Auteur(s) : Leila Kanafi1, Catherine Tauzin2, Barbara Bonnefoy1, Ramuntxo Arotcarena1, Philippe Berthelemy1, Alexandre Pariente1 1Unite d’hepatogastroenterologie, centre hospitalier de Pau, boulevard Hauterive, 64046 Pau cedex, France 2Service d’imagerie medicale, centre hospitalier de Pau, boulevard Hauterive, 64046 Pau cedex, France La periode d’attente de la transplantation hepatique est souvent fertile en complications, parfois generatrices de difficultes diagnostiques [...]

BACKGROUND:The diagnosis of occult elbow fracture in children is often challenging due to equivocal or negative repeated radiographic findings.OBJECTIVE:To evaluate the potential diagnostic role of US in children who have sustained elbow trauma with an elbow joint effusion but no fracture seen on initial radiographs.MATERIALS AND METHODS:The study included 14 consecutive children (age range 5-15 years) with elbow trauma whose elbow radiographs showed an effusion without fracture who underwent emergency imaging (within the first 72 h) with US and MRI. The aim of US was to demonstrate a lipohaemarthrosis in relation to a cortical fracture. MR imaging was used as the reference to differentiate fracture from bone or muscle contusions.RESULTS:In seven children US demonstrated a lipohaemarthrosis, and MRI demonstrated a cortical fracture in all these children. Conversely, among the seven children with simple haemarthrosis seen on US, MRI did not identify a cortical fracture in six and demonstrated a cortical fracture in one.CONCLUSION:Posttrauma elbow joint effusion in children is not always related to a cortical fracture. US appears to be a reliable, accurate, widely available and effective low-cost tool in these cases. The diagnostic clue is the detection of a lipohaemarthrosis in the articular recess.

The authors report the case of a 14-year-old boy with complete isthmic rupture of a horseshoe kidney after a bicycle accident. The imaging diagnosis was difficult because of the presence of a massive retroperitoneal haematoma. However, sonogaraphy and CT should be sufficient to detect associated signs, such as malrotation of the renal hila and low-lying kidneys. Laparotomy was indicated because of the unstable haemodynamic state, allowing haemostasis and suture of the two isthmic Sections.