Ultrasonographic findings in developmental dysplasia of the hip in Iraqi infants

Ultrasound [U/S] is valuable modality for evaluating the hip in infants because it enables direct imaging of the cartilaginous portion of the hip that cannot be seen on plain radiographs. Furthermore, U/S examination enables dynamic study of the hip with stress maneuvering. U/S is the preferred imaging modality which used to study the hip disorders like developmental dysplasia of hip [DDH], because it is sensitive indicator of malposition, instability and lack of acetabular development. U/S accomplishes all of these without exposing the infant to ionizing radiation, not expensive, non-invasive and available. The aim of our study is to determine the effectiveness and sensitivity of ultrasound examination of neonates to confirm the early clinical diagnosis of developmental dysplasia of hip [DDH] especially in the high risk groups of neonates and young infants. We conducted a retrospective review of ultrasonographic imaging in 60 neonates and young infants [36 females and 24 males; age range, 1-9 months, median age, 4 months]. U/S examination of the hip joint were evaluated for, percent bony coverage [PBC], which indicates the percentage of the femoral head that covered by the bony acetabulum, normally, 50% or over of the femoral head should be covered by bony acetabulum. And evaluated for Graf angles, alpha angle which defines the bony acetabulum and normally it is more than 60 degree and beta angle which indicates the cartilaginous development and it is normally less than 55 degree. Also evaluate the femoral head flattening which usually associated with delayed ossification, shortening and anteverting of the femoral neck .DDH is more common in the female patients [F:M = 3:1] Instability and dislocation is usually unilateral, this is seen in 30 patients [50%], [unilateral :bilateral = 3:1]. Left hip is more commonly affected, this is seen in 24 patients [40%],[L:R = 4:1]. Children born by caesarian section are more likely to have associated instability or dislocation of the hip, 10 patients [25%]. First born baby are more affected, 4 patients [10%] and usually these children are more likely to have been breech presentation during their gestation, 14 patients [35%]. Family history of DDH is seen in 6 patients [15%]. The U/S is the preferred modality for evaluating the hip in infants who are younger than 6 months. U/S of infant's hip can be used in the diagnosis of DDH and also in monitoring of treatment or follow-up the improvement in the acetabular maturity and morphology, as well as the location of femoral head can be documented to assist in the guidance of therapy plan

Computed tomography performance in renal cystic diseases

Renal cysts represent notably dilated nephrons or collecting ducts. A cystic kidney is a kidney with three or more cysts. The accuracy of CT diagnosis of typical simple renal cyst approaches 100% but many renal cysts do not fulfill the criteria for simple renal cyst, such lesions vary from simple renal cysts which do not require surgery to renal neoplasms with cystic component that need surgical resection. Contrast-enhanced helical CT scanning has 96% sensitivity and 95% specificity in detecting carcinoma in acquired renal cystic diseases. To confirm the sensitivity, specificity and performance of the spiral computed tomography [CT] in diagnosis and evaluation of the renal cysts and to study the CT criteria which categorize and separate the renal cystic lesions that require surgery [malignant neoplasm] from those that do not. Fifty patients were scanned with spiral CT, 22 of them were males and 28 were females, their ages ranging from 20-70 years with mean age 50 years old, these patients undergo CT examinations with and without contrast enhancing material. All the patients were proved to have renal cysts radiologically and symptomatically. The patients presented with cortical simple renal cysts were 16 patients [32% of all the cases]. Medullary simple renal cyst were found in 9 patients [18% of the total number of cases]. 3 patients presented with autosomal recessive and dominant poly cystic kidney disease [8% of total cases]. 1 case found with cystic kidney associated with tuberous sclerosis [2% of total cases]. Para-pelvic renal cysts are seen in 7 patients [14% of total cases]. Cystic angiomyolipoma [fat density] are seen in 3 patients [6% of total cases]. Acquired renal cystic disease is found in 1 patient [2% of total cases]. Complicated renai cysts [hemorrhagic] are seen in 2 patients [4% of total cases]. Medullary cystic diseases were found in 2 patients [4% of total cases]. Multicystic dysplastic kidney was found in 1 patient [2% of total cases]. Malignant Cystic kidney lesion [cystic renal cell carcinoma] was found in 1 patient [2% of total cases]. Females are more affected than the male, 28 females [56%] while the affected males were 22 [44%]. The more involved age group was between 50-59 years old, they were 15 patients [9 males and 6 females]. The left kidney [34%] is more involved than the right kidney [32%], while both kidneys were involved in [34%] of the cases. The spiral CT scan is the most sensitive imaging modality useful in diagnosis of cystic kidney and it is of valuable importance in evaluation and categorization of cystic renal masses in attempt to separate the lesions that require surgical resection from those do not