Donald R. Kirks

Malrotation—The ubiquitous anomaly

Although anomalies of rotation and fixation of the gastrointestinal tract are recognized to be associated frequently with anomalies of the abdominal wall and diaphragmatic hernia, the frequency with which these common anomalies are associated with other congenital and acquired lesions of the gastrointestinal tract has not been sufficiently emphasized. Sixty-two percent of our series of 34 patients were associated with such lesions as upper gastrointestinal atresias and stenoses, intussusception, and Hirschsprungs disease. The embryologic and anatomic features of rotational anomalies, their clinical presentation, and radiologic features are presented with the suggestion that knowledge of this information, along with the appreciation of the frequent association of malrotation with other common congenital and acquired abnormalities, will help to prevent the devastating morbidity and mortality of undiagnosed midgut volvulus.

Imaging of neuroblastoma: an overview

This review article briefly describes the pathology, clinical features, prognosis, and treatment of neuroblastoma. The emphasis is on applications of newer diagnostic modalities (sonography, nuclear scintigraphy, computed tomography) for imaging and staging. The potential role of magnetic resonance imaging and spectroscopy is discussed.

Cervical spine fractures and dislocations in children

A retrospective analysis of pediatric admissions over 10 years revealed 29 patients with cervical spine injuries. Eleven patients were below 12 years of age, and 10 of these had injuries involving C1, C2, or the occipitoatlantal articulation. Eighteen patients were between 12 and 16 years of age with injuries distributed throughout the cervical spine similar to injuries in the adult population. Our results suggest that teenagers with suspected cervical injuries are best evaluated by an adult radiographic series including trauma oblique views. In younger patients, careful evaluation of occipitoatlantoaxial alignment and the prevertebral soft tissues is required for diagnosis and selection of additional imaging evaluation.

The Currarino triad: complex of anorectal malformation, sacral bony abnormality, and presacral mass

The Currarino triad is a unique complex of congenital caudal anomalies including anorectal malformation, sacral bony abnormality, and presacral mass. The usual symptomatology is constipation due to anorectal stenosis. Contrast enema and computed tomographic myelography are the imaging modalities of choice for diagnostic confirmation and clarification of the anomalies. The clinical features, unique radiologic appearance, and importance of a correct diagnosis of the Currarino triad are reviewed.

Radiological Evaluation of Visceral Injuries in the Battered Child Syndrome

Diagnostic imaging plays an important role in the recognition, evaluation, and follow-up of visceral injuries in the battered child syndrome. Conventional radiography is important for the diagnosis of associated skeletal fractures, pulmonary parenchymal injury, gastric dilatation, and pneumoperitoneum. An upper gastrointestinal series is the examination of choice in suspected intramural duodenal hematoma. Ultrasonography is helpful in the diagnosis of retroperitoneal hematoma, acute traumatic pancreatitis, and pancreatic pseudocyst. Nuclear scintigraphy is valuable if injury is limited to the liver or spleen. CT is the imaging modality of choice for assessing generalized blunt abdominal trauma as well as evaluating the extent of injuries to the liver, spleen, pancreas, kidneys, and mesentery.

Traumatic atlanto-occipital disruption in children

Ten cases of traumatic atlanto-occipital disruption in pediatric patients are reported. All injuries resulted from motor vehicle accidents, the majority of which were pedestrian/automobile. Three patients survived their injury for a period greater than one year. The importance of recognizing atlanto-occipital disruption is stressed because of its relative frequency in severely traumatized pediatric patients, particularly pedestrian/vehicle incidents, and because of the potential for survival. Diagnosis, in most instances, is based on the lateral cervical spine radiograph. The most applicable diagnostic features in children, as demonstrated on the lateral cervical spine radiograph, are reviewed.

Bilateral avulsion fractures of the anterior superior iliac spines in sprinters

Three cases of bilateral pelvic avulsion fractures in adolescent sprinters are reviewed. Anacute avulsion fracture of the anterior superior iliac spine (ASIS) occurred during active running in three teenaged sprinters. Radiography confirmed a healed fracture of the contralateral ASIS. The clinical features and radiologic appearances are characteristic. The pathophysiology of this type of unique pediatric fracture is discussed. Conservative treatment is successful.

Neonatal Hepatic Calcification Secondary to Transplacental Infection

Transplacentally acquired infections which cause prenatal and neonatal hepatitis can cause hepatic calcification in the newborn. Three cases are reported in which congenital toxoplasmosis and herpes simplex viral infections were causes of neonatal hepatic calcification. Autopsies performed in 2 of the cases revealed extensive dystrophic hepatic calcifications.

Diagnostic Imaging of Pediatric Abdominal Masses

This overview delineates the clinical and pathological features of various abdominal mass lesions found in neonates and in older infants and children. The application and limitations of imaging procedures currently available are reviewed with emphasis on the principles and advantages of advanced imaging techniques. Selected pediatric abdominal masses are discussed and their radiologic features illustrated. Integrated imaging strategies for abdominal masses in the newborn and in the older infant and child are proposed.

The diagnosis of primary and recurrent tracheoesophageal fistulas: Value of selective catheterization

To avoid an unnecessary second thoracotomy, unequivocal demonstration of a recurrent tracheoesophageal fistula after repair of esophageal atresia with tracheoesophageal fistula is mandatory. Transesophageal selective catheterization of the fistula during cineesophagography may resolve the ambiguities of routine cineesophagography and rod lens telescopic bronchoscopy.