David W. Boldt

Radiological findings in total aganglionosis coli.

The radiological findings in 13 patients with total aganglionosis coli were reviewed. There was a male to female ratio of 7:6. Fifty-four percent of patients presented in the first week of life, but a significant number (31%) did not present until after 1 month of age. All patients had plain film evidence of bowel obstruction when referred for a barium enema. There were no pathognomonic barium enema findings, and barium enema results covered the entire spectrum of findings which can be encountered in the neonate and young infant with bowel obstruction. Seventy-seven percent had normal calibre colon, 23% had micro colon, 23% had a shortened colon, 46% had colonic wall irregularity, 33% had significant ileal reflux. Delayed evacuation of barium from colon occurred in the two patients who had delayed films. Total colonic aganglionosis should be considered in any infant or young child with plain film evidence of bowel obstruction, whatever the barium enema findings. Hirschsprungs disease and the level of transition can only be definitively diagnosed by biopsy.

Paediatric pulmonary nodules: a comparison of computed tomography, thoracotomy findings and histology

Eighteen computed tomography (CT) studies of the lungs prior to thoracotomy in 15 children with presumed pulmonary metastases were compared retrospectively with surgical and pathological findings. Computed tomography detected 86% of the malignant lesions and technical factors were thought to be important where larger nodules were missed. Although CT does not differentiate benign and malignant lesions, 90% of lesions detected at CT in this study contained tumour. In four patients it was found that nodules that increased in size on serial CT contained viable tumour, whereas nodules that decreased in size while a patient was on chemotherapy might or might not contain viable tumour.

Acute Pseudobulbar Palsy Due to Bilateral Focal Cortical Damage: The Opercular Syndrome of Foix-Chavany- Marie

Two children are described who suddenly developed an encephalitic illness with intractable bilateral facial seizures. The seizures subsided over several days, but the children were left with the signs of pseudobulbar palsy and are unable to speak or swallow effectively. Bilateral destructive lesions in the opercular regions evolved on computed tomographic scans. Both children were treated with acyclovir relatively early in the illness, and cerebrospinal fluid and serum antibodies support the diagnosis of herpes simplex virus encephalitis. (J Child Neurol 1989;4.-131-136).

Bilateral congenital lacrimal sac mucoceles with nasal extension.

This paper describes the CT findings in a case of bilateral congenital lacrimal sac mucoceles in a full-term infant. The patient was also found to have a unilateral choanal stenosis.

Bilateral metachronous periosteal osteosarcoma

The first case of bilateral metachronous periosteal osteosarcoma (OS) is reported. A 14‐year‐old white boy presented with a 1‐month history of pain and swelling in his right thigh. Periosteal OS was diagnosed on a basis of the radiologic and pathologic findings. Treatment was with local resection and total hip replacement after a short course of high‐dose methotrexate; multi‐agent chemotherapy was continued postoperatively for 3 months. He remained well for 3 years. He then represented with a mass in the left femur that had been slowly growing for about 1 year. Radiologic and biopsy studies showed periosteal OS. Full investigations showed no evidence of metastatic disease. Treatment consisted of local resection without chemotherapy. He remained well for 6 months after the second excision until developing multiple pulmonary metastases. All further therapy was refused. The question as to whether the second tumor was a new primary lesion or a metastasis is discussed, together with possible differential diagnoses. Cancer 58:1139‐1143, 1986.

Computed tomography of partial growth plate arrest: initial experience

Twelve growth plates in 11 patients with clinical evidence of partial growth plate tethering underwent thin slice (1.5 mm) axial high resolution computed tomography (CT), or direct coronal CT. The normal epiphyseal plate was readily visualised as a low density layer of soft tissue density between adjacent sclerotic margins of epiphysis and metaphysis. Two growth plates had greater than 50% obliteration and ten had partial obliteration. Our preliminary results show excellent correlation between the CT findings and surgical pathology. We expect that CT will replace polytomography in the operative evaluation of partial growth plate arrest, as it has in our institution.Twelve growth plates in 11 patients with clinical evidence of partial growth plate tethering underwent thin slice (1.5 mm) axial high resolution computed tomography (CT), or direct coronal CT. The normal epiphyseal plate was readily visualised as a low density layer of soft tissue density between adjacent sclerotic margins of epiphysis and metaphysis. Two growth plates had greater than 50% obliteration and ten had partial obliteration. Our preliminary results show excellent correlation between the CT findings and surgical pathology. We expect that CT will replace polytomography in the operative evaluation of partial growth plate arrest, as it has in our institution.

Inappropriate use of contrast studies prior to referral of neonatal gastrointestinal anomalies and bowel obstruction

Abstract Ten cases of neonatal gastrointestinal anomalies and bowel obstruction are described, in which contrast studies were carried out prior to transfer. Nine of the 10 infants had bile‐stained vomiting, indicating the need for immediate surgical referral. The contrast studies resulted in delayed referral, deferment of appropriate resuscitation, and complications associated with the study. In several cases the wrong type of study, or the wrong contrast medium was used. These 10 infants required urgent surgical referral, not a sophisticated radiological procedure in geographic and surgical isolation.