C. K. Hayden

Intussusception: indications for ultrasonography and an explanation of the doughnut and pseudokidney signs

Ultrasonography has been shown to be valuable in the detection of intussusception [9–13], but a question arises, as to just when this study should be performed. Should it be a general screening procedure or should it be utilized for specific cases only? Upon reviewing the literature, and the findings in 14 of our patients, we feel that it should be utilized as a general screening procedure. In addition, we offer a different explanation for the typical doughnut and pseudokidney signs seen with intussusception.

Enteric duplication cysts in children: Are their ultrasonographic wall characteristics diagnostic?

We reviewed eight cases of gastrointestinal duplication cysts to determine whether the combination of an echogenic inner mucosal layer and hypoechoic outer muscular layer could be seen consistently enough to be of diagnostic value. We compared our findings to those seen in twenty-seven other abdominal cysts and conclude that when identified together, the two layers are highly suggestive, if not completely diagnostic of enteric duplication cysts.

Viral vs. bacterial pulmonary infections in children (Is roentgenographic differentiation possible

This study was conducted to determine whether one could identify viral and bacterial pulmonary infections with confidence. It has been our impression for some time that one could differentiate viral from bacterial pulmonary infections on the basis of roentgenographic findings alone and to test this hypothesis, we conducted this study where the roentgenographic findings first were categorized as being due to viral or bacterial infection and then compared with clinical results. The overall accuracy was just over 90% and our method of analysis is presented.

How useful is gastroesophageal reflux scintigraphy in suspected childhood aspiration

It has been suggested that gastroesophageal reflux scintigraphy (GRS) might be useful in assisting one in determining therapy for patients suspected of aspirating or becoming apneic second-ary to gastroesophageal reflux. This, however, has not been our experience and in reviewing 23 patients with recurrent pneumonia and/or apnea who had GRS, we were able to detect aspiration in only one. This was especially significant since 13 (59%) of these patients had demonstrable reflux, and of these, eight were treated successfully for suspected aspiration even though none was demonstrated isotopically. To be sure, the demonstration of pulmonary aspiration with GRS had little influence on patient selection and response to therapy. For this reason we feel there is little justification in depending on the GRS for the specific purpose of trying to document pulmonary aspiration in infants and children who are refluxing.

Rickets: A roentgenographic scheme for diagnosis

The roentgenograms in seventy-two (72) patients with all forms of rickets were reviewed in an attempt to determine whether specific forms of rickets could be identified and classified roentgenographically. All cases were clinically proven and after analyzing the roentgenographic changes in all of the patients, it was determined that such a scheme was possible. This scheme allows one to either diagnose the specific type of rickets or offer a short, pertinent differential diagnosis from roentgenograms alone.

The dens-arch synchondrosis versus the Hangman's fracture

The synchondrosis between the dens and arch of C2 is a normal structure in infants and children. It is not visible on lateral views of the cervical spine, but is routinely visible on oblique views. In such cases it has a distinct tendency to mimic a C2-arch fracture. The varying appearance of this synchondrosis and its differentiation from a true fracture of C2 are the subjects of this report.

Short segment pyloric narrowing

Short segment narrowing of the pyloric canal is a common finding in infants with chronic vomiting, and most often is due to pylorospasm. In such cases, it is transient, and offers no real problem in diagnosis. On the other hand, when it persists, a question arises as to whether it is due to fixed stenosis. Differentiation of the two conditions is difficult, but important, for while spasm can be treated medically, true stenosis requires surgical intervention. Just how to accomplish this differentiation is the subject of this report, and for the most part, centers around the infants response to a therapeutic trial of antispasmodics. Patients with pylorospasm respond favorably, while those with fixed stenosis do not. Generally, these latter patients require polyromyotomy, but in the occasional infant, so little muscle hypertrophy is present that we have found pyloroplasty to be the preferred procedure.

The posteriorly tilted dens A normal variation mimicking a fractured dens

The normal dens occasionally can be posteriorly tilted and in such cases, can mimic a fractured, posteriorly tilted, dens. Differentiation of the two conditions depends on: [1] knowledge that this normal variation of the dens occurs, and [2] demonstrating that no fracture exists. In many cases, this latter determination can be accomplished on plain films, but in other cases, laminography is required.

Incomplete (bending?) fractures of the mandibular condyle in children.

Incomplete, bending or bowing fractures of the mandibular condyle in children frequently go undetected. The reason is that the bending deformity often is subtle and passes for normal. This is especially true if the fractures are bilateral.

Barium enema findings (? segmental colitis) in four neonates with bloody diarrhea — possible cow's milk allergy

Four neonates with sudden onset of bloody diarrhea and barium enema findings suggestive of segmental colitis are reported. The infants were not very ill and in all four, the condition was self-limiting. An exact etiology for the condition was not determined but in all of the infants a possible association with cows milk intolerance was suggested.