Congenital cystic adenomatoid malformation of the lung (CCAM) is diagnosed by prenatal ultrasonography with an increasing frequency but controversy persists as to its prognosis and prenatal management. Method: A multi-institutional study of cases of CCAM diagnosed antenatally identified by ultrasonographers and by a review of hospital charts. Results: We obtained 48 cases from five centers. We estimate the incidence of CCAM at 1:25,000 to 1:35,000 pregnancies. The incidence of voluntary abortions was 15% (7/48), of spontaneous abortions 2% (1/41) and of postnatal death 10% (4/40). One of the postnatal deaths was from trisomy 18. Of the 7 aborted fetuses, 2 had multiple malformations and 1 had severe hydrops and oligohydramnios; the other 4 had a large mass with mediastinal displacement but without hydrops. When pregnancy was allowed to continue, 56% of the lesions regressed spontaneously, even though one third of these had initial progression. In 17 cases (42%) the mediastinal shift corrected itself, sometimes by simple growth of the fetus but most often by a decrease in the size of the lung mass. In 1 fetus, repeated needle decompressions followed by double-pigtail catheter drainage of large cysts allowed regression of hydrops. Despite this, neonatal death occurred from pulmonary hypoplasia. Conclusion: CCAM can lead to fetal or neonatal demise from hydrops, lung hypoplasia, prematurity or severe associated malformations, but has a good prognosis in the majority of cases.

OBJECTIVE. We describethe sonographic appearanceand vascularization of hemangio mas and determine if vessel density and peak systolic Doppler shifts distinguish hemangiomas from other superficial soft-tissue masses. SUBJECTSAND METHODS. Ourpilotstudyincluded 20 infants andchildren withhemangiomas who were to undergo biopsy before treatment with interferon alpha-2b. We used Doppler sonography to determine the number of vesselsper square centimeter, peak arterial Doppler shift, resistive index, and signs of arteriovenous shunting. All hemangiomas showed high vesseldensity (more than five per squarecentimeter) and high Doppler shifts (more than 2 kHz), and these two factors became our diagnostic criteria. A prospective study of I 16 pa tients was then carried out. One hundred sixteen consecutive pediatric patients with superficial soft-tissue masses were examined using Doppler sonography: sonographic findings were compared with the final diagnoses that were established by biopsy, CT, or clinical follow-up. and a peak arterial Doppler shift exceeding 2 kHz were correctly diagnosed as hemangiomas (sensitivity, 84%; specificity, 98%). One artenovenous malformation showed high vesselden sity and high Doppler shifts, but none of the other masses that were not hemangiomas did. RESULTS. The final diagnoses included70 hemangiomas, 20 venousmalformations,Eleven patients with hemangiomas who were being treated with interferon at the time of the study fulfilled only one of the two diagnostic criteria. CONCLUSION. Highvessel density andhighpeakarterial Dopplershiftcanbeusedtodistinguish hemangiomas from other soft-tissue masses.H emangiomas,which areamongthe most common soft-tissue tumors in infants [1â€"3), typically appearas slightly raised,bluish red subcutaneousmasses that resemblethe surface of a strawberry and regressasthe child grows older. Someheman giomasdo not havethis typical appearancebe cause part or all of the lesion is deep in the soft tissue and the overlying skin appears normal.These lesions are difficult to distinguish clini cally from more suspicioussoft-tissuemasses, such as vascularmalformations, soft-tissueUi mors (e.g., metastasesfrom neuroblastomaor rhabdomyosarcoma),and infantile myofibro matosis.Children with suchlesionsareusually referredfor imaging studies or biopsy.Blood flow in superficial vessels is readily discernible using Doppler sonography. We soughtto ascertainwhetherhemangiomashave characteristic features that can be seen using high-frequency gray-scale and Doppler sonog raphy and whether they can be distinguished from other superficial soft-tissuemassesin in fantsandchildren. Subjects and Methods PilotStudyTo determine the general appearanceand vascu

When investigating pelvic pathologic conditions in female pediatric patients, one needs to be aware of the developmental changes that take place around puberty. The prepubertal uterus is thin, with a fundus equal in size to the cervix. Owing to the hormonal stimulation of puberty, the uterus enlarges and the fundus becomes prominent. The ovaries are demonstrated with ultrasonography (US) at all ages. Ovarian volume increases after 6 years of age. Microcystic follicles are normally seen throughout childhood. US is the modality of choice for imaging the pediatric female pelvis. The main indications for pelvic US in the pediatric age group are pubertal precocity or pubertal delay, pelvic pain or pelvic masses, and ambiguous genitalia. Vaginal bleeding in the prepubertal child can be due to a vaginal foreign body, vaginal rhabdomyosarcoma, or precocious puberty. Common causes of primary amenorrhea in teenagers include gonadal dysgenesis (Turner syndrome) and müllerian (uterovaginal) anomalies. Pelvic pain or pelvic masses in pediatric patients can be due to ovarian torsion, hemorrhagic ovarian cyst, pelvic inflammatory disease, or ectopic pregnancy.

A morphologic classification of in utero urinary tract dilatation is presented. Ninety-two hydronephrotic fetal kidneys diagnosed with ultrasound were graded according to the proposed classification. The findings suggest that grade I dilatation (anteroposterior diameter of the renal pelvis less than 10 mm) should be considered normal. Grades II and III constitute an intermediate hydronephrosis, requiring postnatal urologic surgery in nearly half the cases. Grade IV (moderate dilatation of the calyces, with easily identified residual renal cortex) and grade V (severe dilatation of the calyces with atrophic cortex) are clearly pathologic and require neonatal corrective surgery. It is hoped that use of this simple and practical classification will facilitate communication and comparison of results in the literature.

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