Susan J. White

Antenatal ultrasound findings in cystic adenomatoid malformation

A case of congenital cystic adenomatoid malformation of the lung is presented with prenatal ultrasound findings. The present case appears to be the third instance reported in which the diagnosis was made antenatally by ultrasound, and the first which resulted in a live birth, although the patient succumbed to pulmonary hypoplasia.

Central carpal instability - Capitate lunate instability pattern: Diagnosis by dynamic displacement

Eleven patients have been diagnosed as having a central carpal instability that has, to our knowledge, not been previously described. The clinical symptom complex is one of pain and clicking in the region of the midcarpus and, at times, frank snapping, usually while lifting heavy objects. Tight grasping, especially in supination, tends to provoke the symptoms. In ten of the patients, the diagnosis of instability was demonstrated by a dynamic traction displacement technique with the aid of fluoroscopy, in one patient the instability pattern was recognized only at the time of surgical exploration of the carpus. One patient has undergone a surgical procedure to reinforce the dorsal ligamentous support at the capitate lunate area. The other ten patients have become asymptomatic as a result of modifying their activities. The capitate lunate instability pattern (CLIP wrist) is a definite and distinct entity, which may be diagnosed with appropriate studies.

Pneumatosis intestinalis in dermatomyositis

Pneumatosis intestinalis is a rare complication of collagen vascular disease. The current case is the third reported occurrence of pneumatosis in dermatomyositis (Mueller et al., 1972, Oliveros et al., 1973), and the first in which this finding was not preceded by steroid therapy. Unlike its appearance in scleroderma, pneumatosis in dermatomyositis seems to be associated with a benign course, but it must be distinguished from a perforated viscus. A twelve-year-old black female was admitted to the University of Michigan Hospital for evaluation of dermatomyositis diagnosed on muscle biopsy three years previously. She complained of difficulty swallowing but had no abdominal pain or other symptoms referable to the gastrointestinal tract. She had never been treated with systemic steroids.

Congenital biliary dilatation: a spectrum of disease detailed by ultrasound

Recently we have examined six children with the diagnosis of choledochal cyst who demonstrate a greater spectrum of biliary involvement than expected. Classically choledochal cysts have been divided into types and subtypes based on the configuration of common bile duct dilatation; however, this simplified information is misleading since surgical management is dependent on the exact extent of intrahepatic and extrahepatic biliary abnormalities. The pre-operative ultrasound examination must be meticulous to provide enough pertinent anatomic details. Much of the intrahepatic anatomy is not visualized at surgery nor on the operative cholangiograms where reflux of contrast into the intrahepatic ducts may not be consistently achieved.

Dynamic radiographic evaluation of obscure wrist pain in the teenage patient

Chronic wrist pain in the teenage patient constitutes a diagnostic challenge. Carpal instability patterns and internal joint derangements may be difficult to diagnose by physical examination and conventional plain radiographs. Dynamic radiographic studies frequently provide a better understanding of abnormal wrist mechanics. We reviewed our experience with fluoroscopy and radiocarpal arthrography in 14 teenage patients with chronic wrist pain. Videotape fluoroscopy was performed in all 14 patients. Dynamic radiocarpal arthrography was then performed in 10 patients in whom fluoroscopic findings were normal or more information was needed. These imaging methods led to a diagnosis in 64% of the patients and excluded a significant anatomic carpal abnormality in the other patients. In the teenage patient, internal derangements of the intercarpal ligaments are usually posttraumatic rather than attritional in origin. Dynamic radiographic techniques provide an accurate means for the diagnosis of these specific anatomic carpal abnormalities.

CT evaluation of chondroblastoma

Chondroblastoma is a rare benign primary bone tumor with generally characteristic plain radiographic features. In some cases, however, the benign nature and the extent of the lesion may not be appreciated using conventional radiography. We report the CT findings of chondroblastoma in three patients. In one patient CT clearly defined cortical destruction, which was not well visualized on plain radiography or conventional tomography. In a second patient CT showed a sclerotic rim absent on plain radiography; this suggested the benign nature of the lesion. Other advantages and potential pitfalls of CT in evaluating chondroblastoma are discussed.

The radiographic appearance of the endorectal pull-through*

Children and young adults with ulcerative colitis and polyposis syndromes requiring colectomy are increasingly undergoing the endorectal pull-through procedure. We reviewed the contrast studies of the neorectum of 27 patients and the abdominal radiographs in 26 patients after the endorectal pull-through operation. Normal features included smooth mucosa with loss of the small bowel features, dilatation of the neo-rectum on consecutive examinations, and an enlarged presacral space. The normal appearance before closure of the ileostomy varied depending upon the amount of distension of the pull-through segment; redundant ileum within the rectal muscle sleeve was seen in the two patients. Abnormalities included rectovaginal fistulas, sinus tracts, focal strictures requiring dilatation, complete obstruction, mucosal irregularities, and generalized narrowing with lack of distensibility. These abnormalities are attributable to inflammation and were associated with a poor clinical outcome. A contrast examination of the pull-through segment is useful to exclude the presence of serious inflammatory change before ileostomy closure or in the patient with excessive diarrhea or obstruction.