Pulmonary consolidation and inflammation: inflammatory pseudotumour in young children.

Here we report two children with a pulmonary inflammatory pseudotumour; a rare entity in children, that often initially presents as a pneumonia, but with the possibility of serious consequences if unrecognised and untreated. One of the children presented is 6 months which is extremely young for this tumour. Difficulties in presentation, management strategies and prognosis are described. Certainly, this is a condition that should be considered even in a very young child with an inflammatory condition presenting as a solid lesion in the lung which does not resolve or even progresses.

Ultrasonic diagnosis of separation of the proximal humeral epiphysis in the newborn.

A difficult delivery of a newborn infant may result in a traumatic separation of the proximal humeral epiphysis from the metaphysis through the physis. When the ossification center of the epiphysis is not yet visible radiographically, the correct diagnosis may be missed and the injury may be mistaken for a dislocation or Erb palsy. As a non-invasive diagnostic method, ultrasonography has proved to be a particularly valuable diagnostic tool.

Post-traumatic intrahepatic arteriovenous fistula.

A case is reported where, after multiple stab-wounds in the liver, a large intrahepatic arteriovenous fistula producing portal hypertension, a non-obstructive portal thrombus and chronic cholecystitis have developed. The fistula was closed by catheter embolization with surgical access to the left hepatic artery. Occlusion of the arterial flow at some distance from the fistula was rendered ineffectual by the collateral circulation. Deposition of a tufted steel coil exactly on the site of the fistula resulted in obliteration. The portal thrombus, supposedly developed from haemodynamic alterations, appeared to be resolved in a postoperative angiogram. Angiography and, to some degree, ultrasound B-scanning are indispensable for a timely detection of post-traumatic vascular malformations of the liver.

Intramural diverticulosis of the esophagus.

A description is given of the etiology and pathology of intramural esophageal diverticulosis as so far discussed in the literature. In view of the course and the clinical findings in two young patients in whom this diagnosis was established, it is suggested that intramural diverticulosis develops as a result of a devolopmental disorder in the autonomic nervous system.

Wandering spleen in three children.

Three children with wandering spleen are presented. Liver-spleen technetium99m sulphur colloid scintigraphy is a helpful diagnostic tool that will demonstrate the abnormally located spleen or absent splenic activity when the blood supply is interrupted by a twisted pedicle. The diagnosis can also be made by angiography, but this relatively elaborate procedure is usually not necessary. Absence of the normal ligamentous attachments of the spleen associated with a long splenic pedicle may well be the cause of the wandering spleen and its torsion.

Arterial patterns in the hand and pollicisation.

The arterial pattern of the human hand shows remarkable variations in so called normal individuals. In patients with congenital deformities of the hand there are also be variations based on embryonic disturbances. Therefore, the total pattern is complex. Successful transfer of fingers depends on an adequate blood supply. In some individuals there are variations in the patterns of blood supply which make a finger transfer more risky. Modern angiography makes the study of the arterial patterns of the hand possible. The authors state that angiography is essential in the pre-operative examination of a candidate for finger transfer. Three case histories illustrate this statement.

Osteomyelitis: early scintigraphic detection in children.

The value of scintigraphy in the early detection of osteomyelitis is demonstrated in children who had signs and symptoms suggestive of bone infection. Nine patients between 2 and 13 years of age were evaluated with technetium Tc 99m diphosphonate bone scintigrams and roentgenograms. Blood cultures were performed in all patients, and bone biopsy or drainage was obtained in six patients. The diagnosis of osteomyelitis was made in seven patients; one patient had a subperiosteal abscess surrounded by osteomyelitis, and one patient had cellulitis. The seven children with osteomyelitis had focal increase of radiopharmaceutical uptake in the bone. The child with the subperiosteal abscess had an area of decreased uptake in the center of the abscess surrounded by a zone of increased uptake of the radioactive bone-seeker. The patient with cellulitis had soft tissue changes by X-ray and a normal bone scintigram. In the seven patients with osteomyelitis, the bone scintigram was performed during the early phase of the disease and no bony changes were present on the roentgenogram. In one patient with subacute osteomyelitis, soft tissue changes were seen radiologically. Only three of the seven children with osteomyelitis developed radiological bony changes. Since bone scintigraphy can detect early local bone derangement, it is recommended in the initial evaluation of children in whom osteomyelitis is suspected.

Splenic vein thrombosis with oesophageal varices: a late complication of umbilical vein catheterization.

On the basis of observations made on three infants, a description is given of a late complication of umbilical vein catheterization not hitherto reported. The children showed the symptoms of thrombosis of the splenic vein with secondary splenomegaly and marked gastric and/or esophageal varices, while the portal vein showed no abnormality. The diagnosis was preoperatively established by means of selective angiography of the superior mesenteric artery and the splenic artery. Treatment in these three cases consisted of splenectomy, with good clinical and radiological results.