[Radiologic aspects of pulmonary aspergillosis in chronic septic granulomatosis in children. Apropos of 17 cases]

The authors describe the radiological aspects of pulmonary aspergillosis in chronic granulomatous disease in children. The radiological anomalies reveal the aspergillosis in 35% of the cases. Association of alveolar opacities, chronic peripheral, sometimes bilateral, with localized pleural thickening must raise the diagnosis. CT scan allows an early diagnosis of parietal and mediastinal involvement and can show invisible lesions on standard chest film.

[The contribution of pulsed Doppler in kidney transplantation]

In order to evaluate the value of pulsed-Doppler studies in renal transplantation, we analyzed 101 procedures in 89 transplant recipients. The resistivity indices was used to quantify results. In 45 children with no complications, pulsed-Doppler results were normal. No arterial signal was present in seven recipients. Thrombosis of the renal artery was confirmed upon arteriography and surgery in all these cases. Eight patients had stenosis of the renal artery that was demonstrated upon the pulsed-Doppler study and confirmed upon arteriography. Among 18 patients with acute tubular necrosis, 12 had normal pulsed-Doppler results, two had a diastolic flow decrease, and four had abolition of diastolic flow. Among five recipients with cellular rejection, four had a normal pulsed-Doppler study, one a diastolic flow decrease, and one abolition of diastolic flow. Among six recipients with vascular rejection, two exhibited flow reversal and three had abolition of diastolic flow. Pulsed-Doppler is a good tool for studying vascular complications involving renal transplants and helps differentiate vascular rejection from other complications.

[Evaluation of new markers of bone metabolism in renal osteodystrophy in children]

Serum intact parathormone (PTH 1.84) and osteocalcin levels were evaluated as early markers for secondary hyperparathyroidism in a group of pediatric patient treated with chronic hemodialysis. PTH 1.84 levels which were more closely related with alkaline phosphatase levels than PTH 53.84 levels, allowed to identify a group of children without biologic or roentgenographic evidence of hyperparathyroidism and with a normal residual hormone level. PTH 1.84 levels seem to be a reliable indicator of parathormone secretion than conventional assays and may be used as a routine test for monitoring children under chronic hemodialysis. Conversely, the plasma osteocalcin level measured by radioimmunoassay was increased in all studied patients regardless of parathyroid status and seemed to be of little value for monitoring renal osteodystrophia. Lumbar vertebral plate bone density studies disclosed abnormalities of bone mineralization in half the children with renal failure. Dialyzed or non dialyzed. Patients with decreased bone mineralization presented, in most of cases, a history of previous steroid treatment. A group of children with very severe renal failure had increased bone mineralization. The interpretation of this abnormality remains to be determined.

[Treatment using transluminal angioplasty of arterial stenosis of kidney transplants in children]

We report our experience with endoluminal angioplasty for the treatment of arterial stenosis involving transplanted kidneys in children. Four anatomic groups were individualized: stenosis of the iliac artery proximal to or at the level ot the anastomosis, single stenosis of the main renal artery, double stenosis of the main renal artery and/or a branch of the renal artery, and multiple arterial lesions. Angioplasty is performed under general anesthesia using balloon catheters appropriate for pediatric patients. Prevention of spasm and heparin therapy are essential. Results depended on the distal vascular bed. Good results were achieved in those patients with a dilatation distal to the stenosis and no multiple arterial lesions (type IV) that actually reflect vascular rejection. The overall success rate was estimated at 66% and the recurrence rate at 22%.

MR imaging of the posterior hypophysis in children

The posterior lobe of the pituitary gland was studied by MR imaging in 30 children without pituitary gland disease and compared with studies from a group of 13 children with central diabetes insipidus, including eight cases of primary diabetes insipidus and five cases of diabetes insipidus secondary to suprasellar tumors (four proved germinomas, one still unknown tumor). Two components in the sella turcica were identified in all 30 children without pituitary gland disease, and the posterior lobe was identified as a high-intensity structure on T1-weighted images. In all 13 patients with diabetes insipidus, the normal hyperintense signal of the posterior hypophysis was absent on T1-weighted images. Three patients with suprasellar tumors presented with a progressively enlarging pituitary stalk on follow-up. Our findings show that absence of the normal hyperintense signal of the posterior lobe is closely related to a loss of function of the neurohypophysis. Size or signal modification of the pituitary stalk should suggest the development of a suprasellar tumor.

[The Kasabach-Merritt syndrome with pancreatic localization in a newborn infant]

The case of a neonate with a large pancreatic hemangioma belonging to the Kasabach-Merritt syndrome is reported. Selective embolization of one of the main vessels originating from the gastroduodenal artery resulted in a progressive increase of blood platelet levels and in a concomitant change in the hemangiomatous structure at ultrasound examination, as well as in a subsequent acceleration of somatic growth. At 8 months of age, there were no more clinical, radiological, ultrasonographic or biological signs of the hemangioma. This case report emphasizes the interest of embolization in the Kasabach-Merritt syndrome.

MRI study of lumbosacral lipoma in children

The authors report 16 cases of lumbosacral lipoma in children studied by MRI. The exact position of the cord and its relationship to the lipoma were well demonstrated in all cases but one. There was as high incidence (25%) of syringomyelia in the terminal conus. Arnold Chiari malformation was never associated, which differentiates lumbosacral lipomas from myelomeningoceles. However, the nerve roots and their relationship to the lipoma were rarely visualized. Despite these drawbacks, MRI is the examination of choice if lumbosacral lipoma is suspected in children.

Pancreatic venous samplings in infants and children with primary hyperinsulinism

The authors present 19 cases of hyperinsulinism in children worked up with selective pancreatic venous samplings (PVS). Focal lesions were found in 7, diffuse secretion in 8 and normal insulin levels in 4. In three patients with focal hypersecretion less extensive surgery could be performed and confirmed the presence of focal lesions in two. These preliminary results are encouraging and PVS seems to be a valuable technic for detection of focal lesions in the pancreas of children with hyperinsulinism.

Radiological treatment of common bile duct lithiasis in infancy

The authors report a series of 10 infants aged from 20 days to 11 months, presenting with CBD lithiasis, explored and cured by radiological procedure. US showed BD dilatation in 9 cases, sludge in the GB in 5 and in the CBD in 2. Histological findings of cholangitis were present in 4 infants. PTC was performed by GB puncture in 6 and BD puncture in 4. There was evidence of a filling defect in CBD but no anatomical anomaly. Blackish concretions were removed through a side-holes catheter or pushed in the duodenum by washing with saline. An external drainage was left a few days to allow control cholangiogram. Three infants underwent subsequent surgery but no residual lithiasis was found. No recurrence has occurred with a follow-up ranging from 10 months to 7 years. Mechanisms of this entity are discussed.

[MRI of aortic arch anomalies in children. Initial results]

A prospective study by nuclear magnetic resonance in 7 infants with respiratory disorders and with a barium swallow suggestive of anomalies of the aortic arch was conducted. It allowed the definition of an investigation protocol including sedation, RF coil adapted to infants size, naso-gastric tube placement, thin MR sections. Sequences are T1 weighted with ECG gating in two perpendicular frontal oblique and transverse oblique planes determined on a scout sagittal MR acquisition. Precise determination of the anatomy of the vascular malformation and its relationship with the trachea and esophagus were obtained. After definition of the investigation protocol, MRI was found to be a very effective evaluation technique for aortic arch anomalies. It can be proposed as an alternative to preoperative digital angiography. Its indications remain to be defined in relation to the clinical features and the results of the chest X-ray and barium swallow.

The calculation of intracranial volume using CT scans

A method of calculating intracranial volume from horizontal computerized tomography scan slices is presented. The accuracy of this technique was confirmed by applying it to 10 dry skulls and comparing the values obtained with the true intracranial volumes, as determined by filling the skulls with water. Values ranging between 98.14% and 102.6% of the true values were obtained, the mean error being 1.13%. This technique is now being used to study intracranial volume changes in children with craniostenosis.

Budd-Chiari syndrome in children: report of 22 cases

Clinical, radiologic, and histologic features in 22 children with Budd-Chiari syndrome are reported. Three children had acute refractory ascites; all the others had hepatomegaly, which was detected either fortuitously or because of abdominal pain or distention. Results of liver function tests were normal or only moderately abnormal. In most cases a combination of ultrasonography and needle liver biopsy pointed to the diagnosis of Budd-Chiari syndrome, which was confirmed by angiography. Eighteen children underwent surgery involving various techniques, depending on the degree of patency of the inferior vena cava. Five children died postoperatively. Histologic studies of the liver, carried out in 12 of the surviving children, showed disappearance or regression of centrilobular hemorrhagic infiltration. Half of the surviving surgical patients are now free of complications after a follow-up of 7 months to 7 years; the others have either secondary thrombosis of the inferior vena cava or stenosis of the shunt or have experienced late pulmonary complications. Our results suggest that (1) Budd-Chiari syndrome must be considered a possible diagnosis in children with firm hepatomegaly and normal or near normal liver function, (2) surgery provides good results in many instances, and (3) the possibility of late complications requires careful follow-up.

[Tuberculous calcifications of the bladder wall in children]

A case of tuberculous urinary bladder calcifications in a 13 year old boy is reported. The lesion is rare in adults and no case is published in the literature as occurring in children.

MRI of hypothalamic hamartomas in children

Eight cases of hypothalamic hamartomas (HH) diagnosed in children by clinical, biological and CT studies have been explored by MRI and compared with a control group of twenty children without hypothalamohypophyseal signs. MRI revealed the hamartoma in all cases. Its location and position relative to the floor of the third ventricle was precisely determined. The signal intensity of the lesion was identical to that of normal grey matter on T1-weighted images (300/600.28), but an hyperintense signal was observed over T2-weighted images (1800.60/120) in seven of the eight cases. These data suggest that HH are somewhat different in structure from normal brain tissue. MRI variations in signal intensity should be taken into account in the diagnostic work-up of these lesions.

Computerised tomography in the evaluation of expansile lesions arising from the skull vault in childhood--a report of 5 cases

Expansile lesions of the skull vault are rare in childhood, and often present as relatively asymptomatic calvarial swellings. The cases of 5 children with expansile lesions of the skull vault due to both benign and malignant primary bone lesions are described. The value of computerised tomography in demonstrating that the "tumour" arises primarily from the skull vault as opposed to the underlying brain, and in demonstrating clinically unsuspected endocranial extension of the mass is described. The CT findings in 2 cases of aneurysmal bone cyst, including the significance of the presence of "fluid levels" in reaching a definitive diagnosis are discussed. The successful pre-operative embolisation in one case of aneurysmal bone cyst is reported.

[Cystic or pseudocystic ovarian masses in young girls. The role of ultrasonic diagnosis]

Twenty adnexal tumors have been discovered between 7 and 16 years old girls. With few exceptions, the sonographic appearance in nonspecific. They were grouped in four categories: teratomas, cystadenomas, adnexal torsions, polycystic diseases. Surgery with be discussed upon consideration of age, clinical signs and sonography, and diagnostic emergency will be emphasized in case of acute adnexal torsion.

[Neonatal ovarian cysts. The role of ultrasonic diagnosis]

Nine cases of adnexal cysts diagnosed by antenatal ultrasonography, have been followed after birth and operated upon. Simple ovarian cysts as well as old adnexal torsions appear as sonolucent masses. Acute adnexal torsion appears as mixed or solid masse. Sonographic appearance can help the post natal management of these masses.

[Diffuse mediastinal, retroperitoneal and hepatic neurofibromatosis in 4-year-old child. Value of puncture biopsy guided by computerized tomography]

A case of neurofibromatosis in a 4 year-old girl is reported. Extensive localization to mediastinum, retroperitoneal space and liver is particularly infrequent. Histological diagnosis was obtained through a needle biopsy of the retroperitoneal space and the liver under the control of CT scan X-ray. Prognosis seems to be related to the tracheal compression.