[Pseudoxanthoma elasticum: A rare cause of gastrointestinal bleeding in children]

INTRODUCTION

Pseudoxanthoma elasticum (PXE) is a rare autosomal recessive connective tissue disorder, characterized by calcification and progressive fragmentation of elastic fibers. Gastrointestinal lesions are rare in children and may be responsible for serious complications. This article reports two pediatric cases of PXE revealed by gastrointestinal bleeding.

CASE REPORTS

An 11-year-old boy and a 12-year-old girl were hospitalized for gastrointestinal bleeding. Digestive endoscopy showed hemorrhagic gastroenteritis bulbitis in the first case and it was normal in the second. Abdominal ultrasound showed diffuse linear calcifications in both cases. The diagnosis of PXE was retained based on the presence of vascular disease in both patients, a skin lesion in the girl, and an ocular lesion in the boy. The genetic study confirmed the diagnosis of PXE identifying two ABCC6 mutations in the composite state in the boy: the c.2263G> A (p.G755R) mutation on exon 18 and the c.3421C> T (pR1141X) mutation on exon 24 and the 4021G> A (R1164Q) mutation in the homozygous state of ABCC6 exon 24 in the girl.

CONCLUSION

Digestive manifestations are unusual ; however, pseudoxanthoma elasticum should be considered in all cases of gastrointestinal bleeding for no apparent reason. Early diagnosis allows prevention and measures to control the risk factors and limit the progression of complications.

[Typical form of Mayer-Rokitansky-Küster-Hauser syndrome and ectopic kidney. A rare association]

The Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a spectrum of Müllerian anomalies characterized by congenital vaginal aplasia and absent uterus or a rudimentary one in female subjects with normal endocrine status. The ovaries and fallopian tubes are present. The prime feature is a primary amenorrhea in women presenting normally developed secondary sexual characteristics and normal external genitalia. The etiology remains unknown. This syndrome is subdivided in two types. It may be isolated (type I) or associated with other malformations (type II). Type I is less frequent than type II. We report a case of MRKH syndrome in a 21-year-old woman who presented a primary amenorrhea studied with transabdominal and pelvic ultrasonography and pelvic magnetic resonance, which demonstrated a complete agenesis of uterus, a functional cyst in the right ovary, and a left pelvic ectopic kidney. We studied the MRKH syndrome with review of the literature.

[Imaging features of neurofibromatosis involving the urinary bladder]

Neurofibromatosis type 1 is a phacomatosis with neurocutaneous involvement. Urinary bladder involvement is rare and the imaging features are seldom reported. Involvement of the urinary bladder may be isolated or associated with more diffuse disease. The imaging features of neurofibromas are fairly characteristic and may often suggest the correct diagnosis, especially in patients with known NF1. We report the imaging features of bladder involvement in 3 patients with known NF1.

[Hemoptysis revealing a pulmonary arterial aneurysm on Behçet disease in children: role of computed tomography]

Behçet's disease is a systemic condition whose discovery during hemoptysis on a pulmonary artery aneurysm is rare, especially in children. Through the case of a 11-year-old boy, the authors emphasize the importance of imaging in diagnosis of this disease, whose progression can be fatal if hemoptysis is violent.

[Imaging of pancreatic and hepatic tuberculosis in an infant presenting with jaundice]

The incidence of abdominal tuberculosis has increased over the last decade and can mimic any other disease. Pancreatic involvement is an uncommon cause of jaundice in children. A case of obstructive jaundice due to pancreatic tuberculosis in an infant, with hepatic involvement is reported. The sonographic and computed-tomographic features are described.

[Tubular duplication of the oesophagus in children: report of one case]

The authors report a case of tubular duplication of the oesophagus discovered in a 1 month old infant and describe the main characteristics of this rare anomaly.

Syndrome de Lemierre : à propos d’une observation pédiatrique

We report a case of Lemierre syndrome with extensive thrombophlebitis of the internal jugular and subclavian veins with multiple septic emboli to the lungs and pericardium. This report illustrates a case of this forgotten disease in a child and the unusual presence of pericardial involvement.

[Isolated congenital left ventricular diverticulum: report of a paediatric case]

Congenital cardiac diverticulum is a rare malformation formed by an outpouching of the ventricular wall, in particular the left ventricle. The thoraco-abdominal type is more frequent than the isolated thoracic type. Topographical and imaging considerations regarding an isolated congenital left ventricular diverticulum incidentally discovered in a 9-year-old-boy are reviewed.

Le lymphome primitif du foie : à propos d’un cas pédiatrique

Primary non Hodgkin's lymphoma of the liver is a very rare entity, compared with secondary hepatic lymphomatous involvement. It is exceptional in children. The authors report the case of a 9 year-old boy, who presents a primary hepatic lymphoma and review the role of medical imaging for diagnosis and follow-up.

Syndrome de persistance du canal müllérien avec ectopie testiculaire transverse : une association rare

Persistent mullerian duct syndrome with transverse testicular ectopia is a very rare pathological association, often fortuitously discovered in boys during repair for inguinal hernia or cryptorchidism. The authors present the case of an 15 year old adolescent with cryptorchidism, in whom ultrasonography of the right iliac fossa showed 2 testicles and a uterus. Surgical exploration confirmed the diagnosis.

La tuberculose hépato-splénique chez l’enfant

Isolated tuberculous involvement of the liver and spleen is infrequent. We report such a case in a child. The differential diagnosis of isolated multi-nodular diseases of the liver and spleen is reviewed.

Aspect inhabituel d’un lipoblastome axillaire chez un nourrisson

Lipoblastoma is an uncommon benign soft tissue tumor of infancy and early childhood with a predilection for the extremities. CT and MRI can confirm the presence of fat components in the tumor. In addition, MRI better shows the anatomical extent. By showing lipoblastoma proliferation, histology confirms the diagnosis. Gross total excision is the treatment of choice. The authors report a case of unusual lipoblastoma of the axillary region, composed of fatty components with multiple cystic areas presenting at birth, with recurrence 9 months after excision.

Localisation sternale de la tuberculose osseuse

Isolated involvement of the sternum is rare, representing less than 1% of tuberculosis osteomyelitis. Only a few cases of sternal tuberculosis have been reported in the pediatric literature. The authors report the case of a 10 year old boy presenting with a 6 month history of presternal swelling and pain. Computed tomography (CT) showed a ring-enhancing hypodense soft tissue mass surrounding the sternum, with marked cortical thickening. Treatment included both surgical intervention and medical therapy.

[Telangiectatic osteosarcoma of the scapula: a case report]

Telangiectatic osteosarcoma is a rare entity and rarely involves flat bones. The authors report the case of a 4 year old child, with a four month history of progressive left shoulder swelling. Radiographs and CT of the left shoulder revealed a large lytic lesion with cystic areas of the scapula, simulating the appearance of an aneurysmal bone cyst. Surgical biopsy was performed and showed telangiectatic osteosarcoma.

Bilateral facial squamous cell carcinoma in an 18-month-old girl with xeroderma pigmentosum

Squamous cell carcinoma (SCC) of the skin usually occurs in older patients and commonly develops from actinic keratosis. Patients with xeroderma pigmentosum (XP) are highly sensitive to ultraviolet radiation and prone to develop multiple skin malignancies and can acquire SCC at an early age. We report an 18-month-old girl with XP who presented clinically because of a bilateral facial skin mass that was biopsied and found to be SCC. To our knowledge, the case we describe represents the youngest XP patient to have developed facial SCC.

[Bronchogenic cyst of the tongue: a very rare localization]

Bronchogenic cysts are extremely rare in the tongue. We explain this localization by abnormal detachment of accessory lung buds from the primitive foregut. MR is the best imaging modality to evaluate lesions of tongue. Enucleation is the best treatment option. We present and discuss the case of a six month old infant presenting with a congenital tongue mass. This mass was a bronchogenic cyst.

[Emergency ultrasound diagnosis of ovarian torsion in children : nine case reports]

OBJECTIVE

To report the ultrasonographic aspects of ovarian torsion in nine pediatric cases.

PATIENTS AND METHODS

The age range was from 16 months to 14 years. The patients presented with a variety of symptoms, including pain in the site of torsion. Ultrasonography was performed in all patients, and color Doppler studies in four.

RESULTS

Ultrasonography showed a cystic mass in six patients, a solid mass with peripheral cysts in two patients and an adnexal cyst in one patient. Color Doppler revealed absence of flow in three patients. The patients were treated by coeliosurgery.

CONCLUSION

Ovarian torsion is a serious gynecologic emergency. Torsion is rare during childhood and has a non-specific clinical presentation. Ultrasound and Doppler are the imaging study of choice. The ovarian salvage was attributable to the combination of delay in patient presentation and surgical delay.

[Non-Hodgkin lymphoma of the calcaneus and ovary in an infant]

The authors report a case of non-Hodgkin lymphoma with involvement of the calcaneus and ovary in a 4 year- old girl. Calcaneal involvement by this tumor is unusual and ovarian involvement is infrequent.

[Cerebro-costo-mandibular syndrome. A case-report]

The cerebro-costo-mandibular syndrome is a rare and serious congenital disorder characterized by the association of posterior rib malformations, micrognatia and mental deficiency. Death due to respiratory failure is usual during the first days or months of life. The various clinical and radiological aspects of this disease are described based on a recent observation.

La dysplasie métatropique : à propos de deux frères

Metatropic dwarfism is a rare heritable skeletal dysplasia. We report on two brothers, 4-month-old and 9-year-old, affected by the disease. Clinical and radiological features of the disease at different ages are discussed. Prenatal diagnosis is possible by ultrasonography. No treatment is available. Prevention by genetic counselling remains the principal possible assistance to high risk families.

[Primary extensive hydatidosis of the thigh: unusual radiological aspects]

Soft tissue involvement by hydatid disease remains unusual (5%) even in endemic areas. Patients typically present late because disease progression is slow and often asymptomatic. The authors report the unusual imaging appearance in a 59 year old woman with a one year history of progressive diffuse painless swelling of the left thigh. Ultrasonography showed multiple anechoic and hypoechoic cystic lesions, some of which containing serpentine echogenic structures consistent with partly calcified membranes. CT and MRI confirmed a diagnosis of hydatid disease and were helpful to demonstrate the relationship between cysts and adjacent structures. Surgical management was performed early because of fistulization to the skin.

[Hydatid disease of the urinary bladder: a case report]

All organs in the human body may be affected by hydatid disease. Urinary tract involvement in hydatid disease is not common, corresponding to only 2-4% of cases. The kidneys are the most commonly affected organs in the urinary tract. We report a case of hydatid cyst of the urinary bladder.

[Pneumoblastoma in an adult: a case report]

Pneumoblastoma of the adult is rare. It presents more often as a large heterogenous and peripheral parenchymal mass. In this case, chest radiographs showed a small homogeneous mass in the right lung apex. The solid nature but non-specific appearance of the mass was confirmed at CT. The histological diagnosis was obtained from surgical biopsy. The interest of this observation is the rare occurrence of the lesion in adults and the atypical imaging features in this patient.