Iatrogenic mediastinitis in bronchiolitis: Importance of avoiding pharyngeal aspiration.

An 11-month-old infant was hospitalized for his first episode of severe bronchiolitis, with pneumomediastinum on the chest x-ray performed in the emergency room before hospitalization. After a few days, the occurrence of a feverish torticollis motivated a CT scan, revealing mediastinitis. An iatrogenic perforation was objectified in the posterior wall of the esophagus, probably caused by nasopharyngeal aspiration. This exceptional case has never been reported before, except in premature infants. This encouraged us to report this case to change systematic aspiration practices and prefer nasal suctioning in healthy infants with bronchiolitis presenting to the emergency department.

[Diagnosis of local recurrence after conservative treatment of breast cancer. A comparative study of a series of 50 cases]. / Diagnostic des récidives locales après traitement conservateur du cancer du sein. Etude comparée d'une série de 50 cas.

In order to determine the diagnostic features of recurrences after conservative treatment of breast cancer, 100 files have been studied. Fifty cases of glandular recurrence have been analysed and compared to 50 control cases of same stage, age and follow-up, without recurrence. In 58% of cases, the diagnosis was established during the course of a visit requested by the patient. In 84% of the cases the recurrence was found to be within the tumorectomy zone. The significant glandular pains, mammary density and deformation, nipple retractions and the radiological evidence of microcalcifications and irregular opacities seem to be strongly indicative of recurrence. The simultaneous clinical and radiological expression of recurrence was not noted in more than 52% of cases.

Spontaneous hematoma of the kidney simulating a nephroblastoma. Report of two cases.

The International Society of Pediatric Oncology (SIOP) 6 clinical trial for Wilms' tumor (WT) includes preoperative chemotherapy for all nonmetastatic patients. Approximately 50% of patients treated in this manner can be classed stage 1 after surgery. This strategy requires a positive diagnosis in the absence of histologic data. Diagnostic errors are very rare: Only 1.5% of the first 856 cases entered in the SIOP 6 trial were found to be benign. This article reports two very similar cases of spontaneous hematoma of the kidney that were initially misdiagnosed as hemorrhagic WT. Unusual severe acute anemia was a feature of both cases. Even the most modern state-of-the-art imaging techniques were unable to rule out the possibility of a tumor subjacent to a voluminous renal hematoma. The patients' courses during preoperative chemotherapy were of no formal diagnostic value, and the correct diagnosis was not made until surgery.

MR imaging of the posterior hypophysis in children.

The posterior lobe of the pituitary gland was studied by MR imaging in 30 children without pituitary gland disease and compared with studies from a group of 13 children with central diabetes insipidus, including eight cases of primary diabetes insipidus and five cases of diabetes insipidus secondary to suprasellar tumors (four proved germinomas, one still unknown tumor). Two components in the sella turcica were identified in all 30 children without pituitary gland disease, and the posterior lobe was identified as a high-intensity structure on T1-weighted images. In all 13 patients with diabetes insipidus, the normal hyperintense signal of the posterior hypophysis was absent on T1-weighted images. Three patients with suprasellar tumors presented with a progressively enlarging pituitary stalk on follow-up. Our findings show that absence of the normal hyperintense signal of the posterior lobe is closely related to a loss of function of the neurohypophysis. Size or signal modification of the pituitary stalk should suggest the development of a suprasellar tumor.

MRI study of lumbosacral lipoma in children.

The authors report 16 cases of lumbosacral lipoma in children studied by MRI. The exact position of the cord and its relationship to the lipoma were well demonstrated in all cases but one. There was as high incidence (25%) of syringomyelia in the terminal conus. Arnold Chiari malformation was never associated, which differentiates lumbosacral lipomas from myelomeningoceles. However, the nerve roots and their relationship to the lipoma were rarely visualized. Despite these drawbacks, MRI is the examination of choice if lumbosacral lipoma is suspected in children.

[Cystic or pseudocystic ovarian masses in young girls. The role of ultrasonic diagnosis]. / Masses ovariennes kystiques ou pseudokystiques de la fillette. Rôle de l'échographie.

Twenty adnexal tumors have been discovered between 7 and 16 years old girls. With few exceptions, the sonographic appearance in nonspecific. They were grouped in four categories: teratomas, cystadenomas, adnexal torsions, polycystic diseases. Surgery with be discussed upon consideration of age, clinical signs and sonography, and diagnostic emergency will be emphasized in case of acute adnexal torsion.

[Neonatal ovarian cysts. The role of ultrasonic diagnosis]. / Kystes de l'ovaire néonataux. Rôle de l'échographie.

Nine cases of adnexal cysts diagnosed by antenatal ultrasonography, have been followed after birth and operated upon. Simple ovarian cysts as well as old adnexal torsions appear as sonolucent masses. Acute adnexal torsion appears as mixed or solid masse. Sonographic appearance can help the post natal management of these masses.