肠旋转不良伴中肠扭转的CT诊断

目的：研究CT对肠旋转不良伴中肠扭转（volvuhus in intestinal malrotation,VIM)的诊断价值。方法：回顾性分析6例手术证实的VDIM的CT表现。男5例,女1例,年龄7～25岁,平均13岁。结果：6例均表现为肠系膜根部类团块影,其中4例见典型“漩涡征”,2例呈类“靶征”,但增强扫描亦出现“漩涡征”。毗邻部肠袢扩张,肠系膜静脉不同程度淤积扩张,2例伴受累系膜、肠壁重度水肿。6例均见系膜根部肠系膜上动脉（superior mesenteric artery,SMA）、肠系膜上静脉（superior mesenteric vein,SMV)血管正常排列迷失。结论：“漩涡征”伴系膜根部SMA、SMV正常排列迷失为本病的特征性CT表现。     

Aluminum bone disease in children: radiographic features from diagnosis to resolution

Two children with chronic renal failure developed aluminum intoxication as a result of long-term ingestion of aluminum hydroxide for the control of hyperphosphatemia. In each child, bone biopsy confirmed severe osteomalacia, the absence of features of hyperparathyroid bone disease, and massive aluminum deposition at the bone-osteoid junction. Radiographs during the period of aluminum intoxication demonstrated osteopenia, pathologic fractures, fraying of the metaphyses of the long bones, and widening of the physis. When aluminum hydroxide therapy was discontinued (each patient) and aluminum was removed with chelation therapy (one patient), radiographs demonstrated a distinctly unusual pattern of healing. Calcification of the long bones began at the most recently formed osteoid and then proceeded toward the diaphysis. This unusual healing pattern created lucent defects and a transient "bone within a bone" appearance, which resolved with further healing.     

Sonographic diagnosis of volvulus in midgut malrotation

We report a case of midgut malrotation with volvulus in an adult diagnosed by ultrasonography, and we present the sonographic appearance of a specific sign of this uncommon anomaly: whirl-like encircling loops of bowel around the abnormal disposed mesenteric vessels.This case is part of an exhibition that will be presented at the European Congress of Radiology, Vienna, Austria, Sep 15–20, 1991 Offprint requests to: D. Casas     

MSCTA在儿童肠旋转不良伴中肠扭转中的诊断价值

目的:探讨MSCT血管成像(MSCTA)在儿童肠旋转不良伴中肠扭转中的诊断价值.方法:回顾性分析经手术证实的11例肠旋转不良伴中肠扭转患儿的临床资料和CT表现,其中男8例,女3例,年龄13天～8岁,中位年龄2.3岁.11例患儿均行CT平扫及增强检查,并采用多平面重组(MPR)、最大密度投影(MIP)、容积再现(VR)技术对图像进行后处理.结果:10例患儿表现为"漩涡征",1例患儿表现为"换位征",6例患儿可见"鸟喙征",5例患儿表现为肠管扩张、积液,4例可见肠壁及肠系膜肿胀,4例可见腹盆腔积液.结论:MSCTA对诊断儿童肠旋转不良伴中肠扭转具有重要价值.     

The difficult diagnosis of cartilaginous tibial eminence fractures in young children

Purpose

Anterior tibial eminence fracture is the main mode of ACL failure in patients with open physes. In young children, purely cartilaginous avulsions of the tibial ACL insertion are possible. The aim of this study was to focus on patients referred for misdiagnosed cartilaginous tibial eminence fractures.

Methods

Ten young patients with cartilaginous tibial eminence fractures were identified in the hospital database. Six of them were misdiagnosed and included in this retrospective case series. Clinical data at the time of injury, radiographs and MRI were analysed in order to evaluate the causes which could have led to inappropriate management.

Results

The patients’ median age at the time of injury was 7 years (5–8.5). The main cause of injury was a low-energy domestic accident (n = 4). Radiographs at the time of injury were normal (n = 4) or showed a very thin ossification (n = 2). The traditional MRI findings of ACL injuries were all negative. On T2 sequences, an epiphyseal fluid signal allowed for a retrospective diagnosis. Cartilaginous tibial eminence fractures were regularly prolonged posteriorly giving a ‘double-PCL sign’ in 4 of the 6 patients. On a median of 6 months (2.5–48) after the injury, patients were referred for repeat giving ways (n = 5) and/or limitation of extension or hyperextension (n = 4). Symptoms were related to non-union, ossification and secondary enlargement of the avulsed fragment.

Conclusions

Post-traumatic knee joint effusions in children aged 9 or younger, even occurring after a low energy trauma and with normal radiographs, should suggest a cartilaginous tibial eminence fracture. Systematic MRI examinations should be mandatory in these patients in whom the avulsed fragment may appear as a double-PCL sign. During follow-up, new radiographs are recommended. A better knowledge of this rare entity should allow us to avoid misdiagnosis and to perform an early refixation of the avulsed fragment.

Level of evidence

III.     

Opportunistic esophagitis in AIDS: radiographic diagnosis

Thirty-five of 90 patients with acquired immunodeficiency syndrome (AIDS) seen between 1983 and 1986 underwent esophagography (double contrast in all but two) to rule out opportunistic esophagitis; 20 of the 35 were found to have fungal or viral esophagitis. A radiographic diagnosis of Candida esophagitis was made in 17 patients because of varying degrees of plaque formation. Seven of those patients had a grossly irregular or "shaggy" esophagus; in four, the diagnosis of AIDS was initially suspected from this finding. In the remaining three patients, a radiographic diagnosis of viral esophagitis (herpes simplex in two and cytomegalovirus in one) was made because of discrete ulcers on a normal background mucosa. Eighteen patients had endoscopic, clinical, or autopsy findings that corroborated the radiographic diagnosis; follow-up data were not available for two patients with Candida esophagitis. This experience suggests that fungal and viral esophagitis can often be differentiated with double-contrast esophagography, enabling appropriate antifungal or antiviral therapy to be instituted without endoscopic intervention.     

Osteoid osteoma: the difficult diagnosis

The diagnosis of osteoid osteoma can be difficult. We present eight children where the diagnosis of osteoid osteoma was difficult, due to a clinical history suggesting an alternative diagnosis, misleading radiological findings, or where the osteoid osteoma was in an unusual site. In some cases, diagnosis was only reached after biopsy, despite radiological investigation and radioisotope studies. The diagnosis should be considered in a child with bony pain or bony swelling, especially where the history is a chronic one. We present a radiological algorithm for the investigation of patients suspected of having an osteoid osteoma.     

Macrodystrophia lipomatosa: radiographic diagnosis.

Macrodystrophia lipomatosa is a rare form of localized gigantism characterized by progressive overgrowth of all the mesenchymal elements with a disaproportionate increase in the fibroadipose tissues. This congenital abnormality occurs most frequently in the distribution of the median nerve in the upper extremity and in the distribution of the planter nerves in the lower extremity. It is usually recognized at birth or in the neonatal period. As the patient grows, the deformity begins to mechanically interfere with joint function, vascular supply, and innervation. Six cases are described with emphasis on the radiographic findings which differentiate this entity from other forms of local gigantism. These findings include a predominately distal involvement, enlargement of the phalanges and soft tissue elements of the digit, and lucencies within the soft tissues.     

Epidermolysis bullosa: radiographic findings in 16 cases

Epidermolysis bullosa is a group of dermatologic disorders with varied inheritance patterns having the common manifestation of blister or bulla formation after minor trauma. Sixteen patients with the disease had the following radiographic manifestations: esophageal stricture (16), fecal impaction (six), vaginal stenosis (one), epithelial bridging and fusion of the digits (six), and aspiration changes in the lungs (two). Esophageal strictures involved the pharynx or cervical esophagus in eight cases and were multiple in five; they ranged in length from 2 mm to 15 cm and tended to progress over time. The findings of esophageal stricture, particularly when multiple and involving the proximal esophagus, and/or the presence of distal phalangeal atrophy with soft-tissue webbing suggest the diagnosis of epidermolysis bullosa.     

Lung torsion: radiographic findings in nine cases

Torsion of the lung, although relatively rare, can occur under three sets of circumstances: spontaneously, usually in association with some other pulmonary abnormality; following traumatic pneumothorax; and as a complication of thoracic surgery. Nine cases of pulmonary torsion were analyzed. The radiographic findings are a collapsed or consolidated lobe that occupies an unusual position at plain radiography, at plain or computed tomography, at angiography, or at bronchography; hilar displacement in a direction inappropriate for that lobe; alteration in the normal position and sweep of the pulmonary vasculature; rapid opacification of an ipsilateral lobe following trauma or thoracic surgery; marked change in position of an opacified lobe on sequential radiographs; bronchial cutoff with no evidence of a mass; or lobar air trapping. Mortality is high if the torsion goes unrecognized and surgical fixation is delayed.     

Ileal endometriosis: radiographic findings in five cases

PURPOSE: To determine the radiographic findings in five patients with ileal endometriosis. MATERIALS AND METHODS: A search of radiology files revealed five patients with surgically proved endometriotic implants in the ileum at enteroclysis (three patients), at small-bowel follow-through (one patient), and at double-contrast barium enema study (one patient). The radiographic findings were reviewed retrospectively. Clinical, surgical, and histopathologic findings were also reviewed. RESULTS: All five patients were nulliparous women (mean age, 34.4 years; age range, 28-41 years). Four patients presented with abdominal and/or pelvic pain, but only one of these four had cyclic pain that coincided with menstruation. Barium studies revealed endometriotic implants in the terminal ileum within 10 cm of the ileocecal valve in four patients and in the mid-ileum in one. The radiographic findings consisted of extrinsic mass effect with variable spiculation and tethering of folds in two patients, annular lesions with spiculated folds and abrupt or tapered borders in two, and a plaque-like lesion in one. In four patients who underwent double-contrast barium enema studies, associated endometriotic implants were found in the rectosigmoid colon. CONCLUSION: Ileal endometriosis usually involves the terminal ileum within 10 cm of the ileocecal valve and manifests as a spectrum of findings on barium studies. Ileal endometriosis should therefore be considered when these findings are present in young, nulliparous women with abdominal or pelvic pain.     

Intestinal anisakiasis: US in diagnosis.

Eighteen consecutive patients with intestinal anisakiasis were studied with high-resolution ultrasound (US) and barium studies. US showed markedly thickened bowel loops associated with luminal narrowing, swelling of Kerckring folds, and decreased peristalsis. A small amount of ascitic fluid around the bowel loops was found, and cytologic examinations of the ascites revealed a dense infiltration of eosinophils. Barium studies demonstrated segmental mucosal edema of the small intestine: The most common site was the distal ileum, and the mean length of the edematous lesion was 19 cm. All patients underwent treatment of symptoms without laparotomy, and their symptoms disappeared by the eighth day after onset. Patients with acute abdominal symptoms should be asked about the intake of raw or undercooked fish. If the above US features are found, the diagnosis of intestinal anisakiasis must be seriously considered to avoid unnecessary surgical treatment.     

Artificial urinary sphincters in children: radiographic evaluation

Use of the artificial urinary sphincter to treat incontinence in children has increased over the past decade. The hydraulic fluid used in this device is radiopaque, and the radiologist is directly involved in its evaluation. Despite advances in design and surgical technique, mechanical failures and other complications occur. Our experience with 34 artificial sphincters implanted in 31 children during 1973-1983 is reviewed, giving a method of radiographic evaluation, diagnostic errors to avoid, examples of sphincter malfunction, and common complications.     

Candida esophagitis: accuracy of radiographic diagnosis

Candida esophagitis was diagnosed radiographically in 106 patients. Endoscopy was performed in 32 of these patients, and the diagnosis was confirmed in 27. The diagnosis was missed radiographically in seven other cases proved endoscopically. Thus, Candida esophagitis was diagnosed on esophagography in 80% (27/34) of proved cases, with five false-positive examinations. Single-contrast technique was employed in nine cases with a sensitivity of 55%, and double-contrast technique was used in 25 cases with a sensitivity of 88%. With double-contrast technique, esophagography appears to be a more accurate method for diagnosing Candida esophagitis than has been suggested in the literature.