[Prenatal diagnosis of a giant cystic lymphangioma in the axillothoracic wall]. / Diagnostic anténatal d'un lymphangiome kystique géant de la paroi thoraco-axillaire.

Cystic lymphangiomas are benign malformative tumors of the lymphatic vessels, rare but potentially serious and usually located in the cervical region. The diagnosis is usually easy, but the treatment is sometimes difficult because of their location and extension into the surrounding tissue. We report a case of giant cystic lymphangioma of the right axillary-thoracic wall diagnosed by prenatal ultrasound at 20 weeks gestation. The male infant was born at 37 weeks gestation with a large, swelling, lateral parietal right chest. Ultrasound soft tissue and chest CT scan confirmed the diagnosis of giant cystic lymphangioma of the right axillary-thoracic wall. Surgical excision was performed on the 21st day after birth and the mass was excised incompletely. The postoperative course was uncomplicated. Ultrasound soft tissue follow-up showed the persistence of multiple cystic structures in the axilla. Prenatal diagnosis of these tumors is essential for planning multidisciplinary management in early postnatal care.

[Esophageal strictures in children with epidermolysis bullosa]. / Sténoses œsophagiennes de l'épidermolyse bulleuse.

UNLABELLED: Esophageal stricture is a rare but often severe complication of recessive dystrophic epidermolysis bullosa in children. The purpose of the study was to review this digestive complication with emphasis on diagnostic modalities and therapeutic management. PATIENTS AND METHODS: This was a retrospective study of two pediatric cases of esophageal stenosis that occurred during generalized recessive dystrophic epidermolysis bullosa of the Hallopeau-Siemens type. RESULTS: The 2 patients were aged 8 years 8 months and 11 years 5 months, respectively. Dysphagia was of early onset, before the age of 10 years in both cases. Esophageal opacification led to the diagnosis of esophageal stenosis located in the upper 1/3 of the esophagus in 1 case and at the junction between the middle and the lower 1/3 of the esophagus in the other case. None of the 2 patients received medical treatment, and pneumatic dilation was the treatment method that was advocated. Esophageal endoscopy showed the stenosis and helped guide the positioning of the balloon catheter. These patients underwent 2 and 3 sessions of dilation, respectively, at intervals of 2 months and 1 year. Balloon dilation has allowed the patients to have a more comfortable life with decreased dysphagia and a substantial improvement in nutritional status. However, this improvement was transient (1 patient had symptomatic recurrence of stenosis after 3 years), which shows that monitoring of the patients and the resumption of dilatation sessions may be necessary. CONCLUSION: Esophageal strictures in dystrophic epidermolysis bullosa of the Hallopeau-Simens type are severe and difficult to support. Pneumatic dilatation is the treatment of choice for the fragile esophagus. It gives satisfactory results and can be repeated without significant risk.

[Retrovesical hydatid cyst in children: report of 3 cases]. / Le kyste hydatique rétrovésical chez l'enfant: à propos de trois cas.

Retrovesical hydatid cyst is rare, even in endemic regions. From a presentation of three cases, the authors will review the clinical findings and illustrate the imaging features of this pathology and relate diagnostic and therapeutic difficulties.

[Cystic echinococcosis in children in Tunisia: fertility and case distribution of hydatid cysts]. / L'échinococcose hydatique de l'enfant en Tunisie: fertilité et localisation des kystes.

Cystic echinococcosis, which commonly starts during childhood or adolescence, is a serious problem of public health in Tunisia. For 121 children (161 cysts), the localization and fertility of cysts as well as viability of their protoscoleces were determined. Results indicated that the lung was the primary localization of cyst (59%) followed by the liver (35%). Children's infection is more frequent in male than in female (sex ratio 1.96) and the greatest number of cases is observed in the 4-9 year age groups (94 cases). The fertility of the cyst was independent of its site or its size and no incidence of age of children was detected. Nevertheless, the fertility rate is higher in females than in males for the liver localization.

Genetic differences between Tunisian camel and sheep strains of the cestode Echinococcus granulosus revealed by SSCP.

Ovine and dromedary Echinococcus granulosus isolates from Tunisia were identified as G1 and G6 strains based on polymorphism of the mitochondrial cytochrome C oxydase CO1. Single strand conformation polymorphism (SSCP) was used in order to examine the genetic variation within and between Tunisian G1 and G6 strains and to estimate the extent of selfing. The dromedary isolates are genetically distinct from sheep isolates (high value of genetic variation between populations: Fst= 0.46). No significant deficiency in heterozygotes was found in sheep isolates, whereas heterozygote deficiency (suggesting selfing) was found in a limited number of camel isolates.

[Omental lipoblastoma: a case report]. / Lipoblastome omental: à propos d'un cas.

Lipoblastoma is a rare benign neoplasm of foetal fat tissue. To our knowledge, less than ten cases of omental lipoblastoma have been reported in the literature. We present a new case of omental lipoblastoma in a 3-month old girl. The role of CT in the diagnosis and surgery planning of this tumor will be discussed.

[Imaging of pulmonary hydatid cyst in children]. / Imagerie du kyste hydatique du poumon chez l'enfant.

PURPOSE: We present the various imaging features of pediatric pulmonary hydatidosis based upon a series of 232 cases. The importance of chest radiographs and thoraco-abdominal ultrasound is emphasized. PATIENTS AND METHODS: A retrospective study of 232 children with pulmonary hydatidosis is presented. The 232 cases (130 boys and 102 girls, age range: 18 months to 14 years) were studied between January 1982 and December 2001. Chest radiographs were available in all cases, chest ultrasound in 156 cases and abdominal ultrasound in 212 cases. CT was only performed in 40 cases. Surgery was performed for all patients. Diagnosis was confirmed with serology tests and/or pathological study of resected cysts. RESULT: The total number of pulmonary cysts detected on chest radiographs was 344. The right lung was more frequently affected than the left (208 lesions). A simple cyst was the most commonly observed lesion (220 cysts). Complicated forms were noted in 118 cases. 180 cysts were observed at ultrasound. A simple cyst presenting as an anechoic mass was noted in 140 cases. In 38 cases, the lesion was heterogeneous. In two lesions endocystic germinal membranes were detected. CT visualized 50 lesions. Thirty three lesions were complicated with endocystic floating or collapsed membranes. Bronchiectasis was observed in seven cases. CONCLUSION: Chest radiographs and thoraco-abdominal ultrasound are very useful for the diagnosis of pulmonary hydatidosis and evaluation of lesion extension. CT is useful for diagnosis of atypical or complicated lesions and to detect bronchiectasis.

Molecular evidence of ovine (G1) and camel (G6) strains of Echinococcus granulosus in Tunisia and putative role of cattle in human contamination.

Three hundred and seventy-two cysts coming from 50 humans, 166 cattle, 153 sheep and 3 camels were collected in order to establish some epidemiological molecular information in Tunisia for the first time. The analysis by PCR-RFLP of ITS1 sequence showed that all the human, ovine and bovine cysts were due to the common sheep strain of Echinococcus granulosus. The sequencing of the CO1 gene of 37 isolates confirm the G1 genotype of this strain. For seven of these isolates, we found the mutation C56T which is present in the three principal intermediate hosts: human (three cysts), cattle (three cysts) and sheep (one cyst). With regard to the G1 genotype, we identified three other point mutations. The camel strain G6 is uniquely found in the three camels isolates and not in the other intermediate hosts analysed. The fertility of the bovine cyst represents 48% that means that this host is involved in a bovine-dog cycle and consequently represents a reservoir of sheep strain in Tunisia. Our results confirm the importance of the prophylaxis measures in order to disrupt the cycle of transmission sheep-dog in Tunisia. Nevertheless, the supervision of bovine infection should be reinforced because this intermediate host may constitute an important link with the human contamination.

Genetic relationships between sheep, cattle and human Echinococcus infection in Tunisia.

Allozyme variation at seven polymorphic loci (GPI, EST, MDH, MPI, DIA, PEP, PGM) was studied to examine genetic variation within and between sheep, cattle and human populations of Echinococcus granulosus in Tunisia. A high degree of genetic similarity was shown between the cysts of the three host origins. Nevertheless, whereas, the ovine and human samples were highly similar, the cattle samples were slightly different genetically. We conclude that humans are mostly infected by parasites originating from sheep liver. The intense deficiency in heterozygotes was partly artefactual (Wahlund effect) and partly due to self-fertilisation.

Balloon dilatation of anastomotic strictures secondary to surgical repair of oesophageal atresia.

The purpose of this study was to evaluate the efficiency and safety of oesophageal balloon dilatation in strictures secondary to surgical treatment of oesophageal atresia in 25 children. Patients comprised 15 males and 10 females, aged 1-36 months. Median age was 4 months (interquartile range (IQR)=19). The strictures were more than 50% of oesophageal lumen and the delay from surgical treatment to balloon dilatation varied from 1 month to 36 months. Associated gastroesophageal reflux was noted in 15 patients. All procedures were performed under sedation using fluoroscopic guidance. Balloons of increasing diameter, 4-20 mm were used. Water soluble contrast swallow was performed after each dilatation session. A total of 115 balloon dilatation sessions were performed with a range of 1-14 procedures per patient (median 4 dilatations, IQR=4.5). Dilatation relieved the stricture in all patients over a follow-up period varying from 4 months to 33 months. The best results were noted in children under 6 months, who needed two or few dilatation sessions, with relative risk (RR) of 0.52 and 95% confidence interval of 0.29-0.92. The presence of associated gastroesophageal reflux indicated a high risk (RR of 12, p<0.001) for undergoing more than two balloon dilatation sessions. The only serious complications observed were two cases of oesophageal perforation, which were treated conservatively. Fluoroscopically guided balloon dilatation is a safe and effective treatment in the management of strictures secondary to surgical repair of oesophageal atresia, especially when started early (within 6 months of surgery) and not associated with gastroesophageal reflux.

Intrahepatic spontaneous portosystemic venous shunt: value of color and power Doppler sonography.

Spontaneous portosystemic venous shunts (SPVSs) within the hepatic parenchyma are rare. Fewer than 50 cases have been reported, and most of them were diagnosed by angiography. We present a case of SPVS diagnosed by color Doppler sonography in a 5-year-old boy admitted for bleeding due to rupture of esophageal varices. Conventional color and power Doppler sonography as well as CT showed a large shunt between the posterior branch of the right portal vein and the inferior vena cava. We believe that accurate diagnosis and follow-up of SPVS can be done with color Doppler sonography without resorting to angiography.

[Subcapsular hematoma complicating acute pyelonephritis]. / Hématome sous-capsulaire compliquant une pyélonéphrite aiguë.

Spontaneous subcapsular renal hematoma is rare and essentially associated with malignant, or benign tumor vascular diseases, inflammatory processes. In few cases, no cause was detected. We observed one additional case in a diabetic women. She presented fever, and bilateral flank pain. Ultrasonography showed bilateral subcapsular hematoma. Computed tomography confirmed these findings and demonstrated multiple area of acute focal pyelonephritis.

[Primary psoas abscess in children: 6 cases]. / Les abcès primitifs du psoas chez l'enfant: six cas.

BACKGROUND: Primary psoas abscess is very rare in childhood; its diagnosis and treatment can be improved by the use of recent imaging techniques. PATIENTS: Six children, aged 11 months to 10 years (mean: 51 months) were admitted from January 1987 to 15 December 1993 because they suffered mainly from fever, lumbar pain and/or homolateral flexed hip. Examination showed a painful inguinal mass in five patients and hyperleucocytosis in all. X-rays showed disappearance of the external limit of psoas in two patients; ultrasonography showed enlarged psoas in all, associated with hypoechogenic mass in two and without echo in four patients. CT scan showed the abscess in all cases, permitting a needle aspiration for bacteriological studies: Staphycococcus aureus was present in five cases. Drainage of the abscess by CT-guided percutaneous catheter was performed in two patients. Surgical drainage was performed in three including one for whom percutaneous catheter drainage did not succeed. The two other patients were only given antibiotics. CONCLUSION: CT-guided needle aspiration to establish presence and nature of fluid collection is a well established technique that may be extended to treatment of psoas abscesses.

[Posterior vertical lumbotomy in pediatric practice. Apropos of a series of 294 cases]. / La lombotomie verticale postérieure en pratique pédiatrique. A propos d'une série de 294 cas.

The study involves 294 cases. Essentials indications of posterior approach were for pelvic stones or lumbar ureteral stones 198 cases. Theres used this approach for abnormalities in the uretero-pelvic-jun (32 cases) and some staghorn srones (24 cases). The lateral posterior vertical lumbotomy passesses the advantage over classical lateral lumbotomy of being less disturbing to muscle, being less painful postoperatively stay.