[Acute abdomen in childhood and adolescence].
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Abdomen, Acute↗
Biomedical subjects
J Tröger
Publications and source records attributed to J Tröger.
[Osteomyelitis during the growth period. Diagnostic imaging].
In acute osteomyelitis of childhood a rapid diagnosis and initiation of antibiotic therapy is necessary in order to prevent late sequelae. Thus, diagnostic imaging plays a crucial role. If acute osteomyelitis is suspected in a child, imaging starts with conventional radiography in order to exclude other differential diagnoses. This is followed by sonography for the purpose of diagnosing a subperiosteal abscess or joint fluid from which the causative organism could be isolated. If the diagnosis is unclear, the next step should be either MRI or 99mTc-MDP bone scan, depending on the possibility of clinical localization and the site of the suspected lesion. MRI is superior to bone scan in depicting the exact anatomy, which is extremely important in spinal osteomyelitis and preoperatively. The bone scan can show the whole skeleton in one examination and should be favored if there is no definite localization or in suspected multifocal osteomyelitis. Rarely scintigraphy with labeled white blood cells is indicated. The 67Ga scan, however, should not be used in children because of the high level of radiation exposure. The different imaging modalities are described in detail and an imaging diagnostic workup is outlined.
Acute Disease↗
Childhood intussusception: management perspectives in 1995.
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Child↗
Muscular involvement in the Holt-Oram syndrome.
Holt-Oram syndrome is an autosomal dominant disorder characterised by radial ray and congenital heart defects. Recently, a gene for this disorder has been identified on chromosome 12q24.1, encoding a T box transcription factor. However, the functional role of the gene product is not completely understood. We present results of neurological, radiological, and muscle magnetic resonance imaging (MRI) investigations in 13 patients from eight unrelated families. Besides heart defects, clinical signs ranged from thenar abnormalities to bilateral phocomelia. The former were present in all patients. MRI showed hypoplasia of discrete muscles which clinically showed as non-progressive weakness. The structural pattern of residual muscles was normal on MRI, which together with normal muscular power, electromyography, and muscle enzyme investigations excluded a progressive neuromuscular disorder. The number and location of hypoplastic muscles correlated with the severity of skeletal involvement. Thus, patients with hypoplasia of large and proximal muscles had phocomelia, and those with mere intrinsic hand muscle hypoplasia had only a triphalangeal thumb or no skeletal malformation. On the basis of these observations, we conclude that disturbed fetal limb muscle development is involved in the bony malformations of the upper limbs.
Adult↗
Bilateral radial deficiency with lower limb involvement.
We describe a 10-month-old boy with an unclassified form of radial aplasia with absent thumbs, tibia hypo/-aplasia, and partial absence of toes. Only a few cases with similar limb deficiencies have been published. We try to classify the malformations on the basis of embryological considerations and discuss possible differential diagnosis.
Adult↗
Ultrasonographic evaluation of the anterior recess in the normal hip: a prospective study on 166 asymptomatic children.
PURPOSE: To redefine the ultrasonographic features of the normal hip joint in children and to establish a normal value for the neck-capsule distance (NCD) of its anterior recess. MATERIALS AND METHODS: 332 hips of 166 asymptomatic children were examined sonographically. In a sagittal section plane the maximum distance between the anterior surface of the femoral neck and the anterior limit of the articular capsule (NCD-A) was measured. RESULTS: The hypoechoic synovial membrane occupying the anterior recess could always be differentiated from the capsule. An additional thin layer of synovial fluid was detected in 12% of probands. The configuration of the capsule varied with different rotation positions of the legs. In small children the mean NCD-A increased from 2.5 mm at 65 cm height to 5 mm at 100 cm height. In larger children the mean NCD-A was 5.5 mm. The mean right-to-left difference was 0.5 mm with a pathological limit of 2 mm. CONCLUSIONS: The pathological limit of the NCD-A increases from 3.5 to 7.5 mm in relation to the height. Sonographic investigation of the pediatric hip joint must include detailed demonstration of anatomical structures to avoid misinterpretations.
Adolescent↗
[Morphometric findings of the healthy pediatric gallbladder in ultrasound].
AIM: Ultrasonographic determination of gallbladder wall thickness, volume and excretion in children. METHOD: In 76 children (1-16 years) we determined the volume of the fasting and stimulated gallbladder by the ellipsoid formula (length X width X depth X 0.523). We also measured the gallbladder wall thickness. Stimulation was performed with a standardised breakfast. RESULTS: We always measured the gallbladder wall thickness 3 mm or less and did not find a difference between fasting and stimulation. There was no correlation between gallbladder wall thickness and status of contraction. The healthy gallbladder should excrete at least 25% of the fasting volume within 1 hour. CONCLUSION: Ultrasound is a suitable method to determine the excretion of the gallbladder. In children standardised meals can be used as stimulus instead of commercial stimulating meals.
Adolescent↗
[Ultrasound of extracerebral spaces in infants: standardized examination technique].
High resolution ultrasound (5/7.5 MHz, linear array) allows imaging of the extracerebral space in infants. A standardised state-of-the-art imaging technique is described that can be performed during routine cranial sonography. Diagnosing dilated subarachnoid space is possible by comparison to normal values. Pathological findings of the subarachnoid and subdural space can be differentiated. Evaluation of the following conditions is possible: external hydrocephalus, cortical atrophy, pyogenic meningitis, subdural hematoma and hygroma. High resolution ultrasound can add helpful information in situations in which magnetic resonance imaging or computed tomography were previously needed. Since it is a noninvasive method, ultrasound is ideal for follow-up studies and hence the method of choice.
Dilatation, Pathologic↗
Diagnostic value of spinal US: comparative study with MR imaging in pediatric patients.
PURPOSE: To assess the diagnostic value of spinal ultrasonography (US) in pediatric patients. MATERIALS AND METHODS: The findings on 38 spinal US scans in 30 patients (mean age, 5.5 months) were compared with those of corresponding magnetic resonance (MR) images. RESULTS: MR imaging showed a normal spinal canal in 14 of 38 examinations, a congenital anomaly in 22, and a neoplasm in two. In 32 of 38 examinations, US allowed exactly the same diagnosis as MR imaging. In five examinations, US depicted the main abnormality, but MR imaging revealed additional findings. In one examination, no consensus was achieved. Whenever US scans were normal, MR images also did not depict any spinal disorder. In all 24 examinations with abnormal MR findings, US enabled detection of the abnormality. CONCLUSION: Spinal US seems to represent a valuable diagnostic tool for congenital anomalies of the lower spine in infants and is recommended as the primary imaging modality in those patients.
Child↗
Case report. Microcephalic osteodysplastic primordial dwarfism type II: a child with unusual symptoms and clinical course.
UNLABELLED: We report on a 13-month old boy with microcephalic osteodysplastic primordial dwarfism (MOPD), whose radiographic signs correspond with type II of this entity. Some of his clinical signs, such as the anomalies of the external genitalia and the urinary tract, are common to this subgroup of MOPD, but he also shows unusual clinical signs including bilateral knee dislocation and hypoplasia of the anterior corpus callosum. His clinical course was unusual with several episodes of breathing difficulties and increased intracranial pressure secondary to craniosynostosis at the age of 16 months. After front-orbital advancement for the treatment of brachycephaly, his psychomotor development improved remarkably. CONCLUSION: MOPD type II may have a wider range of expression than previously delineated.
Abnormalities, Multiple↗
[Computer graphics methods for 3-dimensional imaging of intrapulmonary space-occupying lesions of CT and MRI images].
AIM: To improve the pre-operative planning of interventional procedures in thorax surgery different methods of computer-graphical visualization of intrapulmonary lesions and adjacent anatomical structures based on CT and MR data were realized and compared to each other. DESIGN: In 21 patients with intrapulmonary lesions the image data was segmented by interactive and automatic algorithms and different reconstruction techniques were applied (maximum intensity projection; color-encoded and transparent surfaces; volume rendering). Based on these three-dimensional reconstructions, different views from arbitrary perspectives (including simulated endoscopic images) were generated and animated film sequences of the 3D scene were displayed with 30 frames/second. RESULTS: For all patients under review, a high-quality presentation of the relevant structures was obtained by use of the applied computer-graphical techniques. Even combinations of different visualization methods in one image can be generated with the software we developed. CONCLUSIONS: The various methods for image segmentation allow a fast and comfortable processing even of large data sets. The calculated values of tumor surface and volume can be used for quantitative studies and therapy control. The planning of surgical and interventional procedures can be supported by the simultaneous visualization of the intrathoracic lesion and the surrounding structures.
Aged↗
Intussusception reduction techniques.
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Fluoroscopy↗
Hydrostatic reduction of intussusception under US guidance.
The current nonoperative management of ileocolic intussusception includes hydrostatic and pneumatic reduction, both performed under fluoroscopic monitoring. Recently, a new technique--ultrasound-guided reduction--replaced the conventional approach in our institution. Over a 20-month period, 46 intussusceptions were diagnosed sonographically in 40 patients. In all cases, reduction was attempted under ultrasound guidance by means of a normal saline enema. In 42 cases (91%) reduction was successful and only four patients had to be operated (two resections, two manual reductions). Complications did not occur. This technique permits distinct visualization of the entire process, providing a clear and detailed echogram of the fluid-filled large and small intestine. We established the following definite criteria of reduction: disappearance of the target, demonstration of the ileocecal valve, visualization of the fluid reflux, and fluid filling of small bowel loops. The presented technique for the reduction of intussusception without radiation exposure is reliable and safe, and appears to be one of the most promising methods for the nonoperative treatment of ileocolic intussusception.
Enema↗
[Identification of wood splinters in soft tissues with ultrasound].
Two cases of wooden foreign bodies in soft tissue found by ultrasound are described. Furthermore we proved the existence of a typical sonographic pattern of wood in muscle tissue.
Animals↗
[Child abuse. Important findings in diagnostic imaging].
The radiologist must be familiar with all signs of the battered child syndrome to prevent misinterpretation. Important clinical signs are hematoma at different ages and in uncommon locations. The principle imaging signs are subdural hematoma, brain contusion and multiple skeletal injuries sometimes at different ages. The parents or the persons responsible for care often neglect mentioning an injury. The principle signs are shown and a diagnostic flow chart is presented.
Battered Child Syndrome↗
Localized Langerhans cell histiocytosis of bone: treatment and follow- up in children.
We report a case of Langerhans cell histiocytosis (LCH) involving the right scapula in a 4-year-old child. Because of progressive shoulder pain and immobility methylprednisolone was injected directly into the lesion under computed tomography (CT) guidance. Follow-up studies with magnetic resonance imaging (MRI) and ultrasound (US) revealed continuous ossification of the osteolytic lesion with healing after 6 months. Plain films and CT confirmed the healing process. We consider intralesional corticoid instillation a safe method when performed under CT guidance. For initial evaluation and follow-up, MRI and US yielded reliable results in comparison to plain films and CT, thus helping to reduce the radiation dosage in children.
Administration, Topical↗
Abdominal sonography in the evaluation of heterotaxy in children.
Heterotaxy is a rare congenital disorder characterised by abnormal viscero-vascular situs with either left or right isomerism that usually coincides with complex cardiac malformation. A precise diagnosis must be made for the selection of the most appropriate treatment. The diagnosis and evaluation of these conditions have been dependent on invasive studies such as angiocardiography, although more recently magnetic resonance imaging (MRI) has been advocated. In paediatric patients MRI is far from ideal because of the need for sedation and monitoring during the examination. The authors reviewed the modalities used in the evaluation of heterotaxy with emphasis on the use of ultrasonography, including pulse and colour flow Doppler imaging. A series of 14 children with heterotaxy is presented; ten with left abdominal isomerism (polysplenia) and four with right isomerism (asplenia). Results of abdominal sonography were compared with those of echo- and angiocardiography, surgery and autopsy. Of the ten children with left abdominal isomerism, two had no cardiac abnormalities. All those with right isomerism had a complex vitium. One patient with left abdominal isomerism proved to have right atrial isomerism. Some new reproducible patterns in viscero-vascular derangement are reported. The predictable patterns of left and right isomerism are outlined and atypical features discussed.
Abnormalities, Multiple↗
The post-reduction donut sign.
A donut-shaped intestinal structure in the lower right abdomen, observed during abdominal ultrasound investigation following nonoperative intussusception reduction, may create a diagnostic problem concerning differentiation from a residual or recurrent intussusception or underlying small bowel disease. In 30 cases of ileocolic intussusception an abdominal ultrasound examination was performed after reduction, the success of which was proven by radiological and clinical criteria. More than half of the examinations showed an aperistaltic "donut" in the ileocecal region which was similar to the target sign commonly seen in intussusception. Differentiation was possible according to the following two criteria: first, the diameter of the donut was smaller than that of the original target sign seen in these patients. Second, the donut consisted of a broad hypoechoic rim and an echogenic center, whereas the target was normally composed of multiple concentric rings. One third of the patients showed localized thickening of the walls of the distal ileal loops which did not cause diagnostic problems. All of the suspicious intestinal structures disappeared within the first 5 days following reduction. It is our opinion that the post-reduction donut correlates with significant edema of the ileocecal valve and does not represent a mechanical lead point or persisting residual intussusception.
Female↗