N. Ziv

Definitive diagnosis of fracture-separation of the distal humeral epiphysis in neonates by ultrasonography

Fracture-separation of the distal humeral epiphysis in neonates is difficult to diagnose radiologically because the cartilaginous epiphysis is radiolucent. We report a case in which fracture-separation of the distal humeral epiphysis in a neonate was diagnosed with the help of ultrasonography, which provided a clear delineation of the injury.

Osteopathia striata, cranial sclerosis with cleft palate and facial nerve palsy

Osteopathia striata (OS) is a rare bone dysplasia characterized by longitudinal sclerotic striations of the long bones. It is of no clinical importance, but OS associated with cranial sclerosis represents a separate entity with a high incidence of palatine malformations and deafness. Only 19 cases of this entity have been reported in the literature. One patient of this series also had facial nerve paralysis. This paper presents a second case of OS, cranial sclerosis, palatine pathology and recurrent facial nerve paralysis. This incidence of 2/20 (10%) does not seem to be coincidental but raises the possibility that facial nerve palsy is one of the clinical manifestations of this specific bone abnormality.

The enigma of stress fractures in the pediatric age: Clarification or confusion through the new imaging modalities

Cortical thickening and/or periosteal reaction in long bones of children and adolescents continue to present a diagnostic difficulty for the pediatric radiologist. A history of physical activity points to the possibility of stress fracture, nevertheless bone malignancy or chronic inflammatory changes have to be excluded. The MRI findings in recent cases of stress fractures were confusing. An extensive metadiaphyseal abnormal signal from the medullary cavity was observed. Only the meticulous correlation between the various imaging modalities established the correct diagnosis.Stress fractures can occur in a normal bone that is subjected to repeated trauma, with the strain being less than that which causes an acute fracture. Localized pain is the presenting symptom [1]. This kind of fracture is encountered in adolescents who are often involved in competitive physical exercise.The conventional radiographic examination shows the evidence of the fracture repair rather than the fracture itself: localized periosteal reaction and endosteal thickening. A radiolucent cortical fracture-line is usually not demonstrated [2]. The radiologic appearance can be problematic in the pediatric age and necessitates differentiation from osteomyelitis or bone malignancy.The diagnostic investigation includes multidirectional bone radiographs, Tcm99 polyphosphate bone scientigraphy [3] and computerized tomography [4]. Recently MRI has been added to the diagnostic armamentarium.This paper presents the experience gained in the diagnosis of pediatric stress fractures which were investigated and followed up by MRI. It was found that this modality did not contribute to the establishment of the final diagnosis of stress fracture.

Neuroblastoma : evaluation with contrast enhanced MR imaging

The use of GD-DTPA was introduced recently for MR imaging of the body. This paper presents our experience with GD-DTPA enhanced MRI in the evaluation of neuroblastoma in children. The characteristics of the tumor-enhancement are described, its contribution to the diagnosis and the follow-up of this disease are discussed.

Isolated sphenoidal sinusitis in children

Abstract Acute isolated infectious sphenoiditis is an uncommon, potentially dangerous condition which is often misdiagnosed because of its nonspecific symptoms and paucity of clinical signs. We present eight children with isolated sphenoiditis who were managed in our medical centre during the last 2 years and review the literature. All the patients were adolescents or pre-adolescents and all experienced moderate to severe refractory oppressive headache. Four had a history of sinusitis or allergic rhinitis. None had fever or any other directing clinical sign. Diagnosis was made by cranial computer tomography. All were treated with antibiotics and recovered completely without infectious or neurological complications. Conclusion Acute isolated infectious sphenoiditis should be considered in adolescents and pre-adolescents who present with constant moderate to severe oppressive headache. Awareness of this entity will enable early diagnosis and initiation of antibiotic treatment which is essential to avoid complications and surgical intervention.

Bronchiectasis in children: Assessment by CT

The prevalence of bronchiectasis (BR), in general, is decreasing, yet the disease can produce significant morbidity in children. In the pediatric age group the classical investigation by bronchography implies general anaesthesia, thus carrying an additional risk of complications. CT has proved highly accurate in the diagnosis of BR in adults. It is also considered a reliable modality for the diagnosis of BR in children. This conclusion was reached by analysing the radiographic and the CT findings in 40 children with the clinical suspicion of BR in 25 of whom the CT examination was positive. Nine patients of this last group had bronchography as well. There was complete correlation in the diagnosis and location between the CT and the bronchographic findings. Thus, it seems that the occurrence of this disease is still high in the pediatric population in the appropriate clinical and radiological setting. The imaging evaluation of BR should include chest radiographs, computerized tomography and, if surgery is planned, bronchography as well.

Liver candidiasis. The various sonographic patterns in the immunocompromised child

Liver candidiasis is characterised by small abscesses spread throughout the organ at random. These lesions may be identified sonographically. In the active phase of the disease, hepatomegaly is seen together with the “wheel in wheel” phenomenon, the “wagon wheel” appearance and/or the “bulls eye” lesion. Later on, hypoechoic defects develop. When the echogenic foci are revealed, the healing phase is initiated. These manifestations are demonstrated in 4 pediatric oncology patients. The sonographic patterns as well as its differential diagnosis from primary liver tumors, metastatic infiltrations or other abscess formations are discussed.

Colonic stricture secondary to torsion of an ovarian cyst

Intestinal obstruction in the newborn is a potentially life-threatening complication. The most common causes are meconium plug, meconium ileus, intestinal atresia, intestinal malrotation, and Hirschprungs disease. We present an unusual case of intestinal obstruction caused by torsion of an ovarian cyst. The left fimbria and ovary swirled around the sigmoid colon, causing colonic stricture.

Involvement of the Foot and Ankle in Patients with Gaucher Disease

Of 48 children with type I Gaucher disease treated at our hospital, 11 had involvement of the foot and ankle that first appeared in adolescence. Follow-up ranged from 3 to 27 years (average, 10 years). We reviewed their clinical and radiographic histories. Patients presented with four types of pain: six (7 events of pain) complained of dull pain defined as nonspecific; seven (11 events) had severe pain caused by bone crisis; two (2 events) had moderate progressive pain caused by pathological fractures; and one had painful swollen ankles caused by degenerative arthritis. Greater awareness of these complications in patients with Gaucher disease will prevent misdiagnosis and lead to early treatment.

The bubble sign in the gasless abdomen of the newborn.

The bubble sign (BS) in the gasless abdomen of the newborn is a helpful clue in the diagnosis of an upper gastrointestinal obstruction. The already swallowed air serves as the natural contrast agent. The single, double and triple BS are described in view of 23 cases indicating the level of the obstruction, and its differential diagnosis is discussed. The presence of BS in the gasless abdomen of the newborn is an indication for surgery until proved otherwise. With the increasing experience by ultrasonography, this modality should be considered as the first bed-side procedure when suspecting upper gastrointestinal obstruction, and then be confirmed by radiograms.