Vesicoureteric reflux is an important association of paediatric urinary tract infection. Fluoroscopic micturating cystourethrography and radionuclide cystography have been employed for detecting and grading vesicoureteric reflux. However, both modalities involve ionising radiation, which can pose significant radiation risk to growing children. They also have a lower detection rate due to intermittent fluoroscopic technique in micturating cystourethrography, and lower spatial resolution in radionuclide cystography. Therefore, newer radiation-free ultrasound-based contrast-enhanced voiding urosonography has been developed in Europe for 15 years. This article aimed to summarise the current literature and discuss the first local pilot study in our institution on detection of vesicoureteric reflux by contrast-enhanced voiding urosonography. Contrast-enhanced voiding urosonography is a valid alternative to micturating cystourethrography in assessing vesicoureteric reflux, based on its superior diagnostic performance, reliability, safety, feasibility, and radiation safety for children. Therefore, it should be incorporated in the guideline for investigating paediatric urinary tract infection.
Objective: To identify specific angiographic factors associated with haemorrhagic presentation of brain arteriovenous malformation in Chinese paediatric patients.
Design:Retrospective cross-sectional observational study.
Setting
Main outcome measures:The following parameters were evaluated for their association with haemorrhagic presentation by univariate and multivariate analyses: nidus location, nidus size, nidus morphology (diffuse or compact); origin and number of arterial feeders; venous drainage; number of draining veins; presence of aneurysms, venous varices, and venous stenosis.Results: A total of 67 children and adolescents (28 male, 39 female) with a mean age of 12 years were included. Of them, 52 (78%) presented with haemorrhage. Arteriovenous malformation size (P=0.004) and morphology (P=0.05) were found to be associated with haemorrhagic presentation by univariate analysis. Small arteriovenous Angiographic factors associated with haemorrhagic presentation of brain arteriovenous malformation in a Chinese paediatric population New knowledge added by this study • Studies on paediatric arteriovenous malformation (AVM) are scarce and mostly based in Caucasian populations. This multicentre study involving Chinese paediatric patients found that small AVM nidus size and diffuse nidal morphology are independent risk factors for haemorrhage. Implications for clinical practice or policy • These two angiographic features associated with haemorrhagic presentation can help local clinicians to assess bleeding risk and determine the therapeutic approach (aggressive vs conservative) and treatment timeframe in paediatric patients with cerebral AVM.
HighlightsGiant epithelial splenic cyst is rare and splenectomy is the treatment.Auto-transplantation of ectopic splenic tissues during splenectomy may create diagnostic confusion when subsequent endoscopy or CT scan is performed years after the operation.99mTechnetium sulfur colloid scintigraphy is a useful adjunct and should be considered in doubtful cases.
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