Pediatric Radiology

Dilatation of benign esophageal strictures by means of a balloon-catheter is a well-established procedure in adults. This method is also useful in children. The technique is described and the results of treatment in 10 children are reported. In all our patients the stricture developed after an operation for esophageal atresia with an end-to-end anastomosis. Dilatation with a balloon-catheter seems to have the same or an even better effect than the traditional dilatation with bougies. Complications following balloon-dilatations have been few and negligible in this series and dilatations can be performed using sedation instead of general anaesthesia. Therefore, this method is recommended.

Brain pathology is an important cause of morbidity and mortality in neonates, especially in the premature population. While conventional two-dimensional neurosonography is traditionally used for screening, diagnosis and monitoring of brain disorders such as germinal matrix hemorrhage, periventricular leukomalacia and hydrocephalus, three-dimensional ultrasonography has gained popularity in a variety of clinical applications in recent years. Three-dimensional ultrasonography is not yet widely utilized in pediatric imaging but is a potentially powerful tool for evaluating the neonatal brain. Three-dimensional neurosonography allows imaging of the entire brain in a single volumetric sweep and offers the capability of reconstructing images in the axial plane and performing volumetric analyses that are unavailable in conventional two-dimensional neurosonography. The purpose of this article is two-fold: (1) to present the technical aspects of three-dimensional neurosonography and (2) to illustrate the potential applications of three-dimensional neurosonography in the context of commonly encountered neonatal neuropathology.

Carcinoma of the colon presenting before puberty is rare and few cases have been recorded in radiological literature. The symptomatology is usually vague but may be similar to the classical presentation of adults. The barium enema will also show the same constricting lesions. Two cases are reported, in one of which the initial diagnosis was made by ultrasound.

Các gãy xương bổ sung xảy ra liên quan đến gãy xương bán kính gần, nhưng mức độ của những chấn thương thứ phát này chưa được đánh giá một cách hệ thống. Để xác định tần suất và bản chất của các gãy xương bổ sung liên quan đến chấn thương bán kính gần trong một nhóm bệnh nhi lớn. Các hình ảnh X-quang đáp ứng các tiêu chí tìm kiếm cho gãy xương bán kính gần trong một khoảng thời gian 5 năm đã được xem xét. Đặc điểm gãy xương và sự tồn tại của các gãy xương khuỷu bổ sung đã được ghi nhận và phân tích. Cuộc khảo sát hồi cứu được so sánh với việc giải thích ban đầu và một cuộc khảo sát mù do hai bác sĩ chẩn đoán X-quang cơ xương khớp trẻ em thực hiện. Bốn trăm chín mươi bốn trường hợp gãy xương bán kính gần đã được đưa vào nghiên cứu. Điểm gãy cổ xương là vị trí gãy xương phổ biến nhất (89%). Gãy cổ xảy ra ở những bệnh nhân trẻ tuổi hơn (trung bình: 7,3 năm) so với gãy đầu (trung bình: 13,3 năm) (P<0.001). Các gãy xương khuỷu bổ sung xảy ra ở 39%, phổ biến nhất ở mỏm khuỷu (22%). Các gãy xương bổ sung xảy ra ở những bệnh nhân trẻ hơn (trung bình: 7,2 năm) so với gãy xương bán kính gần đơn lẻ (trung bình: 8,5 năm) (P<0.001). Tràn dịch khớp khuỷu và gãy xương bán kính hoàn toàn hoặc di lệch đều liên quan đến các gãy xương khuỷu bổ sung (P<0.001). Khi so sánh với việc giải thích ban đầu, 25% các gãy xương bổ sung không được xác định trên các hình ảnh X-quang ban đầu, trong đó 44% là không thấy được qua hồi cứu. Việc xác định gãy xương cho thấy độ tin cậy giữa các nhà đọc là rất tốt (hệ số tương quan giữa các nhóm [ICC]: 0.88, 0.94), nhưng sự đồng thuận giữa các bác sĩ về tràn dịch khớp chỉ đạt mức trung bình (ICC: 0.52, 0.41). Các gãy xương bán kính gần ở trẻ em thường xảy ra cùng với các gãy xương khuỷu khác, chủ yếu liên quan đến mỏm khuỷu. Sự nhận thức rõ hơn về những mẫu gãy xương này, đặc biệt trong bối cảnh tràn dịch khớp hoặc gãy xương bán kính hoàn toàn và di lệch, có thể cải thiện khả năng phát hiện để hướng dẫn quản lý phù hợp.

Gastric pneumatosis and abnormal catheter course are presented as radiographic signs of mural placement of a feeding catheter in a neonate's stomach. The uneventful recovery of the child occurred with conservative management.

In 1960 Van Wyk and Grumbach described a syndrome of juvenile hypothyroidism, precocious puberty and ovarian enlargement. These findings undergo complete regression with thyroid hormone replacement therapy. This diagnosis can be made on the basis of imaging findings and thyroid function analysis, avoiding surgery. To relate the distinctive clinical and imaging features and putative pathophysiological mechanism of a series of patients with Van Wyk and Grumbach syndrome (VWGS). Patients with VWGS diagnosed at two large children’s hospitals over a 6-year period beginning in 1999 were retrospectively reviewed. A literature review was also conducted. Five female patients were diagnosed with cystic ovarian enlargement and hypothyroidism at ages ranging from 9 to 17 years. Isosexual precocious puberty was found in prepubescent patients. Associated findings included delayed bone age, ascites, and pleural and pericardial effusions. Ovarian cyst involution occurred following treatment of the hypothyroidism. The association of primary hypothyroidism with cystic ovarian enlargement and precocious puberty is important to recognize. In the absence of suspected ovarian torsion, surgery is unnecessary, as cyst regression occurs after appropriate thyroid hormone replacement. Noncompliance with hormone replacement therapy should be considered when cystic ovarian enlargement is noted in patients with a history of hypothyroidism.

Esophageal balloon dilatation is an effective treatment for anastomotic strictures, but the factors affecting the outcome of dilatation remain unclear. To investigate the predictive factors of esophageal balloon dilatation outcome in children with anastomotic stricture after esophageal atresia repair. We retrospectively reviewed children with esophageal atresia who underwent esophageal balloon dilatation for postoperative strictures between August 2007 and February 2021. We investigated each child’s age, weight and height; type of esophageal atresia surgery; shape, length and level of stricture; esophageal balloon dilatation balloon size; application of mitomycin; number of inflation sessions; and number of esophageal balloon dilatation sessions. The outcome of each esophageal balloon dilatation session was determined as improvement in stricture diameter between pre- and post-esophageal balloon dilatation esophagography. We used uni- and multivariate analyses with generalized estimating equations to evaluate outcome predictors. Overall, 69 children (mean age, 2.3 years; 45 boys) underwent 227 esophageal balloon dilatations. In the univariate analysis, the positive effect of esophageal balloon dilatation decreased with increased age, weight, height, balloon size and number of esophageal balloon dilatation sessions. Additionally, the positive effect was decreased in cervical-level strictures and with the application of mitomycin during esophageal balloon dilatation. In the multivariate analysis, independent prognostic factors of the positive esophageal balloon dilatation effect were age (incidence rate ratio [IRR]: −0.01; 95% confidence interval [CI]: −0.01, −0.002), shape of stricture (IRR: –0.54; 95% CI: −0.91, −0.18) and number of esophageal balloon dilatation sessions (IRR, −0.10; 95% CI: −0.14, −0.18). Repeated esophageal balloon dilatation, older age and eccentric stricture shape are associated with poor response to esophageal balloon dilatation in children with anastomotic strictures after esophageal atresia repair.

Nine of 56 patients with mucopolysaccharidoses (MPS) showed small tracheal diameters on their frontal chest radiographs. Autopsy of an MPS I-H (Hurler disease) patient demonstrated that the small calibre was secondary to deposition of glycosaminoglycan (mucopolysaccharide). Autopsies of two patients with other storage diseases, one with geleophysic dysplasia and one with mucolipidosis II, also exhibited compromise of their airways because of storage material accumulation.