Alan M. Schwartz

Unusual Pelvic Masses: A Comparison of Computed Tomographic Scanning and Ultrasonography

Four unusual pelvic masses, studied by CT and gray scale ultrasonography, demonstrate the comparative values of these modalities for this area of the body. In each instance a significant contribution to the diagnosis was made by one or both techniques. The ultrasound study provides a somewhat better differentiation of solid from cystic lesions, but the CT scan denotes to best advantage the anatomy of the area, and provides a means of viewing bone as well as soft tissue detail.

Posterior arch defects of the cervical spine

Spondylolysis and absence of the pedicle are congenital anomalies of the posterior cervical spine. Their roentgenographic changes may be confused with other more serious entities which may necessitate either emergent therapy or require extensive diagnostic testing and treatment. Four cases are present and the literature is reviewed. A hypothesis for the embryologic etiology of these entities is proposed.

Gastroesophageal Reflux in Infants and Children: Correlation of Radiological Severity and Pulmonary Pathology11

A review of the barium study of 507 children for the presence and severity of gastroesophageal reflux revealed 79 cases with coexisting pulmonary disease. Clinical-radiological analysis of the cases with respiratory disease showed good correlation between the radiographic demonstration of major reflux or no reflux and the presence or absence of pulmonary disease.

Computed tomography in diagnosis of abdominal masses in infancy and childhood. Comparison with excretory urography.

Computed tomography (CT) of the abdomen and pelvis was performed in 26 instances of suspected mass in 24 infants and children. The information obtained was compared to that of standard abdominal radiography and excretory urography (IVP). Results were analyzed prospectively. CT was able to detect and define masses more precisely than abdominal radiography and IVP. The information obtained by CT, in a single noninvasive examination emitting minimal ionising radiation, seems comparable to that offered by a combination of multiple radiological and other imaging procedures. It is conceivable that with accumulating experience and further technological improvement CT may become an excellent screening procedure in the investigation of abdominal and pelvic masses. The high cost of CT scanning may be offset by the benefits cited.

Referred Pain in the Lower Leg - A Cause of Delayed Diagnosis

Three patients presenting with ankle pain are described. In each case the pain was referred from a lesion in the proximal tibia (two osteoid osteomas; one stress fracture). There was considerable delay in diagnosis in two of these cases. It would appear that pain referred from the proximal lower leg to the ankle is not well recognized as a clinical entity. In such cases, radiography of the more proximal limb is suggested. If this proves negative, a bone scan may then be performed.

Hip arthrography in children

A smooth, congruous, femoral head located in a well-formed acetabulum is a prerequisite for a normally functioning and developing hip joint. Hip arthrography is a valuable diagnostic tool for outlining the cartilaginous femoral head and its relationship to the cartilaginous and bony acetabulum. The procedure is easily performed and diagnostically important in many orthopedic diseases. The adductor approach has several distinct advantages which are stressed in this report.

Unusual manifestations of neonatal pharyngeal perforation

The small series of previously described cases of neonatal pharyngeal perforation are reviewed and two additional cases with atypical initial presentations are described. The condition is more common than is currently appreciated, as suggested by one of our cases which remained undetected until many years later. We also wish to emphasise the high location of perforation despite an initial presentation which may appear to the contrary.

Ischemic necrosis of the contralateral hip as a possible complication of untreated congenital hip dislocation.

A five-year-old girl with untreated congenital hip dislocation and contralateral ischemic necrosis is described. The ischemic necrosis may have resulted from abnormal stress loading due to the abnormal contralateral hip.

Intussusception and total body opacification.

Because of atypical clinical presentations, two children with intussusception had intravenous urography as their initial examination of following plan films. In both patients the intussusception was outlined by an opaque rim due to the total body opacification effect on the bowel wall. One patient had a target-like blush on following films which strongly suggested the correct diagnosis. The authors do not advocate intravenous urography to diagnosis intussusception, but if this study is performed because of atypical clinical findings, the radiographic sign should be recognized and lead to a barium enema.

PULMONARY COMPLICATIONS OF GASTROESOPHAGEAL REFLUX/HIATAL HERNIA IN CHILDREN

As part of a retrospective analysis of gastroesophageal reflux (GER) and/or hiatal hernia (HH) in infants and children, all chest films obtained during the month prior to or following an upper gastrointestinal study on 507 consecutive children (April 73-June 75) were reviewed for pulmonary abnormalities (clinically manifest or unsuspected) consisting of either single or multiple areas of consolidation, emphysema, or both. GER and/or HH was found in 209 (41%) of the total group studied and in 55 (67%) of the 82 children with positive chest findings (P<0.001). The 55 pulmonary cases with GER and/or HH were significantly different in age distribution from the 27 patients without abnormalities of the cardia with 48/55 (87%) of the first group aged one year and under while only 14/27 (52%) of the second group fell into this age group (P<0.001). The clinical course and resolution of pulmonary abnormalities by x-ray were related to the presence or absence of cardioesophageal (CE) abnormalities in that either chronic, shifting, and/or recurrent changes were found in 9/27 (33%) of cases without and 26/55 (47%) of cases with GER and/or HH. Finally, in those cases with GER/HH, persistent pulmonary changes occured in 21/35 (60%) with major reflux (grades 3-5) but in only 5/20 (25%) with minor reflux (grades 1 - 2, delayed only) and hiatal hernia only (P<0.02).Tufts Medical School (New England Medical Center Hospital) Department of Pediatrics, Boston.