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Bilateral fetal rhabdomyomatous nephroblastoma is a rare variant of Wilms' Tumor. The authors report the evolution over 48 months of a 10-month-old baby with bilateral nephroblastoma for which a left nephrectomy was initially performed. A right kidney tumor was enucleated preserving the kidney. The transformation of the primary tumor into a completely differentiated cystic nephroblastoma or nephromalike tumor and the appearance of a metachronous lesion was seen. This report emphasizes the role of nephron-sparing surgery in bilateral Wilms' Tumor when a benign transformation occurs under chemotherapy.

The Ring–Sling Complex is an uncommon, congenital vascular and tracheobronchial malformation with a persistent high death rate. We report three patients in whom computed tomography (CT) and magnetic resonance imaging (MRI) were used for the preoperative diagnosis and for staging of the morphologic tracheal and vascular anomalies.

Abstract: We describe radiological demonstration of brain involvement in haemolytic-uraemic syndrome (HUS) in two siblings with a very different clinical course. While the brother presented with a mild, reversible encephalopathy, his sister developed high-signal lesions in the cortex, putamen and caudate nucleus on T1-weighted images, seen as dense areas on CT. Biopsy revealed coagulative necrosis due to microthrombosis without haemorrhage, calcification or infection. These findings suggest a possible prognostic role for MRI in cases of encephalopathy due to HUS.

Bilioma is a rare complication of traumatic liver injury, and the precise site of bile leak is often difficult to demonstrate with a non-invasive technique. We report a case of post-traumatic bile leak in a 15-year-old girl in whom spiral CT after intravenous cholangiography allowed excellent preoperative demonstration of the extent of the liver rupture and an exact location of the bile leak. We think that spiral-CT cholangiography could be an accurate, non-invasive technique to investigate the biliary system in cases of paediatric liver trauma.

Five patients suffering from Erb-Duchenne brachial plexus birth palsy were prospectively studied with MRI. A group of 11 healthy children was used as a control to understand the MRI anatomy of the normal growing glenohumeral joint. A hypoplastic and flattened posterior part of the glenoid fossa and a blunt posterior labrum were found in all patients. Four patients had a blunt anterior labrum and a flattened humeral head. Three patients presented with a posterior subluxation of the humeral head. These results suggest that MRI provides a non-ionising and non-invasive method of demonstrating the early abnormalities of the shoulder associated with obstetrical brachial plexus paralysis, which may prompt orthopaedic correction.

To determine whether color Doppler ultrasonography (CDUS) would add to the understanding of the bladder wall after endoscopic subureteral collagen injection (SCIN), 25 patients were studied with CDUS. The kidney length and echogenicity, the volume of the collagen, the mean length of the urinary jet, the longitudinal and transverse angles, and the distance between the origin of the jet and the midline of the bladder were measured 1 day, 1 month, and 3 months after SCIN and compared to the results of micturating cystourethrograms (MCUs) performed 3 months after SCIN. The collagen was hyperechogenic compared to the bladder wall at the time of injection, and was isoechogenic 1 and 3 months after SCIN. CDUS showed the relationship between the injected collagen and the position of the ureteral orifice. The measurements of jet length, angle, and distance of the ureteral orifice from the midline did not correlate with vesicoureteral reflux assessed by MCU. Although CDUS may demonstrate the location, the size of the injected collagen implant, and its relationship to the ureteral orifice, it is as yet unable to predict vesicoureteral reflux after SCIN. © 1997 John Wiley & Sons, Inc. J Clin Ultrasound 25:201–206, 1997

Forty-six consecutive children with blunt renal injury were evaluated retrospectively to assess the diagnostic accuracy of the different imaging methods, including ultrasonography (US), intravenous pyelography (IVP), and computed tomography (CT), and to determine the optimal radiologic management. Doppler ultrasonography was never performed in an emergency. Classification of the 46 renal injuries was as follows: 25 contusions, 4 lacerations, 11 ruptures, and 6 pedicle injuries. The diagnostic accuracy of IVP (80.8%) was superior to the diagnostic accuracy of US (41%) in all types of renal injuries. IVP should be performed as an emergency procedure when macroscopic hematuria is present, or when an isolated renal injury is clinically suspected. Microscopic hematuria alone is no longer an indication to perform IVP. Asymptomatic patients with microscopic hematuria should have US examination and should be observed with performance of serial urine analyses. Multiply injured and hemodynamically stable children should be evaluated by contrast-enhanced CT. Hemodynamically unstable children should undergo immediate exploratory laparotomy, if it is indicated after assessment by imaging.

This study was undertaken to define the role of ultrasound (US) and magnetic resonance (MR) imaging in the diagnosis and preoperative staging of cervicothoracic lymphangiomas in children. In a retrospective study, 11 patients with surgically and pathologically proved lymphangiomas had MR imaging and 6 of them underwent simultaneous US. US showed superficial hypoechogenic multilocular cystic masses with septa of variable thickness, but failed to demonstrate retropharyngeal, axillary or mediastinal extensions in all patients. All lesions were identified on both MR T1-weighted images (T1WI) and T2-weighted images (T2WI). T2WI provided the best tissue contrast between the lymphangiomas and surrounding tissues. T1WI after i.v. injection of gadolinium DOTA (Gd DOTA) in two patients provided additional information regarding the extent of the lesion. The authors concluded that although lymphangiomas have a distinctive sonographic appearance, MR imaging allowed a better tissue characterisation and tumour exten. T2WI and T1WI after i.v. injection of Gd DOTA are especially helpful for the diagnosis and preoperative staging of cervico-thoracic lymphangiomas in children.

To compare various obstetrical methods with different types of obstetrical fractures, 29 neonates with fractures were evaluated retrospectively. Plain films of skull, limbs and chest were obtained. Transfontanellar ultrasonography was performed in one case and a computed tomographic scan of the skull in two. We reviewed 12 fractures of long bones, 7 fractures of the skull, and 10 fractures of the clavicle. Ten fractures occurred during caesarean sections and 11 in vaginal delivery requiring medical assistance. Depressed skull fractures were associated with manoeuvres and the use of forceps during delivery. Fractures of the long bones were associated with caesarean section, breech delivery with assistance and low birth weight. All fractures were treated conservatively except for skull fractures with depression of more than 2 cm. Early consolidation occurred in all fractures of long bones. The long-term follow-up of all fractures but one revealed no persisting disability. The belief that obstetrical fractures occur primarily in large babies or after breech delivery is not supported by this study.

Rupture of a congenital aneurysm of the sinus of Valsalva is a rare congenital cardiac malformation. This case report describes a congenital aneurysm of the sinus of Valsalva which ruptured into the right ventricle in a 3-year-old girl. The exact route of the fistula through the cardiac walls and the localization of the rupture into the right ventricle was not completely defined by two-dimensional and color Doppler echocardiography and could be determined only by magnetic resonance imaging (MRI).

We report the case of a 12-month-old girl presenting with diabetes insipidus and Cushing's disease. Brain magnetic resonance imaging (MRI) demonstrated a large tumour arising from the sella turcica, extending up to the foramen of Monro and invading the cavernous sinuses. Surgery was performed to remove the suprasellar part of the tumour, and histology revealed an adrenocorticotrophin (ACTH) secreting pituitary adenoma. This entity is very rare in this age group and the MRI features have not previously been described.

In the past ten years, we have found cervical intervertebral disc calcifications in three children on plain films of the cervical spine made because of cervical pain. In each case, we required further radioligical investigations, antero-posterior and lateral linear tomography for two children and an axial computed tomography for one child. In each case, tomography revealed no supplementary useful information. On retrospect, we think that these examinations caused unnecessary irradiation and that they should only be carried out in the rare circumstances when disc calcification is associated with neurological symptoms.

Mesenteric panniculitis is an inflammatory condition of mesenteric fat which may result in peritoneal space occupying lesions. Only two previously reported cases in the English literature have been evaluated by computed tomography (CT). We present 2 additional cases and emphasize that CT patterns are not specific, but suggest the diagnosis in the presence of a well-defined fibrous wall circumscribing a fatty mass containing regions with attenuation near that of water. Lymphoma and mesenteric metastases should be considered the most frequent radiologic, clinical and surgical differential diagnosis.

Mesenteric panniculitis is an inflammatory condition of mesenteric fat which may result in peritoneal space occupying lesions. Only two previously reported cases in the English literature have been evaluated by computed tomography (CT). We present 2 additional cases and emphasize that CT patterns are not specific, but suggest the diagnosis in the presence of a well-defined fibrous wall circumscribing a fatty mass containing regions with attenuation near that of water. Lymphoma and mesenteric metastases should be considered the most frequent radiologic, clinical and surgical differential diagnosis.

A 10-day-old girl who initially presented with fever developed over five days a complete paresis of both upper arms and swallowing difficulty. After emergency drainage of a retropharyngeal abscess, cervical US demonstrated a cervical anterior epidural mass compressing the cord. MRI confirmed the diagnosis of spinal epidural abscess secondary to C4-C5 spondylodiscitis. Surgical removal of the abscess was followed by complete disappearance of the neurologic symptoms after six months of follow-up. This is the first case of spinal epidural abscess in a newborn to be diagnosed by US and MRI preoperatively. The advantages of these non-invasive imaging modalities are discussed, and compared to myelography.

In the experimental model glutaraldehyde cross-linked collagen GAX 65 *with a collagen concentration of 65 mg./ml. has proved to have more persistent implant volume and, therefore, a better antireflux effect than GAX 35, *which is injected more commonly. The aim of this study was to evaluate the potential clinical application of GAX 65.

Nontraumatic shoulder instability is infrequent in children. We examined prospectively with high-field magnetic resonance imaging (MRI) 11 patients with this disorder, including 2 with Holt-Oram syndrome and 11 healthy control subjects. The MR findings in the glenohumeral joint in normally growing children are presented. Two patients with shoulder instability were considered as normal, one presented with type 2 (Zlatkin) labral lesions, three, type 3 and one, type 4 lesions. Close attention to the normal imaging patterns of the maturing glenohumeral joint is required to avoid pitfalls in the interpretation of the images.

We report a case of nonischemic priapism in an 11-year-old boy that occurred after blunt perineal trauma. Color flow Doppler sonography ruled out ischemic priapism and proved itself valuable as part of the emergency diagnostic evaluation of priapism in childhood. Accepted for publication January 3,1992. Accepted for publication January 3,1992.

We report the case of a boy with Budd-Chiari syndrome. At 3 years of age a meso-atrial shunt was inserted for thrombosis of the hepatic veins with associated inferior vena cava occlusion by an enlarged caudate lobe. Seven uneventful years later, the patient was reassessed because of concern about insufficient length of the synthetic shunt. Ultrasound with color Doppler imaging (CDI) and magnetic resonance imaging (MRI) with magnetic resonance angiography (MRA) clearly depicted a patent graft, without kinking, stenosis or other sign of graft dysfunction. Conventional selective angiography confirmed the patency of the shunt. MRI with MRA and CDI are less invasive and less expensive than conventional angiography and might replace this technique for assessment of meso-atrial shunt patency.

Malignant phenylketonuria is a rare disease caused by a deficiency in dihydropteridine-reductase which induce a hyperphenylalaninemia and a deficiency of neurotransmitters such as 3,4,dihydroxyphenylalanine (DOPA) and 5 hydroxytriptophan. The case of a patient with malignant phenylketonuria (PKU) who underwent both CT and MR Imaging is reported. CT demonstrated the characteristic calcifications of the basal ganglia. MRI demonstrated areas of hypersignal on T1 images in the basal ganglia, subcortical frontal and occipital white matter and cortex probably corresponding to calcifications. The MR findings are not specific but could be useful in monitoring the diet and neurotransmitter substitution therapy.

The time course of EE was studied using an indirect calorimeter which fits into an incubator and allows around the clock measurements.In 9 VLB (1134±370g;29±3 weeks; appropriate for gest.age) V02 and VC02 were continuously measured by a mass spectrometer. From these data and urinary nitrogen excretion EE was computed. In order to assess the energetic cost of growth,EE was correlated to the rate of WG and partitionned between growth and nongrowth functions:The following characteristics of energy metabolism in the growing VLB nursed with actual technics (thermoneutrality,glucose infusion early feeding) are suggested by these results:The rate of WG is closely related to EE.The VLB is able to invest a large part of EE to cover the metabolic cost of WG.The metabolic efficiency of WG must be high as shown by the ratio WG/Intake = 0.03 g/kJ (nearly twice the value reported in healthy term babies)