Search

Resume L’invagination intestinale aigue est l’urgence abdominale la plus frequente du nourrisson et du jeune enfant, mais elle peut survenir a n’importe quel âge. La penetration d’un segment digestif dans l’intestin d’aval entraine une obstruction de la lumiere digestive et une compression vasculaire au niveau du collet. Le role du radiologue est essentiel pour le diagnostic mais aussi pour le traitement. L’echographie est devenue l’examen diagnostique de reference. Elle detecte une masse digestive de 20-45 mm de diametre anteroposterieur, en « cocarde » ou en « cible » centree par le segment invagine et son meso. Elle permet d’identifier le type anatomique du boudin, de suspecter une souffrance digestive, de depister une lesion primitive et donc d’orienter la prise en charge therapeutique. Le lavement est realise uniquement a visee therapeutique. L’echographie peut etre egalement indiquee pour guider un lavement hydrostatique, verifier la reduction et dans le suivi pour depister une recidive. L’invagination ileocolique « idiopathique » du nourrisson, de loin la plus frequente, est due a une hyperplasie lymphoide du carrefour ileocaecal. Elle est habituellement reduite par le lavement therapeutique. La chirurgie devrait etre reservee aux formes avec souffrance digestive et/ou avec une lesion primitive (diverticule de Meckel, lymphome de Burkitt localise, duplication kystique, polype). A l’oppose, l’invagination pathologique du grele est tres rare et occlusive. Elle survient sur un terrain particulier (chirurgie recente, purpura rhumatoide, mucoviscidose, syndrome de Peutz-Jeghers) et/ou sur une lesion primitive. Le traitement est chirurgical excepte en cas de lymphome dissemine prouve car la chimiotherapie entraine une reduction spontanee. L’invagination colocolique, exceptionnelle, est secondaire. Facilement reduite au lavement, elle recidive en l’absence d’exerese de la cause locale (polype, tumeur). L’invagination physiologique du grele tres frequente, de petite taille (10 a 19 mm de diametre anteroposterieur), peristaltique, non occlusive et transitoire, doit etre differenciee d’une invagination pathologique.

Developmental dysplasia of the hip can arise in utero due to a dislocating posture, sometimes associated with predisposing genetic factors. The ideal time for diagnosis is during the neonatal period and adequate screening procedures must be in place. Indeed, the plasticity of hyaline cartilage and fibrocartilage combined with the growth potential at this age nearly always result in rapid complete resolution of the deformity. Ultrasound, when indicated, is the best imaging modality for diagnostic confirmation. It allows evaluation of the osteocartilaginous structures, joint space and soft tissues. Ultrasound provides the clinician with a reliable morphologic and dynamic evaluation tool improving the diagnostic accuracy and guiding orthopedic treatment. Our experience, dating back to 1985, is based on a population imaged between 2007 and 2009. From a total of 2480 neonates screened because of abnormal finding or risk factors, we identified 257 cases of dislocation (10%) in 191 neonates : 14 cases of nonreducible dislocation (10 neonates), 30 cases of reducible hip dislocation (24 neonates), 97 cases of dislocatable hip (73 neonates) and 116 cases of subluxable hip (84 neonates). Clinical and sonographic follow-up demonstrated therapeutic success in 237 cases (93%) and failure in 20 cases (one case of subluxable hip, two cases of dislocatable hip, three cases of dislocated hip, 14 cases of nonreducible hip dislocation). Imaging follow-up (6 to 24 months) showed asymmetry in the size of the proximal femoral epiphyses in 20 cases (with resolution in 10 cases), three cases of dysplasia and one case of post-reduction osteochondritis.

RADIOLOGIE ET IMAGERIE MEDICALE : Musculosquelettique - Neurologique - Maxillofaciale - 31-621-A-30

Resume L'auteur decrit les anomalies congenitales du rein et de la voie excretrice superieure chez l'enfant. Les caracteristiques anatomiques de la malformation, son retentissement sur la fonction renale, ses circonstances de decouverte, les techniques d'imagerie utilisees en 2004 pour son diagnostic et son bilan complet, ainsi que les criteres de decision de l'attitude therapeutique, sont rapportes.

Resume Le diagnostic fœtal des anomalies du tube digestif peut etre ameliore par l’utilisation de l’IRM qui permet une bonne visualisation du tube digestif normal, et aide a preciser la nature et la topographie des anomalies, a detecter des malformations severes, a visualiser l’intestin adjacent a des structures kystiques ou tumorales intra abdominales. Notre experience personnelle et les principales donnees de la litterature sont exposees.

Ultrasonography has radically changed the approach of these rare malformations, still diagnosed with difficulties in spite of modern iconography. Bladder anomalies may easily be discovered when associated with otherwise obvious malformations of genitalia. The rest must be suspected for non-specific signs as micturition troubles, multiple urinary tract infections, chronic renal failure. The abnormal bladder is the only common feature of a polymorphic spectrum of diseases including complete or partial duplication or septum, congenital diverticula, vesicovaginal fistula, agenesis and urachal anomalies. Treatment must be accorded to each case and it needs perfect knowledge of open and endoscopic bladder surgery.

The strategy for morphological investigations in children with acute pyelonephritis (APN) remains debatable. We studied 70 children (median age 2.0 years) admitted with a first episode of pyelonephritis using a high-resolution ultrasound technique (RUS) and compared the results with 99m technetium-dimercaptosuccinic acid (DMSA) renal scintigraphy. The DMSA scan was abnormal in 62 children (89%). However, using a high-frequency transducer we found abnormal sonogram changes in 61 children (87%), consisting of an increased kidney volume in 42, and/or a thickening of the wall of the renal pelvis in 42, and/or a focal hyper- or hypoechogenicity in 36, and/or a diffuse hyperechogenicity in 31 children. Micturating cystourethrography was performed in all children, revealing vesicoureteral reflux (VUR) in 22 (31%). Among those children with VUR, 4 had a normal DMSA scan, 2 an abnormal RUS, and 2 a normal DMSA scan and RUS. Our data suggest that B-mode RUS performed with a high-frequency transducer by a trained radiologist is nearly as sensitive as the DMSA scan in diagnosing renal involvement in children with unobstructed APN and in predicting VUR.

Developmental dysplasia of the hip can arise in utero due to a dislocating posture, sometimes associated with predisposing genetic factors. The ideal time for diagnosis is during the neonatal period and adequate screening procedures must be in place. Indeed, the plasticity of hyaline cartilage and fibrocartilage combined with the growth potential at this age nearly always result in rapid complete resolution of the deformity. Ultrasound, when indicated, is the best imaging modality for diagnostic confirmation. It allows evaluation of the osteocartilaginous structures, joint space and soft tissues. Ultrasound provides the clinician with a reliable morphologic and dynamic evaluation tool improving the diagnostic accuracy and guiding orthopedic treatment. Our experience, dating back to 1985, is based on a population imaged between 2007 and 2009. From a total of 2480 neonates screened because of abnormal finding or risk factors, we identified 257 cases of dislocation (10%) in 191 neonates : 14 cases of nonreducible dislocation (10 neonates), 30 cases of reducible hip dislocation (24 neonates), 97 cases of dislocatable hip (73 neonates) and 116 cases of subluxable hip (84 neonates). Clinical and sonographic follow-up demonstrated therapeutic success in 237 cases (93%) and failure in 20 cases (one case of subluxable hip, two cases of dislocatable hip, three cases of dislocated hip, 14 cases of nonreducible hip dislocation). Imaging follow-up (6 to 24 months) showed asymmetry in the size of the proximal femoral epiphyses in 20 cases (with resolution in 10 cases), three cases of dysplasia and one case of post-reduction osteochondritis.

The fetal diagnosis of GI tract abnormalities may be improved by the use of MRI that is able to visualize the normal bowel, may characterize the nature and location of gastrointestinal abnormalities, detect severe malformations, demonstrate the bowel close to cystic or tumoral intra abdominal structures. Our personal experience and recent data of the literature are reported.

We describe the magnetic resonance (MR) patterns of a variety of fetal gastrointestinal (GI) abnormalities. Thirty-two fetuses between 23 and 38 weeks’ gestation with abnormal appearance of the GI tract by ultrasound underwent MR imaging with T1- and T2-weighted sequences. The MR aspect of intestinal atresia (duodenal atresia, one case; small bowel atresia, nine cases) included dilatation of the bowel loops, accurate assessment of the normal bowel distal to the atresia (except in the patient with multiple atresia and apple-peel syndrome), and micro-rectum with decreased T1 signal (except in the patient with duodenal atresia). Megacystis-microcolon-intestinal hypoperistalsis syndrome (one case) was indicated by an abnormal signal of the entire bowel and an abnormal pattern for the urinary tract. Meconium pseudocysts (two cases) were easily differentiated from enteric cysts (two cases). High anorectal malformations with (two cases) or without (one case) urinary fistula and cloacal malformation (one case) are described and MR findings are discussed. The capability of MR imaging to demonstrate the normal bowel with intraperitoneal anomalies (e.g., congenital diaphragmatic hernia, and sacrococcygeal teratoma) is emphasized. MR imaging is informative in the diagnosis of GI tract abnormalities, especially the severe malformations, with much more accuracy than sonography.

Ultrasonography has radically changed the approach of these rare malformations, still diagnosed with difficulties in spite of modern iconography. Bladder anomalies may easily be discovered when associated with otherwise obvious malformations of genitalia. The rest must be suspected for non-specific signs as micturition troubles, multiple urinary tract infections, chronic renal failure. The abnormal bladder is the only common feature of a polymorphic spectrum of diseases including complete or partial duplication or septum, congenital diverticula, vesicovaginal fistula, agenesis and urachal anomalies. Treatment must be accorded to each case and it needs perfect knowledge of open and endoscopic bladder surgery.

To assist the radiologist in differentiating the colitis in children, this review proposes a systematic US approach to the disease, presents the US aspect of the normal colon and describes three distinctive US patterns reflecting the intramural extension of the histopathological changes. Each pattern corresponds to one or several diseases producing alterations in the same layer(s). Stratified thickening suggests an inflammatory mucosal process resulting from infection (as in advanced appendicitis or in infectious colitis) or to inflammation (as in IBD). Nonstratified thickening with loss of the haustral folds reflects a marked submucosal infiltrate. Color Doppler is required to distinguish between an inflammatory disease (as advanced CD or neutropenic colitis) and an ischemic colitis (HUS in children). Nonstratified thickening with preservation of the length of the haustral folds is the sign of an intraluminal deposit due to PMC. Correlating the sonographic pattern and the anatomic distribution of the disease with the clinical and laboratory findings often permits to propose a specific diagnosis.

The authors report a case of localized hypertrophic neuropathy diagnosed by MRI. This 10-year-old girl presented with painless progressive deltoid atrophy. Electrodiagnostic studies demonstrated chronic denervation. An MRI performed with T1, T2, T1 with gadolinium and fat saturation sequences showed a linear 5-cm long segment of hypertrophic brachial plexus cord, with moderate high T2, intermediate T1 signal, and marked post-Gadolinium enhancement. Progressive improvement followed surgical resection with nerve graft repair. Histological study confirmed LHN (perineurial cell proliferation), a rare cause of peripheral neurological deficit. MRI findings may suggest LHN, that should be suspected as well as peripheral nerve compression or tumor; inflammatory neuritis and idiopathic lesion (with normal MRI findings) remain a diagnosis of exclusion. MR aids in the precise localization of the lesion before surgery.

We know that many cerebral lesions are of circulatory origin and it is now important to study cerebral hemodynamics by pulsed and color Doppler ultrasonography. The revolution in the imaging of vascular physiology, the diagnosis, and the prognostic evaluation of vascular disease are not based on morphological sonographic studies but on the Doppler techniques that can display cerebral vessels in the neonate. The results of the hemodynamic investigation in 491 newborns aged from 32 weeks of gestation to 9 months by means of pulsed and color Doppler are reported. Normal values of the resistive index, peak systolic, end-diastolic, and time-averaged velocities in seven different vessels are determined. Some pathological examples are presented. Doppler techniques play a major role in the diagnosis, follow-up, and management of brain damage, whether ischemo-hemorrhagic, infectious, or developmental or tumoral, and of pericerebral collections.

Transfontanelle sonography has become a routine imaging modality to assess infants with macrocrania: detection of hydrocephalus and diagnosis of its underlying etiology, detection and mapping of extra-axial collections, value of Doppler US for diagnosis of intracranial lesions, hemodynamic evaluation using pulsed Doppler imaging.

To evaluate the involvement and consequences of the lower pole pedicle (LPP) associated with ureteropelvic junction syndrome.Retrospective study in 81 children presenting a total of 84 ureteropelvic junction syndromes operated consecutively between 1994 and 1998. Urinary tract ultrasound and cystography were systematically performed. Renal scintigraphy (DTPA or MAG 3) was performed in 80 children. Preoperative intravenous urography was performed in 60 children. LPP was considered to be present when its participation in the obstruction was confirmed intraoperatively (Anderson Hynes technique with uncrossing of the vascular pedicle).Group I: a LPP was revealed in 24 kidneys (28.5% of cases), 17 left kidneys and 7 right kidneys, in 14 boys and 10 girls, with a mean age of 4 years (range: 2 months-14 years). Group II: 60 kidneys without LPP (71.5% of cases), 32 left kidneys and 28 right kidneys, in 40 boys and 17 girls, with a mean age of 2 years (range: 1 month-15 years). The most frequent presenting complaint was recurrent low back pain in 58% of cases in group I (14/24) and 5% of cases in group II (3/60). The mean age at diagnosis was 6 years. Hydronephrosis was detected by antenatal ultrasound in 33% of cases in group I (8/24) and in 72% of cases in group II (43/60). Kidney function in group I was greater than 40% in 19 patients, between 20 and 39% in 2 patients and less than 20% in 2 patients. These results were not influenced by age at diagnosis and were not significantly different from those observed in group II. Renal malrotation was observed in 2 cases in group I and in 12 cases in group II. Histology of the junction revealed nonspecific fibrosis in the same percentage of cases (91%) in the two groups. The mean follow-up was 15 months (range: 2 months-5 years). No surgical failure was observed.Ureteropelvic junction syndrome associated with a LPP appears to present later with recurrent low back pain in older children. It does not worsen the functional prognosis of the affected kidney. LPP can be visualized by duplex ultrasound. It may act as an inducer of obstruction by aggravating a pre-existing abnormality of the ureteropelvic junction. When LPP is associated with isolated dilatation of the pyelocaliceal cavities, the risk of subsequent decompensation requires closer ultrasound surveillance, until puberty.

Resume On connait toutes les difficultes du diagnostic clinique de l’appendicite pediatrique : les formes cliniques sont multiples et frequemment trompeuses, dans 20 a 30 % des cas. Les donnees radiologiques et le bilan biologique sont de peu de secours. Les auteurs apportent leur experience ultrasonore a propos d’une etude retrospective de 1267 cas de douleurs de la fosse iliaque droite et en tirent les conclusions suivantes : Dans les 423 cas d’appendicites aigues, la sensibilite diagnostique de l’echographie est superieure a celle de la clinique (94,7 % versus 81 %). La specificite des ultrasons est de 99 %, la valeur predictive positive de 98 % et la valeur predictive negative de 97,4 %. L’echographie apporte une evaluation de plus en plus precise du stade evolutif de l’infection appendiculaire aussi bien dans l’appendicite simple que dans l’appendicite compliquee. La visualisation ultrasonore de l’appendice normal (82,1 % soit 693 cas/ 844) permet une certitude diagnostique et ameliore le diagnostic differentiel. Orientee par le contexte clinique, l’exploration ultrasonore apporte une semeiologie echographique dorenavant capable de proposer le diagnostic d’une appendicite regressive (24 cas), d’une hyperplasie lymphoide de l’appendice (27 cas) et d’une colique appendiculaire (14 cas). Conclusion Quelle que soit l’evaluation clinique, l’exploration ultrasonore s’impose devant toute douleur de la fosse iliaque droite.

Objectifs Connaitre la demence diagnostique, basee sur le couple ADP-echographie. Savoir determiner le siege de l’occlusion (duodenal, grele ou colique). Connaitre la semiologie des differentes etiologies. Identifier les signes de gravite imposant une chirurgie d’urgence. Messages a retenir Tout vomissement vert chez un nouveau-ne impose une imagerie. L’etape fondamentale est de rechercher un volvulus sur malrotation. Contrairement a l’ASP, l’echographie differencie toujours obstacles grele et colique. Dans le Hirschsprung neonatal, la disparite de calibre echographique est souvent absente. Le lavement aux hydrosolubles est indispensable devant toute occlusion basse. Resume Tout vomissement vert chez un nouveau-ne fait immediatement suspecter une occlusion. L’etude des vaisseaux mesenteriques, recherchant malposition et spire de torsion, est fondamentale. L’image en « double bulle » est caracteristique d’un obstacle duodenal (atresie, stenose). Devant une occlusion basse, la decouverte echo-graphique d’un microcolon complet traduit un obstacle grele. Au niveau du segment dilate, un meconium adherent a la paroi oriente vers un ileus meconial, une importante distension liquidienne est en faveur d’une atresie. L’ileus du prematurissime est rare. Un colon fonctionnel, uniforme ou avec disparite de calibre, temoigne d’une maladie de Hirschsprung, d’un bouchon meconial ou d’un petit colon gauche. L’indispensable lavement aux hydrosolubles, traite ileus meconial et immaturite colique, et demasque la disparite de calibre brutale d’un Hirschsprung. Le Hirschsprung colique total reste en filigrane de toute occlusion basse. Une peritonite, un epanchement gazeux, un pseudokyste meconial, un volvulus indiquent une chirurgie immediate.

Objectifs Savoir que l’indication d’une IRM digestive repose sur un depistage ultrasonore et une discussion multidisciplinaire. Connaitre la semeiologie IRM du tube digestif normal et des principales malformations. Identifier une complication. Messages a retenir Connaitre la technique IRM (Tl, T2, cine 2D). Connaitre le signal specifique du tube digestif fœtal normal : estomac et anses jejunales en hypersignal T2, intensite croissante de l’hyper-signal Tl des anses ileales au colon. Preciser les avantages de l’IRM dans l’evaluation des malformations digestives : vue d’ensemble, appreciation d’un obstacle complet ou incomplet et de sa topographie, visualisation constante d’un microcolon, orientation etiologique precise. Apprecier les complications et evaluer le pronostic. Resume Toute anomalie digestive fœtale doit faire discuter l’indication d’une IRM. L’IRM constitue la meilleure exploration pour preciser la physiologie digestive (signal specifique de l’intestin grele et ducolon) et les consequences d’une malformation obstructive : localisation precise et nature de l’obstacle (atresie, stenose, volvulus), arguments d’occlusion organique : dilatation d’amont, disparite de calibre avec les anses d’aval, microcolon. L’IRM est indispensable pour preciser le contexte etiologique : etude de la paroi, du contenu, du peris-taltisme, de la localisation, de la taille et des malformations associees pour orienter le diagnostic d’un kyste abdominal ; exploration des anses d’aval dans la recherche d’un atresie multiple ; malrotation, absence de peristaltisme et microcolon dans un syndrome microcolon megavessie ; etude du signal colique dans une malformation anorectale ; tour de spire dans un volvulus. L’IRM est efficace pour preciser une complication (kyste meconial) et evaluer un pronostic pejoratif : cloaque, volvulus, necrose digestive d’un laparoschisis.

Objectifs Reconnaitre a l’echographie les formes pathologiques d’invagination du grele (IG). Materiels et methodes Etude retrospective de 17 cas d’IG en 11 ans chez 16 enfants. Les signes cliniques et echographiques incluant la presence d’une occlusion et/ou de liquide piegee dans le boudin sont rapportes. La zone liquidienne mesuree par ses 2 plus grands diametres a ete classee comme faible (2d 10 mm) ou importante (2d > 10 mm). Resultats Symptomatologie revelatrice : douleurs abdominales et vomissements bilieux (n = 14), douleurs (n = 1) ou aspiration bilieuse (n = 1) post-operatoire, anemie (n = 1), associees a des selles sanglantes dans 3 cas. A l’echographie les IG etaient figees, volumineuses (20-45 mm de diametre A-P, 3-20 cm de longueur) avec une occlusion (n = 15) et du liquide piege dans le boudin (n = 8). Valvule et colon normaux. Dans 7 cas on notait une chirurgie recente (n = 3) ou une affection predisposante (n = 4) (purpura rhumatoide (n = 2), mucoviscidose (n = 1), Peutz-Jeghers (n = 1)). Une lesion primitive (n = 11) incluant un Meckel (n = 5), un polype (n = 2), un lymphome (n = 2) et une metastase (n = 1) a ete identifiee en pre-operatoire (n = 7) ou retrospectivement (n = 4). Deux necroses observees parmi les 3 cas avec une importante quantite de liquide. Deux lymphomes confirmes par des biopsies peripheriques. Conclusion L’echographie permet de differencier les formes pathologiques d’IG des formes transitoires plus petites, peristaltiques, non occlusives et sans lesion primitive.

Resume La synovite aigue transitoire est l’etiologie la plus frequente des boiteries de l’enfant, et son diagnostic est maintenant facilite par la possibilite de detecter par l’echographie un epanchement liquidien dans le recessus anterieur de la hanche, avec une tres grande sensibilite. L’epanchement est le plus souvent abondant (et mesure), anechogene, associe a une radiographie (face et profil) normale, chez un enfant de 2 a 6 ans, apyretique, avec une evolution regressive rapide. Toutefois, epanchement intra-articulaire ne signifie pas synovite aigue. Il peut etre le signe : – d’une arthrite ou osteoarthrite septique (moins de 2 ans ou/et fievre) necessitant une ponction du liquide, – d’une maladie de Legg-Perthes-Calve (Rx souvent anormale, cartilage epiphysaire epaissi, epanchement persistant), – d’une reaction articulaire a une pathologie intra-osseuse (osteomyelite, metastase de neuroblastome, hemopathie, osteome osteoide), – plus rarement d’un glissement epiphysaire (contexte clinique different, Rx pathologique), d’une forme monoarticulaire d’arthrite chronique juvenile (tres rare a la hanche). La suspicion d’un diagnostic autre que « rhume de hanche » fera porter l’indication d’un autre examen d’imagerie (scintigraphie, eventuellement IRM). Enfin la prise en charge therapeutique et la surveillance d’une synovite aigue seront discutees.

Objectifs Evaluer la perfusion parietale des parois du tube digestif, mesuree par IRM injectee dynamique, comme marqueur de l’activite clinique de la maladie. Materiels et methodes La perfusion parietale a ete evaluee par IRM 1,5 T au niveau des anses digestives les plus pathologiques. Pour chaque patient, IRM et evaluation clinico-biologique avec mesure du Crohn Disease Activity Index (CDAI) ont ete realises lors d’une poussee de la maladie avant, puis 2 et 6 semaines apres injection d’Infliximab. Les IRM dynamiques ont ete realisees avec des sequences 3D TFE (TR / TE / FA : 3,3 / 1,66 / 10 ; epaisseur 5 mm ; temps d’acquisition : 180 ms ; debit : 6 cc/s). Les mesures de perfusion ont ete analysees de facon quantitative apres « deconvolution » par la fonction d’entree arterielle. Resultats Quarante-huit IRM ont ete realisees chez 16 patients. Les index de perfusion etaient plus importants en cas de maladie active que lors de la phase de remission post-traitement (index de debit : 0,158 vs 0,1012, delai time-to-peak : 19,4 vs 26,2 ; p : Conclusion La perfusion parietale, mesuree a l’aide de sequences IRM injectees dynamiques, reflete de facon objective l’activite de la maladie de Crohn.

Echoencephalography through the fontanelle provides a complete scan of the head allowing the study of the ventricular system and cerebral parenchyma. The closure of the anterior fontanelle is the only limiting factor for this remarkably innocuous technique which is easy to perform (even in neonates under artificial ventilation in incubators), easy to repeat and relatively cheap. The authors report the results of 700 ultrasonic examinations carried out in 467 children. The echostructure of the brain, is studied in detail in 70 normal subjects (30 prematures, 31 at term neonates and infants under 1 year of age). In a population of 397 sick children the abnormal pictures were analysed according to clinical circumstances: perinatal distress (n = 107), prematurity (n = 81), hydrocephalus (n = 31), malformations (n = 9)... Our results confirm the usefulness of this technique for the early anatomic evaluation of any high-risk brain and for the follow-up of the lesions. The respective values of echography through the fontanelle, transcranial echography and computed tomography are discussed.

Cerebral ultrasound imaging by a transfontanelle approach is now a common investigation during the first year of life. This exploratory procedure is non-invasive, non-irradiating, requires no sedation and can be carried out at the infant's bedside. In addition, the classical apparatus can be completed by deep Doppler allowing deep cerebral vessels to be studied. Three cases are reported of aneurysm of Galen's ampulla detected by ultrasound imaging during the neonatal period. Images demonstrated the presence of an abnormal fluid mass in the region of Galen's ampulla, confirmed as of vascular origin by Doppler, and allowed assessment of degree of subjacent ventricular dilatation and possible secondary ischemic lesions. In massive neonatal forms this exploration may be sufficient since prognosis is poor, but in lesions of moderate size CT scan and angiographic examinations and perhaps MR imaging are required. This technique allows detection of this malformation in the fetus and could therefore influence therapy.

Abdominal tumors in childhood are diagnosed almost always by palpation only, the retroperitoneal localization of these are confirmed by I.V.P. The new gray scale ultrasound machine seem to be very useful in the staging of the masses before the surgical operation. For the correct appreciation of the sensibility of gray-scale ultrasound, 6 Wilm's tumors, 6 neuroblastoma and 1 malignant retroperitoneal fibroma were reviewed. These children were echographied just before the surgical procedure and the surgeon's reports were compared with ultrasonics findings. If the sensibility is good to give measurement of the masse and to establish the situation of the tumor toward the midline of the abdominal cavity, the visualisation of the great vessels was not so obvious. However these hepatic structures were well established in all cases. The renal vein was never seen. At the end of this report it's possible to describe differential echographic findings between Wilm's tumor and neuroblastoma. --A Wilm's tumor is a mass well limited in periphery, confused with the kidney and with a frequent sonolucent rim sign. --A Neuroblastoma is a very irregular tumor well separated of the kidney without sonolucent area in its limit. U.S. made after an I.V.P. is in all cases very useful to surgeons. The two methods with their additional findings make almost always arteriography without interest.

This study concerns a homogenous series of 163 cases of intussusceptions in children, seen in the Visceral Pediatric Surgical Unit of Montpellier from 1974 to 1985. The authors differentiate and compare two periods with regard to the year 1980: the first one (P1 = 64 cases) during which, surgery was always the rule;the current one (P2 = 99 cases) where non operative treatment is the modality of choice under precise conditions. Synthetic analysis and comparison of the different therapeutic groups which have been distinguished in every period lead to the following data. 14% of intussusceptions are directly operated whatever the period or the modality of management probably because this group represents the absolute contra-indications of a barium enema--It concerns children with a long duration of the disease, obstructive or peritonitis signs and late diagnosis--Laparotomy is mandatory and finds a high percentage of leading points and ileo-ileal forms. Intestinal resection was necessary in 59.5% of cases. Because of this and a poor general condition, morbidity was high and Hospital stay was long. 56.4% of intussusceptions are operated after failure of barium enema reduction. This hydrostatic irreducibility is probably explained by the prevalence of ileo-colic forms (53.3%) in this group. A shorter duration of the disease (less than 2 days in 43.1%) and a strong majority of idiopathic intussusception (90.5%) are surely responsible of a high percentage (80%) of successful manual reduction without the need of a resection.(ABSTRACT TRUNCATED AT 250 WORDS)

The authors report a survey of the French Group of Visceral Pediatric Surgery, concerning 985 congenital anomalies of the pyeloureteric junction in 883 children. 67.3% of them are boys. This article stresses the recent improvements in prenatal ultrasonography and diagnosis which is now able to individualize a homogeneous group of asymptomatic children ready to be repaired in the early post-natal period. Early reconstruction is associated with the greatest degree of recovery of renal function. In children, the average age is 4 years 9 months at diagnosis. In 43.6% clinical symptoms suggest an infectious problem. Pain is noted in 35.5% and an abdominal mass is discovered in 13.3%. Excretory urography (IVP), ultrasonography and cystography are still the main investigations to be done in all cases. But it is now necessary to use modern isotopic technics such as DMSA and diuretic DTPA to quantify obstruction with accuracy and follow long-term evolution after treatment. Treatment is surgical and conservative in 81.4%. Almost all of the uretero-pyeloplasties are performed according to the dismembered technic usually with temporary nephrostomy drainage. Renal reduction is reserved only for the redundant and decompensated renal pelvis. Morbidity is low (2.5%) and good results can be expected in about 95% of cases.

Primary ureteral tumors are rare and benign ones constitute only a small portion. Of the benign neoplasms, fibro epithelial polyps are probably the most common and could be considered to be an exceedingly rare cause of Hydronephrosis in children. The exact etiology of benign ureteral polyps is not certain but it is likely that they have a congenital one. They are mesodermal in origin and consist of a thick fibrous stalk covered by a layer of normal transitional epithelium. They are more commonly found in boys (80.6%), who present usually with abdominal pains or renal colics. Fibro-epithelial polyps often rise in the proximal ureter and renal pelvis, especially at the left side (69.4%). Radiographic signs are those of a non typical uretero-pelvic Junction obstruction. IVP and retrograde ureterogram usually demonstrate a long, thin, filiform, lucent filling defect within the ureteral lumen with moderate hydronephrosis. Appropriate treatment of these benign tumors is local excision with or without segmental resection. Prognosis should be considered as excellent without a report of recurrence. A review of the literature revealed 33 cases of ureteral polyps in children. We report here 3 additional cases of obstructing fibro epithelial polyps, observed in boys aged respectively 4, 8 and 9 years.