research paper thumbnail of Orbital lymphomatoid granulomatosis – a rare cause of proptosis

Pediatric Radiology, 2014

A 1-year-old girl with unilateral proptosis was found to have primary orbital lymphomatoid granul... more A 1-year-old girl with unilateral proptosis was found to have primary orbital lymphomatoid granulomatosis - a condition rarely occurring in children. This multisystem angiocentric, angiodestructive, lymphoproliferative disease typically involves the lungs, with ocular involvement being extremely uncommon. Our case serves to illustrate the imaging findings of this unusual condition and highlight a rare cause of proptosis.

Research paper thumbnail of Immune reconstitution inflammatory syndrome after initiating highly active antiretroviral therapy in HIV-infected children

Pediatric Radiology, 2009

The outcome of HIV infection has improved since the widespread availability of highly active anti... more The outcome of HIV infection has improved since the widespread availability of highly active antiretroviral therapy (HAART). Some patients, however, develop a clinical and radiological deterioration following initiation of HAART due to either the unmasking of occult subclinical infection or an enhanced inflammatory response to a treated infection. This phenomenon is believed to result from the restored ability to mount

Research paper thumbnail of Accuracy of radiographer reporting of paediatric brain CT

Pediatric Radiology, 2007

Background Radiographer reporting has been studied for plain films and for ultrasonography, but n... more Background Radiographer reporting has been studied for plain films and for ultrasonography, but not in paediatric brain CT in the emergency setting. Objective To study the accuracy of radiographer reporting in paediatric brain CT. Materials and methods We prospectively collected 100 paediatric brain CT examinations. Films were read from hard copies using a prescribed tick sheet. Radiographers with 12 years' and 3 years' experience, respectively, were blinded to the history and were not trained in diagnostic film interpretation. The radiographers' results were compared with those of a consultant radiologist. Three categories were defined: abnormal scans, significant abnormalities and insignificant abnormalities. Results Both radiographers had an accuracy of 89.5% in reading a scan correctly as abnormal, and radiographer 1 had a sensitivity of 87.8% and radiographer 2 a sensitivity of 96%. Radiographer 1 had an accuracy in detecting a significant abnormality of 75% and radiographer 2 an accuracy of 48.6%, and the sensitivities for this category were 61.6% and 52.9%, respectively. Results for detecting the insignificant abnormalities were poorer. Conclusions Selected radiographers could play an effective screening role, but lacking the sensitivity required for detecting significant abnormality, they could not be the final diagnostician. We recommend that the study be repeated after both radiographers have received formal training in interpretation of paediatric brain CT.

Research paper thumbnail of Significant airway compromise in a child with a posterior mediastinal mass due to tuberculous spondylitis

Pediatric Radiology, 2005

Research paper thumbnail of Tuberculous iliac artery aneurysm in a pediatric patient

Journal of Vascular Surgery, 2013

Vascular complications of tuberculous infections are rare and occur even less frequently in the p... more Vascular complications of tuberculous infections are rare and occur even less frequently in the pediatric population. Tuberculous pseudoaneurysms can occur either as a result of contiguous spread from a neighboring focus-invariably infected lymph nodes-or by hematogenous spread and seeding of acid-fast bacilli that lodge in the adventitia or media via the vasa vasorum. We report a case of turberculous right common iliac artery pseudoaneurysm in a 12-year-old and review the relevant literature.

Research paper thumbnail of Multiple injuries diagnosed using full-body digital x-ray

Journal of Pediatric Surgery, 2006

Missed injuries in patients with multiple trauma are primarily attributable to inadequate radiogr... more Missed injuries in patients with multiple trauma are primarily attributable to inadequate radiography. A case is presented that demonstrates the value of a full-body digital radiography system in diagnosing pathology in pediatric multiple trauma patients. Full-body imaging allowed the identification of a ruptured diaphragm, a pelvic fracture, and a femoral fracture on a single radiographic projection in the resuscitation room, facilitating immediate intervention.

Research paper thumbnail of Magnetic Resonance Imaging Versus Histopathology in Wilms Tumor and Nephroblastomatosis

Journal of Pediatric Hematology/Oncology, 2014

Magnetic resonance imaging (MRI) has become the principal tool for Wilms tumor (WT) assessment an... more Magnetic resonance imaging (MRI) has become the principal tool for Wilms tumor (WT) assessment and follow-up. MRI and histopathologic findings were not congruent in 2 of the q30 scanned patients with renal masses (2008 to 2011). Three lesions thought to be WT on MRI were found to be a sclerotic nephrogenic rest (1), cystic renal dysplasia (1), and focal chronic pyelonephritis (1). The "typical" features suggesting nephroblastomatosis and WT on MRI are unreliable and such lesions require biopsy for histopathologic diagnosis, especially when nephron-sparing surgery is necessary to preserve renal function.

Research paper thumbnail of Skull fracture as a herald of intracranial abnormality in children with mild head injury: Is there a role for skull radiographs?

Australasian Radiology, 2003

The aim of the present study is to assess if skull fracture is a useful predictor of intracranial... more The aim of the present study is to assess if skull fracture is a useful predictor of intracranial abnormality in children with minor head injury (MHI) and to evaluate the usefulness of skull radiographs. Retrospective review of CT scans and skull X-rays (SXR) of children <14 years of age with blunt head injury and correlation with the Glascow Coma Score definition of MHI (GCS > 12/15 or > 9/11) over a 1-year period was done. Three-hundred and eighty-one patients were included with a mean age of 6 years. Thirty-one percent of patients had intracranial abnormality. Forty-nine percent of all patients had fractures either on CT or SXR and 49% of these had intracranial abnormality on CT. Eighty-five percent of patients with drainable collections had associated fractures. Twenty-three percent of MHI had abnormalities on CT, of which 32% were drainable collections. All patients with MHI who had drainable collections showed a fracture. Some protocols for paediatric head injury recommend CT for all patients while others rely on clinical indicators. In developing countries, CT is neither widely available nor accessible, and preselection of patients is necessary. We demonstrated that omitting CT in MHI could result in missed intracranial abnormalities. All MHI with drainable collections had fractures. Fractures identified on SXR can be added to the clinical indications for CT in MHI and can improve detection of 'silent' drainable collections.

Research paper thumbnail of Overnight oximetry in African children with human immunodeficiency virus

Archives of Disease in Childhood, 2012

Research paper thumbnail of A pilot study evaluating the “STATSCAN” digital X-ray machine in paediatric polytrauma

Emergency Radiology, 2007

A pilot study evaluating the use in paediatric polytrauma of the STATSCAN, a low-radiation dose, ... more A pilot study evaluating the use in paediatric polytrauma of the STATSCAN, a low-radiation dose, fanbeam digital radiography unit (Lodox Systems, Sandton, South Africa). Over 3 months, 23 polytrauma patients treated at the Emergency Unit of the Red Cross Children's Hospital in Cape Town, South Africa, were imaged on the STATSCAN. Image quality, diagnostic equivalence and clinical efficiency were compared with a computed radiog-raphy (CR) system (Fuji FCR 5000, Fuji Photo Film, Tokyo, Japan). The STATSCAN antero-posterior bodygram correlated well technically and diagnostically with CR, showing 96% of the fractures in the cohort. It allowed superior visualisation of the trachea and main bronchi and imaging was, on average, 13% faster than CR. The STATSCAN could play an important role in paediatric polytrauma. The clinical significance of its superior demonstration of the trachea and main bronchi requires further evaluation.