Menucha Pery

Ultrasonography in Crohn's disease

Eighteen patients with acute and subacute Crohns disease were examined by ultrasound. In 7, ultrasound was the initial screening procedure leading to the diagnosis of Crohns disease. This diagnosis was subsequently proved by results of barium studies. The most frequent ultrasonographic finding was conglomeration: an irregular mass containing scattered echodense and sonolucent areas that represented matted inflamed bowel loops. Some of the conglomerations showed a fine diffuse echo pattern with ill-defined posterior borders due to poor transmission. These areas denoted mesenteric fat covering the matted loops (fatty conglomeration). Other ultrasonographic findings were the “target” or “bulls eye” sign, abscess formation, and fluid in the cul-de-sac.

Familial distal renal tubular acidosis with neurosensory deafness: early nephrocalcinosis.

Nephrocalcinosis was observed in 3 children of one family with distal renal tubular acidosis (dRTA). At presentation, all 3 patients had failure to thrive, rickets, hyperchloremic metabolic acidosis, hypokalemia, hypophosphatemia and hypercalciuria. At a later age, sensorineural hearing impairment was detected. Nephrocalcinosis was diagnosed in the index case at the age of 5 years, when a plain abdominal roentgenogram was first made; in the younger brother and sister, nephrocalcinosis was detected earlier at the age of 4 months and 5 weeks, respectively. All 3 patients required large doses of alkali (7.5-9.5 mEq/kg body weight/day) during infancy and early childhood to correct the acidosis and to prevent progression of the nephrocalcinosis. Contrary to the current notion that in children with dRTA, nephrocalcinosis is observed only after the age of 3 years, it appears that in some instances nephrocalcinosis may develop in early infancy. The occurrence of nephrocalcinosis at a very young age may be a manifestation of a severe genetically transmitted variant of dRTA and emphasizes the need for early diagnosis and optimal treatment of these patients from the first days of life.

In utero Diagnosis of Bladder Perforation with Urinary Ascites

Prenatal sonographic diagnosis of fetal obstructive uropathy is relatively common. However, the complication of spontaneous rupture of the obstructed bladder in utero causing fetal urinary ascites is extremely rare. This case report describes an unusual case of congenital bladder perforation and urinary ascites diagnosed in utero. The pertinent literature is reviewed.

The value of ultrasound in Schoenlein-Henoch purpura

We report the results of ultrasound studies on 11 children with Schoenlein-Henoch purpura. In 8 children the ultrasound examination was normal. In two of three patients with macroscopic haematuria, haemorrhagic cystitis, a previously undescribed finding in Schoenlein-Henoch purpura, was found. In one case the gall bladder wall and the wall of several adjacent loops of bowel were markedly thickened. Follow up examinations after clinical recovery demonstrated complete resolution of these abnormalities. Our observations demonstrate that diagnostic ultrasound may have an important role before more expensive and invasive procedures are employed in patients with Schoenlein-Henoch purpura.

Percutaneous kidney needle biopsy in children is less traumatic than in adults

Hemorrhagic complications following percutaneous kidney needle biopsy were prospectively assessed in 20 children and adolescents (age 2-17 years) undergoing a total of 22 biopsies. Macroscopic hematuria was observed in 1 case and hematocrit reduction of more than 3% in 2. Gray-scale ultrasonography performed in all patients 48 h after the biopsy detected peri- and intrarenal hematomas in 2 cases. Based on these data and those from another study on children, comparison to three similar studies in adults showed a 9.3% mean incidence of macroscopic hematuria in children versus 36.2% in adults (p less than 0.01), a 9.1 versus 31.3% mean incidence of hematocrit reduction of more than 3% (p less than 0.05), and a mean incidence of only 10.9% in children versus 65.6% in adults of radiologically detected peri- and intrarenal hematomas (p less than 0.001). We conclude that percutaneous kidney needle biopsy in children is less traumatic than in adults. Hence when relating to hemorrhagic complications of the procedure, the two populations have to be addressed separately.