Osteofibrous dysplasia. A report of two cases

Two cases of osteofibrous dysplasia of long bones are reported, one in a neonate with ipsilateral tibial and fibular involvement and the other in a 6-year-old patient with bilateral tibial lesions. The radiological features of the younger patient were remarkably different from those of the older one. These two different and age-related radiological patterns have also been found in most cases previously reported. All the lesions tended to regress spontaneously.

Infantile fibrosarcoma of femur

We describe the clinical presentation and pathological features of an infantile fibrosarcoma of the femur that occurred in a 3 1/2-month-old male infant. The tumor grew rapidly, reaching large size within a few months, finally requiring amputation. The tumor was poorly circumscribed, infiltrating the adjacent soft tissue extensively. Microscopically, it was a highly cellular tumor composed of immature-appearing spindle-shaped cells. Ultrastructural study revealed mesenchymal cells with fibroblastic and histiocytic differentiation.

Computed tomography of infantile hepatic hemangioendothelioma

Computed tomography (CT) was performed on five infants with hepatic hemangioendothelioma. Precontrast scans showed solitary or multiple, homogeneous, circumscribed areas with reduced attenuation values. Tiny tumoral calcifications were identified in two patients. Serial scans, after injection of a bolus of contrast material, showed early massive enhancement, which was either diffuse or peripheral. On delayed scans, multinodular tumors became isodense with surrounding liver, while all solitary ones showed varied degrees of centripetal enhancement and persistent central cleftlike unenhanced areas. The authors believe that these CT features are characteristic and obviate arteriographic confirmation.

[Importance of ultrasound in the study of cerebral pathology in childhood]

Results of 491 studies of the brain with gray-scale sonography in 341 patients with ages ranging from one day to one year are reported. Sonographic appearance of normal brain, cerebral abscesses and hemorrhages in neonates, together with sonographic findings of some congenital brain anomalies are described.

Infundibulopelvic stenosis in children

Of 11,500 children who underwent excretory urography during a 17-year period, three were found to have the rare renal malformation infundibulopelvic stenosis, characterized by caliceal dilatation, infundibular stenosis, and hypoplasia or stenosis of the renal pelvis. The contralateral kidney was absent in two cases and normal in the other. Voiding cystourethrograms were normal in all three. Renal sonography showed a variable degree of caliceal dilatation without associated pelvic dilatation. The diagnosis was confirmed by retrograde ureteropyelography in one case. Two patients were followed for 12 and 18 months, respectively; both remained asymptomatic with normal renal function, and sequential sonographic examinations of their kidneys have shown no significant changes. The third patient died of an unrelated condition. Infundibulopelvic stenosis has highly characteristic radiographic features, and prognosis is good for most affected patients.

Pulmonary sequestration associated with unilateral pulmonary hypoplasia and massive pleural effusion. A case report and review of the literature

Pulmonary sequestration associated with pulmonary hypoplasia and pleural effusion is very uncommon. Only three cases have been previously reported in the literature. We add one more case and describe its interesting clinical, radiological and pathological findings.

Choanal atresia. Report of seventeen cases

Seventeen cases of choanal atresia are presented, of which 13 were female and 4 male. In 11 patients the malformation was bilateral, being unilateral in the remaining 6; 8 patients also presented other malformations amongst which esophageal atresia and congenital heart disease were the most common. Treatment is surgical, and the prognosis depends largely on the presence or absence of associated malformations.

Unilateral hyperplasia of the coronoid process in a child: a cause of restricted opening of the mouth

A case of unilateral hyperplasia of the coronoid process in a nine-year-old girl is reported. The radiological features are diagnostic; removal of the elongated coronoid process and postoperative physiotherapy will, in most cases, restore full mandibular movement.

[Alterations of skull development in shunt-treated hydrocephalus. Analysis of pathogenic factors (author's transl)]

Skull roentgenograms of 184 children with hydrocephalus treated with shunts were revised. Radiological abnormalities of the skull related to CSF drainage were found in 49,5% of cases. Presence of X-ray abnormalities was correlated with the age of patients at operation, sex, etiology of hydrocephalus, type of shunt device, head circumference at operation and follow-up. Results were submitted to statistical analysis. In this study it is clearly demonstrated that age and head circumference before operation have a strong influence in the pathogenesis of this picture.

The Coffin-Siris syndrome. A report of four cases and review of the literature

Four additional cases of the Coffin-Siris syndrome bring the number of reported cases to 16. This disorder is characterized by the absence or hypoplasia of the nails, especially those of the fifth fingers and toes, growth retardation and mental deficiency, microcephaly, coarse facial appearance, sparse scalp hair and lax joints. Feeding difficulties and respiratory problems are common in infancy. Absence or hypoplasia of the distal and middle phalanges, especially those of the fifth finger and toes and retarded bone maturation are the most common radiological features.

Bronchial perforation and bronchoesophageal fistulas: tuberculous origin in children

A case of bronchial perforation and two cases of bronchoesophageal fistula of tuberculous oritin are presented. The lesions were radiologically identified by bronchography in one patient and esophagography in the other two. One patient with bronchoesophageal fistula died. His lesion had been erroneously considered to be congenital. At surgery, widespread pulmonary tuberculosis was found. The other two patients responded to antituberculous chemotherapy. In one of them, a follow-up barium esophagogram showed a large esophageal diverticulum located where a previous fistulous opening had closed.

Mastocytosis with skeletal and gastrointestinal involvement in infancy. Two case reports and a review of the literature

Two cases of mastocytosis with skeletal involvement in children three and six months old are reported. Bone lesions, either sclerotic or lytic, were encountered in their skeletal surveys. Gastrointestinal lesions in children with mastocytosis are exceedingly rare; in addition to skeletal lesions, one of our patients had a large duodenal ulcer. The diagnosis of mastocytosis was established by skin biopsy in both patients. A review of the literature is also presented.

Traumatic pharyngeal pseudodiverticulum in neonates and infants. Two case reports and review of the literature

Thirty one cases of pharyngeal pseudodiverticulum have been reported in the literature; twenty nine were diagnosed during the neonatal period. Respiratory distress, increased oral secretions, difficulty with feeding and the impossibility of passing a nasogastric catheter were the most common symptoms and/or signs. Pneumomediastinum, pneumothorax, cervical emphysema and ectopic location of a feeding catheter, alone or in combination, were identified in the chest roentgenograms of 16 patients. Esophagography and/or endoscopy were the diagnostic methods of choice. The exact location of the perforation was identified in 18 patients. Most of the perforations were in either the posterior pharyngeal wall or in the pyriform sinuses. The survival rate was as good amongst the medically treated patients as in those who underwent surgery.

Congenital dilatation of the intrahepatic bile ducts (Caroli's disease)

Caroli's disease (congenital dilatation of the intrahepatic bile ducts) was diagnosed in an 11-year-old girl with the aid of intravenous cholangiography. Recurrent abdominal pain, fever, and intermittent obstructive jaundice are the most common symptoms and usually develop during childhood or young adulthood. Operative cholangiography has been the most valuable method of diagnosing the condition and determining the location and extent of the disease process.

[Acceleration of postnatal development, hypertony, enlargement of the middle phalanges and of the distal metaphyses of the femur, peculiar facies: a case of Weaver's syndrome?]

A child is described with accelerated bone maturation, large dysplastic ears, and hypertelorism. These are features of both the Marshall-Smith and Weaver's syndrome. The child was mentally retarded and had enlargement of the middle phalanges, features only seen in Marshall-Smith syndrome. However, there was also enlargement of the metaphyses, a characteristic of Weaver's syndrome. The possiblity that these syndromes may represent different manifestations of the same entity is discussed.