Donald B. Darling

The radiographic diagnosis of congenital hypertrophic pyloric stenosis

Criteria from forty-six cases of hypertrophic pyloric stenosis have been analyzed to determine the effectiveness of roentgenographic examination in instances where clinical examination yielded no certain diagnosis. The incidence and type of radiographic signs are tabulated with illustrative examples. A correct diagnosis of 95.5 per cent was obtained in this group of patients.

The Value of the Double-Track Sign as a Differentiating Factor between Pylorospasm and Hypertrophic Pyloric Stenosis in Infants

The development of vomiting in the infant after the immediate neonatal period frequently requires radiographic investigation of the underlying cause. The classical case of hypertrophic pyloric stenosis presents little problem, but an infant with a severe and prolonged pylorospasm may be difficult to differentiate from one with hypertrophic pyloric stenosis. In this communication, a group of proved cases of hypertrophic pyloric stenosis is compared with a similar group of cases of pylorospasm to determine identifying features of each. The main roentgenographic signs of hypertrophic pyloric stenosis are the string (Fig. 1), the shoulder (Figs. 1 and 2), the beak (Figs. 1 and 3), and the tit (Figs. 1 and 4). With the string sign an area of constant narrowing appears to be rigid and free of peristaltic activity in the prepyloric region and pylorus. This is due to the restriction of distensibility by the hyper-trophied muscle of the pylorus. The narrowed channel presents a curve upward and slightly to the left...

Preoperative Diagnosis of Choledochal Cyst by Hepatoscintography

THE preoperative diagnosis of congenital cystic dilatation of the common bile duct (eholedochal cyst) continues to represent a challenging surgical and radiologic exercise. The classic triad of abd...

The Roentgenological Aspects of Goldenhar's Syndrome (Oculoauriculovertebral Dysplasia)

Oculoauriculovertebral dysplasia is a syndrome involving the eye and eyelids, ear, mandible, facial bones, and vertebrae. The initial case was described by von Arlt (26) in 1845. In 1963 the total number of recorded cases was brought to 42 by the report of 2 cases by Gorlin (10), who suggested the term oculoauriculovertebral dysplasia as a descriptive name for this entity, which is also known as Goldenhars syndrome. His review of the literature covered in detail the systemic manifestations of the disease. Although significant roentgenographic abnormalities occur, to our knowledge there has been no description of the findings in the radiologic literature. We have had the opportunity to examine six patients with this syndrome seen at the Boston Floating Hospital of the New England Medical Center Hospitals. Four of these patients have been described in a recent article by Berkman and Feingold (2). Two additional cases are presented, and the findings in all six cases are summarized in Table I. Case Reports D...

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.

Posterior mediastinal accessory thymus

T w o C H I L D R E N , each wi th pos te r io r m e d i a s t i n a l mass , u n d e r w e n t a t h o r a c o t o m y for suspec ted n e o p l a s m . Acces sory thymic tissue, separa te f r o m a n o r m a l b i l o b e d thymus in the usual posi t ion, was f o u n d in each chi ld . Ectopic t hymic t issue shou ld be inc luded in the d i f fe rential d iagnosis o f a pos te r io r med ia s t i na l m a s s in a child.

Large screen image amplification with closed-circuit television employing television tape-recorder.

The ever increasing public emphasis on the hazards of radiation and the ever expanding fields of motion radiography present challenges to the radiologist and to the manufacturer of x-ray equipment. At the same time that more extensive use of motion studies is made, every effort must be concentrated on limiting the amount of radiation during any given examination. The recently opened x-ray department at the Childrens Hospital of Pittsburgh utilizes television tape-recording of the fluoroscopic image, mediated through a newly developed image Orthicon television camera2 optically coupled to a 9-inch image amplifier. The system permits recording on television tape and simultaneous viewing on the closed-circuit television monitor at the same low levels of radiation as are required for closed-circuit television viewing alone. This paper will outline some of the considerations that went into the planning of the department. Image amplifiers with field diameters of 4 1/2 and 5 inches have been available for nine ...

The roentgenographic manifestations of Cushing's syndrome in infancy.

Three cases of Cushings syndrome in infancy are described, and the x-ray changes found in previous case reports are reviewed. Atrophy of the thymus associated with excessive deposits of fat and atrophy of muscles in the extremities appear to be characteristic of this age group. When seen in combination with osteoporosis and retarded bone maturation, Cushings syndrome should be suggested. Definitive diagnosis requires an endocrinological evaluation combined with investigation of the adrenal glands by excretory urography, selective angiography, and/or retroperitoneal air insufflation.

A simple device for obtaining lateral acetabular views of the hip in infants.

The acetabular lateral view of the hip has considerable usefulness in orthopedic work in infants, especially in cases of congenital dislocation. It is difficult, however, to get comparable projections of both hips routinely, and with the usual method someone must stand in the direct x-ray beam during the exposure. The method to be described not only eliminates irradiation to personnel but makes it easier to obtain satisfactory pictures. The device is a modification of the acetabular box used elsewhere. Basically it is made in the form of the letter “T” with a slot across the top into which a cassette can be inserted vertically. Side rails are attached to the base of the “T” so that a compression band can be used and an extension of the “T” above the slot makes it possible to immobilize the legs and feet in a Flexi-cast (Fig. 1). A separate base on which a circular track is mounted permits the acetabular box to be rotated 360° on three large ball bearings which are attached to the box and fit onto the trac...

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.