G. Gorincour

Prenatal prognosis of congenital diaphragmatic hernia using magnetic resonance imaging measurement of fetal lung volume

To investigate the correlation between fetal lung volume (FLV), measured with magnetic resonance imaging (MRI), and postnatal mortality in newborns with prenatally diagnosed isolated congenital diaphragmatic hernia (CDH).

Feasibility of fetal cardiac magnetic resonance imaging: preliminary experience.

Coronal RARE sequence showing the fetal visceroatrialsitus, assessed in relation to the bronchial tree: the embryologicallynormal left main bronchus (with the stomach on the same side) israther long with no early division (large arrow), whereas the rightone is short, more vertical, and has an early division (small arrow).

Angioscanner post-mortem: faisabilité de l'abord artériel sous guidage échographique

Nous rapportons un cas d’angioscanner post-mortem corps entier realise par ponctionarterielle femorale sous controle echographique, chez un patient de 24ans, victime d’unaccident de moto, decede a l’arrivee du Samu. Le scanner a ete demande dans un cadremedicolegal suite a l’examen externe par les medecins legistes qui retrouvaient essen-tiellement des contusions de la face et du thorax. Des prelevements sanguins et d’urines,notamment toxicologiques, ont ete realises avant la procedure.L’acquisition a ete realisee 20h apres le constat du deces sur un scanner 64coupesdouble source (Siemens Medical System, Erlangen, Allemagne) avec un protocolecomportant une premiere acquisition sans injection corps entier. Initialement, l’arterefemorale droite a ete ponctionnee sous controle echographique a l’aide d’un catheter18gauge—30mm, puis catheterisee a l’aide d’un guide hydrophile 0,035’’ (Terumo). Uneinjectiontestaeterealiseegrâceaunintroducteuravalve6Fmettantenevidenceunedis-section de l’artere iliaque externe et une extravasation de produit de contraste. L’arterefemorale gauche a donc secondairement ete ponctionnee, toujours sous guidage echogra-phique, et catheterisee par un kit de microponction (Skater Introducer, Angiotech), dontle guide, qui presente une extremite plus souple, a sans doute permis un catheterisme

Prenatal diagnosis of Blake's pouch cyst following first‐trimester observation of enlarged intracranial translucency

A 27-year-old primigravida with no relevant medical history was seen for her first prenatal appointment and first-trimester ultrasound scan at 12 + 1 weeks’ gestation. The crown–rump length (CRL) was 57.8 mm and the nuchal translucency thickness was 1.3 mm. First-trimester evaluation for combined risk did not indicate that the pregnancy was at high risk for aneuploidy, with a risk of 1/10 000. Following the publications by Chaoui and Nicolaides et al.1–3, we systematically measure intracranial translucency (IT) at the first-trimester scan. For this fetus the IT was 3.5 mm (Figure 1), which is well above the 95th percentile for CRL according to established reference ranges1. The patient was examined again at 23 and 32 weeks’ gestation. Examination of fetal anatomy at 23 weeks showed a large cyst connecting the fourth ventricle with the retrocerebellar space. The vermis was present, along with otherwise normal fetal morphology and biometry. We noted an enlargement of the fourth ventricle and an elevation of the lower part of the vermis, which was shifted away from the posterior part of the brainstem in an anticlockwise rotation (Figure 2). Using the methodology described by Guibaud and des Portes4 for the diagnosis of anomalies of the posterior fossa, we concluded that the fetus had a persistent Blake’s pouch (or Blake’s pouch cyst). At the time of writing the infant was 1 month old with normal findings on neurological examination and on transfontanellar ultrasound examination performed 2 weeks after birth (Figure 3).

Congenital lung malformation: Evaluation of prenatal and postnatal radiological findings

Background and objective:  This study evaluated the accuracy of prenatal MRI and postnatal CT imaging in the identification of congenital cystic adenomatoid malformation and bronchopulmonary sequestration by comparison with histological analysis.

Introduction of the use of a pediatric PICC line in a French University Hospital: review of the first 91 procedures.

PURPOSE In order to assess the establishment of a pediatric PICC line service in a University Hospital after the first 91 consecutive procedures. MATERIALS/PATIENTS AND METHODS Retrospective study over a period of 24months. The criteria analysed were success or failure of the procedure, indication, age when inserted, type of PICC line, mean length of use and development of complications such as accidental removal, venous thrombosis or infection. RESULTS Ninety-one PICC lines were inserted in 74 patients between 4months and 25years old (sex-ratio: 1.1 girls/boys). The procedure was performed under general anaesthesia in four cases (4.4%) and under EMLA and MEOPA in 87 cases (95.6%). The insertion was ultrasound guided through the basilic (n=63, 70%), humeral (n=18, 20%) or cephalic (n=9, 10%) veins in the non-dominant arm (L in 62 cases, R in 28 cases). The insertion success rate was 99% (n=90). The main indications were starting antibiotic therapy (n=47, 52%), chemotherapy (n=34, 38%) and parenteral nutrition (n=5, 5%). The devices used were single lumen 3F (n=4, 4%), single lumen 4F (n=31, 34%), double lumen 4F (n=2, 2.2%), single lumen 5F (n=12, 13%), and double lumen 5F (n=41, 45%). The PICC line was used for an average period of 45days (14 to 300days). The complications found were accidental removal (n=2, 2.2%), catheter fracture (n=2; 2.2%), obstruction (n=5, 5.5%), suspected infection (n=1, 1.1%), and venous thrombosis and pulmonary embolism (n=3, 3.3%). The overall complication rate was 14.4% (n=13) including 4.4% serious complications (n=4). CONCLUSION PICC lines are a future solution in pediatrics. This technique is reliable and has a similar complication rate to studies carried out in adults, most of which can be prevented by careful catheter maintenance and informing the care staff.

Les urgences abdominales non traumatiques de l’enfant

Do advances in MR imaging and Computed Tomography have encroached upon the private territory of Ultrasound-Doppler imaging on paediatric practice? Do the enthusiasm promoted by the use of CT on non traumatic acute abdomen in adult has contaminated the indomitable village of paediatric radiologist? Undoubtfully, Ultrasound-Doppler stayed the first imaging modality to perform. However, the habits are less crystallised than a few years ago. The goal of this article is to describe the ultrasound findings and the potential indications for MRI or CT in the major non traumatic abdominal paediatric emergencies.

Magnetic resonance imaging in the prenatal diagnosis of congenital diarrhea

Congenital diarrhea is very rare, and postnatal diagnosis is often made once the condition has caused potentially lethal fluid loss and electrolyte disorders. Prenatal detection is important to improve the immediate neonatal prognosis. We aimed to describe the prenatal ultrasound and magnetic resonance (MRI) imaging findings in fetuses with congenital diarrhea.

Management of choledochal cyst: Evolution with antenatal diagnosis and laparoscopic approach.

BACKGROUND/AIM: Laparoscopic excision of a choledochal cyst (CC) with hepaticojejunostomy gained a wide acceptance in the treatment of children even in neonatal period. Although, the use of prenatal diagnostic techniques causes a significant increase in antenatal diagnosis of CC, the time of surgical intervention during infancy is still controversial. A retrospective study was performed to evaluate the results of laparoscopic management of CC with special emphasis on antenatal diagnosis and treatment, and to compare the results with open procedure. MATERIALS AND METHODS: The patients who were diagnosed with choledochal cyst and underwent either open or laparoscopic hepaticojejunostomy in two centres, hopital d’enfant de La Timone from Marseille and hopital Robert Debre from Paris between November 2000 and December 2009 were included in the study. The data obtained from medical reports were evaluated for sex, time of antenatal diagnosis, age at time of operation, operative time, time of postoperation. RESULTS: A total of 19 hepaticojejunostomy were performed, including 10 open procedures (group A), and 9 laparoscopic procedures (group B, 4 were diagnosed prenatally, without conversion to open procedure). There were 3 boys and 16 girls, ranging in age from 2 weeks to 16 years. Patients in the group A were older than patients in the group B. The mean hospital stay and time to return of bowel fuction was longer in the group B. there were 60% of pre-operative complications in group A versus 22% in group B. There was one postoperative complications in group B (biliary leakage nedeed redo surgery). No significant differences were found between different parameters except for operative time (288.56 min in the group B versus 206 min in the group A. (p = 0.041)). CONCLUSIONS: Our initial experience indicates that the laparoscopic approach in infancy is technically feasible, safe, and effective, with a low morbidity and a comparable outcome to the open approach. Therefore, we propose a laparoscopic approach for antenatally diagnosed CC as early as possible, before the onset of complications.

The 'daughter cyst sign': a sonographic clue to the diagnosis of fetal ovarian cyst.

The first sonographic diagnosis of ovarian cyst was reported in a living fetus in 19751. Since then these cysts have been increasingly recognized in newborns as a result of being identified prenatally on ultrasound examination. Whatever the postnatal age, ovarian cysts are considered to be abnormal when they are ≥ 20 mm in diameter, otherwise they are diagnosed as maturing follicles. A maturing follicle (diameter < 20 mm) is physiological and occurs in all preovulatory phases. They vary in size from 40 μm to 20 mm and occur in 34% of stillbirths and neonates that die in the first 28 days of life2. When a fetal ovarian cyst is suspected prenatally, problems of confirming its ovarian origin and detecting complications must be overcome. We recently reviewed the records of 12 newborns referred over a 6-year period to our pediatric surgery department for the management of an abdominal cystic mass, which was consistent with a fetal ovarian cyst. Prenatal sonographic images, which were generated by several operators who were not specifically trained to look for this sign, were retrospectively analyzed. Fourteen cystic intra-abdominal masses were found in 12 fetuses (two cases of bilateral cysts). In each case, the ultrasound findings were consistent with fetal ovarian cyst being the most likely diagnosis (see later). The mean gestational age at the time of diagnosis was 31 weeks. In 11 fetuses no other malformation was found. Amniocentesis performed in two cases revealed normal female karyotypes. In the remaining fetuses, fetal gender was ultrasonographically determined as female. Prenatal puncture of the mass was never performed. Within the first 2 days of life, abdominal ultrasonography was performed to determine subsequent procedures, i.e. expectant management when the cyst was uncomplicated and measured < 4 cm in diameter, transabdominal puncture when the cyst was uncomplicated and > 4 cm in diameter, or surgery when the cyst was symptomatic, bilateral or sonographically complicated. In three cases in our series (one with a complicated cyst and two with simple cysts) a single, round, anechogenic structure, or ‘daughter cyst’, was found within the fetal ovarian cyst, adjacent to the wall (Figure 1). One of the simple cysts became complicated after birth. The diameters of the ‘mother cysts’ ranged between 24 and 46 mm with a mean diameter of 35 mm. The largest diameters of the ‘daughter cysts’ were 12, 15 and 18 mm, and the mean diameter was 13 mm. All newborns underwent postnatal scans that confirmed the diagnosis of ovarian cyst. The diagnosis of fetal ovarian cyst is most likely to be made during a routine ultrasound examination3, or following an obstetric complication caused by the cyst. When a fetal intra-abdominal cystic structure is found, the diagnosis of an ovarian cyst might be suspected when: the fetal gender is confirmed as female; discovery is made Figure 1 Fetal ultrasound scan at 34 weeks’ gestation showing the gross ovarian cyst containing the small ‘daughter cyst’.