Improved plainfilm diagnosis of right aortic arch anomalies with high kilovoltage-selective filtration-magnification technique

In the pediatric patient, the presence of a right aortic arch is an important roentgen observation. It may be associated with vascular rings and cyanotic heart disease and may complicate the repair of tracheoesophageal fistula. It may be missed on conventional low KVP radiographs but is easily detected on high kilovoltage-filtered films with air gap magnification.

Calcific thrombi of the inferior vena cava in infants and children

Calcified caval thrombus should be considered in any infant or child where calcifications are noted in the high right retroperitoneal area on plain x-rays of the abdomen. Although typically bullet-shaped in configuration, the calcium distribution in the neonate may be atypical or incompletely developed, suggesting neuroblastoma. Definitive diagnosis can be made by inferior vena cavagram. As no deaths or complications have been attributed to the lesion in the cases thus far reported, no specific treatment is recommended.

Wilms' tumor to the heart: clinical and radiographic evaluation

The clinical and radiographic appearances of four children with cardiac extension of Wilms' tumor and four cases from the literature are described. Four of the eight children were seen for "cardiac problems" and four for "routine" Wilms' tumor. In those "routine" cases, there were no clinical suggestions of inferior vena cava or cardiac extension. Preoperative screening for tumor extension may be crucial. However, because of the rarity of cardiac extension, it would be appropriate to screen patients by noninvasive methods such as gray scale ultrasound of the abdomen, echocardiography, or computed tomography before any invasive procedure is considered.

Ulcerative esophagitis and colitis in a pediatric pantient with Behcet's syndrome. Response to steroid therapy

The gastrointestinal manifestations of Behcet's syndrome including colitis and esophageal ulceration have been recognized in recent years. In the present case, a girl with Behcet's syndrome was followed since age 11 for oral, vaginal, perianal ulcers and neurological involvement. At age 16 she developed esophageal ulceration and colitis, was treated with steroids and improved. Endoscopic and radiographic findings are presented, previously reported cases are reviewed and treatment is discussed.

Diagnosis oligohydramnios-related pulmonary hypoplasia (Potter syndrome): value of portable voiding cystourethrography in newborns with respiratory distress

Potter renal nonfunctional syndrome is an association of facial and limb anomalies, pulmonary hypoplasia, and fetal renal anomalies which lead to marked oligohydramnios, including renal agenesis (true Potter syndrome), renal cystic dysplasia, and obstructive uropathies. Some infants survive long enough to develop severe respiratory distress secondary to pulmonary hypoplasia. The underlying renal disease is often noted only at autopsy. We studied four infants, only one of whom had clinical signs of the renal nonfunction syndrome. Portable voiding cystourethrography revealed a tiny bladder in three infants with cystic dysplasia kidneys (two of these infants had reflux into unused ureters). Bladder hypertrophy and vesicoureteral reflux secondary to posterior uretral valves were noted in the fourth infant.

Slipped femoral capital epiphysis as a sequela to childhood irradiation for malignant tumors

Five cases of slipped femoral capital epiphysis were noted in children with prior irradiation for malignancy whose femoral head and neck had been included in the radiation portal. Three of the 5 were patients who had lymphoma. As a result of increasing survival rates for these types of patients, this previously unrecognized radiation-related growth disturbance may be more likely to be seen in the future.

Left adrenal neuroblastoma with normal-appearing urogram

Adrenal neuroblastomas are usually diagnosed by intravenous urography because of the displacement of the kidney or distortion of its contour. This report describes five children with left adrenal neuroblastoma where the mass was purely anterior to the kidney and produced displacement vectors similar to tumors in the body or tail of the pancreas.

Neonatal small left colon syndrome: its relationship to aganglionosis and meconium plug syndrome

Neonatal small left colon syndrome is a cause of functional colon obstruction in newborn infants, with a high association of maternal diabetes. There has been much confusion regarding its relationship to meconium plug syndrome and aganglionosis. Six cases of aganglionosis (2 in infants of diabetic mothers) were encountered in which the radiographic findings were identical to small left colon syndrome, indicating the need for caution in dismissing aganglionosis solely on the basis of a small left colon seen radiographically in a newborn infant with colon obstruction. Small left colon and meconium plug syndrome are overlapping entities in the total spectrum of functional intestinal obstruction in newborn infants.

The radiologic and pathologic spectrum of the prune belly syndrome. The importance of urethral obstruction in prognosis

The definition, history, and clinical presentation of the prune belly syndrome are outlined. Review of autopsy material and survivors reveal three groups of patients, and the author describes the choices of management available for both groups. Highlighted is the role of the radiologist.

Anorexia nervosa - the paucity of radiologic findings in more than fifty patients

Anorexia nervosa is a self-imposed progressive starvation based on a psychiatric disorder. More than fifty patients (mainly adolescent girls) have had extensive radiologic evaluation. The radiographic findings are an absence of subcutaneous fat, with reduced muscle mass; the gastrointestinal findings are limited to moderate non-obstructive dilatation of small bowel loops with minimal effect on transit. These findings reflect the cachexia and in no way are diagnostic of anorexia nervosa per se.

Fatal desquamative interstitial pneumonia in an infant: case report with transmission and scanning electron microscopical studies

Desquamative interstitial pneumonia in a young infant followed a rapidly fatal course and developed morphologic features of honey-combing, giant cell pneumonia, and pulmonary alveolar proteinosis. The rapid and fatal progression of the disease in spite of steroid therapy and the polymorphous histologic appearance of the lungs at autopsy raise doubt that the disease is a relatively benign and uniform entity and invalidate the classical initial histologic features as prognostic indicators.

Upper airway obstruction in infants and small children. Improved radiographic diagnosis by combining filtration, high kilovoltage, and magnification

Selective filtration, high kilovoltage, and fine focal spot magnification produce detailed radiographs of the airway of infants and small children. This technique has been applied to the study of upper airway obstruction in the glottic, subglottic, and supraglottic areas. Its great diagnostic yield is accompanied by a reduction in radiation dose compared to that of a nonfilter technique. The physical factors dictating choice of filter and film-screen combination are discussed.

Opinion: Caveat doctor: the x-ray collimator industry takes a giant step backward

Markedly improved imaging of the upper airway in infants and children with magnification high kVp technique is accomplished with added heavy filtration. Unfortunately, in the newer x-ray collimators, no slot is provided for this purpose. The authors can think of no reason, medical, physical or economic, as to why a simple slot cannot be provided. A few manufactures make machines with the added filter slot; all radiologists are urged not to neglect this information when selecting new equipment.

Megacystis-microcolon-intestinal hypoperistalsis syndrome: a new cause of intestinal obstruction in the newborn. Report of radiologic findings in five newborn girls

Five newborn girls presented with small intestinal obstruction and microcolon and a giant bladder (megacystis). Organic causes of obstruction were not found, and the gastrointestinal tract failed to function after appropriate diversion. Two died in the postoperative period, two lived several months on central venous hyperalimentation, and one died at 34 months of age following chronic though intermittent hyperalimentation. Pathologic studies showed an abundance of ganglion cells in both dilated and narrowed areas of intestine; the combined small bowel-colon length was one-third of normal in the absence of an evident obstructive or vascular insult. The five patients represent the most severe manifestation of defective intestinal peristalsis in a larger group of distended newborns in whom organic gastrointestinal obstruction is not found. Treatment with central venous hyperalimentation may sustain life, and some patients eventually recover gastrointestinal function. The hypoperistalsis is largely refractory to pharmacologic treatment; its cause is unknown.

Excretory urographic demonstration of ureteral displacement by sigmoid fecal impaction simulating retroperitoneal tumor

Two cases of curvilinear lateral ureteral displacement in children with abdominal masses are reported. The masses proved to be sigmoid fecal impactions. This possibility must be considered before embarking on radiographic or surgical evaluation of possible retroperitoneal neoplasm.

Tracheal agenesis

Tracheal agenesis is a rare anomaly that produces neonatal respiratory distress and has been uniformly lethal to date. In this malformation the entire trachea is usually absent, air reaching the bronchi through a communication with the esophagus, and the lungs are normally formed. The diagnosis should be suspected in any infant in whom improved ventilation is obtained despite difficult intubation and abnormal tracheal tube placement. Coexistent cardiac, gastrointestinal, and genitourinary anomalies are common. The growth of the tracheoesophageal septum and the elongation of the dividing foregut are crucial phases in the morphogenesis of this malformation.

The Weissenbacher-Zweymuller syndrome of micrognathia and rhizomelic chondrodysplasia at birth with subsequent normal growth

Two patients are reported with the clinical and roentgenographic findings of the Weissenbacher-Zweymuller syndrome. The features are neonatal micrognathia (Pierre Robin syndrome), rhizomelic chondrodysplasia with dumbbell shaped femur and humeri. The bone changes tend to regress and there is normal growth on serial studies. A third case seemed at birth to show similar roentgenographic changes but was dwarfed; serial observations revealed him to be a case of the Kniest syndrome with micrognathia as an added feature. The term "micrognathic dwarfism" suggested by Maroteaux is probably best aboided since it will inevitably include a variety of conditions, only some of which are associated with dwarfism.

Calcified intraluminal meconium in newborn males with imperforate anus. Enterolithiasis in the newborn

Five cases are reported and reference is made to 3 previous similar cases of calcified intraluminal meconium in newborn males with "imperforate anus." A rectourinary fistula was found in most of the patients; none of the cases had meconium peritonitis. The calcifications may develop in areas of prolonged stasis; the possible added role of the mixture of urine and meconium in utero is raised.

Pancreatitis and the battered child syndrome. Report of 2 cases with skeletal involvement

Two cases of pancreatitis associated with the trauma of child abuse are reported. In the first case the skeletal survey was initially negative but the child later showed widespread roentgen evidence of intramedullary necrosis and periosteal new bone reaction. These lesions healed without treatment. In the second patient, the pancreatitis was accompanied by ascites and subsequently by bile peritonitis, duodenal obstruction, and a bile-filled abscess in the pancreas. This patient had skeletal fractures. The clinical problems of these 2 patients emphasize the need not only to relate pancreatitis to the battered child syndrome but also to distinguish between the bone changes due to direct trauma and those related to pancreatitis.