We report two children who developed hypersensitivity reactions of varying severity following barium meal examination, the more severe of which was associated with documented severe food allergy. For children with this risk factor, contrast studies should be performed only where facilities and personnel are available for immediate resuscitation of all sizes of child. For children such as these, consideration should be given to the use of pure barium sulphate.

BACKGROUND:Despite having appropriate sonographic equipment available many radiologists remain unfamiliar with B mode sonography of the eye.OBJECTIVE:This article reviews the advantages and disadvantages of B mode sonography of the paediatric eye. We illustrate the spectrum of eye abnormalities occurring in paediatric practice and the sonographic appearance of clinical entities for which sonography is appropriate.MATERIALS AND METHOD:We reviewed our experience of eye sonography within a paediatric radiology department over 8 years. A total of 212 sonographic examinations were performed on 206 eyes in 103 children, aged from 3 days to 16 years (mean 4.6 years).RESULTS:Sonography was well tolerated by the children, was a very useful imaging modality and was the only diagnostic imaging modality required in 94%. Supplementary computed tomography (CT) was performed in ten of 206 eyes (5%) and magnetic resonance imaging (MR) was performed in two of 206 eyes (1%).CONCLUSIONS:B mode sonography is a very useful imaging modality for suspected ocular or orbital pathology in children and is often the appropriate first line investigation following clinical evaluation. Radiologists familiar with sonography of the eye can provide valuable support to their ophthalmology colleagues.

HomeRadioGraphicsVol. 15, No. 6 PreviousNext Pediatric case of the day. Chordoma of the clivus.K J Poskitt, M A Sargent, M G Norman, A M Fink, D A StringerK J Poskitt, M A Sargent, M G Norman, A M Fink, D A StringerK J PoskittM A SargentM G NormanA M FinkD A StringerPublished Online:Nov 1 1995https://doi.org/10.1148/radiographics.15.6.8577974MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Article HistoryPublished in print: 1995 FiguresReferencesRelatedDetailsCited BySkeletal Radiology, Vol. 50, No. 7British Journal of Neurosurgery, Vol. 25, No. 4Journal of Neuro-Oncology, Vol. 98, No. 1Recommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 15, No. 6 Metrics Altmetric Score PDF download

Acute gastric volvulus (GV) is a rare pediatric emergency that requires prompt surgical detorsion and gastropexy. In order to clarify the clinical and radiologic features of GV, we reviewed eight cases seen over the past 7 years. The symptoms could be classified as acute, chronic, or intermittent, and included a spectrum of gastrointestinal (GI), respiratory, and nonspecific symptoms. When GV was acute or intermittent, the diagnosis was made on the characteristic appearance of plain abdominal radiographs, whereas in chronic GV an upper GI series was most useful. Endoscopy confirmed or suggested the diagnosis in four cases of intermittent or chronic volvulus. Anterior gastropexy was performed in five patients, gastrostomy in two, and gastroduodenostomy in one. None have recurred over 1 to 7 years of follow-up. Intermittent GI or respiratory symptoms of GV may make the diagnosis difficult. Plain abdominal radiographs, upper GI series, and endoscopy aid the diagnosis. Prompt gastric decompression and anterior gastropexy is the recommended treatment.

OBJECTIVE The purpose of this study was to determine if the frequency of vesicoureteric reflux on voiding cystourethrography in children with a history of urinary tract infection varies according to the specialty of the physician requesting the examination. MATERIALS AND METHODS The study included 309 children (192 girls, 117 boys) with a history of urinary tract infection who had their first voiding cystourethrogram. The median age at first voiding cystourethrogram in boys was 12 months; in girls, it was 48 months. The reports of these examinations were retrospectively reviewed, and the presence of vesicoureteric reflux was recorded. The age and sex distribution of children referred for voiding cystourethrography by pediatric urologists and nephrologists (subspecialists) was compared with the age and sex distribution of children referred by pediatricians, family practitioners, and adult urologists (other clinicians). The rate of detection of vesicoureteric reflux was calculated according to age and sex. Ages studied were younger than 1 year, younger than 2 years, 2-4 years, and 5 years or older. The frequency of vesicoureteric reflux in children referred by subspecialists was compared with the frequency in children referred by other clinicians, allowing for the age and sex of the children. RESULTS The sex distribution of children referred for voiding cystourethrography was similar for subspecialists and other clinicians. More children younger than 2 years old were referred by other clinicians than by subspecialists. Vesicoureteric reflux was found in 30% of boys and 29% of girls. The frequency of reflux in boys did not change with age. The frequency of reflux in girls 5 years or older (15%) was less than in younger girls. We found no significant difference between the rates of reflux in boys and girls within the age groups examined. The overall rate of detection of reflux in patients referred by subspecialists (30%) was almost the same as that in patients referred by other clinicians (29%). We also found no difference in the frequency of reflux in children referred by subspecialists compared with children referred by other clinicians after allowing for the age and sex of the children. CONCLUSION In children with a history of urinary tract infection, the rate of detection of vesicoureteric reflux on voiding cystourethrography is independent of the specialty of the physician requesting the examination.

HomeRadioGraphicsVol. 15, No. 4 Previous Pediatric case of the day. Infected fourth branchial pouch sinus with an extensive complicating cervical and mediastinal abscess and left-sided empyema.M J Murdoch, J A Culham, D A StringerM J Murdoch, J A Culham, D A StringerM J MurdochJ A CulhamD A StringerPublished Online:Jul 1 1995https://doi.org/10.1148/radiographics.15.4.7569124MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Article HistoryPublished in print: 1995 FiguresReferencesRelatedDetailsCited ByPosterior Mediastinal Mass: An Uncommon Presentation of a Branchial Cleft CystWendolin JOrtiz, Elva CAhumada, Olivaldo LPaz-Moreno, Robert LMcKowen, MarioCervantes2022 | CureusFourth branchial pouch or cleft anomaliesJaimeDoody, LindsaySobin2017 | Operative Techniques in Otolaryngology-Head and Neck Surgery, Vol. 28, No. 3Residual Fistula of Fourth Branchial Arch Anomalies and Recurrent Left-Side Cervical Abscess: Clinical Case and Review of the LiteratureBasselHallak, SalimBouayed, CrispinLeishman, KishoreSandu2014 | Case Reports in Otolaryngology, Vol. 2014Management of congenital fourth branchial arch anomalies: a review and analysis of published casesKeyvanNicoucar, RolandGiger, Harrison G.Pope, ThomasJaecklin, PavelDulguerov2009 | Journal of Pediatric Surgery, Vol. 44, No. 7Fourth Branchial Cyst Presenting with Neonatal Respiratory DistressTzer-ZenHwang, Yuh-JyhLin, Sen-TienTsai2000 | Annals of Otology, Rhinology & Laryngology, Vol. 109, No. 4Recommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 15, No. 4 Metrics Altmetric Score PDF download

One hundred consecutive patients being investigated for scoliosis were studied using a double cassette containing a conventional film screen and a stimulable phosphor plate. The images were separated, randomised and scored thrice by three radiologists for anatomic structure visualisation. The exposure to the plate and film and repeat rate were measured. Scoliosis angles were comparable on both sets of images, however, visualisation of vertebrae, vertebral end plates, pedicles, spinous processes and other structures were significantly improved (p < 0.0001). Intra- and inter-observer reliability was high with good intraclass correlation. There was a 40% potential exposure reduction, and retakes were decreased from 3 to 0%. We conclude that stimulable phosphor images give better anatomic structure visualisation with potential radiation exposure reduction and lower repeat rate.

This report describes an intraosseous maple branch fragment which presented on initial radiographs as a benign appearing lytic bone lesion. Sonography and CT confirmed the presence of intraosseous and intra-articular foreign body and chronic foreign body reaction.

At The Hospital For Sick Children, the use of air has recently replaced the use of barium in the reduction of intussusceptions. The purpose of this study was to review the results from 200 consecutive patients with intussusceptions, 100 patients treated with barium enema and 100 patients treated with air enema. The groups were similar with regard to sex, average and median ages, and presenting symptoms and signs. Successful reduction was achieved in 75% of episodes of intussusception treated with barium enema and 76% treated with air enema. Failure of either modality showed a high association with the presence of either a lead point or an ileoileal or ileoileocolic intussusception. Among those cases of unsuccessful reduction, operation was performed in all 59 cases; resection in 30 cases, manual reduction in 19, and spontaneous reduction was found in 10. There were three perforations during attempted reduction with barium and two with air. All perforations were treated by resection and primary anastomosis. There were 18 recurrent intussusceptions following barium enema reduction and nine following air enema reduction. Therefore, with the lower absorption of x-rays by air and the relatively inert nature of air (compared with barium in the event of a perforation), we feel that air enema is the treatment of choice in the initial management of intussusception.

Multiple cardiac rhabdomyomata were discovered on necropsy tissue review of a previously well child with megacystis-microcolon-intestinal hypoperistalsis syndrome, who died unexpectedly at home at 40 months of age. Multiple cardiac rhabdomyomata occur rarely and have not previously been reported with this syndrome. They are most frequently associated with tuberous sclerosis. The finding of multiple cardiac rhabdomyomata in this patient suggests the possibility that these two rare conditions may be associated. Putative gene loci for tuberous sclerosis have been assigned to the long arms of chromosomes 9 and 11 and it is possible that the cardiac rhabdomyomata seen in this patient are a serendipitous indicator of the location of the megacystis-microcolon-intestinal hypoperistalsis gene.

Eight children with mucopolysaccharidosis I (MPS I), representing 33% of all children with MPS I seen at our institution during an 18-year period, developed hypertension. Five of these hypertensive children also exhibited symptoms of aortic coarctation. The radiographic evaluation of four of these children with MPS I (three with Hurler syndrome, MPS I H, and one with Scheie disease, MPS I S) and arteriopathy affecting the thoracic aorta, abdominal aorta, and visceral and renal arteries is presented. Hypertension developed in all four children before they were 4 years old; three had differences between upper- and lower-extremity blood pressures. Irregular narrowing of the abdominal aorta with either multiple minor asymmetric wall lesions (n = 2) or abrupt concentric narrowing (n = 2) was present in all children as shown by aortography (n = 3), sonography (n = 3), MR imaging (n = 2), and/or autopsy (n = 1). A variety of other vessels also were involved, including the ascending aorta (n = 1) and vertebral (n = 1), axillary (n = 1), intercostal (n = 2), lumbar (n = 2), mesenteric (n = 3), renal (n = 2), and iliac arteries (n = 3). Autopsy in one child demonstrated thickened heart valves, narrowing of the coronary arteries, and irregularity of the aorta due to deposition of mucopolysaccharide material within the intima. Our series demonstrates various facets of the arteriopathy of MPS I as shown by sonography, MR imaging, and angiography.

To assess the sonographic frequency of simple renal cysts in children, the authors retrospectively reviewed the results of abdominal sonographic studies of 16,102 children performed over a 5-year period between January 1, 1985, and December 31, 1989. Patients with abnormal renal function, dysplastic kidneys, or a family history of polycystic kidney disease were excluded from the study. The authors' review of the sonograms revealed 37 simple cysts in 35 patients (0.22%); the cysts were evenly distributed by age and sex and measured from 0.3 to 7.0 cm in maximum diameter. Sixteen cysts (43%) were in the upper pole of the right kidney. Follow-up sonographic studies of 23 cysts in 22 patients for up to 5 years showed no change in size in 17 cysts (74%). The largest cyst was drained percutaneously; all other cysts were managed conservatively. No patient showed deterioration of renal function. Therefore, the authors concluded that in a pediatric patient demonstrating normal renal function, no further intervention is necessary when a simple renal cyst is identified at sonography.

A 15-year-old boy had lymphoblastic lymphoma of the left tonsil after being treated for bilateral Wilms' tumor (BWT) at 7 months of age. In addition, a fully differentiated Wilms' tumor was diagnosed in the remaining, partially nephrectomized left kidney. Development of second malignancies in patients with a history of BWT, as compared with those with unilateral Wilms' tumor, is discussed. A possible explanation for the concurrently diagnosed, fully differentiated Wilms' tumor in the remaining left kidney is suggested.