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Gorham's disease usually manifests as diffuse osteolysis but may be complicated with pleural effusion. We describe the case of a 12 year-old boy who had repeated pleural effusions. Radiographs show a mediastinal widening and an interstitial syndrome related to hemolymphangiomatous involvement.

This case of mesenchymatous hamartoma in a nine-year-old boy, was an incidental finding on a chest X ray. CT and MRI suggested the diagnosis showing a large (9 x 11 x 14 cm) mass developed in the right lower lung with sharp margins, without any sign of pulmonary or mediastinal compression. This lesion contained fatty areas on both CT and MRI. It showed no calcification. It enhanced slightly after IV contrast. On T2 WI, it appeared lobulated with low signal intensity septa. Presence of fatty tissues and lobulated margins were suggestive of the diagnosis of mesenchymatous hamartoma. A 1.2 kg mass was surgically removed. The tumor was attached to the right lower lobe by a small pedicle. Pathological examination disclosed fatty and connective tissues. This rare observation shows a good correlation between CT, MR, surgery and pathological examination.

Image quality and patient doses received during chest bedside examinations performed with conventional (film-screen combination) and photostimulable phosphorus plate systems were compared in a study carried out in 1993 in a French pediatric radiology department. Seventy one children (36 males and 35 females) aged between 9 days and 18 years (average: 43 months) were included in the study. Technical performances of all radiological equipment used were permanently checked through a quality control program. One conventional and 3 "photostimulable" films were performed for each patient included (mAs product selected for "photostimulable" system was progressively reduced down to 60% of that of conventional technique). TLD Lithium Fluoride chips were used to measure entrance surface dose during the examination. Image quality of 284 films (213 "photostimulable" + 71 conventional) was assessed by three independent radiologists. Advantages and drawbacks of both studied imaging techniques are discussed in terms of patient dose reduction and image quality.

endoscopic retrograde cholangiography may be difficult or unfeasible in children. It also may be complicated by acute pancreatitis. The purpose of this study was to determine the diagnostic contribution of spiral CT cholangiography in pediatric patients.seven patients, age ranging from 10 months to 13 years were explored without general anesthesia. Eight spiral CT cholangiographies were performed. The patients were suspected to have biliary or pancreatic lesions. Spiral CT was performed 60 minutes after slow infusion of iodipamide (Transbilix-Guerbet). The dose was correlated to the body surface. 3D reconstructions were done using the surface rendering or the MIP technique.biliary tract opacification and 3D reconstructions were considered of good quality in 6 out of 8 studies. It was normal in 2 cases. A duplication of the duodenum communicating with the choledocus was found in 1 case. Biliary lithiasis with a stone in the cystic duct was found in 1 case. Two choledocal cysts with bile ducts dilatation were diagnosed. A post operative biliary leak with bile ducts dilatation was found in one case. The spiral CT was not diagnostic in 2 patients: a case of choledocal cyst, the study was of poor quality due to inadequate sedation and a case of Caroli's disease with a high serum bilirubin level. Four patients had an endoscopic or a percutaneous cholangiography: to explore the pancreatic ducts (2 cases), poor CT study due to the inadequate sedation in 1 child, and the case of Caroli's disease.spiral CT is feasible even in young children. It should reduce the indications for endoscopic or percutaneous cholangiography. It has to be performed as the first examination in cases of biliary or pancreatic diseases when surgery is contemplated.

Intestinal duplications are rare and are usually diagnosed in the first two years of infancy. They can occur at any level of the alimentary tract from the oral cavity to the anus. Duodenal duplication accounts for approximately 7% of all intestinal duplications. A previously healthy 4-year 6-month old boy was admitted with progressive increasing vomiting. Physical examination was normal, the serum amylase level was moderately increased. Upper gastrointestinal series showed an extrinsic compression defect of the proximal duodenum. Ultrasonography showed a 3 cm diameter cyst in the head of the pancreas. A duplication was suggested. Helical CT cholangiography showed a communication between duplication and the biliopancreatic common channel. The biliary tree was normal. Surgical resection of the intrapancreatic lesion was performed. Microscopic examination of the specimen revealed a duodenal duplication.

To assess the validity and the interest to health of systematic herniography in cases of unilateral inguinal hernia in children under two years of age.Decision theory was used to assess the effect of herniography on individual health by estimating gonadic benefit and establishing a benefit-risk ratio, and on collective health by the use of cost-effectiveness analysis.a decision tree and algorithms were developed.Decision analysis is used in complex medical decision making, clarifying choices and subdividing a problem into several more manageable sub-problems. The threshold approach pinpoints factors requiring more information.

We report one case of multilocular cyst of the kidney in one year and three months female infant who underwent echography, computed tomography and MRI before surgery. MR image accurately reflect the morphology of the tumor: the capsule is hypointense on T1-weighted images, the septa show moderate enhancement with intravenous contrast. Varied intensities from fluid in the visualised locules presumably represent different concentration of proteins. MR imaging features are highly suggestive but non pathognomonic of the disease. Positive diagnosis always require histology.

Objectifs Illustrer les situations cliniques frequentes en pediatrie et exposer les questions que pose l’ORL aux radiologues. Materiels et methodes A partir d’une selection de dossiers de patients explores dans le service, nous presentons les differentes pathologies rencontrees. Leur exploration repose principalement sur la tomodensitometrie. Resultats Quatre situations cliniques predominant : le traumatisme, l’infection, la surdite et la pathologie tumorale. En cas de traumatisme, l’urgence est neurochirurgicale. L’examen tomodensitometrique de seconde intention precisera le trait de fracture et son caractere labyrinthique ou extra-labyrinthique. Dans le cadre de l’infection, l’otite sero-muqueuse et l’otite aigue ne sont pas des indications tomodensitometriques. La mastoidite exteriorisee doit etre exploree pour preciser son extension et rechercher une localisation septique cerebrale ou une thrombophlebite. La pathologie infectieuse chronique du rocher est representee par le cholesteatome acquis ou congenital. Une surdite de transmission oriente vers une pathologie de l’oreille moyenne ou externe, a type d’aplasie mineure ou majeure. Si elle est de perception l’imagerie est centree sur l’oreille interne et oriente le bilan etiologique (recherches genetiques). Les deux lesions tumorales les plus frequentes de l’enfant sont l’histiocytose langerhansienne et le rhabdomyosarcome. Conclusion La connaissance de la pathologie pediatrique du rocher permet une meilleure prise en charge du patient.

Objectifs Illustrer les pathologies frequentes en pediatrie et exposer les questions que pose l’ORL aux radiologues. Materiels et methodes A partir d’une selection de dossiers de patients explores dans le service, nous presentons les differentes pathologies rencontrees. Leur exploration repose principalement sur la tomodensitometrie. Resultats Trois situations cliniques predominant : la pathologie congenitale, l’infection et la pathologie tumorale. La pathologie congenitale des fosses nasales decouverte le plus souvent par une detresse respiratoire fait rechercher : une atresie choanale, une hypoplasie des orifices piriformes, une imperforation des voies lacrymales, une meningoencephalocele, un gliome et un teratome. La pathologie infectieuse sinusienne en dehors de l’ethmoidite qui est une urgence therapeutique ne se rencontre pas avant l’âge de 5 ans et ne necessite le plus souvent pas d’exploration. La polypose nasosinusienne est rare en dehors de la mucoviscidose. La mucocele est egalement associee a la mucoviscidose ou est secondaire a un traumatisme. Le polype antro-choanal de Killian et l’angiofibrome nasopharynge meritent d’etre connu. Les pathologies tumorales malignes sont dominees par le rhabdomyosarcome, le lymphome, l’UCNT du cavum. Conclusion Connaitre la pathologie des fosses nasales et sinusiennes pediatriques pour une meilleure prise en charge de l’enfant.

Objectifs Illustrer les situations cliniques les plus frequentes d’urgences abdominales pediatriques non traumatiques (nouveau-ne exclu). Confronter les images a la clinique et aux resultats operatoires pour tenter de preciser l’apport de l’imagerie pour les decisions operatoires. Materiels et methodes A partir d’une selection de dossiers de patients explores dans le service, nous presentons les differentes pathologies rencontrees, leur exploration en imagerie en fonction de la clinique et la confrontation per-operatoire. Resultats Les consultations pour urgences abdominales en pediatrie sont principalement motivees par des douleurs abdominales aigues, des vomissements avec ou sans fievre. Il conviendra de preciser l’âge de l’enfant, les donnees complementaires de l’interrogatoire et de l’examen clinique, pour determiner les examens les mieux adaptes en privilegiant les techniques non irradiantes. Les dossiers illustrent les pathologies douloureuses abdominales mecaniques (invagination intestinale aigue, occlusions mecaniques dont l’occlusion sur brides et le volvulus par anomalies de rotation, l’appendicite, le syndrome hemolytique et uremique, le purpura rhumatoide) ; la pathologie hepatobiliaire (cholecystite, lithiase) et pancreatique ; la pathologie urinaire (lithiase, pyelonephrite et anomalie de la jonction pyelo-ureterale), les anomalies genitales (torsion ovarienne, hydrometrocolpos avec (imperforation hymeneale) ou sans amenorrhee primaire (gynatresie). Conclusion L’imagerie, adaptee aux donnees cliniques fournies par le chirugien viscerale aux urgences, tente de preciser la conduite a tenir chirurgicale.

Objectifs La traumatologie du sport en pediatrie est en augmentation. Ce poster didactique presente les particularites des lesions rencontrees a l’âge pediatrique. Materiels et methodes A partir d’une selection de dossiers de patients explores dans le service, nous presentons les differentes pathologies rencontrees et leur exploration en imagerie. Resultats La pathologie osseuse (macrotraumatique et microtraumatique) : la pathologie macrotraumatique est caracterisee par le type et la localisation des fractures et par la frequence des arrachements des points d’ossification secondaire. La localisation (bassin, genou, rachis) depend de l’âge de l’enfant et de l’activite sportive effectuee. La pathologie microtraumatique est representee principalement par les fractures de fatigue et les osteochondroses. Elles constituent des pieges diagnostiques notamment en IRM. Les lesions articulaires comportent les fractures osteochondrales, les lesions meniscales et les lesions ligamentaires qui sont plus rares en pediatrie. Les lesions tendineuses sont souvent intriquees avec les osteochondroses en leur point d’insertion (la resistance mecanique de l’os est inferieure a celle des tendons). Les lesions musculaires (hematome, rupture) sont rares. La myosite ossifiante circonscrite constitue un piege diagnostique. Conclusion La croissance du squelette, la resistance respective de l’os, des tendons, des ligaments et des muscles sont differentes chez l’enfant et chez l’adulte ce qui explique la difference des pathologies observees.

Objectifs La traumatologie du sport en pediatrie est en augmentation. Ce poster didactique presente les particularites des lesions rencontrees a l’âge pediatrique. Materiels et methodes A partir d’une selection de dossiers de patients explores dans le service, nous presentons les differentes pathologies rencontrees et leur exploration en imagerie. Resultats La pathologie osseuse (macrotraumatique et microtraumatique) : la pathologie macrotraumatique est caracterisee par le type et la localisation des fractures et par la frequence des arrachements des points d’ossification secondaire. La localisation (bassin, genou, rachis) depend de l’âge de l’enfant et de l’activite sportive effectuee La pathologie microtraumatique est representee principalement par les fractures de fatigue et les osteochondroses. Elles constituent des pieges diagnostiques notamment en IRM. Les lesions articulaires comportent les fractures osteochondrales, les lesions meniscales et les lesions ligamentaires qui sont plus rares en pediatrie. Les lesions tendineuses sont souvent intriquees avec les osteochondroses en leur point d’insertion (la resistance mecanique de l’os est inferieure a celle des tendons). Les lesions musculaires (hematome, rupture) sont rares. La myosite ossifiante circonscrite constitue un piege diagnostique. Conclusion La croissance du squelette, la resistance respective de l’os, des tendons, des ligaments et des muscles sont differentes chez l’enfant et chez l’adulte ce qui explique la difference des pathologies observees.

Objectifs Rapporter 3 cas de GIST's pediatriques. Materiels et methodes Trois GIST's ont ete prises en charge dans notre hopital sur une periode de 6 ans. Il s’agissait de patients âges de 14 ans (2 garcons, 1 fille). Les circonstances de decouvertes etaient des douleurs abdominales avec vomissements pour le premier, des saignements digestifs avec douleurs abdominales et syndrome inflammatoire chronique pour la deuxieme et une echographie abdominale pour paragangliome chez un frere jumeau pour le dernier. Tous ont ete explores par scanner et 2 par echographie abdominale. Resultats L’echographie abdominale a permis dans les deux cas d’objectiver la lesion (masse hyperechogene ou heterogene). Des metastases hepatiques ont ete vues dans un cas. Les examens tomodensitometriques ont confirme la localisation gastrique des lesions. Pour le 3 e cas, il objectivait une invagination jejunale sans tumeur individualisable. Le diagnostic de GIST a ete etabli par etude histologique et immunohistochimique de la piece operatoire pour le premier, de la biopsie percutanee pour le deuxieme et endoscopique pour le troisieme. Le traitement a ete chirurgical dans tous les cas. Deux patients ont egalement ete traites par GLIVEC. Conclusion Devant une tumeur gastrique et jejunale, il faut mettre dans la gamme diagnostique les GIST's.

The authors report about four cases of urinoma detected during the neonatal period in three boys and one girl with congenital uropathy. It appeared as an infravesical obstruction in three cases (2 posterior urethral valves, one anterior urethral diverticulum) and as an obstruction of the pyeloureteral junction in the last case. The examination was prompted by the detection of a mass in the side during the clinical examination. The diagnosis is based on ultrasound, which evidences the liquid and extrarenal character of the urinoma and often allows demonstrating the underlying uropathy. The kidney may be difficult to localize if the urinoma is very large. IVP or radionuclide scanning may contribute to the diagnosis as they allow assessing the functional value of the kidney. The urinoma protects the kidney from the consequences of uropathy by allowing a relative decompression of the pyelocaliceal structures.

The authors report 7 cases of neo-natal adrenal hematoma diagnosed by ultrasound. A traumatic delivery was found in 4 cases. In 4 cases a flank mass was palpated. In 3 cases the adrenal hematoma was asymptomatic, discovered by echotomography. I.V.P. showed a typical appearance in only 1 case out of 5. The first ultrasonic examination was performed between day 5 and day 12. It showed a fluid filled mass in 5 cases and a predominantly fluid mass in 2 cases. Both sides were involved twice. The ultrasonic follow-up 8 days later always showed a decrease in size, in 1 cases calcifications appeared. The authors compare their results with those of the literature and discuss the differential diagnosis with neo-natal neuroblastoma.

The practice of systematic X ray screening for congenital dislocation of the hip leads to the discovery of a somewhat rare anomaly: the calcification of the vestigial segment of the umbilical artery. The authors describe 6 cases of this peculiar condition of which the diagnosis is easy and does not necessitate any complementary investigation. This finding has no pathological significance; this condition must be considered as a normal variant.