Congenital bilobar emphysema

Two cases of congenital bilobar emphysema are presented, both of which caused neonatal respiratory embarrassment. Plain radiography and lung scintigraphy revealed bilobar involvement in one child prior to surgery, while the bilobar involvement in the other child was found during a follow-up study.

Hypertrophic osteoarthropathy caused by lipoid pneumonia

A case of hypertrophic osteoarthropathy in a 5-year-old Saudi boy is presented. The child developed painful joints, was found to have clubbing of fingers and radiologically hypertrophic osteoarthropathy was demonstrated. The underlying cause of the condition was ingestion of animal fat in infancy, with a history of ghee oil aspiration which caused a chronic lung inflammation, lipoid pneumonia, proven by lung biopsy.

Primary pelvic bone tumours in children and adolescents--imaging correlation

Eight children aged 6 to 17 years (mean 13.3 years) were examined using conventional radiography, radionuclide bone scintigraphy, CT and MR imaging for pre-treatment assessment of extensive primary pelvic bone tumours. The tumours evaluated were Ewing's sarcoma (n = 4), osteogenic sarcoma (n = 3), and chondrosarcoma (n = 1). Each imaging modality made a contribution to the evaluation of the primary tumour. Conventional radiography and bone scintigraphy were necessary for the initial diagnosis, with CT playing a complementary role. MR imaging and/or dynamic contrast-enhanced CT were mandatory prior to surgical resection.

Syndrome of camptodactyly, arthropathy and coxa vara (CAC syndrome)

Three Saudi children (two female, one male) are described who presented with familial arthropathy associated with congenital camptodactyly. This rare but recognized clinical entity has a variable clinical presentation and may be associated with pericarditis and coxa vara. Camptodactyly was observed in the neonatal period in all patients, while joint swelling was observed between the third and 11th month. Pericarditis was suspected in the referral hospital in one patient but was not subsequently confirmed at our institution, raising the possibility that pericarditis may be reversible. Radiological examination of the hips showed coxa vara with short femoral neck in all patients. Synovial biopsy in the three patients revealed proliferating synovial epithelium with moderate fibrocollagenous densities and multinucleated giant cells, occasional lymphocytes or neutrophils but no plasma cells were identified. This is the first series of this familial arthropathy with a triad of camptodactyly, arthropathy and coxa vara (CAC syndrome) in Saudi Arabia which is to be considered in patients where more than one family member has juvenile arthritis.

Massive theca-lutein cysts, virilization, and hypothyroidism associated with normal pregnancy

A 28-year old primigravida with massive bilateral theca-lutein cysts associated with a non-molar pregnancy is reported. The pregnancy resulted in a spontaneous premature vaginal birth of a 27-week gestation female infant, with no placental pathology or congenital anomalies. During the same pregnancy and post partum period the patient manifested an associated synchronous endocrinopathy of severe hypothyroidism and virilization. The cysts, except for one 2.5 cm in size still present, completely resolved with non-surgical approach during the 10 months period following delivery.

Radiological features in congenital camptodactyly, familial arthropathy and coxa vara syndrome

The association of congenital camptodactyly, familial arthropathy and coxa vara is a rare but recognized clinical entity. The radiological manifestations were reviewed in five patients. In the hips, coxa vara, short broad femoral necks and intraosseous cysts were demonstrated in all patients. Abnormal modeling of the acetabulum, increased joint space, effusion, small iliac wings and intraosseous herniation of fluid were found in four out of five patients. Somewhat flat, slightly irregular femoral heads were seen in three patients. In the knees, effusion was demonstrated in all five patients and thick cartilage in three. The elbow, wrist and ankle joints showed abnormal modeling with evidence or suspicion of intraarticular fluid in the majority of patients. Flexion deformities of the fingers were seen in all patients.

Focal xanthogranulomatous pyelonephritis in a young child

An 18-month-old female child presented with fever and an abdominal mass, which, after ultrasonography, computed tomography, and magnetic resonance imaging was considered to be an atypical cystic renal neoplasm. Nephrectomy was performed. Histopathological examination demonstrated the mass to be focal xanthogranulomatous pyelonephritis. This lesion should be considered in the differential diagnosis of renal neoplasms in childhood, particularly cystic Wilms' tumor or Wilms' tumor with significant intratumoral hemorrhage.

Magnetic resonance imaging study of acetabular morphology in developmental dysplasia of the hip

Acetabular morphology in developmental dysplasia of the hip (DDH) can be delineated by magnetic resonance imaging (MRI) more accurately than by previously available imaging methods. We describe the acetabular morphology observed in 10 girls and one boy aged < 3 years with untreated DDH. The bony pathology was iliac bone widening with lateral drift of the superior and posterior portions of the acetabular floor (extrusio acetabulae), loss of sphericity, and diminished aperture of the acetabulum. The cartilage changes were a distortion and overgrowth of the acetabular cartilage, including labrum, and a convex appearance of the posterior portion of the acetabular cartilage.

Transverse myelitis in a child with Down's syndrome and schistosomal colitis

This is a report of an 11-year-old Saudi child with Down's syndrome who presented with a 3-month history of diarrhoea, anal fissures and bleeding per rectum. The child was investigated in a local hospital and found to have evidence of colitis. He was referred to our hospital for further investigation and management. Six weeks prior to transfer, the child developed weakness of the lower limbs resulting in inability to walk. The child was found to have Schistosoma mansoni colitis complicated by spinal cord involvement presenting as transverse myelitis. Two 1-day courses of therapy with praziquantel resulted in a satisfactory recovery, enabling the child to walk by himself.

Bicornuate nonfused rudimentary uterine horns with functioning endometria and complete cervical-vaginal agenesis: magnetic resonance diagnosis

A case is reported of a 16-year-old adolescent with cryptomenorrhea. The patient had a congenital anomaly of a bicornuate, nonfused, separate rudimentary blind uterine horns with functioning endometria, and complete cervical-vaginal agenesis. Ultrasound, laparoscopy, and minilaparotomy for unilateral salpingectomy failed to accurately identify the exact classification of the anomaly. Magnetic resonance imaging, however, accurately correlated with operative findings of exploratory laparotomy and McIndoe procedure.

Haemangiomatous polyp of the posterior urethra in a boy

Urethral haemangiomas are rare and usually involve the entire urethra or are localized to the anterior urethra. Posterior urethral polyps are uncommon. A posterior urethral polyp was removed from a 3-year-old boy which proved to be haemangioma. In the histological classification of posterior urethral polyps, haemangioma should therefore be included.

Osteodysplastic variant of primordial dwarfism

A patient with intrauterine growth retardation and marked postnatal retardation of growth had microcephaly and the orofacial and dental characteristics of the Seckel phenotype. In addition she had short forearms, metaphyseal flare, especially of the distal femora, triangular distal femoral epiphyses, and pseudoepiphyses of the hands, all characteristics of an osteodysplastic variant. Parental consanguinity suggests autosomal recessive inheritance.

MRI in distal vaginal atresia

Magnetric resonance imaging in two young females with abdominal pain revealed vaginal atresia with massive hematocolpos but a normal cervix and uterine body. Information obtained with MRI was superior to ultrasound and CT and is suggested as the examination of choice prior to surgical correction.

Disseminated BCG-osteomyelitis in congenital immunodeficiency

A 9 month old female infant, who had BCG vaccination postnatally, was found to have severe combined immunodeficiency. She developed extensive disseminated skeletal osteomyelitis. Radiological studies showed numerous radiolucent lesions without reactive changes.

Intestinal lymphangiectasia masquerading as coeliac disease

Intestinal lymphangiectasia (IL) usually presents with either non-specific general or gastro-intestinal symptoms. As IL may mimic other gastro-intestinal disorders, the diagnosis is often delayed. Intestinal lymphangiectasia was diagnosed in three children who were originally treated as cases of coeliac disease. Two were sisters who had been placed on a gluten-free diet, for 3 years in one and 10 years in the other, with no favourable response. The third patient had been tried on various formulae and underwent many investigations for failure to thrive, oedema, abdominal distension and recurrent chest infections. The diagnosis of IL was based on clinical history, physical examination and radiological and histological findings. The three patients were commenced on a medium-chain triglyceride-based diet and vitamins, with satisfactory results.

Bile-plug syndrome

A case of bile plug syndrome in a 6-week-old male infant is described. The clinical, radiological and pathological appearances suggested the preoperative diagnosis. Confirmation and correction of this condition was made surgically.

Striation of the renal pelvis and ureter in bilharziasis

The intravenous urograms of 80 patients aged 16 to 29 (mean 23) with urinary bilharziasis were reviewed to determine the frequency of striation of the renal pelvis and ureter. Another 345 patients aged 16 to 29 (mean 22) with various abdominal and urological symptoms, had intravenous urography during the same period and were used as a reference group. Striation of the upper urinary tract was demonstrated in 21% of the patients with urinary schistosomiasis but in only 3% of the reference group. Striation constitutes an early radiological change in this disease.

The significance of associated lesions including dislocation in fractures of the neck of the radius in children

A series consisting of 29 children with markedly dislocated fractures of the neck of the radius has been analysed. The method of measuring the angular dislocation is discussed. A true dislocation not exceeding 30 degrees may be left unreduced. Associated skeletal lesions of the elbow imply a less favourable prognosis.