Mutsuhisa Fujioka

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%).

Esophageal duplication cyst complicated by Mycobacterium avium complex infection.

Mycobacterium avium complex (MAC) infection is very rare in immunocompetent children, therefore the correct diagnosis and appropriate treatment are often delayed. 1 Esophageal duplication cyst is also a rare congenital foregut anomaly. Making a definitive diagnosis is difficult preoperatively, although various imaging techniques can help to localize these lesions and exclude other causes. 2 Here we present a patient who had an esophageal duplication cyst with MAC infection, including findings of chest radiography, computed tomography (CT), and magnetic resonance imaging (MRI).

A young infant with Goldbloom syndrome

The patient was a Japanese girl who was the second child of unrelated, healthy parents. Hydrocephalus was disclosed on fetal ultrasonography at 33 weeks gestation, which prompted the obstetrician to perform a cesarean section at 34 weeks gestation. Birth weight was 2418 g, height 45 cm and head circumference 35.6 cm. Apgar scores were 8 and 10 at 1 and 5 min, respectively. She underwent ventriculo-peritoneal shunt for congenital aqueduct stenosis at 10 days of age. Tonicclonic convulsion commenced at 3 months of age, but it was well controlled by anti-convulsant medication. At 4 months of age, she was brought to our medical service with a 3 day history of febrile illness and painful swelling of the left knee joint. Physical examination revealed swelling, tenderness and warmth of the thigh without alteration of the overlying skin. Joint fluid in the knee was not overt. Laboratory examination disclosed an increased erythrocyte sedimentation rate (ESR, 45 mm/h), increased C-reactive protein (CRP, 2.6 mg/dL) and increased white blood cell count (WBC, 20 000/mm3). Other laboratory data including Ca, P, alkaline phosphatase and tests for syphilis and tuberculosis were normal. Blood culture was Pediatrics International (1999) 41, 110–112

Magnetic resonance imaging of clival marow in patients with anorexia nervosa

Hematological abnormalities, commonly associated with anorexia nervosa (AN) patients, are thought to be the results of serous atrophy in the bone marrow. Magnetic resonance imaging (MRI) has been utilized to ascertain T1 and T2 prolongation of marrow intensity in the lumbar spine, pelvis and proximal femora. The results correlate well with the severity of hematological abnormalities and body mass index. More importantly, the propensity for peripheral marrow involvement of T2 prolongation contrasts with the axial involvement in other marrow disorders. MRI undertaken in patients with AN to exclude hypothalamic tumor showed that the clival marrow was equivalent to the peripheral marrow. The signal pattern of clival marrow on sagittal T1 weighted MR images was evaluated in four teenage female patients with AN complicated by hematological abnormalities. Although the clival marrow intensity should be uniformly high in teenagers, three patients, two with pancytopenia and one with leukopenia and anemia, exhibited homogenous low intensity. One patient who had leukopenia only and the highest body mass index, showed inhomogeneous low intensity. The signal changes returned to normal in all patients but one, who died before examination after 6–11 months, at which time the others had almost recovered their original weight and normal hemogram. T1 prolongation in the clival marrow represents bone marrow dysfunction and the inhomogeneity of the signal change may imply relative preservation of hematopoiesis and body fat composition. Lack of knowledge of this phenomenon may lead to diagnostic confusion with other marrow disorders on cranial MRI.