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Neck lesions are not uncommon in children and typically present with localised swelling. The neuroradiologist's goal is the diagnosis of cervical lesions as a concomitant pathological finding, especially in cases with intraspinal spread. Neck lesions can be classified in terms of etiology as congenital, inflammatory or neoplastic, but this division is not the best suited to a radiological approach. A more useful diagnostic indicator is the location of the lesion with a further classification based on its radiological hallmarks. An assessment of age distribution is also important for a correct diagnosis.

Purpose This study was performed to develop a standardized methodology for the sonographic assessment of clubfoot at birth and at the end of both conservative treatment and surgical correction. Methods Forty-two congenital clubfeet and 42 normal feet were examined sonographically in the position of spontaneous alignment and during passive manual correction. Scans along 4 planes provided information relevant to the assessment: sagittal posterior, sagittal anterior, coronal lateral, and transverse. Results Sagittal posterior sonograms demonstrated the progressive gain of dorsiflexion ability during the different steps of treatment for clubfoot. Sagittal anterior sonograms could not demonstrate the normal alignment of the navicular in clubfeet because of the bone's medial displacement. On transverse sonograms, the talar head and the medially displaced navicular may lie on the same plane, depending on the severity of the deformity. Coronal lateral sonograms provided for estimation of the relationships between the calcaneus and cuboid, which were described by the calcaneal-cuboid angle. Conclusions Sonography is a promising technique for assessment and monitoring of clubfoot during treatment. The method described here yields accurate and reproducible information about the anatomy of the nonossified clubfoot, helping the orthopedic team decide on appropriate treatment steps. © 2004 Wiley Periodicals, Inc. J Clin Ultrasound 32:235–242, 2004; Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jcu.20022

We report a case of a neonate with tetralogy of Fallot with aneurysmal dilatation of the pulmonary artery, complicated by bilateral relapsing pneumothorax. The relapsing air leak made it necessary to place up to five chest drains and to switch from conventional ventilation to high frequency ventilation. In the course of 30 days, all drains were removed. Once other anatomical and functional malformations of the respiratory system had been appropriately excluded and reasonable haemodynamic stability had been achieved, the patient underwent successful radical corrective heart surgery in hypothermia and cardioplegia. We emphasize the advantage of resolving respiratory failure preoperatively to guarantee the success of corrective heart surgery and treatment of other surgically severe cases.

Osteonecrosis (ON) is a critical complication in the treatment of childhood leukemia and lymphoma. It particularly affects survivors of acute lymphoblastic leukemia and non-Hodgkin lymphoma reflecting the cumulative exposure to glucocorticosteroid therapy. ON is often multiarticular and bilateral, specially affecting weight-bearing joints. A conventional approach suggests a surgical intervention even if pharmacological options have also recently been investigated. We reported two cases of long time steroid-treated patients who underwent Bone Marrow Transplantation (BMT) for hematological disease. Both patients developed femoral head osteonecrosis (ON) that was diagnosed by magnetic resonance imaging (MRI) and the ON was also accompanied with pain and a limp. Despite of the conventional strategies of therapy, we successfully started a short-term treatment with bisphosphonates in order to decrease the pain and the risk of fracture.

Purpose: We describe 3 cases of testicular cystic dysplasia that were diagnosed only by sonography to avoid an invasive approach. Materials and Methods: Three patients 5, 8 and 12 years old, respectively, had increased testicular volume and/or intermittent pain. Sonographic examination of the testis by high frequency (7.5 mHz.) probes showed the typical onset of testicular cystic dysplasia, characterized by several small focal or diffuse intraparenchymal cystic formations. Results: Biopsy or orchiectomy was not considered. At 16, 18 and 24 months of followup, respectively, testicular pain was absent in our 3 cases and sonographic findings were unchanged. Conclusions: Clinical and sonographic followup is considered sufficient to evaluate possible changes in the clinical course of this pathological condition which, although benign, still remains to be defined.

Fetal gallstones were visualized sonographically in two cases at 30 and 37 weeks' gestation; follow-up scans at 2 and 3 months, respectively, disclosed their spontaneous resolution. The hypotheses advanced to explain the formation of echogenic material in the fetal gallbladder are reviewed, and the clinical utility of postnatal long-term sonographic follow-up is stressed. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology

Background: Medical treatment of gallstones with ursodeoxycholic acid (UDCA) or chenodeoxycholic acid (CDCA) has not been evaluated in children. Aim: The purpose of this study was to assess the effectiveness of UDCA in the treatment of gallstones in children. Method: UDCA was used to treat 15 patients, (7 boys and 8 girls; mean age, 7.8 years; range, 3 months to 15 years) for 1 year. All had radiolucent stones with a maximum diameter of 10 mm and a normally contractile gallbladder. Results: The stones disappeared completely in two children but returned later. All symptomatic patients became symptom free. Conclusion: UDCA is ineffective in the treatment of gallstones in children except in terms of relieving symptoms while on treatment.

In the pediatric population a broad spectrum of intrascrotal pathology ranging from congenital to neoplastic lesions present as a painless scrotal mass. The aim of our 10-year retrospective study was to review 71 pediatric cases of a painless scrotal mass to determine the overall and age specific prevalence of diseases manifesting as such masses.From 1980-1991, 71 patients 1 day to 16 years old with a painless scrotal mass underwent evaluation using 7.5 or 10 MHz. ultrasound probes with transverse and longitudinal sections.The painless scrotal mass was testicular in 61 cases (86%, 28 neoplasms, 27 congenital malformations, and 6 posttraumatic/inflammatory lesions) and extratesticular in 10 (14%, 5 neoplasms, 2 hematoceles, 2 pachyvaginitis and 1 sebaceous cyst). Patient age distribution showed 2 peaks at 0 to 1-year and 13 to 14-year intervals. More than a third of the painless scrotal masses (24 cases) were found during the first year of life, predominantly congenital anomalies (in utero torsion) and neoplasia. A total of 45 patients (63%) underwent surgery (orchiectomy in 39 and conservative treatment in 6) and a pathognomonic echo pattern allowed nonsurgical treatment in 26 (37%).Testicular ultrasound proved to be highly reliable in differentiating intratesticular from extratesticular lesions but it demonstrated poor specificity because of extensive overlap between benign and malignant pathologies. Therefore, testicular ultrasound changed the management of a few select cases of a painless scrotal mass (epididymal cysts/spermatoceles and in utero torsion).

Nodular regenerative hyperplasia (NRH) of the liver is a condition of unknown origin, rarely occurring in children, usually accidentally discovered, described in association with a variety of clinical conditions and drugs. Confusion with other types of hepatic masses may pose a problem and for this reason NRH is considered a “tumor-like lesion.” Histologically it consists of single or multiple regenerative foci. Hepatic failure and rupture of the liver have been rarely described as complications in adults, and not in children, and malignant transformation has not been demonstrated. Neither surgical removal nor other treatment is needed. These features are described as they were found in two patients we encountered. © 1996 Wiley-Liss, Inc.

Three typical cases of fibrous mastopathy associated with diabetes mellitus are described. The histological change is a connective-tissue overgrowth with vasculitis and some proliferation of duct epithelium. The clinical changes are indistinguishable by physical or radiographic findings from malignancy. In young patients with long-standing diabetes the presence of one of more suspicious clinical and imaging findings can suggest the presence of this lesion but a surgical biopsy or, at least, a close follow-up is required.

Asymptomatic scrotal masses (ASM) in children constitute an entity of pathologies, ranging from congenital anomalies to neoplasms. Testicular ultrasound is the imaging modality of choice in the evaluation of ASM, although there is extensive overlap between benign and malignant lesions. Five children with ASM of benign origin are presented: 2 boys had extratesticular mass (one paratesticular lipoma and one voluminous sebaceous scrotal cyst); the remaining 3 patients had testicular mass (one supernumerary testis, one intratesticular cyst and one unilateral testicular hypertrophy). Basing on the ultrasonographic appearance, a certain diagnosis of benign lesion was made only in the last 2 cases; the remaining patients underwent explorative inguinotomy in order to rule out any malignancy. Some guidelines for proper diagnosis of ASM in childhood are proposed by the authors. However, at least in children, testicular preservation should not be based only on the sonographic findings, and surgical exploration is mandatory whenever the nature of the lesion remains unclear.

Fetus in fetu is a rare pathological condition, presenting as a congenital tumor. It consists of a malformed parasitic twin that is found within the body of its sibling. Less than 70 cases have been reported and in most of them a definite diagnosis was only made during surgery. We present a case with two fetuses in the retroperitoneum and describe the criteria to be kept in mind for a correct preoperative diagnosis, using the current imaging modalities.

Patients with cat-scratch disease (CSD) may develop visceral manifestations such as hepatic and splenic granulomas. Normally, the granulomas disappear within 1-5 months. Two previous reports have described the evolution of splenic lesions into small calcifications. We report a case of cat-scratch disease in which long lasting multiple and disseminated hepatic and splenic granulomas evolved into coarse calcifications.

Diverticulosis of the main bronchi, not associated with other organ abnormalities, developed in a 12 year old child. This abnormality caused recurrent bronchopneumonia in the lung with the main bronchi diverticulosis. Fibreoptic bronchoscopy helped to locate the lesion and selective bronchography, with injection of contrast medium through the suction channel of the fibreoptic bronchoscope, showed the morphology of this rare malformation.

The ultrasound image of gas-containing gallstones was evaluated in three cases. In two, the stones were studied in vitro in a phantom gallbladder by ultrasound, and then by microradiographic techniques. The third case was investigated in vivo by ultrasound and computerized tomography (CT). The presence of gas-containing fissures, which are not detectable on ultrasound, was demonstrated. In contrast, wider fissures, or a true gas bubble, produce reverberation echoes which depend upon the quantity of gas present within the gallstone.

artery Prognostic value of nephrography in atherosclerotic occlusion of the renal ISSN: 1524-4563 Copyright © 1986 American Heart Association. All rights reserved. Print ISSN: 0194-911X. Online 72514 Hypertension is published by the American Heart Association. 7272 Greenville Avenue, Dallas, TX 1986, 8:962-964 Hypertension http://hyper.ahajournals.org/content/8/10/962.citation located on the World Wide Web at: The online version of this article, along with updated information and services, is