Value of systematic post mortem radiographic examinations of fetuses--400 cases

A retrospective study of 400 cases of fetal deaths has been carried out to assess the value of systematic post mortem radiological examination. Apart from general diagnosis purpose, special attention was given to the assessment of bone age and mineralization. The results were correlated with the clinical, U.S., chromosomal and pathological data. Computerized analysis of our information show the following results: (1) The radiological examination was valuable for the final diagnosis in 13.5% of cases. (2) It brings additional information in 34.5% of cases. (3) It had no diagnostic value in 52%. Furthermore, several points deserve attention such as apparition of teeth (21 weeks), calcaneum (24 weeks). Major osteoporosis was always associated with a constitutional bone disease or an infectious process. An excessive length of the upper limbs (12) was seen in 11 cases of anencephaly. We suggest that a radiological examination should not be routinely performed, when the diagnosis is otherwise obvious, but should be considered in the presence of dwarfism, or other limb abnormalities and when the gestational age is uncertain. The films provide essential information especially for further genetic counselling. Systematic post mortem radiographic examinations are performed in all naturally aborted fetuses over 11 weeks of gestation in our institution. A retrospective study of the last 400 cases was designed in order to assess the value of this examination, with regard to overall diagnosis and assessment of bone maturation and mineralisation.

[Diagnostic difficulties of isolated symptomatic unilamellar periosteal appositions. Uncommon form of fatigue fracture in children]

We describe five cases of painful periosteal reaction occurring in children. The initial radiographic appearance of stress fracture may be troublesome since the new bone formation may be confused with malignant bone lesion. Because of the importance of making a correct diagnosis multiple imaging techniques will often be employed. We discuss the radiographic signs and their usefulness in the differential diagnostic of periosteal reaction.

[Malignant bone tumors in children. Is there still a role for arteriography?]

The authors have studied retrospectively 32 children with malignant bone tumor. All patients underwent conventional arteriography just before surgery. Distal foci of hypervascularisation and venous thrombosis, not seen at CT, may alter surgical treatment. When large extension to soft tissues is present, the arteriography remains unchallenged to evaluate the venous involvement.

Sonographic hepatic arterialisation in newborns receiving parenteral nutrition

Two cases of severe liver disease with portal hypertension in the newborn are reported. Such complications occurred after necrotizing enterocolitis requiring total parenteral nutrition and digestive exclusion for a long time. Ultrasonography showed an hepatic arterialisation with portal hypertension.

[Post-traumatic arthritis of the wrist caused by an intra-articular foreign body]

The authors report the case of a 12 year-old child presenting with post-traumatic arthritis of the wrist with intra-articular metallic foreign bodies. The trauma was initially considered to be benign, not operated on and forgotten by the child and its family. Excision of a synovial granuloma was followed by a favorable outcome.

[Isthmus lysis and spondylolisthesis. A traumatic pathology]

Fourty-five children presenting with an isthmic lysis, complicated or not with spondylolisthesis were studied. The authors suggest that the isthmic lysis could be a stress-induced lesion, a "fatigue fracture" which may heal if treated early, before spondylolisthesis occurs. The main point is therefore an early diagnosis.

[Radiologic approach to endocrine pathology in childhood]

The new imaging techniques (ultrasound, CT, digital subtraction angiography) have greatly modified the diagnostic approach to the endocrinopathies in pediatric age, notably if of surgical interest. The main clinical indications to the ultrasound and/or CT study of hypophysis, thyroid, adrenals and female internal genital tract are synthesized in this paper. A diagnostic flow-chart is also suggested for each clinical entity.

[African histoplasmosis. A case]

The case reported concerns a 12 year-old girl, native of the Cameroons, hospitalized in France for the treatment of the most severe disseminated type of African histoplasmosis (Histoplasma duboisii). In addition to a severe infectious syndrome, the child presented with 3 associated typical involvements: diffuse lymphadenopathy, skin lesions consisting of nodules of the face and trunk and suppurative osteo-articular lesions with an impressive radiological appearance: extensive bone lysis and metaphyseal fractures, without any sign of bone reconstruction, even after several months of treatment. This is rare a disease, but one that should be recognized, especially in its onset localized form, in a patient presenting with infectious osteoarthritis with a torpid evolution leading to the diagnosis of tuberculous or pyogenic infection, or even of osteosarcoma. The disseminated lesions may be difficult to distinguish from the multifocal bone lesions of sickle-cell disease osteomyelitis.

[Idiopathic juvenile osteoporosis (author's transl)]

A young girl aged 13 years was hospitalized for metaphyseal fractures of both knees, and was found to have idiopathic juvenile osteoporosis which followed a favourable course over a period of one year. The authors recall the difficulties encountered in diagnosing this rare affection as no specific biological changes have been demonstrated. The criteria used are: the age of the patient, the disease usually becoming evident in the prepuberty period, the contrast between the very severe osteoporosis noted on radiological examination and the perfect general condtion of the patient, the negative biological tests results, and finally, the spontaneous repair of the osteoporosis in one to four years.

Radiological aspects of the small bowel after extensive resection in children

The authors present radiological aspects of small bowel after extensive resection. They describe the main phenomena related to compensatory hypertrophy: dilatation of the loops, mucosal fold-thickening and motor disturbances. The main complications demonstrated by the radiological examination are presented; gallstones, non-functioning anastomosis, bacterial overgrowth.