Alveolar rhabdomyosarcoma presenting with symmetrical bony and renal metastases in infancy.

Alveolar Rhabdomyosarcoma is a small round cell tumour in which may be radiologically and histologically difficult to differentiate from other small round cell tumours such as lymphoma, neuroblastoma and Ewing's tumours. We report a case in infancy of disseminated alveolar rhabdomyosarcoma with symmetrical renal and bony metastases.

Ultrasonography in the evaluation of neck abscesses in children.

A prospective study evaluating the benefits of preoperative ultrasonography of paediatric neck abscesses is presented. Twenty-three consecutive children who presented with suspected neck abscesses to the Accident and Emergency Department at the Temple Street Children's Hospital between 1990 and 1992 have been evaluated prospectively. On admission, ultrasonography showed a collection of pus in 11 children and these underwent incision and drainage. The other 12 had intravenous antibiotics. Six of these remained pyrexial and had a repeat ultrasound after 72 h revealing pus which was drained. The remaining were managed successfully with medical treatment. In this study there were no negative surgical interventions and we recommend ultrasonography for preoperative evaluation of children with suspected inflammatory neck abscesses.

Sonographic evaluation of the abdomen in Henoch-Schonlein purpura.

This study evaluates the role of ultrasound in the monitoring of abdominal symptoms of Henoch-Schonlein purpura. Clinical and radiological records of patients with gastrointestinal symptoms necessitating ultrasound scans were reviewed. Forty-four patients attended The Children's Hospital, Dublin, between August 1989 and December 1992, 15 (34%) of whom had abdominal ultrasound scans. There were 13 boys and two girls, ranging in age from 3.75 to 13.5 years. Abdominal radiographs in 13 patients did not add any significant information. Ultrasound detected thickened bowel wall in all 15 patients (0.4-1.1 cm), free peritoneal fluid in 10, ileus of affected loops in five, and bowel dilatation in eight. Serial ultrasound examinations in 12 patients followed the progress of bowel involvement, with resolution of mural thickening, return of peristalsis, reduction in ascites and bowel dilatation. There were seven intussusceptions in five patients, measuring 2.18-7.4 cm, which were documented as loose in four (i.e. where air or fluid lay between the intussusceptum and the intussuscipiens). Surgery was performed in three patients in the earlier years of the study; serial ultrasound monitoring has enabled a more conservative approach to be adopted in the latter years of the study. We conclude that ultrasound is the imaging modality of choice in evaluating the bowel manifestations of Henoch-Schonlein purpura. It provides an easy, noninvasive, objective method of monitoring patient progress. It allows direct visualization of bowel involvement and detection of complications such as intussusception. Routine abdominal radiographs are not recommended, unless perforation is clinically suspected.

Isolated single umbilical artery--the case for routine renal screening.

To determine the incidence of silent renal anomalies in infants with isolated single umbilical artery (SUA), all infants with SUA and without other obvious congenital anomalies, identified over a six year period, were screened using renal ultrasonography. Over 35,000 placentas were examined. An isolated single umbilical artery was identified in 112 (0.32%). Nineteen infants had abnormal renal imaging. Eight of 112 (7.1%) had significant persisting abnormalities. Vesicoureteric reflux was found in five infants (4.5%). It is recommended that renal ultrasonography be performed for all infants with isolated SUA.

Ultrasonography to diagnose and exclude intussusception in Henoch-Schönlein purpura.

Abdominal pain is a frequent symptom in the child with Henoch-Schönlein purpura and raises the suspicion of intussusception or perforation. One hundred and fifty two children with a diagnosis of Henoch-Schönlein purpura over 11 years were reviewed. Of these 60 had abdominal pain, 19 gastrointestinal bleeding, and nine were suspected intussusception. Intussusception was confirmed in two of these cases with ultrasonography. Ultrasound is an important tool in the early diagnosis of intussusception complicating Henoch-Schönlein purpura. Where the intussusception appears loose an expectant policy, with careful monitoring, may allow spontaneous reduction. It may also be used in monitoring patients for postoperative recurrence of intussusception, mural haematoma, and uncomplicated intestinal vasculitis with oedema.

Unusually placed oesophageal foreign body.

Oesophageal foreign bodies are common occurrences. A variety of cases have been reported in the past. We present here a unique case of an unusually placed foreign body.

Duplex Doppler sonography for renal artery stenosis in the post-transplant pediatric patient.

Of 60 renal transplant patients who underwent 134 duplex Doppler sonograms, 38 had normal frequency shift profiles and 8 showed only minimal disturbances, within normal post-transplantation limits. Fourteen patients had hypertension and showed a very abnormal profile. In 3 of the 14 the hypertension was controllable medically, and the remaining 11 underwent angiography. Duplex Doppler sonography showed gross turbulence (spectral broadening, bidirectional flow) and high frequency shift confirmed on angiography to represent 50 to 75% main renal artery stenosis in 8 of these 11, and major renal intrahilar vessel stenosis in 2. In the remaining patient, no Doppler signal was found and 95% stenosis was present. In 1 patient with intrahilar stenosis, arterial signals detected in the renal veins indicated the presence of a post-biopsy arteriovenous fistula. One patient with main renal artery stenosis also had a fistula, which was masked by a 70% stenosis. All patients with angiographically proven renal artery stenosis had a distinctive abnormality of the Doppler arterial flow pattern.

Blunt injury to the pancreas in children: selective management based on ultrasound.

Twenty-one children with blunt injuries to the pancreas were treated over a 5-year period. Group I consisted of 12 patients brought to our hospital within 24 hours of injury. Group II included nine patients who were referred to us more than 24 hours after injury following initial treatment at another hospital. Two group I patients died within four hours of admission from other causes. Three had early laparotomy for other injuries. Of these, two had a contusion and one had a complete transection of the pancreas. All recovered uneventfully after appropriate surgical treatment. The remaining seven were all treated nonoperatively. Two had obstructive pancreatitis secondary to duodenal hematomas, three had pancreatic contusions, and two developed pancreatic pseudocysts. All seven recovered completely without operation. In group II, three patients had undergone laparotomy elsewhere. All three had pancreatic contusions. However, only one had appropriate drainage of the injured pancreas; he recovered uneventfully. Two, who were not drained, developed pseudocysts and one of these required surgical drainage by cystgastrostomy. The other six patients in group II presented to our hospital with established pseudocysts. Three of these resolved with nonoperative treatment but three required drainage. Overall, six of ten posttraumatic pancreatic pseudocysts resolved without surgical treatment. The single most useful diagnostic test in the management of these patients was abdominal ultrasound (US). US revealed specific anatomic lesions of the pancreas--contusion, obstructive pancreatitis, or pseudocyst--and provided an objective guide to management. Surgical intervention is not necessary in all cases of pancreatic trauma.

Simplified peripheral arteriography.

Demonstration of both iliofemoral arteries and their peripheral run-off is usually performed either by the translumbar approach, or by placing a pigtail catheter at the aortic bifurcation. A modified version of the old retrograde pressure method, simply using a cannula in one femoral artery, is described. There was considerable saving in materials, personnel and time. This method may once again be the method of choice in a busy radiology department.

Therapeutic arterial embolisation: report of five years' experience.

Therapeutic arterial embolisation was performed in 48 patients. Gelfoam, Oxycel, Bucrylate, Gianturco wire coils and lyophilised dura mater were used. Indications included control of acute haemorrhage, pre-operative vascular reduction, palliation of inoperable lesions, or to render such lesions operable, and elective definitive treatment. The technique was not considered to be of significant value as a pre-operative measure but was successful for the control of haemorrhage, the management of inoperable lesions and as an elective definitive treatment for various unusual lesions. One patient died and three had complications. The choice of occlusive material is discussed and depends upon the nature and vascularity of the lesion and whether short- or long-term occlusion is required.