Reinhard Schumacher

Cerebral spinal fluid flow, venous drainage and spinal cord compression in achondroplastic children : impact of magnetic resonance findings for decompressive surgery at the cranio-cervical junction

Abstract In order to investigate the diagnostic properties of MRI of the brain and spine in achondroplastic children with regard to decompressive surgery, 25 patients were examined by conventional morphological and by “functional” imaging of CSF flow and magnetic resonance angiography (MRA) of the veins and sinuses at the cranial base following a special protocol. The results were compared to those from age-matched controls and were correlated with each other and retrospectively with the neurological findings. Measurements of distances and angulations at the cranio-cervical junction (CCJ) from MR scans showed similar values to those from conventional radiographs and CTs and thus can be used without correction for spatial distorsion. Signs of cervical medullary compression, myelomalacia and intramedullary cyst formation were found in six, seven and three children respectively. These alterations correlated significantly with each other (P < 0.05). Semiquantitative evaluation of CSF flow demonstrated interruption of CSF pathways at the CCJ, which correlated with CCJ narrowing (P < 0.05). MRA showed a significant narrowing of the jugular foramina with a variable compensatory enlargement of the emissary veins and a significant reduction of the total outflow area (P < 0.01). There were no significant correlations between these MR changes and neurological deficits. Conclusion Due to this unexpectedly poor correlation between magnetic resonance and clinical findings in achondroplastic children, the present role of magnetic resonance in the clinical setting is limited to the demonstration of spinal cord compression in individual cases. In three of our patients with prominent neurological abnormalities, the severe changes demonstrated by magnetic resonance imaging strongly supported the indication for surgical decompression.

Stippled epiphyses in fetal alcohol syndrome

We report on punctate epiphyseal calcifications (stippled epiphyses) in the fetal alcohol syndrome and present the differential diagnosis of chondrodysplasia punctata. A literature survey shows that epiphyseal calcifications accompanying alcoholic embryopathy are regularly located in the lower limbs and rarely found in the upper extremities.

Urachal remnants in asymptomatic children: Sonographic morphology

The sonographic morphology of urachal remnants is not well known and findings tend to be misinterpreted. We present urachal remnants in 16 asymptomatic children (1 week-16 years). In the prevesical part two different types of urachal remnants were found: the tubular type with a small outer muscle wall and the fusiform type with a muscle wall thickness up to 12 mm. Further subvariants are presented. Differential diagnosis of the fusiform type includes urachal cyst and tumorous muscle thickening.

Progressive calcifications of lung and liver in neonatal herpes simplex virus infection

We report a female neonate who developed severe septicemia presenting with pneumonia and hepatitis due to an infection with herpes simplex virus type II. In spite of antiviral as well as intensive care therapy, three weeks after admission, extensive hepatic calcification was demonstrable on abdominal radiograph, a sign of severe cellular necrosis. In contrast the pulmonary infiltration recovered completely. The clinical follow up was completed by ultrasound and radiography. The infant died at the age of two months secondary to severe postnecrotic hepatic failure. At autopsy, histological evaluation confirmed the former diagnostic and technical findings; in addition, pulmonary calcifications were detected morphologically which had not been seen on the chest radiograph. The significance of progressive organ calcifications for the prognosis of recovery has been discussed.

Congenital diastematomyelia in the upper thoracic spine. Diagnostic comparison of CT, CT-myelography, MRI, and US

Diastematomyelia (DM) in the upper thoracic spine is a rare congenital abnormality.The case presented is a comparison of CT, CT myelography, magnetic resonance imaging (MRI), and high resolution ultrasound imaging (US) in a female newborn.

Unusual pattern of gastric and hepatic infiltration in an infant with acute monocytic leukemia

A 10-month-old girl with acute monocytic leukemia is presented. Ultrasound of the abdomen on admission showed an unusual distribution of leukemia infiltrates in the stomach and liver. The leukemic infiltrates in the wall of the stomach presented as intraluminal polyps, while the leukemic infiltration of the liver was strictly confined to the portal vessels.

Artefakte im Ultraschallbild

Abgesehen davon, dass die gesamte sonographische Bildgebung ein Artefaktogramm ist, werden speziell beim Ultraschall Abbildungsprodukte als Artefakte bezeichnet, die nicht real sind, also keine anatomischen Strukturen abbilden, unvollstandig, am falschen Ort, mit unkorrekter Helligkeit, in unkorrekter Form und unkorrekter Grose erscheinen.

Differential Diagnosis of Single Skeletal Defects

This section focuses on the radiographic differential diagnosis of single defects of the fetal skeleton. Complying with the character of this book as a radiographic tool, the number of conditions in the differential lists has been limited in two ways: 1. The disorder should have at least one radiographic sign in addition to the key feature, thus allowing one to make a diagnosis or suspect a diagnosis by radiographic analysis alone. For instance, the combination of an amputated limb with anencephaly — both recognizable on a fetogram — leads to a diagnosis of the ADAM complex. On the other hand, isolated vertebral segmentation defects in the upper thoracic spine without additional radiographic findings are relatively unspecific and can be seen in a great number of disorders. As radiology does not help in the differential diagnostic process, these isolated defects have not been included. 2. The disorder should be relatively common, i.e., have an entry in the OMIM database. Isolated case reports without an OMIM number have not been included in the differential diagnostic lists. Comprehensive lists of all possible disorders associated with a given defect are available in databases such as POSSUM or the London dysmorphology database.

Orbita und Bulbus oculi

Das Auge eignet sich wegen seiner oberflachhchen Lage hervorragend zur sonographischen Untersuchung. Insbesondere konnen der Augenhintergrund und die bulbusnahen Teile des N. opticus mit seinen Hullen gut beurteilt werden.