Biomedical subjects
Publications and source records attributed to J O Haller.
A case of acute polyhydramnios occurred at 26 weeks' gestation. Prenatal sonography demonstrated a placental chorioangioma. Acute polyhydramnios is clinically distinct from nonacute polyhydramnios and carries a high perinatal mortality rate. As in our case, fetal death often results from complications of prematurity.
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The injury pattern in the child who falls from a height is markedly different from that in the adult, so a different imaging protocol is needed. To help establish such a protocol, the authors reviewed the charts and imaging records of 45 children and infants 12 years of age and younger who had fallen one to six stories. Extremity fractures were the most common injury, occurring in 20 patients. Head injuries (including skull fractures) occurred in 19 patients. Abdominal injuries were present in only one patient. Pneumothoraces were seen in four patients and lung contusions in two patients. Fractures of the pelvis, spine, and os calcis were uncommon. The height of the fall did not enable prediction of either the severity or type of injury. The authors recommend radiography of the cervical spine and chest alone in the initial evaluation of the injured child and greater willingness to obtain computed tomographic (CT) scans of the head in children than in adults. Radiographs of the pelvis, thoracolumbar spine, and lower extremities, as well as CT scans of the head and abdomen, should be obtained on a case-by-case basis, and not according to protocol, as is often the situation in adults.
The radiologic findings in five neonates with choledochal cyst associated with extra-hepatic biliary atresia are described. All five patients (age range, 13-72 days) presented with jaundice and acholic stools. In all four patients who underwent sonographic examination, a cystic structure separate from the gallbladder representing the choledochal cyst was shown. The diagnosis of atresia of the distal common bile duct was made preoperatively in all cases by hepatobiliary scintigraphy. Diagnosis was confirmed by surgical findings and was demonstrated by intraoperative cholangiography in four cases. All patients were successfully treated with surgical intervention within 1 month from the time of diagnosis. Early detection of this rare disorder, which may be distinct from choledochal cyst found in children and adults, is important to prevent fatal complications of biliary obstruction. The combined use of sonography and hepatobiliary scintigraphy can correctly identify this subset of patients with persistent neonatal jaundice and provide valuable information for prompt surgical management.
Fenestrations of the septum pellucidum may be noted in hydrocephalic infants. This finding and its changing image was noted in six premature infants evaluated by neurosonography over time periods ranging from weeks to months. Breaks in the septum were noted to occur from 14 days to 23 weeks after the sonographic diagnosis of hydrocephalus. Some of these fenestrations were noted to increase in size and/or become bilateral over time. The awareness of evolving fenestrations and their late-stage images helps avoid confusion with partial and complete agenesis of the septum pellucidum and their possible associated neuroanatomical abnormalities.
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Four cases are presented in which young girls received radiation therapy to treat childhood malignancies. Subsequently, one breast, which had been included in the radiation field in each case did not develop. This phenomenon has been seen after orthovoltage as well as supervoltage therapy, but is not mentioned in recent diagnostic imaging literature.
The case of a 14-year-old teenager is reported who had large sternoclavicular masses. The young man had chronic renal disease due to chronic glomerulonephritis and had been on hemodialysis maintenance for many years. CT showed the masses to be lobulated with low attenuation septa. Metastatic calcification occurs in various systemic diseases.
Five children with complicated appendiceal inflammatory disease are reported. They presented with nonspecific signs and symptoms, but three had liver abscess and two had inflammation of the portal vein. The inflamed portal vein may act as a conduit to the liver for bacteria, or it may become thrombosed and cause portal hypertension and hypersplenism. In one child, symptomatic portal hypertension developed 10 years after the initial disease. In children, an ultrasonic finding of a focal liver mass of low-to-mixed echogenicity or the presence of low-attenuation areas on computed tomographic scans should suggest the possibility of a hepatic abscess, and the radiologist has a major role in suggesting complicated inflammatory disease of the appendix as the cause. Similarly, when portal vein thrombosis or portal hypertension are found, the radiologist should consider complicated inflammatory disease of the appendix as the cause.
The authors describe radiologic findings in five patients with spontaneous perforation of the common bile duct (a rare disorder). The patients were 5 weeks, 9 weeks, 3 months, 11 months, and 2 1/2 years old at presentation. The most common presenting complaints were jaundice and abdominal distention (due to ascites). Sonographic findings included ascites in three patients, a loculated fluid collection around the gallbladder in two patients, and both in one patient. The biliary tree was undilated in all patients. Results of hepatobiliary scintigraphy definitely demonstrated that intraperitoneal fluid originated from the biliary tract. Intraoperative cholangiography was used to confirm the diagnosis at surgery. All children were successfully treated with surgery. Recognition of these findings on sonograms and subsequent confirmation with scintigraphy are important to prevent delays in diagnosis of a potentially fatal condition.
The authors report three cases of ductus venosus calcification as an additional cause of vascular liver calcification in the newborn. All three infants had umbilical venous catheters. The calcification may be caused by extravasated fluids given through the catheter or by local trauma due to catheter insertion. An obliquely oriented, paravertebral "tram-track" calcification in the right upper quadrant, particularly in a premature infant with a history of umbilical venous catheterization, should suggest the diagnosis of calcified ductus venosus.
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