Semeiotics of bone tumors in children.

In recent years, the study of bone disorders has changed thanks to the progressive development of imaging techniques. In our opinion, however, different from what happens in the study of pathologic conditions in other organs and systems, conventional radiology remains the diagnostic cornerstone for bone disorders and especially bone tumors. In any case, plain radiography must always be performed first. The radiologic approach to primary bone tumors includes a series of steps to collect the necessary information to suggest, with the following contribution of radiography, the most likely diagnosis. The approach is basically statistical and many parameters should be considered. As far as bone tumors in children are concerned, the basic role of the statistical variable 'patient age' is apparent and this information should be considered even before any others. Despite the difficulties in assessing the frequency of bone tumors we tried to read homogeneously some of the statistical data reported in literature. Tumor incidence in a given age class is a very important diagnostic tool. Lesion location is the second step in the radiologic work-up: the involved bone and bone segment should be assessed and correlated with the preferential site of a specific tumor. Regarding the bone tumors detected in the first 5 years of life, an interesting question is whether a vertebra plana is due to a benign or a malignant lesion. The lytic lesion will be well defined by CT and MRI will be very useful in depicting bone marrow and surrounding soft tissue involvement. However, many processes have a similar imaging pattern. We believe that before biopsy the frequent, marked infiltration of surrounding soft tissues in vertebra plana should suggest a diagnosis of malignant tumor rather than of tumor-like lesion.

[Fractures of the temporomandibular joints in childhood from indirect trauma to the chin. A report of 4 cases]. / Fratture delle articolazioni temporo-mandibolari nell'infanzia da traumi indiretti sul mento. Presentazione di 4 casi.

We observed four cases of temporomandibular joint fractures in children; all from indirect chin traumas. Traditional X-ray is not enough for a correct radiological diagnosis. CT, in particular with the axial scans, electronics coronal reconstructions, and where is possible direct sagittal scans, is able to give us a correct diagnosis about the nature and the site of the fractures.

Post-operative ileo-ileal intussusception: sonographic approach.

Two children developed ileo-ileal intussusception a few days after major abdominal surgery. Sonographic study was of primary importance in the evaluation of this lesion which was apparent from clinical and radiographic signs of intestinal obstruction but not from barium enema.

"Brown tumor" of the maxilla.

A case of brown tumor of hyperparathyroidism in a young girl with a long history of chronic renal failure and hemodialysis therapy is reported. The diagnosis can be reached with the aid of the classic skeletal radiological sign which address the evaluation of both CT and MR imaging.

Contribution of ultrasonography in the diagnosis of achalasia.

We present a case of achalasia diagnosed with the aid of ultrasonography (US). After having examined the clinical-radiological characteristics of the disease, and after having noted the diagnostic possibilities of manometry and endoscopy, we emphasize the use of US to clearly show the thickening of the muscular wall and the dilatation of the distal esophagus. In those of pediatric age, particularly, US permits differential diagnosis with the esophageal leiomyoma, which is difficult to obtain with other techniques. We suggest, therefore, including US in the study of patients with stenosis of the third distal section of the esophagus.

[Congenital valves of the ureter. Comments on 7 cases studied in childhood]. / Le valvole congenite dell'uretere. Considerazioni su 7 casi studiati nell'età pediatrica.

Ureteral valves are a rare cause of congenital obstructive uropathy in pediatric age. Symptoms onset is variable and depends directly on the degree of valvular obstruction. Seven cases of ureteral valves were studied in the Radiology Department of "Bambino Gesù" Pediatric Hospital in Rome; every type of technique available in the hospital was employed. For each case, the authors carefully describe the clinico-radiological approach which led to the diagnosis of obstruction due to the presence of one or more valvular structures (hydronephrosis). Intravenous urography proved to be the most sensitive examination to confirm the diagnosis of suspected obstruction made on the basis of US findings, and to assess its precise location. Segmental ascending pyelography was also employed, which consists in cystoscopically inserting a ureteral catheter into the renal pelvis, and then administering a contrast medium which allows the fluoroscopic visualization, both above and below the stricture, of the ureteral segments. The technique also allows the detection of other valves of the same ureter not otherwise recognizable. All 7 patients underwent surgery; follow-up at 12 months demonstrated clinical symptoms regression and a good functional and morphological recovery of the involved ureter.

Congenital ectopic vas deferens with hypospadias.

A case of an ectopic vas deferens of an undescended testis is presented which was associated with hypospadias. These abnormalities came to light because of the systematic approach we have adopted for the investigation of hypospadias in our hospital.