Lionel W. Young

The Sphenoidal Sinuses: Radiographic Patterns of Normal Development and Abnormal Findings in Infants and Children

Developmental patterns of sphenoidal sinuses were determined from lateral radiographs of 1702 patients from newborn to 15 years of age. Pneumatization of the conchal sinuses was seen as early as 6 months of age; 90% showed sphenoidal sinus pneumatization by 4 years of age; 100% by 10 years of age. Extension of pneumatization into the basisphenoid may be evident after 4 years of age, and 95% showed basisphenoidal pneumatization after age 12. An apparent lack of pneumatization of the sphenoidal sinuses in patients over 10 should stimulate investigation for sphenoidal sinus disease. Although isolated sphenoidal sinus abnormalities were rare, sphenoidal sinus involvement was common (67--75%).

Acute chondrolysis complicating Legg-Calvé-Perthes disease

Of 270 children with Legg-Calvé-Perthes (LCP) disease, roentgenographic evidence of chondrolysis was noted in 12 (4.5%) within one year after diagnosis and appropriate management. Only in six hips of these 12 patients did the retrospective clinical, histological, and orthopedic findings fulfill the diagnostic requirements for chondrolysis. Sequential roentgenographic findings included initial periarticular osteoprosis and subchondral cortical irregulatities, subsequent narrowing of the joint space, premature fusion of the growth plate, and eventual development of degenerative arthritis. The early roentgenographic recognition of chondrolysis is emphasized because it has an untoward effect on the prognosis of LCP and should there-fore prompt a different orthopedic approach.

Effectiveness of abdominal radiographs in visualizing chewable iron supplements following overdose

The purpose of this study was to determine the clinical effectiveness of visualizing chewable and nonchewable iron supplements remaining in the gastrointestinal tract following an overdose. A 5-year retrospective review of 93 pediatric patients who had ingested potentially toxic amounts of an iron supplement found that 58% had abdominal radiographs taken. Fifty-five percent of these patients had ingested chewable multiple vitamins with iron and 40% had ingested nonchewable tablets. After radiographic review, radiopaque densities could be marginally visualized in only one case of ingestion of a chewable iron supplement. The mean serum iron level of patients who had ingested a chewable form of iron was 270 micrograms/dL. An in vitro study was performed to determine the radiopacity of various chewable multiple vitamins with iron. It was concluded that although chewable multiple vitamins with iron are radiopaque in vitro, clinical radiographic visualization is unlikely.