Pancreatic neoplasms are rare in children and vary widely between benign and malignant causes and between cystic and solid lesions. Epithelial tumors are most common and include solid pseudopapillary tumor, pancreatoblastoma, islet cell neoplasms, and cystic lesions.

ObjectiveTo test the hypothesis that impaired cerebral autoregulation (ICA) increases the susceptibility of premature infants to adverse outcomes, we determined the relationship of ICA and cerebral reactivity (CR) measured in the first 96 hours of life to the outcome of grade 3 or 4 intraventricular haemorrhage (IVH) and/or death within 1 month.SettingSingle-centre level IV neonatal intensive care unit.PatientsNeonates 24–29 weeks’ gestation less than 12 hours old with invasive blood pressure monitoring.DesignCerebral saturations and mean arterial blood pressure were recorded every 30 s for 96 hours. For each 10 min epoch, the correlation coefficient (r) was calculated for mean arterial blood pressure versus cerebral saturations. The epoch was considered to have ICA if r>0.5 and CR if r<0.ResultsSixty-one subjects were included. During the first 96 hours, ICA occurred 17.6% and CR occurred 41% of recorded time. In those without adverse outcomes, ICA decreased and CR increased by postnatal day (p<0.05). Adjusted for birth weight and gestational age, those with IVH and those who died spent more time with ICA and less time with CR (p<0.05) over the entire recording period. Those with IVH had 1.5-fold increase in time with ICA on day 2 (p=0.021), and decrease in time with CR on day 3 (p=0.036). Compared with survivors, non-survivors spent more time with ICA on days 3 and 4 (p<0.005), and less with CR on day 3 (p=0.032).ConclusionICA and CR vary by postnatal day and these patterns are associated with adverse outcomes.

Developmental dysplasia of the hip (DDH) is the most common hip pathology in infants. Although its exact pathophysiology remains incompletely understood, its long-term prognosis depends not only on the severity of the dysphasia, but also on the timely implementation of appropriate treatment. Unrecognized and untreated hip subluxations and dislocations inevitably lead to early joint degeneration while overtreatment can produce iatrogenic complications, including avascular necrosis of the femoral head. In the past two decades, imaging has become an integral part of the clinical screening, diagnosis, and monitoring of children with DDH. Optimal timing for imaging and appropriate use of imaging can reduce the incidence of late diagnoses and prevent iatrogenic complications. In general, ultrasound of the hips is recommended in infants under the age of 4 months while pelvic radiography is recommended in older infants due to the fact that the femoral head ossific nucleus typically is not formed until 4 to 6 months of age.

Bilateral hilar 18 F-FDG-avid foci are often noted on PET studies of patients without lung cancer. This finding may lead to diagnostic uncertainty about the presence of metastatic disease. Our objective was to evaluate features of these foci associated with benign or malignant etiology. Methods: We performed a retrospective study of patients with cancer with bilateral hilar foci on 1 or 2 sequential 18 F-FDG PET studies between 2002 and 2006. Patients with lung cancer, sarcoidosis, or anthracosis/ silicosis were excluded. Variables evaluated were maximum standard uptake values (SUV max), purity (absence of 18 F-FDGavid foci in nonhilar mediastinal nodes), symmetry (difference between left and right side SUV max), the primary tumor, node size determined by CT, and, in those who participated in 2 studies, stability of uptake over time. The gold standard was histologic diagnosis or long-term clinical follow-up (range, 19-41 mo; mean, 25 mo). Results: Fifty-one patients with the finding of bilateral hilar 18 F-FDG-avid foci underwent a staging-only PET study; 52 scans from an additional set of patients demonstrated this abnormality on at least 1 of 2 sequential studies, the first of which was performed for staging. On univariate analysis, variables associated with malignancy were SUV max (6.6 6 4.1 vs. 3.5 6 1.0 for benign, P , 0.001; t test); impurity (P , 0.001; x 2 test), with 79% of impure scans versus 18% of pure scans being malignant; node size determined by CT (P 5 0.027); and change in uptake between scans 1 and 2 (change in SUV 5 2.7 6 2.1 vs. 0.73 6 1.1 for benign, P , 0.01; t test). Variables associated with benign etiology were: symmetry (difference between left and right sides 5 0.57 6 0.54 for benign vs. 1.8 6 1.7 for malignant, P , 0.01), purity, and colorectal primary (75% of colorectal were benign vs. 34% of breast, 49% of lymphoma, and 37% of other, P 5 0.030; x 2 test). After multivariate analysis, SUV max and purity were found to be independent predictors, with the odds of malignancy increasing by 1.54 (95% confidence interval, 1.16-2.05) for each unit increase in SUV and decreasing by 0.08 (95% confidence interval, 0.03-0.22) if pure. Conclusion: In patients with nonlung cancer, in particular colorectal, foci of symmetric and mild uptake limited to the hilar regions that are stable on 2 sequential PET studies despite intervening anticancer therapy are likely related to a benign etiology.

Ewing sarcoma is the second most common primary osseous malignancy in children and young adults. However, infrequently, it can arise outside the skeletal system; rarer still, it can originate within the lung parenchyma. In this case report, we describe such a case in a 23-year-old male. We also review the literature to summarize imaging findings for this rare malignancy.