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Hemolymphangioma is a benign malformation of the lymphatic vessels. Cervical localisation is the most frequent. Mediastinal localisation is rare, but may be life-threatening because of airway compression. We report on a four-month-old boy who presented, in a context of epidemics, with clinical signs of acute bronchiolitis requiring mechanical ventilation for several days. Chest X-rays showed an important mediastinal mass with airways compression. Diagnosis was evoked on CT-scan aspects and confirmed by histology. Surgery allowed complete resolution, but dysphonia and oropharyngeal disorders persisted for several months. This rare congenital malformation is reviewed.

We report two cases of a choledochal cyst associated with dilatation of the cystic duct. This unusual variant of choledochal cyst was explored by ultrasonography and MR cholangiopancreatography.

To determine if teaching hospital imaging units are adequately staffed: how are the medical activities of radiologists distributed in such units?A questionnaire was sent to all teaching hospital radiologists in June 2001. The questionnaire covered 7 areasUrgent cases represent, on average, 22% of patients. Imaging procedures are becoming more frequent (increase of 2 to 8% per year). The mean working week (excluding periods on duty and on call) is 48 hours per FTE radiologist. The mean time spent on teaching, expertise and organization is 10 hours per week. The mean working time per FTE radiologist is thus 58 h/week. The medical activity per FTE radiologist represents 530.240e.The workload of radiologists in teaching hospitals is extremely high, whatever the indicator used (time or activity), indicating major under-staffing.

To standardize the ultrasound evaluation in congenital hip dysplasia according to the consensus meeting of 1991 in Paris. Detection of congenital anomalies is a daily pediatric challenge. The coronal plane at US of the hip is considered as the gold standard: its technique, its morphologic and dynamic results either normal or pathological, have been described. A standardized report and a simple terminology are proposed. 2. To explain the role of ultrasound, when performed in close collaboration with a pediatric orthopedic surgeon, for initial diagnosis and follow-up of anatomical anomalies. The role of arthrography and MR imaging will be discussed. 3. To describe the benefit of the ultrasound in cases of painful hip in children, including osteoarthritis, acute synovitis, osteochondritis. . . In these cases, the assessment of the hip is also done with radiographs, computer tomography, MR imaging and bone scan.

The objective of our study was to assess the rate of abnormal radiographic findings in the most frequent osteoarticular locations of traumatic injury in a pediatric population.During two periods of 12 weeks each, all patients admitted to the pediatric emergency department for osteoarticular trauma who underwent radiography were prospectively included in this study. A connection was drawn between the rate of abnormal radiographic findings for the seven most frequently radiographed locations and the clinical findings.Of 3128 locations of trauma in 2470 children, only 22% of the radiographic examinations were considered to reveal abnormal findings. In decreasing order, the hand and fingers, the ankle, the wrist, the knee, the elbow, the foot and toes, and the forearm were the most frequently examined locations. The rate of abnormal findings was 25.7% for the hand and fingers, 9.0% for the ankle, 42.5% for the wrist, 9.5% for the knee, 33.3% for the elbow, 18.3% for the foot, and 43.2% for the forearm. When only the direct sign of fracture was taken into account, these rates decreased for the ankle and knee to 2.6% and 1.9%, respectively. There was always a significant link between the degree of clinical suspicion and the rate of abnormal radiographic findings. However, fewer than 50% of the cases with high clinical suspicion of fracture were radiographically confirmed.It appears necessary, especially in cases of lower limb trauma, to evaluate clinical tests, including the implementation of the Ottawa ankle rules, to reduce the number of unnecessary radiographic examinations. This reduction will improve some parameters of children's quality of life and will significantly decrease the cost of emergency care.

We report an uncommon presentation of Legionella pneumophila infection following a placentalblood transplantation in an immunodeficient child. The patient presented with lung nodules and liver abscesses. We discuss how a digestive contamination can be suspected.

We report three pediatric cases of infectious colitis that were misinterpreted on US examination as Crohn's disease. These colitis were limited to the left colon and presented with transmural hypoechoic thickening of the wall and homogenous hyperechoic appearance of the surrounding fat.

Renal US was prospectively performed in 124 madagascan children less than 1 year of age. Patients were examined in the prone position and maximum kidney length was measured in the longitudinal plane. These measurements and the height and weight of our patient population were compared to published tables. Kidney length and height and weight of our patient population were inferior to the previously published reference data and the growth curve of kidneys steeper than normative standards (p0.001). Because of the important variability in US measurement of kidney length it is not possible to definitely conclude that length and growth curve of kidneys in madagascan children are statistically different from those of the published normative standards.

We report two cases of children with malignancies and subpleural nodules found on computed tomography (CT) scan. In both cases the diagnosis was anthracosis. This pathologic condition has never been reported in children. Causes of anthracosis include a smoking environment, living in urban areas and air pollution.

We report an atypical presentation of Mycoplasma pneumoniae infection observed in a patient with primary hypogamma-globulinemia. Pulmonary miliary was combined with sternal and femoral osteomyelitis. These unusual CT findings could be explained by immunodeficiency with impaired antibody response.

Objective. To describe the imaging findings of vascularized fibular grafts (VFG) in large bone reconstruction in children and teenagers. Design and patients. Fifteen patients aged from 4 to 19 years underwent VFG for bone reconstruction for primary tumors involving bone in 13 cases and for chronic osteomyelitis in 2 cases. Lesions were located in the femur (6 cases), the tibia (6 cases), the humerus, the distal fibula and the ilium. Radiographic follow-up was performed in all patients, radionuclide studies in 12 patients and MRI in 8. Results. Plain films showed a lamellated periosteal reaction on the VFG within 3 weeks following the procedure in all cases. Fusion of VFG and host bone occurred during the first 3 months. Radionuclide uptake of the VFG was seen in all cases but one. MRI showed cortical thickening and conservation of the high signal intensity of fatty marrow on T1-weighted sequences, and periosteal enhancement on dynamic post-contrast studies in all but one of the patients. Conclusion. Radionuclide studies and MRI show the periosteal enhancement and assess the viability of the VFG satisfactorily. However, we feel that plain films may be sufficient to ascertain this viability.

Pulmonary blastoma is a rare malignant tumor. A new case is reported in a 3 years 6 month-old girl. An apparent clinical remission was first obtained after a surgical treatment followed by a conventional chemotherapy during six months. Afterwards the persistence of a microscopic residual pulmonary disease lead us to deliver successfully an intensive chemotherapy followed by autologous peripheral blood stem cells reinjection. The child remains disease free 12 months after graft. Problems set by the histogenesis of this tumor, its unspecific clinical and paraclinical features and the role of conventional and intensive chemotherapy followed by autologous bone marrow transplantation are discussed on the basis of a review of 50 cases in the literature.

Recent reports indicate that, compared with MR imaging, plain film radiography often underestimates the extent of injury in children with physeal fracture-separation. Such underestimation may have significant therapeutic and prognostic outcomes. We performed this study to assess the benefit of MR imaging compared with plain film radiography in the diagnosis and immediate treatment of acute fractures of the distal tibial physis.Twenty-nine patients with acute fractures, including 15 Salter-Harris II, four Salter-Harris III, four Salter-Harris IV, and six triplane fractures, were prospectively examined by MR imaging with gradient-echo sequences. The MR images were compared with plain film radiographs. All cases were reviewed in a blind fashion by two experienced radiologists to determine the Salter-Harris classification on the basis of first plain film radiographs and then MR images. Two experienced pediatric surgeons were asked to propose treatment on the basis of first plain film radiographs and then MR images. Both the radiologists and the surgeons were asked to rate the two techniques in terms of degree of confidence and overall diagnostic effectiveness.Only 1 or 29 fractures (3%) was misclassified by plain film radiography. MR imaging never caused the treatment plan to be modified. However, the position of fracture fragments in Salter-Harris IV and triplane fractures was always better appreciated on MR images, facilitating more accurate surgical treatment. Except for those in the misclassified fracture, all other fracture lines were seen on both plain film radiographs and MR images but were more easily seen on MR images.Gradient-echo MR imaging allowed easier assessment of fracture lines than did plain film radiography, but the latter technique remains the primary means of evaluating epiphyseal injuries. For acute fractures of the lower extremity of the tibia, gradient-echo MR imaging should be limited to complex fractures and to cases in which the classification of a fracture on the basis of plain film evaluation is uncertain.

The purpose of this study was to evaluate the attitude of French pediatric radiologists regarding the presence or absence of parents during pediatric imaging of their child. A mail survey was sent to the French members of the "Société Francophone de Radiologie Pédiatrique". We asked about the inclusion of parents during pediatric imaging procedures. They gave the reasons for their choice and stated if parental presence was helpful or not for the achievement of imaging procedures. Responses were received from 76% of those surveyed. Excluding vascular and interventional procedures, few respondents (13%) permit parents to be present for all types of examinations. One respondent excluded parents from every procedure. Others excluded parents from selected studies: plain films (18%), upper gastrointestinal series (33%), contrast enema (44%), retrograde (47%) and suprapubic (67%) voiding cystourethrography, intra-venous pyelography (45%), US (5%), CT (27%), MRI (25%). Regarding angiography, only 2% of the respondents allow parental presence. Every respondent performing interventional procedures did not accept parents in the interventional suite. When parents were present, they were close to their child (76%) and could help in his immobilization (47%). Most of the respondents (49%) thought parental presence to affect examination in a favorable way. The opposite opinion was supported by 25% of them. An equivocal response was given in 26% of the answers. Numerous reasons supported these responses, they could be classified according to the child and his illness, the parents, the radiologist and his team, the examination performed. Most pediatric radiologists in France allow parents to accompany their children during selected examinations. Radiologists vary in their perception of how parental presence affects the outcome of the pediatric imaging procedures.

Objectifs Preciser la place actuelle de l’imagerie dans le diagnostic et la surveillance de la myosite ossifiante circonscrite (MOC). Materiels et methodes Nous avons revu les dossiers cliniques et d’imagerie de onze enfants porteurs d’une MOC. Le mode de revelation, les aspects radio-scanographiques, echographiques et IRM sont analyses. La place de la biopsie et la presence de sequelles sont evaluees. Resultats Les patients sont tous des garcons, de moyenne d’âge 10 ans (4-15 ans). Ils presentaient tous un traumatisme local recent. La douleur constante etait associee dans 4 cas a une tumefaction. Les cliches standard montraient des masses des parties molles calcifiees en peripherie dans 10 cas, une reaction periostee adjacente etait presente 4 fois. Sept patients ont eu un scanner qui montrait la calcification peripherique de la masse. Les anomalies de signal IRM etaient tres variables. La surveillance etait radiographique, scanographique en cas d’apposition periostee associee. Deux enfants ont ete operes au stade sequellaire. Conclusion Malgre la place fondamentale de l’IRM dans l’exploration des tumeurs des tissus mous, celle ci n’apparait pas utile dans le diagnostic et la surveillance d’une MOC sous reserve que le diagnostic ait ete formellement etabli par l’imagerie photonique. La biopsie peut faussement orienter vers une tumeur maligne.

Calcifications in lymphoma are rare findings prior to therapy. We report our experience with a 13-year-old boy who presented with a primary calcified duodenal Burkitt's lymphoma. US and CT findings are described. Two differential diagnoses are discussed.

Objectif Etudier la capacite de l’IRM fœtale de detecter une malrotation intestinale. Materiel et Methodes Etude retrospective sur 5 ans de notre base de donnees d’IRM fœtales non cerebrales. Resultats Quatre cent une IRM fœtales furent analysees. Dans 34 cas (8,5%), le jejunum proximal etait considere en position anormale, cad ailleurs que dans le flanc gauche sous l’estomac sur les sequences ponderees en T 2 . Dans 22 cas (65%), le jejunum etait situe dans l’hemi-thorax gauche dans le cadre d’une hernie diaphragmatique gauche (groupe A). Dans 7 cas (20%) il etait en position extra-abdominale dans le cadre d’un laparoschisis (group B). Dans 5 cas (15%) il etait anormalement situe dans l’abdomen, en position mediane ou dans le flanc droit, avec un estomac en position normale (group C). Tous les cas des groupes A et B ont ete confirmees en periode post-natale ou a l’autopsie. Dans 4 cas du groupe C (syndrome de Prune-Belly, poche colonique, atresie digestive, cardiopathie) la malrotation n’etait pas suspectee en echographie et etait confirmee apres la naissance. Dans le dernier cas, l’intestin etait refoule a droite par une duplication digestive geante, et le TOGD post-natal etait normal. Conclusion Grâce a son excellente resolution en contraste en ponderation T 2 , l’IRM fœtale identifie avec precision une position anormale du jejunum, en dehors de toute suspicion echographique, avec une excellente correlation postnatale.

A new case of duodenal atresia with gas below the obstruction is reported. This apparently contradictory feature is due to a bifid termination of the common bile duct in the duodenum, air by-passing the atretic area. The anomaly was proven by operative cholangiography.

Three pediatric cases of hydatic cyst of the kidney are reported. This is a very rare condition in children. Usually, the presentation is a cystic space-occupying lesion of the kidney. Several diagnostic methods are available but it is stressed that ultrasonography may be sufficient. Surgical treatment is still necessary.

An open-label noncomparative clinical study was conducted to evaluate the efficacy and tolerance of ioversol (Optiray 300), a new low-osmolality non ionic contrast medium, in body contrast-enhanced CT scanning in infants and children. Fourty pediatric patients who required contrast-enhanced CT scanning for evaluation of chest, abdominal or pelvic masses participated in the study. The vascular enhancement was judged to be excellent or good in 72.5% of the cases and the CT scans were judged to be diagnostic in 95% of the cases. Ioversol was well tolerated in the study with only two mild adverse reactions (nausea and vomiting, and metallic taste).

Three pediatric cases of malignant rhabdoid tumor of the neck are described. Clinical data and imaging findings (US, CT and MRI) are stressed. The mass was well defined, containing punctate calcifications in two cases and encasing the vessels in two other cases. Two patients were treated with a chemotherapy regimen according to MMT 89 SIOP protocol, one had chemotherapy and radiotherapy. Two children died of progressive disease; the remaining child who had complete surgical removal of the tumor is on remission 17 months after diagnosis.

Objectifs Connaitre les principales lesions vasculaires de l’enfant. Connaitre leur semeiologie clinique. Connaitre leur semeiologie echographique et IRM. Discuter de la strategie d’exploration devant la decouverte d’une lesion vasculaire. Messages a retenir L’âge de l’enfant est un element important d’orientation. Le caractere congenital ou acquis des lesions reduit la gamme diagnostique. L’echographie de premiere intention fait la majorite de ces diagnostics. Elle determine l’indication de l’IRM et le type de sequences a effectuer. La radiographie est systematique quand la nature ou les limites de la lesion ne sont pas identifiees en echographie. Resume Les lesions les plus frequentes sont pour les tumeurs, les hemangiomes immatures (HI) et pour les malformations les lymphangiomes kystiques et les malformations veineuses. L’analyse echodoppler permet de separer les lesions a haut debit (hemangiome et malformation arterio-veineuse) des lesions sans ou a bas debit (lym-phangiome et malformation veineuse). L’IRM est indiquee en cas de doute pour la caracterisation ou pour le bilan d’extension pre-therapeutique. La reconnaissance echographique de ce type de lesions determine le type de sequences IRM multiplanaires principales, ponderees T2 pour les malformations a flux lent et angiographiques en cas de malformation arterio-veineuse. La biopsie en l’absence d’identification formelle est a discuter en consultation multidisciplinaire.

Objectifs pedagogiques Connaitre la physiopathologie. Decrire les germes impliques. Connaitre le role et l’apport des differentes techniques d’imagerie dans le diagnostic et le pronostic. Definir les grandes lignes de la prise en charge. Messages a retenir Les infections osteo-articulaires de l’enfant en croissance sont des urgences medico-chirurgicales, le plus souvent hematogenes. L’arthrite et l’osteomyelite sont frequentes chez l’enfant car les zones de croissance (qui sont juxta-articulaires) sont richement vascularisees. Toute douleur osseuse ou articulaire febrile chez l’enfant est une infection osteo-articulaire jusqu’a preuve du contraire. Les prelevements bacteriologiques sont d’autant plus urgents a realiser qu’ils doivent preceder l’antibiotherapie. Le pronostic fonctionnel est constamment mis en jeu. Le pronostic vital rarement.

Conservative surgery of primary bone tumors, which has become possible owing to the progress made by chemotherapy, must be carcinological, and it is therefore based on a thorough assessment of local tumor extension. CT and MRI have proven their great value for this assessment. While CT clearly shows the calcified tissue and the extension into soft tissue, MRI is more effective to delineate the tumoral and intraosseous margins and, more importantly, for the exploration within bone, for which it has the advantage of making a study in all planes possible. The anatomical substrate and exact meaning of the MR signal of pathological tissue still remains to be specified. However, MRI already appears to be the essential examination for the assessment of local bone tumor extension. If it did not have contraindications, it could replace CT within the next few years.

Amongst the endothoracic forms of Wegener's granulomatosis, tracheal, bronchial and above all mediastinal localisations are unusual. Such a case having a bad outcome is reported here. Computed Tomography (TDM) was used to assess the extend of pulmonary parenchymal involvement. Magnetic Resonance Imaging (MRI) was superior to TDM for showing transmural infiltration of the tracheal and the origin of main bronchi.

Objectifs Evaluer en IRM, dans une population d’enfants et d’adolescents presentant un traumatisme isole de la cheville, la realite et la frequence des lesions ligamentaires. Materiels et methodes Etude prospective chez 117 enfants admis aux urgences pour traumatisme de la cheville et ne presentant pas de fracture sur les cliches standard face et profil. Realisation d’une IRM en antenne de surface comprenant 5 sequences : T1 et DP-T2 saturation de graisse dans le plan coronal et DP-T2 dans le plan axial transverse en coupes de 3 mm jointives. Resultats Cinquante garcons (43,1 %) et 66 filles (56,9 %) d’âge moyen 11,6 ans (minimum 8 ans, maximum 15 ans) ont ete inclus. Quatre vingt sept pour cent (102 /117) des IRM etaient analysables. Chez vingt cinq patients une lesion interessant au moins le faisceau talo-fibulaire anterieur etait presente ; il s’agissait de lesions mineures avec epaississement et modification de signal du ligament dans 20 cas et de lesions majeures avec interruption de la continuite de ce ligament dans 5 cas. Pour ces 5 derniers patients, la physe tibiale etait ouverte dans 2 cas (2 %) et fermee dans 3. Conclusion L’entorse grave de la cheville sans fracture osteo-chondrale associee existe mais reste exceptionnelle chez les patients a physe ouverte.

Objectifs Etudier l’irradiation respective et la qualite des images de deux systemes radiographiques, numerique par balayage vs conventionnel, dans le cadre de l’exploration de scolioses idiopathiques a l’âge pediatrique. Materiels et methodes Etude prospective randomisee, portant sur 85 patients de moins de 16 ans ; rachis en totalite de face en incidence postero-anterieure. Analyse de la dose recue au niveau inter-orbitaire, thyroidien, mammaire, et a mi-distance ombilic-symphyse pubienne par des frittes thermoluminescents. Resultats A qualite egale d’exploitation des informations fournies par les deux systemes radiographiques, l’utilisation de la numerisation permet une reduction de dose en moyenne de 69 %. Cette reduction est de 300 % pour la thyroide et de 50 % pour les glandes mammaires. Par contre cette technique de numerisation avec les parametres utilises accroit l’irradiation de 33 % au niveau ombilicsymphyse. Conclusion La numerisation par balayage permet une reduction significative de l’irradiation. L’optimisation de cette technique reste necessaire pour reduire la dose aux organes genitaux.

Objectifs pedagogiques Presenter les aspect normaux du pancreas de l’enfant en echographie, scanner et IRM. Definir la place actuelle de ces examens en fonction de la pathologie suspectee qu’elle soit traumatique, congenitale, hereditaire ou tumorale. Decrire la semeiologie en imagerie des rares tumeurs pancreatiques (nesidioblastome, pancreatoblastome, tumeur de Frantz, infiltrations ganglionnaires au cours des lymphomes, …). Resume Malgre les avancees technologiques recentes en particulier de l’IRM, l’echographie demeure l’outil de premiere intention dans l’approche en imagerie du pancreas de l’enfant.

Objectifs L’etude morphologique de la hanche par l’echographie remonte aux travaux de Graf en 1983. Rapidement l’echographie devient un complement indispensable de l’examen clinique dans le depistage de la maladie luxante. Ce depistage repond a des imperatifs, dont l’existence de certains facteurs de risque. La gemellite a ete incriminee. Le but de cette etude est donc d’apprecier l’incidence reelle liee aux grossesses gemellaires. Materiels et methodes Par une etude retrospective, nous avons revu les echographies de hanche realisees systematiquemment chez des jumeaux. Les examens ont ete realises par une equipe entrainee a la methode morphologique de GRAF. Resultats Trois cent seize nourrissons ont ete echographies de fevrier 1991 a mars 2004, âges en moyenne de 2 mois. Quarante cinq echographies, initialement de Type IIa, se sont normalisees au controle realise 2 mois plus tard. Seuls deux nourrissons ont ete traites avec succes pour un Type IIb unilateral et un Type IIc bilateral. Conclusion Les resultats de cette etude preliminaire ne permettent donc pas de retenir la gemellite seule comme un facteur de risque. Il existe probablement une sommation de facteurs de risque que des etudes ulterieures pourront preciser.

Objectifs pedagogiques Decrire la strategie d’exploration en imagerie de ce type d’urgence. Detailler la semeiologie echographique des pathologies les plus frequentes : appendicite, maladies inflammatoires chroniques, pathologies ovariennes, invaginations intestinales, enterocolites ulcero-necrosantes…… Faire le point sur la place du scanner et de l’IRM dans notre pratique quotidienne. Resume La pathologie traumatique ne sera pas detaillee, traitee dans un autre cours. L’âge de l’enfant et le tableau clinico-biologique sont des elements d’orientation capitaux et permettent souvent au clinicien de porter un diagnostic. Le but de l’imagerie est de confirmer ce dernier ou de le rectifier, de preciser le siege et l’importance de l’atteinte et de rechercher des anomalies associees liees ou non a la pathologie causale. L’echographie est l’examen incontournable toujours necessaire souvent suffisant. Si la pathologie digestive est de loin la cause la plus frequente des urgences abdominales pediatriques il ne faut pas oublier les causes pelviennes et urinaires voire pulmonaires. La realisation dans un deuxieme temps d’un scanner ou d’une IRM est exceptionnelle en dehors de la pathologie traumatique.