Cranial Ultrasonography in Infantile Encephalitic Beriberi: A Useful First-Line Imaging Tool for Screening and Diagnosis in Suspected Cases

BACKGROUND AND PURPOSE

Brain imaging is central to the diagnosis of infantile encephalitic beriberi. Because cranial sonography findings have not been described in infantile encephalitic beriberi, our aim was to investigate its role in the diagnosis of this condition.

MATERIALS AND METHODS

We performed a retrospective review of head sonography of infants (admitted between November 1, 2014, and March 31, 2015) who presented with encephalopathy. Cranial ultrasonography scans were studied for the alteration of echogenicity of the basal ganglia.

RESULTS

Of the 145 consecutive infants who presented with encephalopathy, 58 had thiamine-responsive encephalopathy (infantile encephalitic beriberi) and 87 had encephalopathy due to other causes. Forty-eight of 145 infants with encephalopathy showed hyperechoic basal ganglia. A hyperechoic appearance of the basal ganglia on cranial ultrasonography was found to have a sensitivity of 71% (41/58) and a specificity of 92% (80/87) in diagnosing infantile encephalitic beriberi. The sensitivity of cranial sonography increased with age. It was a maximum of 93% (14/15) in the 5 months and older age group. Specificity was a maximum of 100% (18/18) in infants older than 5 months of age. Sensitivity was maximum in Wernicke encephalopathy at 90% (18/20) and least in the acidotic form at 43% (10/23). Follow-up showed gradual normalization of the hyperechoic appearance of the basal ganglia during 8 weeks in 26/41 (63%), with mild atrophy of the basal ganglia in 6/41 (15%)

CONCLUSIONS

Hyperechogenicity of the basal ganglia on cranial ultrasonography is a sensitive finding for the diagnosis of infantile encephalitic beriberi in infants who present with Wernicke encephalopathy.

Renal replacement lipomatosis: A rare type of renal pseudotumor

Replacement lipomatosis of the kidney is the end result of severe atrophy of renal parenchyma with secondary marked proliferation of renal sinus and perirenal fatty tissue. Although ultrasonography may suggest the diagnosis, CT demonstrated the distinctive features most accurately. We report a case of renal replacement lipomatosis with coexistent xanthogranulomatous pyelonephritis and multiple perinephric and parietal wall collections.

The computed tomography diagnosis of paracecal hernia

Paracecal or pericecal hernia is a rare type of internal hernia that causes intestinal obstruction, and its correct preoperative diagnosis is rarely made. Its computed tomography (CT) features are sufficiently characteristic to permit an accurate diagnosis. We present the CT features of a case of paracecal hernia complicated by strangulation to facilitate its early recognition by radiologists and surgeons.