Pediatr Radiol (1990) 20:160-162
Pediatric Radiology 9 Springer-Verlag 1990
Calcified neonatal renal vein thrombosis demonstration by CT and US S. J a y o g a p a l 1, H . L. C o h e n 1, 2, R W. B r i l l 3, R W i n c h e s t e r 3 a n d D . E a t o n 1 1Department of Radiology, Brookdale Hospital Medical Center, 2 Department of Radiology, SUNY-Health Science Center at Brooklyn and 3 Department of Radiology, The New York Hospital-Cornell Medical Center, New York, New York, USA
Abstract. Two cases of calcified r e n a l v e i n t h r o m b o s i s ( R V T ) w e r e d i a g n o s e d , incidentally, w i t h i n t h e first w e e k s of life. T h e C T i m a g e s p r e s e n t t h e v i r t u a l l y d i a g n o s t i c b r a n c h i n g p a t t e r n of calcification t h a t has b e e n p r e v i o u s l y n o t e d on p a t h o l o g y s p e c i m e n r a d i o g r a p h s . T h e C T a n d U S i m a g e s show p e r i p h e r a l r e n a l vein, c e n t r a l r e n a l v e i n a n d i n f e r i o r v e n a cava calcification c o n f o r m i n g to t h e two t h e o r e t i c a l origins o f i n t r a v a s c u l a r calcification. T h e p a tients h a d n o r m a l l a b o r a t o r y results a n d no s y m p t o m s rel a t e d to r e n a l v e i n o r i n f e r i o r v e n a cava t h r o m b i .
Introduction Calcification, in the kidney, d u e to r e n a l v e i n t h r o m b o s i s has b e e n r e p o r t e d as e a r l y as t h e first d a y o f life i n d i c a t i n g a p r e n a t a l origin to t h e p a t h o l o g y , in s o m e cases [1]. A c h a r a c t e r i s t i c faint l a c e l i k e c o n f i g u r a t i o n m a y b e s e e n o n p l a i n film. T h e s e findings are d u e to calcification of t h r o m b u s t h a t m a y t a k e two forms, t h e first, t h r o m b o s i s in the i n f e r i o r v e n a c a v a e x t e n d i n g into t h e r e n a l v e i n and, the second, clot o r i g i n a t i n g in t h e a r c u a t e a n d i n t e r l o b u l a r veins with s p r e a d into t h e m a i n r e n a l v e i n [2]. O u r two cases d e m o n s t r a t e a c o m b i n a t i o n of t h e s e findings o n C T and U S e x a m i n a t i o n .
Case reports
Case 1 A 28 day old male was admitted to Brookdale Hospital Medical Center with fever of one day's duration. Born in Canada to a 22 year old mother, after a normal pregnancy, he was delivered by elective Caesarian section. Birth weight was 4600 grams. The neonatal period was normal and he was discharged from the hospital at six days of age. On admission the patient had signs of an upper respiratory tract infection and a temperature of 39 degrees Centigrade. A urine culture, later thought to be contaminated, was positive for Escherichia coll. Repeat cultures were negative. Sonography of the kidneys showed them to be normal in size, shape and position. Linear echogenicities with shadowing were noted throughout the kidneys, predominantly to the side of and superficial to the medullary pyramids. There was more involvement on the left. Doppler evaluation of the proximal abdominal inferior vena cava (IVC) was unremarkable, but evaluation of the subhepatic IVC was limited. Plain film of the abdomen showed faint calcifications in the area of the renal beds. Computed tomography, without contrast enhancement, showed curvilinear calcifications throughout the left renal parenchyma and the upper half of the right kidney (Fig. 1). Calcification was noted in the IVC and the left renal vein (Fig. 2). BUN and creatinine were normal. The child responded well to antibiotic therapy and has been doing well since discharge.
Fig.1. aNoncontrast CT of the abdomen. Level of the kidneys. Linear densities (arrowheads) are noted on the right, but most prominently throughout the left kidney. These are consistent with endovenous calcified thrombi. b Noncontrast CT of the abdomen. One cut superior to i a. Round calcification is noted in the IVC (arrow), consistent with calcified thrombus. Density on the left (arrowhead) probably represents renal vein thrombus
S. Jayogapal et al.: CT/US neonatal RVT
161
Fig. 3. Ultrasound of IVC. Longitudinal view. Echogenicity (arrow-
heads) within the IVC is consistent with clot
Ultrasound examination prior to discharge on day 20, showed continued evidence of echogenicities in the right kidney and IVC. No hypertension, hematufia or leg edema were evident throughout the hospital stay. Follow-up US examinations performed at 20 and 36 months of age, showed continued evidence of prominent linear echogenicities within the renal parenchyma. There was no renal atrophy.
Fig.2. a Renal ultrasound. Transverse view. Echogenicities (small arrowheads) with posterior shadowing (largerarrowheads)are con-
Discussion
sistent with calcified thrombi, b Renal ultrasound. Longitudinal view. Again, linear echogenicities and shadowing (arrowhead) are seen
S a n d b l o m described two types of R V T [2]. Type i or prim a r y R V T is typically seen in adults without an associated condition and arises in the large renal veins. Type 2 or seco n d a r y R V T is the m o r e c o m m o n form, especially a m o n g pediatric patients and is m o s t often seen in those with a predisposing factor, usually dehydration. L o w renal plasm a flow, polycythemia, anoxia, septicemia, m a t e r n a l diabetes, traumatic delivery, congenital renal vein defects and rarely p r i m a r y renal disease, have all been linked as causes [3, 4]. S a n d b l o m theorized that Type 2 R V T b e g a n with thrombosis in the smaller renal vein branches (arcuate and interlobular veins). Extension into the I V C can occur but is not invariable. The slow double capillary circulation of the kidney is particularly vulnerable to t h r o m bosis w h e n there is h e m o c o n c e n t r a t i o n , dehydration, hypercoagulability or h y p e r o s m o l a r i t y [2, 4-7]. M u c h of the literature discusses these two types, although Macd o n a l d et al. [5] do not accept the distinction. T h r e e fourths of type 2 cases are n o t e d in the first m o n t h of life with a 1.6:1 male p r e d o m i n a n c e [7, 8]. T h e process can occur in utero [1, 9-11]. Bilateral i n v o l v e m e n t is considered m o r e c o m m o n than previously r e p o r t e d [4]. S o m e autopsies have revealed pancreatic islet cell hyperplasia suggestive of m a t e r n a l diabetes despite the lack of evidence of such disease in the m o t h e r [1, 10].
Case 2 A 4500 g, full term male infant was born at another hospital. He was the product of a normal pregnancy to a 36 year old Class A diabetic mother. Delivery was by elective Caesarian section. Amniotic fluid was meconium stained. Apgar scores were 3 at 1 minute and at 5 minutes. He was transferred on the first day of life to New York Hospital because of severe respiratory distress due to meconium aspiration. Admission chest film showed faint lacelike calcification in the right upper quadrant. A single generalized seizure on day 2 was treated with phenobarbital. Abdominal ultrasound performed on day 5, showed multiple echogeuic loci with shadowing in the right kidney. Kidney length measurements were normal. Echogenicity, consistent with clot, was noted within the infrahepatic IVC extending to the level of the bifurcation (Fig. 3). Neurosonography and CT showed venous infarction of the right cerebral hemisphere. Respiratory status improved and ventilatory support was discontinued by day 10. A glucoheptanate renal scan showed the left kidney to have slightly less uptake than the right. BUN and creatinine levels were normal.
S. Jayogapal et al.: CT/US neonatal RVT
162 Clinically, n e o n a t a l R V T is d i a g n o s e d o n t h e basis of unilateral or bilateral renal enlargement with associated hematuria, proteinuria, oliguria, anuria or increasing BUN. Metreweli and Pearson described the ultrasound f i n d i n g s in n e o n a t a l R V T [3]. T h e C T f i n d i n g s o f calcified renal vein and inferior vena cava thrombi have not been p r e v i o u s l y d e s c r i b e d . O n l y t w o t h i r d s of M e t r e w e l i ' s cases had renal enlargement or hematuria. The inferior vena cava was s e e n w e l l i n o n l y 8 of t h e i r 23 cases e x a m i n e d w i t h a r t i c u l a t e d a r m , g r e y scale m a c h i n e s . T h e y b e l i e v e d this was d u e to p a t i e n t d e h y d r a t i o n . S o n o g r a p h i c t e c h n i q u e is a n o t h e r c o n s i d e r a t i o n a n d e v a l u a t i o n of t h e I V C is s i m p l e r w i t h r e a l t i m e i m a g i n g . T h e y n o t e d o n l y o n e d e finitive I V C t h r o m b u s . B o t h o u r cases s h o w i m a g i n g evid e n c e of c o e x i s t e n t I V C a n d r e n a l v e i n t h r o m b o s i s . C a l c i f i c a t i o n [1, 12] f o l l o w i n g R V T h a s a v i r t u a l l y diagn o s t i c p a t t e r n o n p l a i n films. T h e s i m i l a r i t y b e t w e e n t h e C T f i n d i n g s in o u r case i a n d t h e p r e v i o u s l y d e s c r i b e d app e a r a n c e o n a p o s t m o r t e m s p e c i m e n [1] suggests t h a t t h e C T f i n d i n g s m a y b e d i a g n o s t i c as well.
References
1. Brill R Mitty H, Strauss L (1977) Renal vein thrombosis: a cause of intrarenal calcification in the newborn. Pediatr Radiol 6:172 2. Sandblom P (1948) Renal vein thrombosis with infarction in the newborn. Acta Paediatr Scand 35:160
3. Metreweli C, Pearson R (1984) Echographic diagnosis of neonatal renal venous thrombosis. Pediatr Radiol 14:105 4. Oppenheimer E, Esterly J (1965) Thrombosis in the newborn. Comparison between infants of diabetic and non-diabetic mothers. J Pediatr 67:549 5. McDonald R Tarar R, Gilday D, Reilly B (1974) Some radiologic observations in renal vein thrombosis. AJR 120:368 6. McFarland J (1965) Renal venous thrombosis in children. Q J Med [New Series XXXIV] 34:269 7. Lain A, Warren P (1981) Ultrasonographic diagnosis of renal vein thrombosis. A n n Radiol (Paris) 24:7 8. Arneil G, Macdonald A, Sweet E (1973) Renal vein thrombosis. Clinical Nephrol 1:119 9. Evans D, Silverman M, Bowley N (1981) Congenital hypertension due to unilateral renal vein thrombosis. Arch Dis Child 56: 306 10. Tank E, Bessette R Heidelberger K (1974) The definition and diagnosis of antenatal renal vein thrombosis. J Urol 111:242 11. Patel R, Connors J (1988) In utero sonographic findings in fetal renal vein thrombosis with calcifications. J Ultrasound Med 7: 349 12. Sutton T, Leblanc A, Gauthier N, Hassan M (1977) Radiological manifestations of neonatal renal vein thrombosis on follow-up examinations. Radiology 122:435 Received: 9 November 1988; accepted: 22 November 1988 Dr. H. L. Cohen 78 Grove Avenue Cedarhurst, NY 11516 USA
Literature in pediatric radiology (continued from p. 156) Spondylo-metaphyseal dysplasia of Sutcliffe type. Koztowski, K., Bellemore, M.C. (Dept. of Rad. and Orthop. Surg., The Royal Alexandra Hosp. for Children, Sydney,Australia) 62, 862 (1989) Clinical Radiology (Edinburgh)
Bone metastases from Ewing's sarcoma radiologically recapitulate the features of a primary Ewing's tumour. Plowman, E N. (Dept. of Radiotherapy, St. Bartholomew's Hosp., West Smithfield, London EC1A 7BE, England) 40, 498 (1989) Famifial osteochondritis dissecans. Paes, R.A. (Rad. Dept., Roya! Infirmary, Lindley, Huddersfield HD3 3EA, England) 40, 501 (1989) Case report: Fatal pulmonary embolism due to osteogenic sarcoma in a child. Booth, A.J., Tweed, C.S. (X-ray Dept., Hinchinbrooke Hosp., Huntingdon, Cambridgeshire PE18 8 NT, England) 40, 533 (1989) Case report: Malrotation and midgut volvulus presenting as malabsorption. Jackson, A. et al. (Bisset, R., Dept. of Diagn. Rad., Booth Hall Children's Hosp., Charlestown Rd., Blacktey,M9 2AA, England) 40, 536 (1989) Journal of Bone and Joint Surgery. British Volume (London)
Abnormalities of proximal femoral growth after severe Perthes' disease. Sponseller, E D. et al. (The Johns Hopkins Med. Inst., 600 North Wolfe Street, Baltimore, MD 21205, USA) 71-B, 610 (1989) Girl with three legs. Gregosiewicz,A. et al. (Ped. Orthop. Dept., Med. Academy, Staszica 11, PL-20-081Lublin, Poland) 71-B, 708 (1989) Annales de P6dlatrie (Paris)
Endocrinologic complications of cranial irradiation. [In french]. Brauner, R., Rappaport, R. (Unit6 e'Endocrinol. P6d. et Diabbte et INSERM U30, H6pital des Enfants Malades, 149, rue de S~vres, F-75015 Paris, France) 36, 419 (1989) Hydatid cysts in children. Diagnosis and management. [In french]. Chaouachi, B. et al. (H6pital d'Enfants, Bab Saadoun, 1007Tunis, Tunisie) 36, 441 (1989) Tumo~related epilepsy. Report of a case of temporal aslrocytoma. [In french]. Berquin, E et al. (Serv. de P6d. 1 (pr Piussan), H6pital Nord, place Victor-Pauchet, BP 3006,F-80030Amiens cedex, France) 36, 461 (1989) Diverticulum of the stomach in a neonate. Report of a case of congenital diverticulum. [In french]. Benhamou, P.H. et al. (Serv. de P6d. 1 Centre
Hospitalier et Univ., H6pital Nord, place Victoe-Pauchet, BP 3006, F-80030Amiens cedex, France) 36, 476 (1989) Rupture of the stomach in children, Report of a case. [In trench]. Ricard, J. et aL (Serv. de Chirurg. P6d. (pr Canarelli), Centre Hospitaher et Univ., place Victor-Pauchet, BP 3006, F-80030Amiens cedex, France) 36, 479 (1989) Chirurgic P6diatrique (Paris)
Epithelial splenic cysts in the newborn. Prenatal diagnosis and splenectomy. [In french]. Todde, G. et al. (Bagolan, E, Div. di Chirurg. Generale, Ospedale Ped. "Bambino Gesd", Chirurg. Neonatale, 17.zza S.Onofrio, 4, 100165 Roma, Italy) 30,172 (1989) Intermittent wandering spleen interest of splenopexie in a child. [In french]. Scheye, T. H. et al. (Laboratoire d'Anatomie, Facult6 de M6d., B. P. 38, F63000 Clermont-Ferrand, France) 30,175 (1989) Biliary ascariasis. [In french]. Eymeri, J.-C. et al. (Serv. de Chirurg. P6d., CHU Fort-de France, F-Martinique, France) 30,178 (1989) Aktuelle Urologic (Stuttgart)
Idiopathic dilatation of the posterior urethra. [In germ]. Sacher, E et al. (Chirurg. Klinik, Univ.-Kinderspitat, Steinwiesstr.75, CH-8032 Z~rich, Switzerland) 20, 235 (1989) European Journal of Nuclear Medicine (Berlin) Lung ventilation and perfusion scintigraphy in the follow up of repaired con-
genital diaphragmatic hernia. Jeandot, R. et al. (Lambert, B., Nucl. Med. Dept., H6pital Univ. Pellegrin, F-33076Bordeaux, France) 15, 591 (1989) European Journal of Radiology (Stuttgart)
Hilar enlargement in respiratory syncytial virus pneumonia. Odita, J. C. et al. (Dept. of Rad., College of Med., King Saud Univ., R O. Box 2925, Riyadh 11461, Kingdom of Saudi Arabia) 9,155 (1989) Fortschritte aufdem Gebiete der Rfntgenstrahlen und der neuen bildgebenden Verfahren (Stuttgart)
Pleuromediastinal lines in infants, children and adolescents - a contribution to normal x-ray anatomy of the mediastinal borders. [In germ]. Neufang, K. E R., Benz-Bohm, G. (Rad. Inst. der Univ., Zentralklinikum, Ebene 6, Joseph-Stelzmann-Str. 9, D-5000K/31n41, FRG) 151,257 (1989) (r,r, n t ~ n n o H
nn
n
1 "IA~
Pediatric Radiology 9 Springer-Verlag 1990
Calcified neonatal renal vein thrombosis demonstration by CT and US S. J a y o g a p a l 1, H . L. C o h e n 1, 2, R W. B r i l l 3, R W i n c h e s t e r 3 a n d D . E a t o n 1 1Department of Radiology, Brookdale Hospital Medical Center, 2 Department of Radiology, SUNY-Health Science Center at Brooklyn and 3 Department of Radiology, The New York Hospital-Cornell Medical Center, New York, New York, USA
Abstract. Two cases of calcified r e n a l v e i n t h r o m b o s i s ( R V T ) w e r e d i a g n o s e d , incidentally, w i t h i n t h e first w e e k s of life. T h e C T i m a g e s p r e s e n t t h e v i r t u a l l y d i a g n o s t i c b r a n c h i n g p a t t e r n of calcification t h a t has b e e n p r e v i o u s l y n o t e d on p a t h o l o g y s p e c i m e n r a d i o g r a p h s . T h e C T a n d U S i m a g e s show p e r i p h e r a l r e n a l vein, c e n t r a l r e n a l v e i n a n d i n f e r i o r v e n a cava calcification c o n f o r m i n g to t h e two t h e o r e t i c a l origins o f i n t r a v a s c u l a r calcification. T h e p a tients h a d n o r m a l l a b o r a t o r y results a n d no s y m p t o m s rel a t e d to r e n a l v e i n o r i n f e r i o r v e n a cava t h r o m b i .
Introduction Calcification, in the kidney, d u e to r e n a l v e i n t h r o m b o s i s has b e e n r e p o r t e d as e a r l y as t h e first d a y o f life i n d i c a t i n g a p r e n a t a l origin to t h e p a t h o l o g y , in s o m e cases [1]. A c h a r a c t e r i s t i c faint l a c e l i k e c o n f i g u r a t i o n m a y b e s e e n o n p l a i n film. T h e s e findings are d u e to calcification of t h r o m b u s t h a t m a y t a k e two forms, t h e first, t h r o m b o s i s in the i n f e r i o r v e n a c a v a e x t e n d i n g into t h e r e n a l v e i n and, the second, clot o r i g i n a t i n g in t h e a r c u a t e a n d i n t e r l o b u l a r veins with s p r e a d into t h e m a i n r e n a l v e i n [2]. O u r two cases d e m o n s t r a t e a c o m b i n a t i o n of t h e s e findings o n C T and U S e x a m i n a t i o n .
Case reports
Case 1 A 28 day old male was admitted to Brookdale Hospital Medical Center with fever of one day's duration. Born in Canada to a 22 year old mother, after a normal pregnancy, he was delivered by elective Caesarian section. Birth weight was 4600 grams. The neonatal period was normal and he was discharged from the hospital at six days of age. On admission the patient had signs of an upper respiratory tract infection and a temperature of 39 degrees Centigrade. A urine culture, later thought to be contaminated, was positive for Escherichia coll. Repeat cultures were negative. Sonography of the kidneys showed them to be normal in size, shape and position. Linear echogenicities with shadowing were noted throughout the kidneys, predominantly to the side of and superficial to the medullary pyramids. There was more involvement on the left. Doppler evaluation of the proximal abdominal inferior vena cava (IVC) was unremarkable, but evaluation of the subhepatic IVC was limited. Plain film of the abdomen showed faint calcifications in the area of the renal beds. Computed tomography, without contrast enhancement, showed curvilinear calcifications throughout the left renal parenchyma and the upper half of the right kidney (Fig. 1). Calcification was noted in the IVC and the left renal vein (Fig. 2). BUN and creatinine were normal. The child responded well to antibiotic therapy and has been doing well since discharge.
Fig.1. aNoncontrast CT of the abdomen. Level of the kidneys. Linear densities (arrowheads) are noted on the right, but most prominently throughout the left kidney. These are consistent with endovenous calcified thrombi. b Noncontrast CT of the abdomen. One cut superior to i a. Round calcification is noted in the IVC (arrow), consistent with calcified thrombus. Density on the left (arrowhead) probably represents renal vein thrombus
S. Jayogapal et al.: CT/US neonatal RVT
161
Fig. 3. Ultrasound of IVC. Longitudinal view. Echogenicity (arrow-
heads) within the IVC is consistent with clot
Ultrasound examination prior to discharge on day 20, showed continued evidence of echogenicities in the right kidney and IVC. No hypertension, hematufia or leg edema were evident throughout the hospital stay. Follow-up US examinations performed at 20 and 36 months of age, showed continued evidence of prominent linear echogenicities within the renal parenchyma. There was no renal atrophy.
Fig.2. a Renal ultrasound. Transverse view. Echogenicities (small arrowheads) with posterior shadowing (largerarrowheads)are con-
Discussion
sistent with calcified thrombi, b Renal ultrasound. Longitudinal view. Again, linear echogenicities and shadowing (arrowhead) are seen
S a n d b l o m described two types of R V T [2]. Type i or prim a r y R V T is typically seen in adults without an associated condition and arises in the large renal veins. Type 2 or seco n d a r y R V T is the m o r e c o m m o n form, especially a m o n g pediatric patients and is m o s t often seen in those with a predisposing factor, usually dehydration. L o w renal plasm a flow, polycythemia, anoxia, septicemia, m a t e r n a l diabetes, traumatic delivery, congenital renal vein defects and rarely p r i m a r y renal disease, have all been linked as causes [3, 4]. S a n d b l o m theorized that Type 2 R V T b e g a n with thrombosis in the smaller renal vein branches (arcuate and interlobular veins). Extension into the I V C can occur but is not invariable. The slow double capillary circulation of the kidney is particularly vulnerable to t h r o m bosis w h e n there is h e m o c o n c e n t r a t i o n , dehydration, hypercoagulability or h y p e r o s m o l a r i t y [2, 4-7]. M u c h of the literature discusses these two types, although Macd o n a l d et al. [5] do not accept the distinction. T h r e e fourths of type 2 cases are n o t e d in the first m o n t h of life with a 1.6:1 male p r e d o m i n a n c e [7, 8]. T h e process can occur in utero [1, 9-11]. Bilateral i n v o l v e m e n t is considered m o r e c o m m o n than previously r e p o r t e d [4]. S o m e autopsies have revealed pancreatic islet cell hyperplasia suggestive of m a t e r n a l diabetes despite the lack of evidence of such disease in the m o t h e r [1, 10].
Case 2 A 4500 g, full term male infant was born at another hospital. He was the product of a normal pregnancy to a 36 year old Class A diabetic mother. Delivery was by elective Caesarian section. Amniotic fluid was meconium stained. Apgar scores were 3 at 1 minute and at 5 minutes. He was transferred on the first day of life to New York Hospital because of severe respiratory distress due to meconium aspiration. Admission chest film showed faint lacelike calcification in the right upper quadrant. A single generalized seizure on day 2 was treated with phenobarbital. Abdominal ultrasound performed on day 5, showed multiple echogeuic loci with shadowing in the right kidney. Kidney length measurements were normal. Echogenicity, consistent with clot, was noted within the infrahepatic IVC extending to the level of the bifurcation (Fig. 3). Neurosonography and CT showed venous infarction of the right cerebral hemisphere. Respiratory status improved and ventilatory support was discontinued by day 10. A glucoheptanate renal scan showed the left kidney to have slightly less uptake than the right. BUN and creatinine levels were normal.
S. Jayogapal et al.: CT/US neonatal RVT
162 Clinically, n e o n a t a l R V T is d i a g n o s e d o n t h e basis of unilateral or bilateral renal enlargement with associated hematuria, proteinuria, oliguria, anuria or increasing BUN. Metreweli and Pearson described the ultrasound f i n d i n g s in n e o n a t a l R V T [3]. T h e C T f i n d i n g s o f calcified renal vein and inferior vena cava thrombi have not been p r e v i o u s l y d e s c r i b e d . O n l y t w o t h i r d s of M e t r e w e l i ' s cases had renal enlargement or hematuria. The inferior vena cava was s e e n w e l l i n o n l y 8 of t h e i r 23 cases e x a m i n e d w i t h a r t i c u l a t e d a r m , g r e y scale m a c h i n e s . T h e y b e l i e v e d this was d u e to p a t i e n t d e h y d r a t i o n . S o n o g r a p h i c t e c h n i q u e is a n o t h e r c o n s i d e r a t i o n a n d e v a l u a t i o n of t h e I V C is s i m p l e r w i t h r e a l t i m e i m a g i n g . T h e y n o t e d o n l y o n e d e finitive I V C t h r o m b u s . B o t h o u r cases s h o w i m a g i n g evid e n c e of c o e x i s t e n t I V C a n d r e n a l v e i n t h r o m b o s i s . C a l c i f i c a t i o n [1, 12] f o l l o w i n g R V T h a s a v i r t u a l l y diagn o s t i c p a t t e r n o n p l a i n films. T h e s i m i l a r i t y b e t w e e n t h e C T f i n d i n g s in o u r case i a n d t h e p r e v i o u s l y d e s c r i b e d app e a r a n c e o n a p o s t m o r t e m s p e c i m e n [1] suggests t h a t t h e C T f i n d i n g s m a y b e d i a g n o s t i c as well.
References
1. Brill R Mitty H, Strauss L (1977) Renal vein thrombosis: a cause of intrarenal calcification in the newborn. Pediatr Radiol 6:172 2. Sandblom P (1948) Renal vein thrombosis with infarction in the newborn. Acta Paediatr Scand 35:160
3. Metreweli C, Pearson R (1984) Echographic diagnosis of neonatal renal venous thrombosis. Pediatr Radiol 14:105 4. Oppenheimer E, Esterly J (1965) Thrombosis in the newborn. Comparison between infants of diabetic and non-diabetic mothers. J Pediatr 67:549 5. McDonald R Tarar R, Gilday D, Reilly B (1974) Some radiologic observations in renal vein thrombosis. AJR 120:368 6. McFarland J (1965) Renal venous thrombosis in children. Q J Med [New Series XXXIV] 34:269 7. Lain A, Warren P (1981) Ultrasonographic diagnosis of renal vein thrombosis. A n n Radiol (Paris) 24:7 8. Arneil G, Macdonald A, Sweet E (1973) Renal vein thrombosis. Clinical Nephrol 1:119 9. Evans D, Silverman M, Bowley N (1981) Congenital hypertension due to unilateral renal vein thrombosis. Arch Dis Child 56: 306 10. Tank E, Bessette R Heidelberger K (1974) The definition and diagnosis of antenatal renal vein thrombosis. J Urol 111:242 11. Patel R, Connors J (1988) In utero sonographic findings in fetal renal vein thrombosis with calcifications. J Ultrasound Med 7: 349 12. Sutton T, Leblanc A, Gauthier N, Hassan M (1977) Radiological manifestations of neonatal renal vein thrombosis on follow-up examinations. Radiology 122:435 Received: 9 November 1988; accepted: 22 November 1988 Dr. H. L. Cohen 78 Grove Avenue Cedarhurst, NY 11516 USA
Literature in pediatric radiology (continued from p. 156) Spondylo-metaphyseal dysplasia of Sutcliffe type. Koztowski, K., Bellemore, M.C. (Dept. of Rad. and Orthop. Surg., The Royal Alexandra Hosp. for Children, Sydney,Australia) 62, 862 (1989) Clinical Radiology (Edinburgh)
Bone metastases from Ewing's sarcoma radiologically recapitulate the features of a primary Ewing's tumour. Plowman, E N. (Dept. of Radiotherapy, St. Bartholomew's Hosp., West Smithfield, London EC1A 7BE, England) 40, 498 (1989) Famifial osteochondritis dissecans. Paes, R.A. (Rad. Dept., Roya! Infirmary, Lindley, Huddersfield HD3 3EA, England) 40, 501 (1989) Case report: Fatal pulmonary embolism due to osteogenic sarcoma in a child. Booth, A.J., Tweed, C.S. (X-ray Dept., Hinchinbrooke Hosp., Huntingdon, Cambridgeshire PE18 8 NT, England) 40, 533 (1989) Case report: Malrotation and midgut volvulus presenting as malabsorption. Jackson, A. et al. (Bisset, R., Dept. of Diagn. Rad., Booth Hall Children's Hosp., Charlestown Rd., Blacktey,M9 2AA, England) 40, 536 (1989) Journal of Bone and Joint Surgery. British Volume (London)
Abnormalities of proximal femoral growth after severe Perthes' disease. Sponseller, E D. et al. (The Johns Hopkins Med. Inst., 600 North Wolfe Street, Baltimore, MD 21205, USA) 71-B, 610 (1989) Girl with three legs. Gregosiewicz,A. et al. (Ped. Orthop. Dept., Med. Academy, Staszica 11, PL-20-081Lublin, Poland) 71-B, 708 (1989) Annales de P6dlatrie (Paris)
Endocrinologic complications of cranial irradiation. [In french]. Brauner, R., Rappaport, R. (Unit6 e'Endocrinol. P6d. et Diabbte et INSERM U30, H6pital des Enfants Malades, 149, rue de S~vres, F-75015 Paris, France) 36, 419 (1989) Hydatid cysts in children. Diagnosis and management. [In french]. Chaouachi, B. et al. (H6pital d'Enfants, Bab Saadoun, 1007Tunis, Tunisie) 36, 441 (1989) Tumo~related epilepsy. Report of a case of temporal aslrocytoma. [In french]. Berquin, E et al. (Serv. de P6d. 1 (pr Piussan), H6pital Nord, place Victor-Pauchet, BP 3006,F-80030Amiens cedex, France) 36, 461 (1989) Diverticulum of the stomach in a neonate. Report of a case of congenital diverticulum. [In french]. Benhamou, P.H. et al. (Serv. de P6d. 1 Centre
Hospitalier et Univ., H6pital Nord, place Victoe-Pauchet, BP 3006, F-80030Amiens cedex, France) 36, 476 (1989) Rupture of the stomach in children, Report of a case. [In trench]. Ricard, J. et aL (Serv. de Chirurg. P6d. (pr Canarelli), Centre Hospitaher et Univ., place Victor-Pauchet, BP 3006, F-80030Amiens cedex, France) 36, 479 (1989) Chirurgic P6diatrique (Paris)
Epithelial splenic cysts in the newborn. Prenatal diagnosis and splenectomy. [In french]. Todde, G. et al. (Bagolan, E, Div. di Chirurg. Generale, Ospedale Ped. "Bambino Gesd", Chirurg. Neonatale, 17.zza S.Onofrio, 4, 100165 Roma, Italy) 30,172 (1989) Intermittent wandering spleen interest of splenopexie in a child. [In french]. Scheye, T. H. et al. (Laboratoire d'Anatomie, Facult6 de M6d., B. P. 38, F63000 Clermont-Ferrand, France) 30,175 (1989) Biliary ascariasis. [In french]. Eymeri, J.-C. et al. (Serv. de Chirurg. P6d., CHU Fort-de France, F-Martinique, France) 30,178 (1989) Aktuelle Urologic (Stuttgart)
Idiopathic dilatation of the posterior urethra. [In germ]. Sacher, E et al. (Chirurg. Klinik, Univ.-Kinderspitat, Steinwiesstr.75, CH-8032 Z~rich, Switzerland) 20, 235 (1989) European Journal of Nuclear Medicine (Berlin) Lung ventilation and perfusion scintigraphy in the follow up of repaired con-
genital diaphragmatic hernia. Jeandot, R. et al. (Lambert, B., Nucl. Med. Dept., H6pital Univ. Pellegrin, F-33076Bordeaux, France) 15, 591 (1989) European Journal of Radiology (Stuttgart)
Hilar enlargement in respiratory syncytial virus pneumonia. Odita, J. C. et al. (Dept. of Rad., College of Med., King Saud Univ., R O. Box 2925, Riyadh 11461, Kingdom of Saudi Arabia) 9,155 (1989) Fortschritte aufdem Gebiete der Rfntgenstrahlen und der neuen bildgebenden Verfahren (Stuttgart)
Pleuromediastinal lines in infants, children and adolescents - a contribution to normal x-ray anatomy of the mediastinal borders. [In germ]. Neufang, K. E R., Benz-Bohm, G. (Rad. Inst. der Univ., Zentralklinikum, Ebene 6, Joseph-Stelzmann-Str. 9, D-5000K/31n41, FRG) 151,257 (1989) (r,r, n t ~ n n o H
nn
n
1 "IA~
