Anne Paterson

Optic nerve sheath ultrasound in the assessment of paediatric hydrocephalus

ObjectsOptic nerve sheath diameter has been linked with intracranial pressure in previous studies. Measurement of sheath diameter using transorbital ultrasound is proposed as a clinical assessment indicator of developing hydrocephalus in the paediatric population.MethodsA retrospective review of optic nerve sheath ultrasound examinations performed in a clinical setting between 2000 and 2006 for assessment of hydrocephalus in a single institution.ResultsA total of 331 examinations were performed in 160 patients over the study period. A satisfactory image was possible in all cases. Sheath diameters were correlated with clinical case data from concurrent case records.ConclusionTransorbital ultrasound is a reproducible, non-invasive technique for the assessment of optic nerve sheath diameter and is well tolerated in children. Our series revealed asymptomatic baseline value higher than in previous reports. Variation from individual case asymptomatic baseline was the most sensitive variable in the series in determining development of hydrocephalus. This technique is felt to be a useful adjunct in the assessment of hydrocephalus in the paediatric neurosurgical population.

Adrenal pathology in childhood: a spectrum of disease

Abstract. Adrenal lesions in children may present with an asymptomatic adrenal mass lesion, an endocrinopathy, a hypertensive or metabolic crisis or a paraneoplastic syndrome. Some of the underlying disease processes remain localised within the adrenal gland or may develop into disseminated disease. The role of the radiologist is to confirm the adrenal location of a lesion and to document any other foci of disease. Ultrasound, CT, MR imaging and metaiodobenzylguanidine scintigraphy are the most commonly utilised imaging modalities for examining the adrenal glands and their pathologies in children. This paper reviews the spectrum of adrenal disease in childhood and presents the information as a series of radiological appearances: anomalies of adrenal shape, location, number and size, cystic adrenal masses, solid adrenal mass lesions, and adrenal calcifications are all examined. The radiological findings must always be interpreted in conjunction with the patients age, the clinical history, the findings on physical examination and the available biochemical data.

Soccer injuries in children

Soccer is the most popular sport in the world, with FIFA recognising more than 265 million amateur players. Despite the fact that soccer is a contact sport, it is perceived to be relatively safe to play, a factor that has contributed to its status as the fastest growing team sport in the USA. Acute and minor injuries predominate in the statistics, with contusions and abrasions being the most commonly recorded. As would be expected, the majority of soccer injuries are to the lower limbs, with serious truncal and spinal trauma being rare. This article examines the type and anatomic location of injuries sustained by children and adolescents who play soccer, and the main mechanisms whereby such injuries occur. The risk factors underpinning injury occurrence are considered, along with injury avoidance tactics.

Multidetector-row computed tomography three-dimensional volume reformatted 'transparency' images to define an upper pouch fistula in oesophageal atresia

Oesophageal atresia (OA) is an important congenital malformation in which prompt diagnosis and appropriate management can significantly improve outcome. The surgical approach to repair of OA and associated tracheo-oesophageal fistulae (TOF) depends upon correct evaluation of the tracheobronchial tree. Three-dimensional imaging of the tracheobronchial tree using CT data to produce shaded surface displays and virtual bronchoscopy has been reported in paediatric and neonatal patients with OA and TOF and is described as accurate and helpful, non-invasively facilitating the appreciation of complex anatomy prior to surgery. We describe the technique of reconstructing 3D volume-reformatted ‘transparency’ images using insufflated air as a negative contrast medium. This technique is fast, accurate and produces high-quality images that are easy to reproduce.

Congenital malignant peritoneal mesothelioma.

A. McCarthy Children’s Haematology Unit, Royal Belfast Hospital for Sick Children, Belfast, UK An 8-month-old boy presented with a 2-week history of dyspnoea, anorexia and increasing abdominal distension. Physical examination revealed a markedly distended abdomen, which was dull to percussion. US demonstrated a heterogeneous increase in hepatic echogenicity, with multiple intrahepatic cystic lesions (Fig. 1). There was extensive ascites. CT confirmed replacement of most of the right lobe of the liver by a multiloculated cystic lesion. The coeliac axis vessels and superior mesenteric artery were encased by the mass, as were the splenic, main and right portal veins and the IVC (Fig. 2). Aspiration of the liver cysts and peritoneal fluid gave chylous fluid, which contained clusters of ‘atypical’ cells and some reactive mesothelial cells. A liver biopsy was non-diagnostic, showing excess fibrosis and compressed hepatic parenchyma. Laparotomy demonstrated a retroperitoneal tumour that enveloped the IVC and invaded the liver via the portal vein. Subsequent histology revealed a diagnosis of congenital malignant peritoneal mesothelioma (MPM). The patient received palliative PICTORIAL INTERLUDE

Is it normal for boys to pass carrots in their urine

A 6-year-old boy presented with an 18-month history of foul-smelling urine and a 3-month history of diarrhoea. The childs mother asked the surgeon: “Doctor, is it normal for boys to pass carrots in their urine?” Given this unusual clinical information, an enterovesical fistula (EVF) was suspected and later confirmed by cystoscopy. A micturating cystogram (MCUG) demonstrated a fistulous tract between the bladder and the caecum (Fig. 1). A diagnosis of an appendicovesical fistula (A-VF) was made and confirmed at surgery 2 weeks later. The child had attended the Emergency Department 4 years previously with a complaint of right-sided abdominal pain. No diagnosis was made at that time. A-VF accounts for approximately 5% of EVF [1]. The classic presenting symptoms of any EVF are pain, faecaluria, pneumaturia and recurrent urinary tract infections. The last of these are the most common and consistent symptom of A-VF. The diagnosis of an A-VF presents a diagnostic challenge as the fistulous tract is often long and narrow, and therefore often becomes occluded by residue, faecoliths or calculi. The commonest aetiology of A-VF is appendicitis; the inflamed appendix tip adheres to the bladder wall and the subsequent abscess ruptures into the urinary bladder. Other causes of A-VF include appendiceal carcinoid, cystadenocarcinoma and Crohn’s disease. A variety of radiological investigations may be employed in an attempt to visualize A-VF, though often the diagnosis is only made at laparotomy. MCUG, cystoscopy and contrast enemas have all been utilized in the past. The usefulness of CT and MRI have been described more recently [2].

Hickman line fracture in a road traffic accident

Sir, A 5-year-old oncology patient presented with a 24-h history of pain occurring whilst his Hickman line was being flushed. A linogram study was performed to check catheter integrity. It demonstrated a fracture involving both lumens of the right subclavian line (Fig. 1). A more detailed history was sought from the patient’s mother, who revealed they had been involved in a traffic accident the previous day, ironically, as they traveled in the back of an ambulance. The patient had been wearing a seat belt at the time and the shoulder strap had been over his right shoulder; the deceleration force of the accident had been translated directly to the catheter tubing.

Hydrocolpos or Hematocolpos

AJR 2012; 198:W324 0361–803X/12/1983–W324