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    There are 28 cases available...

    Go to the top of the page   ID: 20110329123519 Original case in english  More links about this topic on Pubmed (PubMed Reader)
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    Discussion
     
    Pneumomediastinum/pneumothorax - iatrogenic
    Kraig J. Pneumomediastinum/pneumothorax - iatrogenic. PedRad [serial online] vol 11, no. 3.
    URL: www.PedRad.info/?search=20110329123519


     
     Pediatric Radiology CasesImages to this case: There are X-Ray-images available for this case. [ X-Ray ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    Kraig J. Lage (University of Missouri Hospital and Clinics / Columbia / MO / United States)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    N/A  

     
     Pediatric Radiology CasesGender:

    Male  

     
     Pediatric Radiology CasesRegion-Organ:

    Thorax-Lung  

     
     Pediatric Radiology CasesMost likely etiology:

    physical  

     
     Pediatric Radiology CasesHistory:

    Newborn male (39 weeks gestation) who had a forceps assisted delivery secondary to nonreassuring fetal heart tones. At delivery, infant was cyanotic, had poor tone, and no cry. Infant was dried, warmed, suctioned, and stimulated without response. Bag/mask ventillation was administered with response of heart rate rising to greater than 100. Bag/mask ventillation was continued for one minute until spontaneous respirations. Infant continued to have increased work of breathing with flaring, retractions, and tachypnea. CPAP was continued with decreased work of breathing.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease :

    Alveolar rupture is caused by a pressure gradient between the alveolus and the surrounding interstitium. The pressure gradient is a product of either hyperinflation of the alveolus or a decrease in the surrounding interstitial pressure.

    The air forced into the interstitial tissues tracts centrally toward the peribronchial and perivascular tissue, and may continue into the mediastinum, neck and subcutaneous tissues.

    Because not all alveoli are ruptured, adjacent normal alveoli cause an equalisation of pressure between the affected and damaged alveoli with the result that the interalveolar walls remain intact and the lungs inflated.  

     
     Pediatric Radiology CasesRadiological findings:


    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Large lucency surrounds the superior mediastinum with lucency crossing midline. Subtle lucency is also seen inferior and lateral of the right lung base at the costophrenic angle and hemidiaphragm.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Large lucency surrounds the superior aspect of the anterior mediastinum with elevation of the thymic shadow.



     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    Total constellation (Consens)  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings:

    N/A  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other :

    Pneumomediastinum occurs in approximately 0.1% of neonates and carries a good prognosis, typically without complications or long term sequella.

    Factors predisposing to pneumomediastinum include pneumonia or meconium aspiration syndrome.

    Neonatal pneumomediastinum can be attributable to pulmonary infection, immature lungs and ventilatory support. However, a significant portion of cases of spontaneous pneumomediastinum occur without identifiable risk factors.  

     
     Pediatric Radiology CasesComments of the author about the case:

    Diagnosis of pneumomediastinum is confirmed by frontal CXR.

    Typical radiologic signs are:

    1. In infants, the “spinnaker sign” which is upwards and outwards displacement of thymic lobes raised above the heart by pneumomediastinal air that separates it from the underlying cardiac silhouette.

    2. "continuous diaphragm sign", visible as lucency interposed between the pericardium and the diaphragm.

    3. Linear bands of mediastinal air parallelling the left side of the heart and the descending aorta with the pleura seen as a thin line separated from the mediastinum by the air lucency. The air may extend superiorly along the great vessels into the neck.  

     
     Pediatric Radiology CasesFirst description / History:

    Neonate presenting with respiratory distress.  

     
     Pediatric Radiology CasesLiterature:

    1. Medline: Medline
    Doug Hacking, M.D., and Michael Stewart, M.D.
    Neonatal Pneumomediastinum
    N Engl J Med 2001 June 14; 344:1839

    2. Medline: Medline
    Annik Hauri-Hohl, Oskar Baenziger, and Bernhard Frey
    Pneumomediastinum in the neonatal and paediatric intensive care unit
    Eur J Pediatr. 2008 April; 167(4): 415–418

     

     
     Pediatric Radiology CasesKeywords:

    Pneumomediastinum, Pneumothorax, continuous diaphragm sign, spinnaker sign  

     
     Pediatric Radiology Cases Cite this article:

    Kraig J. Pneumomediastinum/pneumothorax - iatrogenic. PedRad [serial online] vol 11, no. 3.
    URL: www.PedRad.info/?search=20110329123519  

     
     Pediatric Radiology Cases Read similar articles: spinnaker sign&type=1-17">corresponding keywords
    in the same field: Thorax-Lung
    or in the region: Thorax
    or in the tissue/organ: Lung
    or with the etiology: physical
     
     Pediatric Radiology CasesImages to this case: There are X-Ray-images available for this case. [ X-Ray ] View all modalities [ All ]   
     
    Pneumomediastinum/pneumothorax - iatrogenic
    Kraig J. Pneumomediastinum/pneumothorax - iatrogenic. PedRad [serial online] vol 11, no. 3.
    URL: www.PedRad.info/?search=20110329123519


     

    Search similar cases in:
    More links about this topic on Pubmed  More links about this topic on Yahoo  More links about this topic on Altavista  More links about this topic on MSN  More links about this topic on Google  More links about this topic on Fireball

    Peer-reviewed Radiology Search



    Pneumomediastinum/pneumothorax - iatrogenic
    Other cases by these authors:

    Search Kraig J. Lage in Medline Kraig J. Lage (1)   

    Pneumomediastinum/pneumothorax - iatrogenic  
     
    Pneumomediastinum/pneumothorax - iatrogenic
    Kraig J. Pneumomediastinum/pneumothorax - iatrogenic. PedRad [serial online] vol 11, no. 3.
    URL: www.PedRad.info/?search=20110329123519


     

    Which diagnosis have other collegues guessed?


    • IRDS
      Votes: 1 (2 %)


    • Pneumothorax with pneumomediastinum
      Votes: 28 (80 %)


    • Pneumonia
      Votes: 1 (2 %)


    • Child abuse
      Votes: 1 (2 %)


    • Ebstein anomaly
      Votes: 4 (11 %)



        Total answers: 35

     
    Pneumomediastinum/pneumothorax - iatrogenic
    Kraig J. Pneumomediastinum/pneumothorax - iatrogenic. PedRad [serial online] vol 11, no. 3.
    URL: www.PedRad.info/?search=20110329123519


     

    Medical Dictionary
    Search in medical dictionary for
    Or type in a keyword
    ( Provided by The On-Line Medical Dictionary )




    1 = less interesting)
     
    Pneumomediastinum/pneumothorax - iatrogenic
    Kraig J. Pneumomediastinum/pneumothorax - iatrogenic. PedRad [serial online] vol 11, no. 3.
    URL: www.PedRad.info/?search=20110329123519


     


    Go to the top of the page   ID: 20080711190908 Original case in german  More links about this topic on Pubmed (PubMed Reader)
    Add this case to your RSS feeder: Subscribe to RSS feed Add to Yahoo Add to Google Add to AOL Add to Furl Subscribe to Feed Burner feed

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    Discussion
     
    Hereditary multiple exostoses
    Roland Talanow. Hereditary multiple exostoses. PedRad [serial online] vol 8, no. 7.
    URL: www.PedRad.info/?search=20080711190908


     
     Pediatric Radiology CasesImages to this case: There are X-Ray-images available for this case. [ X-Ray ] There are MRI-images available for this case. [ MRI ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    Roland Talanow (The Cleveland Clinic/Cleveland/USA)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    17 Years  

     
     Pediatric Radiology CasesGender:

    Male  

     
     Pediatric Radiology CasesRegion-Organ:

    N/A  

     
     Pediatric Radiology CasesMost likely etiology:

    N/A  

     
     Pediatric Radiology CasesHistory: *

    17 year old male with intermittent pain over lumps on his lower extremities.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease : *

    Hereditary multiple exostoses (HME) is an inherited autosomal dominant disorder where multiple osteochondromas throughout the skeleton are present.

    The pathogenesis of HME is poorly understood, and theories range from isolated islets of cartilaginous tissues from the diaphyseal surface of growing cartilage, a defect in the anchoring of germinal cartilage cells to the physis, or physical-stress theory that focal accumulations of embryonic connective tissue at sites of tendon attachments are converted to hyaline cartilage.

    Patients with HME may present with short stature and asymmetric growth at the knees and ankles, which may lead to deformities. The osteochondromas are located close to the metaphyses, and they may be sessile or pedunculated. The cortex of the lesion is continuous with the cortex of the bone with a homogeneous continuation of the medulla which is a characteristic feature.

    Patients with HME may have 2 to 100s of osteochondromas. Most solitary osteochondromas are discovered incidentally in children and adolescents. Usually, the patients present with a painless skeletal swelling or a slowly growing mass. Fractures, bony deformities, bursa formation, neurologic and vascular injuries, and malignant transformation are complications of osteochondromas. The risk of malignant degeneration is 1-20%. The likelihood of malignant transformation is greater with HME than with other conditions. Most transformations are to a chondrosarcoma, but other sarcomata may complicate the disease. Most patients with this malignant transformation present with a painful mass. Malignant transformation occur only rarely in the first decade and after fifth decades of life.

    Malignancy should be suggested and must be assessed if an osteochondroma grows in a mature skeleton. Additionally, an osteochondroma with a cartilaginous cap greater than 1 cm in an adult should be carefully assessed because this finding has also been associated with an increased risk of malignancy.





    Radiographic features:
    Plain radiographs demonstrate pedunculated or sessile bony excrescence with well-defined margins. In adults, the cartilage cap often contains flecks of calcification. Osteochondromas arise from the surface of the bones contain spongiosa and cortex that appear continuous with the parent bone.
    Most common sites for osteochondromas are the metaphysis at bony sites of tendon and ligamentous attachments. Osteochondromas usually point away from its point of attachment towards the diaphysis with the metaphysis of the affected tubular bone often widened.


    Serial radiographs showing an enlarging osteochondroma with irregularity of its margin and accompanied by a soft tissue mass should alert the clinician to sarcomatous transformation, particularly when the finding is accompanied by pain. Bone erosions and irregularity or scattered calcification are further clues of malignant transformation.

    Often, there are associated defects of bone modeling and bony deformities, in particular bilateral coxa valga and widening of the proximal femoral metaphysis.


    Computer tomography:
    CT can provide excellent bone detail of osteochondromas developing in the spine, shoulder, or pelvis despite the complex nature of these bones.


    Magnetic resonance imaging:
    MRI is useful for assessing continuity of the cortical and medullary bone in an osteochondroma with the parent bone. Cartilage in the cap has high signal intensity on T2-weighted spin-echo MRI. This characteristic allows measurement of the cap, which is an important consideration in malignant transformation. MRI also provides information about inflammation in reactive bursa formation, impingement syndromes, arterial and venous compromise. This study is the method of choice for evaluating compression of the spinal cord, nerve roots, and peripheral nerves.

    MRIs contribute only to the diagnostic workup of cases in which malignant change is suspected because osteochondromas have a characteristic appearance on plain radiographs.

    With chondrosarcomas, the chondroid origin of tumors may be identified with the lobular high signal intensity. Short-tau inversion recovery (STIR) images show peritumoral soft tissue edema in 83% of chondrosarcomas. Muscle impingement should be considered in the differential diagnosis of pain in association with osteochondromatosis. On T2-weighted MRIs, muscle impingement is depicted as increased signal intensity within the muscle.


    Cave:
    A known complication is the increasing size of osteochondromas due to bursitis, and a false-positive diagnosis of malignant transformation has been reported with both CT and MRI. Therefore, ultrasonographic evaluation is always recommended for the evaluation of enlarging solitary osteochondromas.  

     
     Pediatric Radiology CasesRadiological findings: *


    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Large lucency surrounds the superior mediastinum with lucency crossing midline. Subtle lucency is also seen inferior and lateral of the right lung base at the costophrenic angle and hemidiaphragm.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Large lucency surrounds the superior aspect of the anterior mediastinum with elevation of the thymic shadow.




    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Frontal radiograph of the knees demonstrate bilateral pedunculated bony excrescence with cortical continuity and well-defined margins. The peduncles are oriented away from the knee joints.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Lateral radiograph of the right knee demonstrates pedunculated bony excrescence with cortical continuity and well-defined margins.






    MRI 1 <- view MRI 1

    MRI 1: T1 weighted coronal image demonstrates a pedunculated bony excrescence with cortical continuity and well-defined margins at the lateral aspect of the distal femoral metaphasis. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.






    MRI 2 <- view MRI 2

    MRI 2: T2 weighted axial image demonstrates pedunculated bony excrescences with cortical continuity and well-defined margins at the medial aspect of the proximal tibia and lateral aspect of the proximal fibula. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.






    MRI 3 <- view MRI 3

    MRI 3: T2 weighted coronal image demonstrates a pedunculated bony excrescence with cortical continuity and well-defined margins at the lateral aspect of the distal femoral metaphasis. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.






    MRI 4 <- view MRI 4

    MRI 4: Proton density (PD) weighted coronal image demonstrates a pedunculated bony excrescence with cortical continuity and well-defined margins at the lateral aspect of the distal femoral metaphasis. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.



     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    N/A  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings: *

    Fetal alcohol syndrome, Turner syndrome (exostosis of tibia), Tuberous sclerosis (exostosis of long bones), Acrodysostosis , radiation-induced osteochondromas, traumatic bony injury/fractures  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other : *

    Osteochondromas are the most common bone tumors in children. They may be solitary or multiple. They arise from tubular bones and are metaphyseal in location.

    Most frequently affected are long tubular bones, particularly the metaphysis. The sites of predilection include distal femoral metaphysis, proximal humeral metaphysis, tibia, and fibula.

    In 10% of patients, the small bones of the hands and feet are also affected, the scapula only in 1% of cases. The spine is involved only in 2%, but it can lead to cord compression.

    Osteochondromas can be resected with an osteotome. However, this should be performed only when the skeleton has matured, unless the lesion is symptomatic. If resection is performed in an immature skeleton, care should be taken to avoid damaging the epiphyseal plate because severe growth deformity may result.  

     
     Pediatric Radiology CasesComments of the author about the case:

    N/A  

     
     Pediatric Radiology CasesFirst description / History: *

    HME was first described by John Hunter in his lecture on the principles of surgery in 1786. Boyer published in 1814 the first description of a family with HME, followed by Guy's description of a second family in 1825.  

     
     Pediatric Radiology CasesLiterature:

    3. Medline: Medline
    Bovee JV, Hogendoorn PC
    The neoplastic pathogenesis of solitary and multiple osteochondromas
    J Pathol. Mar 2000;190(4):516-7.

    4. Medline: Medline
    Shapiro F, Simon S, Glimcher MJ
    Hereditary multiple exostoses. Anthropometric, roentgenographic, and clinical aspects
    J Bone Joint Surg Am. Sep 1979;61(6A):815-24.

    5. Medline: Medline
    Peterson HA
    Multiple hereditary osteochondromata
    Clin Orthop. Feb 1989;(239):222-30.

    6. Medline: Medline
    Multiple hereditary exostoses: http://www.emedicine.com/radio/topic496.htm

    7. Medline: Medline
    Solitary exostosis: http://www.emedicine.com/orthoped/TOPIC528.HTM  

     
     Pediatric Radiology CasesKeywords: *

    hereditary exostoses, multiple exostoses, exostosis, HME, multiple osteocartilaginous exostoses, diaphyseal achalasia, osteochondromatosis, multiple hereditary osteochondromata, multiple congenital osteochondromata, diaphyseal aclasis, chondral osteogenic dysplasia of direction, chondral osteoma, deforming chondrodysplasia, dyschondroplasia exostosing disease, exostotic dysplasia, multiple osteomatoses osteogenic disease, familial bony spurs, multiple epiphyseal dysplasia, dysplasia epiphysealis hemimelica, Trevor disease, Trevor's disease  

     
     Pediatric Radiology Cases Cite this article:

    Roland Talanow. Hereditary multiple exostoses. PedRad [serial online] vol 8, no. 7.
    URL: www.PedRad.info/?search=20080711190908  

     
     Pediatric Radiology Cases Read similar articles: Trevor's disease&type=1-17">corresponding keywords
    in the same field:
    or in the region:
    or in the tissue/organ:
    or with the etiology:
     
     Pediatric Radiology CasesImages to this case: There are X-Ray-images available for this case. [ X-Ray ] There are MRI-images available for this case. [ MRI ] View all modalities [ All ]   

    Thanks to Martina Paetzel, M.D. for translating this case!

     
    Hereditary multiple exostoses
    Roland Talanow. Hereditary multiple exostoses. PedRad [serial online] vol 8, no. 7.
    URL: www.PedRad.info/?search=20080711190908


     

    Search similar cases in:
    More links about this topic on Pubmed  More links about this topic on Yahoo  More links about this topic on Altavista  More links about this topic on MSN  More links about this topic on Google  More links about this topic on Fireball

    Peer-reviewed Radiology Search



    Hereditary multiple exostoses
    Other cases by these authors:

    Search Kraig J. Lage in Medline Kraig J. Lage (1)   
    Search Roland Talanow in Medline Roland Talanow (25)   

    Hereditary multiple exostoses  
     
    Hereditary multiple exostoses
    Roland Talanow. Hereditary multiple exostoses. PedRad [serial online] vol 8, no. 7.
    URL: www.PedRad.info/?search=20080711190908


     

    Which diagnosis have other collegues guessed?


    • IRDS
      Votes: 1 (2 %)


    • Pneumothorax with pneumomediastinum
      Votes: 28 (80 %)


    • Pneumonia
      Votes: 1 (2 %)


    • Child abuse
      Votes: 1 (2 %)


    • Ebstein anomaly
      Votes: 4 (11 %)



        Total answers: 35

     
    Hereditary multiple exostoses
    Roland Talanow. Hereditary multiple exostoses. PedRad [serial online] vol 8, no. 7.
    URL: www.PedRad.info/?search=20080711190908


     

    Medical Dictionary
    Search in medical dictionary for
    Or type in a keyword
    ( Provided by The On-Line Medical Dictionary )




    1 = less interesting)
     
    Hereditary multiple exostoses
    Roland Talanow. Hereditary multiple exostoses. PedRad [serial online] vol 8, no. 7.
    URL: www.PedRad.info/?search=20080711190908


     


    Go to the top of the page   ID: 20060928135619 Original case in english  More links about this topic on Pubmed (PubMed Reader)
    Add this case to your RSS feeder: Subscribe to RSS feed Add to Yahoo Add to Google Add to AOL Add to Furl Subscribe to Feed Burner feed

    Bookmark and Share


    Discussion
     
    Bowel perforation and ileus after ingestion of magnets
    K Gerlach, Dirk Schaper. Bowel perforation and ileus after ingestion of magnets. PedRad [serial online] vol 6, no. 9.
    URL: www.PedRad.info/?search=20060928135619


     
     Pediatric Radiology CasesImages to this case: There are X-Ray-images available for this case. [ X-Ray ] There are Ultrasound-images available for this case. [ Ultrasound ] There are OP-Situs-images available for this case. [ OP-Situs ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    K. Gerlach, Dirk Schaper (Klinik für Kinderchirurgie Krankenhaus St. Elisabeth und St. Barbara Halle/S.)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    11 Years  

     
     Pediatric Radiology CasesGender:

    Male  

     
     Pediatric Radiology CasesRegion-Organ:

    N/A  

     
     Pediatric Radiology CasesMost likely etiology:

    N/A  

     
     Pediatric Radiology CasesHistory:

    Recurrent intermittend abdominal pain and vomiting for about 1 week. Last bowel movement yesterday - unremarkable. No dysuria. Subfebrile temperature.
    Reduced general appearance, very slim body.
    Abdomen distended, diffuse tenderness, palpable resistance in the right mid- and lower abdomen with mild guarding. Few peristalsis in all four quadrants.

    Lab work: Hb 9,25 mmol/l; Hk 0,430; WBC 14, 3Gpt/l; PLT 424 Gpt/l, CRP 22,09 mg/l;
    Electrolytes, ASAT, ALAT, GGT, Lipase WNL, Amylase 24,5 U/l; BS 6,63 mmol/l;
    Crea 52 g/l; ESR 8 mm/h.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease :

    Magnetic forces act throughout the bowel wall and lead to compression related damage, dysmotility and kinking. Severe injuries and damages of the small bowel, including ischemia, peritonitis and even a case report about death have been described.  

     
     Pediatric Radiology CasesRadiological findings:


    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Large lucency surrounds the superior mediastinum with lucency crossing midline. Subtle lucency is also seen inferior and lateral of the right lung base at the costophrenic angle and hemidiaphragm.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Large lucency surrounds the superior aspect of the anterior mediastinum with elevation of the thymic shadow.




    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Frontal radiograph of the knees demonstrate bilateral pedunculated bony excrescence with cortical continuity and well-defined margins. The peduncles are oriented away from the knee joints.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Lateral radiograph of the right knee demonstrates pedunculated bony excrescence with cortical continuity and well-defined margins.






    MRI 1 <- view MRI 1

    MRI 1: T1 weighted coronal image demonstrates a pedunculated bony excrescence with cortical continuity and well-defined margins at the lateral aspect of the distal femoral metaphasis. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.






    MRI 2 <- view MRI 2

    MRI 2: T2 weighted axial image demonstrates pedunculated bony excrescences with cortical continuity and well-defined margins at the medial aspect of the proximal tibia and lateral aspect of the proximal fibula. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.






    MRI 3 <- view MRI 3

    MRI 3: T2 weighted coronal image demonstrates a pedunculated bony excrescence with cortical continuity and well-defined margins at the lateral aspect of the distal femoral metaphasis. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.






    MRI 4 <- view MRI 4

    MRI 4: Proton density (PD) weighted coronal image demonstrates a pedunculated bony excrescence with cortical continuity and well-defined margins at the lateral aspect of the distal femoral metaphasis. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.




    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Echogenic foreign body.




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Echogenic, segmented foreign body.




    OP-Situs 1 <- view OP-Situs 1

    OP-Situs 1: Introperative findings of a small bowel perforation.



    OP-Situs 2 <- view OP-Situs 2

    OP-Situs 2: Foreign body intraoperative



    OP-Situs 3 <- view OP-Situs 3

    OP-Situs 3: Foreign body in situ



    X-Ray 1 <- view X-Ray 1

    X-Ray 1: KUB: Tablet / rod like metallic foreign body in the right lower abdomen.



     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    N/A  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings:

    Other radiopaque ingested foreign bodies.  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other :

    Laparotomy: Removal of 14 magnets with a total of 9 small bowel perforations, 1 ileocecal fistula, and 2 perforations in the region of the mesenterium commune.

    Intestinal tube splinting, drainage, NG tube
    Retraction of the intestinal tube splinting at POD (post operative day) 5, removal at POD 9, start diet.  

     
     Pediatric Radiology CasesComments of the author about the case:

    Magnets are more frequently seen in nurseries and playrooms due to the arise of new toy variants. The development of extrem strong magnets by the industry brings also new, partly unknown sources of danger to the children. The so called Neodym magnets have an extrem strong force of gravity, which can even cause contusions of fingers. One can easily imagine that ingestion of such kind of magnets may cause rapidly damage to the bowel wall. The magnets attract each other and always try to unite, where the bowel wall does not present an obsticle.  

     
     Pediatric Radiology CasesFirst description / History:

    Injuries due to magnets are known for a longer time in Japan, because magnets are commonly used for muscle relaxation therapy. Severe injuries of the small bowel, including ischemia, peritonitis and death have been described.  

     
     Pediatric Radiology CasesLiterature:

    N/A  

     
     Pediatric Radiology CasesKeywords:

    Ileus, obstructive ileus, mechanic ileus, foreign body, foreign body ingestion, foreign bodies, magnets, metallic rods, metal ingestion, magnet  

     
     Pediatric Radiology Cases Cite this article:

    K Gerlach, Dirk Schaper. Bowel perforation and ileus after ingestion of magnets. PedRad [serial online] vol 6, no. 9.
    URL: www.PedRad.info/?search=20060928135619  

     
     Pediatric Radiology Cases Read similar articles: magnet&type=1-17">corresponding keywords
    in the same field:
    or in the region:
    or in the tissue/organ:
    or with the etiology:
     
     Pediatric Radiology CasesImages to this case: There are X-Ray-images available for this case. [ X-Ray ] There are Ultrasound-images available for this case. [ Ultrasound ] There are OP-Situs-images available for this case. [ OP-Situs ] View all modalities [ All ]   
     
    Bowel perforation and ileus after ingestion of magnets
    K Gerlach, Dirk Schaper. Bowel perforation and ileus after ingestion of magnets. PedRad [serial online] vol 6, no. 9.
    URL: www.PedRad.info/?search=20060928135619


     

    Search similar cases in:
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    Bowel perforation and ileus after ingestion of magnets
    Other cases by these authors:

    Search Kraig J. Lage in Medline Kraig J. Lage (1)   
    Search Roland Talanow in Medline Roland Talanow (25)   
    Search K. Gerlach in Medline K. Gerlach (21)   
    Search Dirk Schaper  in Medline Dirk Schaper (15)   

    Bowel perforation and ileus after ingestion of magnets  
     
    Bowel perforation and ileus after ingestion of magnets
    K Gerlach, Dirk Schaper. Bowel perforation and ileus after ingestion of magnets. PedRad [serial online] vol 6, no. 9.
    URL: www.PedRad.info/?search=20060928135619


     

    Which diagnosis have other collegues guessed?


    • IRDS
      Votes: 1 (2 %)


    • Pneumothorax with pneumomediastinum
      Votes: 28 (80 %)


    • Pneumonia
      Votes: 1 (2 %)


    • Child abuse
      Votes: 1 (2 %)


    • Ebstein anomaly
      Votes: 4 (11 %)


    • Ingestion of batteries
      Votes: 4 (6 %)


    • Residual metallic tube after prior endoscopic laparatomy (appendectomy at the age of 9)
      Votes: 2 (3 %)


    • Bowel perforation and ileus secondary to ingestion of magnets
      Votes: 17 (29 %)


    • Foreign body on film in case of a salmonella induced enteritis
      Votes: 0 (0 %)



        Total answers: 58

     
    Bowel perforation and ileus after ingestion of magnets
    K Gerlach, Dirk Schaper. Bowel perforation and ileus after ingestion of magnets. PedRad [serial online] vol 6, no. 9.
    URL: www.PedRad.info/?search=20060928135619


     

    Medical Dictionary
    Search in medical dictionary for
    Or type in a keyword
    ( Provided by The On-Line Medical Dictionary )




    1 = less interesting)
     
    Bowel perforation and ileus after ingestion of magnets
    K Gerlach, Dirk Schaper. Bowel perforation and ileus after ingestion of magnets. PedRad [serial online] vol 6, no. 9.
    URL: www.PedRad.info/?search=20060928135619


     


    Go to the top of the page   ID: 20041208190125 Original case in english  More links about this topic on Pubmed (PubMed Reader)
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    Discussion
     
    Infratentorial pilocytic astrocytoma
    G Hahn. Infratentorial pilocytic astrocytoma. PedRad [serial online] vol 4, no. 12.
    URL: www.PedRad.info/?search=20041208190125


     
     Pediatric Radiology CasesImages to this case: There are MRI-images available for this case. [ MRI ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    G. Hahn (Bereich Kinderradiologie/Uniklinikum Dresden/Deutschland)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    1 Years  

     
     Pediatric Radiology CasesGender:

    Male  

     
     Pediatric Radiology CasesRegion-Organ:

    N/A  

     
     Pediatric Radiology CasesMost likely etiology:

    N/A  

     
     Pediatric Radiology CasesHistory:

    1 3/4 year old boy with torticollis since birth. Now worsening ataxia and screaming episodes.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease :

    Brain tumors which are diagnosed before the 2nd year, one presumes that they are congenital.
    This is possibly the case with this child, since the symptoms exist since birth.
    The astrocytoma is the most frequent tumor in childhood. 60 % of them are infratentorial.  

     
     Pediatric Radiology CasesRadiological findings:


    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Large lucency surrounds the superior mediastinum with lucency crossing midline. Subtle lucency is also seen inferior and lateral of the right lung base at the costophrenic angle and hemidiaphragm.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Large lucency surrounds the superior aspect of the anterior mediastinum with elevation of the thymic shadow.




    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Frontal radiograph of the knees demonstrate bilateral pedunculated bony excrescence with cortical continuity and well-defined margins. The peduncles are oriented away from the knee joints.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Lateral radiograph of the right knee demonstrates pedunculated bony excrescence with cortical continuity and well-defined margins.






    MRI 1 <- view MRI 1

    MRI 1: T1 weighted coronal image demonstrates a pedunculated bony excrescence with cortical continuity and well-defined margins at the lateral aspect of the distal femoral metaphasis. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.






    MRI 2 <- view MRI 2

    MRI 2: T2 weighted axial image demonstrates pedunculated bony excrescences with cortical continuity and well-defined margins at the medial aspect of the proximal tibia and lateral aspect of the proximal fibula. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.






    MRI 3 <- view MRI 3

    MRI 3: T2 weighted coronal image demonstrates a pedunculated bony excrescence with cortical continuity and well-defined margins at the lateral aspect of the distal femoral metaphasis. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.






    MRI 4 <- view MRI 4

    MRI 4: Proton density (PD) weighted coronal image demonstrates a pedunculated bony excrescence with cortical continuity and well-defined margins at the lateral aspect of the distal femoral metaphasis. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.




    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Echogenic foreign body.




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Echogenic, segmented foreign body.




    OP-Situs 1 <- view OP-Situs 1

    OP-Situs 1: Introperative findings of a small bowel perforation.



    OP-Situs 2 <- view OP-Situs 2

    OP-Situs 2: Foreign body intraoperative



    OP-Situs 3 <- view OP-Situs 3

    OP-Situs 3: Foreign body in situ



    X-Ray 1 <- view X-Ray 1

    X-Ray 1: KUB: Tablet / rod like metallic foreign body in the right lower abdomen.




    Extensive, mostly cystic, partly solid infratentorial brain tumor with consecutive occlusion hydrocephalus and signs of intracranial pressure.


    MRI 1 <- view MRI 1

    MRI 1: T2 weighted sequences with signal intense tumor and perifocal edema intracerebellar.





    MRI 2 <- view MRI 2

    MRI 2: FLAIR with partly signal intense and partly almost liquor intense tumor areas cerebellar. The IV. ventricle is occluded.





    MRI 3 <- view MRI 3

    MRI 3: T1 weighted image with hypointense tumor.





    MRI 4 <- view MRI 4

    MRI 4: T1 weighted image with contrast. Partly contrast enhancement in the solid areas and in the margins of the cysts.





    MRI 5 <- view MRI 5

    MRI 5: T1 weighted image with contrast, sagital view.





    MRI 6 <- view MRI 6

    MRI 6: T1 weighted image with contrast, coronal view.



     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    N/A  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings:

    no  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other :

    Good prognosis since this tumor has WHO grade I and rarely tends to spread liquorgenically.  

     
     Pediatric Radiology CasesComments of the author about the case:

    N/A  

     
     Pediatric Radiology CasesFirst description / History:

    N/A  

     
     Pediatric Radiology CasesLiterature:

    8. Medline: Medline
    A.J.Barkovich
    Pediatric Neuroimaging
     

     
     Pediatric Radiology CasesKeywords:

    infratentorial brain tumor, pilocytic astrocytoma, infratentorial pilocytic astrocytoma, congenital brain tumor  

     
     Pediatric Radiology Cases Cite this article:

    G Hahn. Infratentorial pilocytic astrocytoma. PedRad [serial online] vol 4, no. 12.
    URL: www.PedRad.info/?search=20041208190125  

     
     Pediatric Radiology Cases Read similar articles: congenital brain tumor&type=1-17">corresponding keywords
    in the same field:
    or in the region:
    or in the tissue/organ:
    or with the etiology:
     
     Pediatric Radiology CasesImages to this case: There are MRI-images available for this case. [ MRI ] View all modalities [ All ]   
     
    Infratentorial pilocytic astrocytoma
    G Hahn. Infratentorial pilocytic astrocytoma. PedRad [serial online] vol 4, no. 12.
    URL: www.PedRad.info/?search=20041208190125


     

    Search similar cases in:
    More links about this topic on Pubmed  More links about this topic on Yahoo  More links about this topic on Altavista  More links about this topic on MSN  More links about this topic on Google  More links about this topic on Fireball

    Peer-reviewed Radiology Search



    Infratentorial pilocytic astrocytoma
    Other cases by these authors:

    Search Kraig J. Lage in Medline Kraig J. Lage (1)   
    Search Roland Talanow in Medline Roland Talanow (25)   
    Search K. Gerlach in Medline K. Gerlach (21)   
    Search Dirk Schaper  in Medline Dirk Schaper (15)   
    Search G. Hahn in Medline G. Hahn (38)   

    Infratentorial pilocytic astrocytoma  
     
    Infratentorial pilocytic astrocytoma
    G Hahn. Infratentorial pilocytic astrocytoma. PedRad [serial online] vol 4, no. 12.
    URL: www.PedRad.info/?search=20041208190125


     

    Which diagnosis have other collegues guessed?


    • IRDS
      Votes: 1 (2 %)


    • Pneumothorax with pneumomediastinum
      Votes: 28 (80 %)


    • Pneumonia
      Votes: 1 (2 %)


    • Child abuse
      Votes: 1 (2 %)


    • Ebstein anomaly
      Votes: 4 (11 %)


    • Ingestion of batteries
      Votes: 4 (6 %)


    • Residual metallic tube after prior endoscopic laparatomy (appendectomy at the age of 9)
      Votes: 2 (3 %)


    • Bowel perforation and ileus secondary to ingestion of magnets
      Votes: 17 (29 %)


    • Foreign body on film in case of a salmonella induced enteritis
      Votes: 0 (0 %)


    • Pilocytic astrocytoma
      Votes: 8 (11 %)


    • Hemangioblastoma
      Votes: 0 (0 %)


    • Ependymoma
      Votes: 2 (2 %)


    • Medulloblastoma
      Votes: 2 (2 %)



        Total answers: 70

     
    Infratentorial pilocytic astrocytoma
    G Hahn. Infratentorial pilocytic astrocytoma. PedRad [serial online] vol 4, no. 12.
    URL: www.PedRad.info/?search=20041208190125


     

    Medical Dictionary
    Search in medical dictionary for
    Or type in a keyword
    ( Provided by The On-Line Medical Dictionary )




    1 = less interesting)
     
    Infratentorial pilocytic astrocytoma
    G Hahn. Infratentorial pilocytic astrocytoma. PedRad [serial online] vol 4, no. 12.
    URL: www.PedRad.info/?search=20041208190125


     


    Go to the top of the page   ID: 20041206191142 Original case in english  More links about this topic on Pubmed (PubMed Reader)
    Add this case to your RSS feeder: Subscribe to RSS feed Add to Yahoo Add to Google Add to AOL Add to Furl Subscribe to Feed Burner feed

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    Discussion
     
    Pineoblastoma
    G Hahn. Pineoblastoma. PedRad [serial online] vol 4, no. 12.
    URL: www.PedRad.info/?search=20041206191142


     
     Pediatric Radiology CasesImages to this case: There are MRI-images available for this case. [ MRI ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    G. Hahn (Bereich Kinderradiologie/Uniklinikum Dresden/Deutschland)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    14 Years  

     
     Pediatric Radiology CasesGender:

    Female  

     
     Pediatric Radiology CasesRegion-Organ:

    N/A  

     
     Pediatric Radiology CasesMost likely etiology:

    N/A  

     
     Pediatric Radiology CasesHistory:

    14 year old girl with increasing headaches for 1/2 year. Now additionally emesis and ataxia.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease :

    The tumor develops from parenchymal cells of the pineal gland and is highly malignant. (Small, round cells like Medulloblastoma)  

     
     Pediatric Radiology CasesRadiological findings:


    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Large lucency surrounds the superior mediastinum with lucency crossing midline. Subtle lucency is also seen inferior and lateral of the right lung base at the costophrenic angle and hemidiaphragm.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Large lucency surrounds the superior aspect of the anterior mediastinum with elevation of the thymic shadow.




    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Frontal radiograph of the knees demonstrate bilateral pedunculated bony excrescence with cortical continuity and well-defined margins. The peduncles are oriented away from the knee joints.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Lateral radiograph of the right knee demonstrates pedunculated bony excrescence with cortical continuity and well-defined margins.






    MRI 1 <- view MRI 1

    MRI 1: T1 weighted coronal image demonstrates a pedunculated bony excrescence with cortical continuity and well-defined margins at the lateral aspect of the distal femoral metaphasis. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.






    MRI 2 <- view MRI 2

    MRI 2: T2 weighted axial image demonstrates pedunculated bony excrescences with cortical continuity and well-defined margins at the medial aspect of the proximal tibia and lateral aspect of the proximal fibula. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.






    MRI 3 <- view MRI 3

    MRI 3: T2 weighted coronal image demonstrates a pedunculated bony excrescence with cortical continuity and well-defined margins at the lateral aspect of the distal femoral metaphasis. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.






    MRI 4 <- view MRI 4

    MRI 4: Proton density (PD) weighted coronal image demonstrates a pedunculated bony excrescence with cortical continuity and well-defined margins at the lateral aspect of the distal femoral metaphasis. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.




    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Echogenic foreign body.




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Echogenic, segmented foreign body.




    OP-Situs 1 <- view OP-Situs 1

    OP-Situs 1: Introperative findings of a small bowel perforation.



    OP-Situs 2 <- view OP-Situs 2

    OP-Situs 2: Foreign body intraoperative



    OP-Situs 3 <- view OP-Situs 3

    OP-Situs 3: Foreign body in situ



    X-Ray 1 <- view X-Ray 1

    X-Ray 1: KUB: Tablet / rod like metallic foreign body in the right lower abdomen.




    Extensive, mostly cystic, partly solid infratentorial brain tumor with consecutive occlusion hydrocephalus and signs of intracranial pressure.


    MRI 1 <- view MRI 1

    MRI 1: T2 weighted sequences with signal intense tumor and perifocal edema intracerebellar.





    MRI 2 <- view MRI 2

    MRI 2: FLAIR with partly signal intense and partly almost liquor intense tumor areas cerebellar. The IV. ventricle is occluded.





    MRI 3 <- view MRI 3

    MRI 3: T1 weighted image with hypointense tumor.





    MRI 4 <- view MRI 4

    MRI 4: T1 weighted image with contrast. Partly contrast enhancement in the solid areas and in the margins of the cysts.





    MRI 5 <- view MRI 5

    MRI 5: T1 weighted image with contrast, sagital view.





    MRI 6 <- view MRI 6

    MRI 6: T1 weighted image with contrast, coronal view.




    MRI 1 <- view MRI 1

    MRI 1: T2-TSE transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
    T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas.






    MRI 2 <- view MRI 2

    MRI 2: T2-TSE transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
    T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas.






    MRI 3 <- view MRI 3

    MRI 3: T2-TSE transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
    T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas.






    MRI 4 <- view MRI 4

    MRI 4: T2-TSE sagital: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
    T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas. In the sagital sequences considerable compression of the 4th ventricle, vermis cerebelli and the right cerebellar hemisphere from cranial by the tumor. The brainstem is shifted towards ventral and the aqueduct is completely closed. As much as 1 cm wide, protein rich/hemorrrhagic subdural hygroma laying on the Tentorium and continuing occipital till the interhemispheric cleavage. In the sagital sequences total occlusion of the Foramen magnum by parts of the cerebellar tonsils, which reach caudal till the level of the intervertebral disc of T2/T3.







    MRI 5 <- view MRI 5

    MRI 5: FLAIR-Sequence: In the FLAIR-Sequences present tumor areas strong hyperintense.






    MRI 6 <- view MRI 6

    MRI 6: FLAIR-Sequence: In the sagital sequences considerable compression of the 4th ventricle, vermis cerebelli and the right cerebellar hemisphere from cranial by the tumor.
    The brainstem is shifted towards ventral and the aqueduct is completely closed.

    In the sagital sequences total occlusion of the Foramen magnum by parts of the cerebellar tonsils, which reach caudal till the level of the intervertebral disc of T2/T3.






    MRI 7 <- view MRI 7

    MRI 7: FLAIR-Sequece transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate in the FLAIR-Sequences present tumor areas strong hyperintense.






    MRI 8 <- view MRI 8

    MRI 8: T1 TSE tra with contrast: After contrast application moderate inhomogeneous and in the already signal rich tumor areas peripheral contrast enhancement.






    MRI 9 <- view MRI 9

    MRI 9: T1 TSE tra: After contrast application moderate inhomogeneous and in the already signal rich tumor areas peripheral contrast enhancement.






    MRI 11 <- view MRI 11

    MRI 11: T1-TSE: After contrast application moderate inhomogeneous and in the already signal rich tumor areas peripheral contrast enhancement. As much as 1 cm wide, protein rich/hemorrrhagic subdural hygroma laying on the Tentorium and continuing occipital till the interhemispheric cleavage. Distinct increased dural enhancement supratentorial bilateral.




     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    N/A  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings:

    Germinal tumor of the pineal gland  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other :

    Pineoblastomas in childhood are less common at that location than germinal tumors. The prognosis is dependent from the operability of the tumor and the liquorgenic spreading.  

     
     Pediatric Radiology CasesComments of the author about the case:

    N/A  

     
     Pediatric Radiology CasesFirst description / History:

    N/A  

     
     Pediatric Radiology CasesLiterature:

    9. Medline: Medline
    A.J. Barkovich
    Pediatric Neuroimaging  

     
     Pediatric Radiology CasesKeywords:

    Cerebral tumor, brain tumor, Pineoblastoma, emesis, ataxia, pineal gland, glandula pinealis  

     
     Pediatric Radiology Cases Cite this article:

    G Hahn. Pineoblastoma. PedRad [serial online] vol 4, no. 12.
    URL: www.PedRad.info/?search=20041206191142  

     
     Pediatric Radiology Cases Read similar articles: glandula pinealis&type=1-17">corresponding keywords
    in the same field:
    or in the region:
    or in the tissue/organ:
    or with the etiology:
     
     Pediatric Radiology CasesImages to this case: There are MRI-images available for this case. [ MRI ] View all modalities [ All ]   
     
    Pineoblastoma
    G Hahn. Pineoblastoma. PedRad [serial online] vol 4, no. 12.
    URL: www.PedRad.info/?search=20041206191142


     

    Search similar cases in:
    More links about this topic on Pubmed  More links about this topic on Yahoo  More links about this topic on Altavista  More links about this topic on MSN  More links about this topic on Google  More links about this topic on Fireball

    Peer-reviewed Radiology Search



    Pineoblastoma
    Other cases by these authors:

    Search Kraig J. Lage in Medline Kraig J. Lage (1)   
    Search Roland Talanow in Medline Roland Talanow (25)   
    Search K. Gerlach in Medline K. Gerlach (21)   
    Search Dirk Schaper  in Medline Dirk Schaper (15)   
    Search G. Hahn in Medline G. Hahn (38)   
    Search G. Hahn in Medline G. Hahn (38)   

    Pineoblastoma  
     
    Pineoblastoma
    G Hahn. Pineoblastoma. PedRad [serial online] vol 4, no. 12.
    URL: www.PedRad.info/?search=20041206191142


     

    Which diagnosis have other collegues guessed?


    • IRDS
      Votes: 1 (2 %)


    • Pneumothorax with pneumomediastinum
      Votes: 28 (80 %)


    • Pneumonia
      Votes: 1 (2 %)


    • Child abuse
      Votes: 1 (2 %)


    • Ebstein anomaly
      Votes: 4 (11 %)


    • Ingestion of batteries
      Votes: 4 (6 %)


    • Residual metallic tube after prior endoscopic laparatomy (appendectomy at the age of 9)
      Votes: 2 (3 %)


    • Bowel perforation and ileus secondary to ingestion of magnets
      Votes: 17 (29 %)


    • Foreign body on film in case of a salmonella induced enteritis
      Votes: 0 (0 %)


    • Pilocytic astrocytoma
      Votes: 8 (11 %)


    • Hemangioblastoma
      Votes: 0 (0 %)


    • Ependymoma
      Votes: 2 (2 %)


    • Medulloblastoma
      Votes: 2 (2 %)


    • Astrocytoma
      Votes: 0 (0 %)


    • Medulloblastoma
      Votes: 1 (1 %)


    • Pineoblastoma
      Votes: 14 (16 %)


    • Rathke cyst
      Votes: 1 (1 %)


    • Craniopharyngeoma
      Votes: 0 (0 %)



        Total answers: 86

     
    Pineoblastoma
    G Hahn. Pineoblastoma. PedRad [serial online] vol 4, no. 12.
    URL: www.PedRad.info/?search=20041206191142


     

    Medical Dictionary
    Search in medical dictionary for
    Or type in a keyword
    ( Provided by The On-Line Medical Dictionary )




    1 = less interesting)
     
    Pineoblastoma
    G Hahn. Pineoblastoma. PedRad [serial online] vol 4, no. 12.
    URL: www.PedRad.info/?search=20041206191142


     


    Go to the top of the page   ID: 20040105194544 Original case in english  More links about this topic on Pubmed (PubMed Reader)
    Add this case to your RSS feeder: Subscribe to RSS feed Add to Yahoo Add to Google Add to AOL Add to Furl Subscribe to Feed Burner feed

    Bookmark and Share


    Discussion
     
    Adrenal hemorrhage in a Newborn
    A Nordwig, S Jess, H Hetschko. Adrenal hemorrhage in a Newborn. PedRad [serial online] vol 4, no. 1.
    URL: www.PedRad.info/?search=20040105194544


     
     Pediatric Radiology CasesImages to this case: There are Ultrasound-images available for this case. [ Ultrasound ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    A. Nordwig, S. Jess, H. Hetschko (Halle-Dölau)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    Newborn  

     
     Pediatric Radiology CasesGender:

    N/A  

     
     Pediatric Radiology CasesRegion-Organ:

    N/A  

     
     Pediatric Radiology CasesMost likely etiology:

    N/A  

     
     Pediatric Radiology CasesHistory:

    - Eutrophic newborn
    - Complicated spontaneous breech delivery
    - Amniotic aspiration with infiltrate in the area of the right lower lung lobe. Uncomplicated course.
    - Sonographic screening in the 9th day postpartum  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease :

    A suprarenal/adrenal hemorrhage can be found in 2 to 4 cases out of 1000 newborns and can occur prenatally or postnatally. The most important causes are birth trauma, neonatal asphyxia, systemic disorders and newborn sepsis. With 70%, the right adrenal gland is affected more frequently than the left. Bilateral hemorrhage can be occur in about 5 - 10% - in this case, a corticosteroid substitution may be necessary and necessitating longterm follow-up.  

     
     Pediatric Radiology CasesRadiological findings:


    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Large lucency surrounds the superior mediastinum with lucency crossing midline. Subtle lucency is also seen inferior and lateral of the right lung base at the costophrenic angle and hemidiaphragm.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Large lucency surrounds the superior aspect of the anterior mediastinum with elevation of the thymic shadow.




    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Frontal radiograph of the knees demonstrate bilateral pedunculated bony excrescence with cortical continuity and well-defined margins. The peduncles are oriented away from the knee joints.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Lateral radiograph of the right knee demonstrates pedunculated bony excrescence with cortical continuity and well-defined margins.






    MRI 1 <- view MRI 1

    MRI 1: T1 weighted coronal image demonstrates a pedunculated bony excrescence with cortical continuity and well-defined margins at the lateral aspect of the distal femoral metaphasis. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.






    MRI 2 <- view MRI 2

    MRI 2: T2 weighted axial image demonstrates pedunculated bony excrescences with cortical continuity and well-defined margins at the medial aspect of the proximal tibia and lateral aspect of the proximal fibula. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.






    MRI 3 <- view MRI 3

    MRI 3: T2 weighted coronal image demonstrates a pedunculated bony excrescence with cortical continuity and well-defined margins at the lateral aspect of the distal femoral metaphasis. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.






    MRI 4 <- view MRI 4

    MRI 4: Proton density (PD) weighted coronal image demonstrates a pedunculated bony excrescence with cortical continuity and well-defined margins at the lateral aspect of the distal femoral metaphasis. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.




    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Echogenic foreign body.




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Echogenic, segmented foreign body.




    OP-Situs 1 <- view OP-Situs 1

    OP-Situs 1: Introperative findings of a small bowel perforation.



    OP-Situs 2 <- view OP-Situs 2

    OP-Situs 2: Foreign body intraoperative



    OP-Situs 3 <- view OP-Situs 3

    OP-Situs 3: Foreign body in situ



    X-Ray 1 <- view X-Ray 1

    X-Ray 1: KUB: Tablet / rod like metallic foreign body in the right lower abdomen.




    Extensive, mostly cystic, partly solid infratentorial brain tumor with consecutive occlusion hydrocephalus and signs of intracranial pressure.


    MRI 1 <- view MRI 1

    MRI 1: T2 weighted sequences with signal intense tumor and perifocal edema intracerebellar.





    MRI 2 <- view MRI 2

    MRI 2: FLAIR with partly signal intense and partly almost liquor intense tumor areas cerebellar. The IV. ventricle is occluded.





    MRI 3 <- view MRI 3

    MRI 3: T1 weighted image with hypointense tumor.





    MRI 4 <- view MRI 4

    MRI 4: T1 weighted image with contrast. Partly contrast enhancement in the solid areas and in the margins of the cysts.





    MRI 5 <- view MRI 5

    MRI 5: T1 weighted image with contrast, sagital view.





    MRI 6 <- view MRI 6

    MRI 6: T1 weighted image with contrast, coronal view.




    MRI 1 <- view MRI 1

    MRI 1: T2-TSE transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
    T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas.






    MRI 2 <- view MRI 2

    MRI 2: T2-TSE transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
    T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas.






    MRI 3 <- view MRI 3

    MRI 3: T2-TSE transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
    T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas.






    MRI 4 <- view MRI 4

    MRI 4: T2-TSE sagital: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
    T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas. In the sagital sequences considerable compression of the 4th ventricle, vermis cerebelli and the right cerebellar hemisphere from cranial by the tumor. The brainstem is shifted towards ventral and the aqueduct is completely closed. As much as 1 cm wide, protein rich/hemorrrhagic subdural hygroma laying on the Tentorium and continuing occipital till the interhemispheric cleavage. In the sagital sequences total occlusion of the Foramen magnum by parts of the cerebellar tonsils, which reach caudal till the level of the intervertebral disc of T2/T3.







    MRI 5 <- view MRI 5

    MRI 5: FLAIR-Sequence: In the FLAIR-Sequences present tumor areas strong hyperintense.






    MRI 6 <- view MRI 6

    MRI 6: FLAIR-Sequence: In the sagital sequences considerable compression of the 4th ventricle, vermis cerebelli and the right cerebellar hemisphere from cranial by the tumor.
    The brainstem is shifted towards ventral and the aqueduct is completely closed.

    In the sagital sequences total occlusion of the Foramen magnum by parts of the cerebellar tonsils, which reach caudal till the level of the intervertebral disc of T2/T3.






    MRI 7 <- view MRI 7

    MRI 7: FLAIR-Sequece transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate in the FLAIR-Sequences present tumor areas strong hyperintense.






    MRI 8 <- view MRI 8

    MRI 8: T1 TSE tra with contrast: After contrast application moderate inhomogeneous and in the already signal rich tumor areas peripheral contrast enhancement.






    MRI 9 <- view MRI 9

    MRI 9: T1 TSE tra: After contrast application moderate inhomogeneous and in the already signal rich tumor areas peripheral contrast enhancement.






    MRI 11 <- view MRI 11

    MRI 11: T1-TSE: After contrast application moderate inhomogeneous and in the already signal rich tumor areas peripheral contrast enhancement. As much as 1 cm wide, protein rich/hemorrrhagic subdural hygroma laying on the Tentorium and continuing occipital till the interhemispheric cleavage. Distinct increased dural enhancement supratentorial bilateral.





    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: 9th day of life: At the upper pole of the left kidney, a well defined, about 54 x 32 x 34 mm measuring tumor is identified, which displaces the kidney caudally. The tumor contains heterogenous, echogenic and hypoechoic areas. Doppler sonography shows no perfusion.




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Normal renal parenchyma in a caudally displaced left kidney.




    Ultrasound 3 <- view Ultrasound 3

    Ultrasound 3: Follow-up after 19 days postpartum. At the left upper renal pole, a well defined tumor is again identified, which decreased in size (36 x 20 x 24 mm), containing echogenic and hypoechoic areas.

     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    N/A  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings:

    connatal neuroblastoma, multicystic nephroblastoma  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other :

    The sonographic findings are dependent of time and dependent on the severity of the hemorrhage:

    - Echogenic tumor in the first hours after hemorrhage (accordingly to a fresh coagulum)

    - Anechoic cystic process after 1 - 2 weeks (liquefied hematoma)

    - Decrease in size of the mass with increasing echogenicity and eventually calcification after 4 to 6 weeks.  

     
     Pediatric Radiology CasesComments of the author about the case:

    N/A  

     
     Pediatric Radiology CasesFirst description / History:

    N/A  

     
     Pediatric Radiology CasesLiterature:

    N/A  

     
     Pediatric Radiology CasesKeywords:

    Suprarenal hemorrhage, Adrenal hemorrhage, newborn, suprarenal, adrenal, hemorrhage, adrenal gland, adrenal hemorrhage  

     
     Pediatric Radiology Cases Cite this article:

    A Nordwig, S Jess, H Hetschko. Adrenal hemorrhage in a Newborn. PedRad [serial online] vol 4, no. 1.
    URL: www.PedRad.info/?search=20040105194544  

     
     Pediatric Radiology Cases Read similar articles: adrenal hemorrhage&type=1-17">corresponding keywords
    in the same field:
    or in the region:
    or in the tissue/organ:
    or with the etiology:
     
     Pediatric Radiology CasesImages to this case: There are Ultrasound-images available for this case. [ Ultrasound ] View all modalities [ All ]   
     
    Adrenal hemorrhage in a Newborn
    A Nordwig, S Jess, H Hetschko. Adrenal hemorrhage in a Newborn. PedRad [serial online] vol 4, no. 1.
    URL: www.PedRad.info/?search=20040105194544


     

    Search similar cases in:
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    Adrenal hemorrhage in a Newborn
    Other cases by these authors:

    Search Kraig J. Lage in Medline Kraig J. Lage (1)   
    Search Roland Talanow in Medline Roland Talanow (25)   
    Search K. Gerlach in Medline K. Gerlach (21)   
    Search Dirk Schaper  in Medline Dirk Schaper (15)   
    Search G. Hahn in Medline G. Hahn (38)   
    Search G. Hahn in Medline G. Hahn (38)   
    Search A. Nordwig in Medline A. Nordwig (20)   
    Search S. Jess in Medline S. Jess (1)   
    Search H. Hetschko in Medline H. Hetschko (3)   

    Adrenal hemorrhage in a Newborn  
     
    Adrenal hemorrhage in a Newborn
    A Nordwig, S Jess, H Hetschko. Adrenal hemorrhage in a Newborn. PedRad [serial online] vol 4, no. 1.
    URL: www.PedRad.info/?search=20040105194544


     

    Which diagnosis have other collegues guessed?


    • IRDS
      Votes: 1 (2 %)


    • Pneumothorax with pneumomediastinum
      Votes: 28 (80 %)


    • Pneumonia
      Votes: 1 (2 %)


    • Child abuse
      Votes: 1 (2 %)


    • Ebstein anomaly
      Votes: 4 (11 %)


    • Ingestion of batteries
      Votes: 4 (6 %)


    • Residual metallic tube after prior endoscopic laparatomy (appendectomy at the age of 9)
      Votes: 2 (3 %)


    • Bowel perforation and ileus secondary to ingestion of magnets
      Votes: 17 (29 %)


    • Foreign body on film in case of a salmonella induced enteritis
      Votes: 0 (0 %)


    • Pilocytic astrocytoma
      Votes: 8 (11 %)


    • Hemangioblastoma
      Votes: 0 (0 %)


    • Ependymoma
      Votes: 2 (2 %)


    • Medulloblastoma
      Votes: 2 (2 %)


    • Astrocytoma
      Votes: 0 (0 %)


    • Medulloblastoma
      Votes: 1 (1 %)


    • Pineoblastoma
      Votes: 14 (16 %)


    • Rathke cyst
      Votes: 1 (1 %)


    • Craniopharyngeoma
      Votes: 0 (0 %)


    • Connatal neuroblastoma
      Votes: 1 (1 %)


    • Multicystic nephroblastoma
      Votes: 0 (0 %)


    • Adrenal hemorrhage
      Votes: 12 (12 %)


    • Hemorrhagic renal cyst
      Votes: 1 (1 %)



        Total answers: 100

     
    Adrenal hemorrhage in a Newborn
    A Nordwig, S Jess, H Hetschko. Adrenal hemorrhage in a Newborn. PedRad [serial online] vol 4, no. 1.
    URL: www.PedRad.info/?search=20040105194544


     

    Medical Dictionary
    Search in medical dictionary for
    Or type in a keyword
    ( Provided by The On-Line Medical Dictionary )




    1 = less interesting)
     
    Adrenal hemorrhage in a Newborn
    A Nordwig, S Jess, H Hetschko. Adrenal hemorrhage in a Newborn. PedRad [serial online] vol 4, no. 1.
    URL: www.PedRad.info/?search=20040105194544


     


    Go to the top of the page   ID: 20031212124919 Original case in english  More links about this topic on Pubmed (PubMed Reader)
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    Discussion
     
    Omental cyst
    Dirk Schaper, V Hofmann. Omental cyst. PedRad [serial online] vol 3, no. 12.
    URL: www.PedRad.info/?search=20031212124919


     
     Pediatric Radiology CasesImages to this case: There are Ultrasound-images available for this case. [ Ultrasound ] There are OP-Situs-images available for this case. [ OP-Situs ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    Dirk Schaper, V. Hofmann (Kinderchirurgie St. Barbara-Krankenhaus Halle/S.)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    N/A  

     
     Pediatric Radiology CasesGender:

    N/A  

     
     Pediatric Radiology CasesRegion-Organ:

    N/A  

     
     Pediatric Radiology CasesMost likely etiology:

    N/A  

     
     Pediatric Radiology CasesHistory:

    For weeks the patient had a distended abdomen without signs of distress. Increased abdominal girth (pants didn't fit anymore). No fever, no paraclinical signs. No decease in performance. In sonographic examinations done by the primary care physician and by a pediatric hospital, a suspicion of ascites was expressed. Patient was admitted for clarification.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease :

    N/A  

     
     Pediatric Radiology CasesRadiological findings:


    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Large lucency surrounds the superior mediastinum with lucency crossing midline. Subtle lucency is also seen inferior and lateral of the right lung base at the costophrenic angle and hemidiaphragm.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Large lucency surrounds the superior aspect of the anterior mediastinum with elevation of the thymic shadow.




    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Frontal radiograph of the knees demonstrate bilateral pedunculated bony excrescence with cortical continuity and well-defined margins. The peduncles are oriented away from the knee joints.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Lateral radiograph of the right knee demonstrates pedunculated bony excrescence with cortical continuity and well-defined margins.






    MRI 1 <- view MRI 1

    MRI 1: T1 weighted coronal image demonstrates a pedunculated bony excrescence with cortical continuity and well-defined margins at the lateral aspect of the distal femoral metaphasis. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.






    MRI 2 <- view MRI 2

    MRI 2: T2 weighted axial image demonstrates pedunculated bony excrescences with cortical continuity and well-defined margins at the medial aspect of the proximal tibia and lateral aspect of the proximal fibula. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.






    MRI 3 <- view MRI 3

    MRI 3: T2 weighted coronal image demonstrates a pedunculated bony excrescence with cortical continuity and well-defined margins at the lateral aspect of the distal femoral metaphasis. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.






    MRI 4 <- view MRI 4

    MRI 4: Proton density (PD) weighted coronal image demonstrates a pedunculated bony excrescence with cortical continuity and well-defined margins at the lateral aspect of the distal femoral metaphasis. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.




    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Echogenic foreign body.




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Echogenic, segmented foreign body.




    OP-Situs 1 <- view OP-Situs 1

    OP-Situs 1: Introperative findings of a small bowel perforation.



    OP-Situs 2 <- view OP-Situs 2

    OP-Situs 2: Foreign body intraoperative



    OP-Situs 3 <- view OP-Situs 3

    OP-Situs 3: Foreign body in situ



    X-Ray 1 <- view X-Ray 1

    X-Ray 1: KUB: Tablet / rod like metallic foreign body in the right lower abdomen.




    Extensive, mostly cystic, partly solid infratentorial brain tumor with consecutive occlusion hydrocephalus and signs of intracranial pressure.


    MRI 1 <- view MRI 1

    MRI 1: T2 weighted sequences with signal intense tumor and perifocal edema intracerebellar.





    MRI 2 <- view MRI 2

    MRI 2: FLAIR with partly signal intense and partly almost liquor intense tumor areas cerebellar. The IV. ventricle is occluded.





    MRI 3 <- view MRI 3

    MRI 3: T1 weighted image with hypointense tumor.





    MRI 4 <- view MRI 4

    MRI 4: T1 weighted image with contrast. Partly contrast enhancement in the solid areas and in the margins of the cysts.





    MRI 5 <- view MRI 5

    MRI 5: T1 weighted image with contrast, sagital view.





    MRI 6 <- view MRI 6

    MRI 6: T1 weighted image with contrast, coronal view.




    MRI 1 <- view MRI 1

    MRI 1: T2-TSE transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
    T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas.






    MRI 2 <- view MRI 2

    MRI 2: T2-TSE transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
    T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas.






    MRI 3 <- view MRI 3

    MRI 3: T2-TSE transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
    T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas.






    MRI 4 <- view MRI 4

    MRI 4: T2-TSE sagital: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
    T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas. In the sagital sequences considerable compression of the 4th ventricle, vermis cerebelli and the right cerebellar hemisphere from cranial by the tumor. The brainstem is shifted towards ventral and the aqueduct is completely closed. As much as 1 cm wide, protein rich/hemorrrhagic subdural hygroma laying on the Tentorium and continuing occipital till the interhemispheric cleavage. In the sagital sequences total occlusion of the Foramen magnum by parts of the cerebellar tonsils, which reach caudal till the level of the intervertebral disc of T2/T3.







    MRI 5 <- view MRI 5

    MRI 5: FLAIR-Sequence: In the FLAIR-Sequences present tumor areas strong hyperintense.






    MRI 6 <- view MRI 6

    MRI 6: FLAIR-Sequence: In the sagital sequences considerable compression of the 4th ventricle, vermis cerebelli and the right cerebellar hemisphere from cranial by the tumor.
    The brainstem is shifted towards ventral and the aqueduct is completely closed.

    In the sagital sequences total occlusion of the Foramen magnum by parts of the cerebellar tonsils, which reach caudal till the level of the intervertebral disc of T2/T3.






    MRI 7 <- view MRI 7

    MRI 7: FLAIR-Sequece transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate in the FLAIR-Sequences present tumor areas strong hyperintense.






    MRI 8 <- view MRI 8

    MRI 8: T1 TSE tra with contrast: After contrast application moderate inhomogeneous and in the already signal rich tumor areas peripheral contrast enhancement.






    MRI 9 <- view MRI 9

    MRI 9: T1 TSE tra: After contrast application moderate inhomogeneous and in the already signal rich tumor areas peripheral contrast enhancement.






    MRI 11 <- view MRI 11

    MRI 11: T1-TSE: After contrast application moderate inhomogeneous and in the already signal rich tumor areas peripheral contrast enhancement. As much as 1 cm wide, protein rich/hemorrrhagic subdural hygroma laying on the Tentorium and continuing occipital till the interhemispheric cleavage. Distinct increased dural enhancement supratentorial bilateral.





    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: 9th day of life: At the upper pole of the left kidney, a well defined, about 54 x 32 x 34 mm measuring tumor is identified, which displaces the kidney caudally. The tumor contains heterogenous, echogenic and hypoechoic areas. Doppler sonography shows no perfusion.




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Normal renal parenchyma in a caudally displaced left kidney.




    Ultrasound 3 <- view Ultrasound 3

    Ultrasound 3: Follow-up after 19 days postpartum. At the left upper renal pole, a well defined tumor is again identified, which decreased in size (36 x 20 x 24 mm), containing echogenic and hypoechoic areas.


    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Lower abdominal longitudinal slice. Retrovesical fluid without inner echo. Majority is rather supravesical. A change in position affected the distribution of the fluid minimally.




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Longitudinal slice of the left upper quadrant. Echo-free fluid with no relation to the organ. After the patient was repositioned, only a limited fluid distribution in the abdomen.




    OP-Situs 1 <- view OP-Situs 1

    OP-Situs 1: Laparoscopic assissted removal of the pathological finding





    OP-Situs 2 <- view OP-Situs 2

    OP-Situs 2: Specimen

     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    N/A  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings:

    Mesenterial cyst, ascites  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other :

    Laparoscopy and confirmation of the sonographic suspicion of a cystic structure in the lower abdomen. Laparoscopic assistance for removal of the omental cyst.  

     
     Pediatric Radiology CasesComments of the author about the case:

    N/A  

     
     Pediatric Radiology CasesFirst description / History:

    N/A  

     
     Pediatric Radiology CasesLiterature:

    10. Medline: Medline
    Prasad KK, Jain M, Gupta RK.
    Omental cyst in children presenting as pseudoascites: report of two cases and review of the literature.
    Indian J Pathol Microbiol. 2001 Apr;44(2):153-5

    11. Medline: Medline
    Klin B, Lotan G, Efrati Y, Vinograd I.
    Giant omental cyst in children presenting as pseudoascites
    Surg Laparosc Endosc. 1997 Aug;7(4):291-3.

     

     
     Pediatric Radiology CasesKeywords:

    Omentum majus, Cyst, omental cyst, omentum cyst  

     
     Pediatric Radiology Cases Cite this article:

    Dirk Schaper, V Hofmann. Omental cyst. PedRad [serial online] vol 3, no. 12.
    URL: www.PedRad.info/?search=20031212124919  

     
     Pediatric Radiology Cases Read similar articles: omentum cyst&type=1-17">corresponding keywords
    in the same field:
    or in the region:
    or in the tissue/organ:
    or with the etiology:
     
     Pediatric Radiology CasesImages to this case: There are Ultrasound-images available for this case. [ Ultrasound ] There are OP-Situs-images available for this case. [ OP-Situs ] View all modalities [ All ]   
     
    Omental cyst
    Dirk Schaper, V Hofmann. Omental cyst. PedRad [serial online] vol 3, no. 12.
    URL: www.PedRad.info/?search=20031212124919


     

    Search similar cases in:
    More links about this topic on Pubmed  More links about this topic on Yahoo  More links about this topic on Altavista  More links about this topic on MSN  More links about this topic on Google  More links about this topic on Fireball

    Peer-reviewed Radiology Search



    Omental cyst
    Other cases by these authors:

    Search Kraig J. Lage in Medline Kraig J. Lage (1)   
    Search Roland Talanow in Medline Roland Talanow (25)   
    Search K. Gerlach in Medline K. Gerlach (21)   
    Search Dirk Schaper  in Medline Dirk Schaper (15)   
    Search G. Hahn in Medline G. Hahn (38)   
    Search G. Hahn in Medline G. Hahn (38)   
    Search A. Nordwig in Medline A. Nordwig (20)   
    Search S. Jess in Medline S. Jess (1)   
    Search H. Hetschko in Medline H. Hetschko (3)   
    Search Dirk Schaper in Medline Dirk Schaper (59)   
    Search V. Hofmann in Medline V. Hofmann (17)   

    Omental cyst  
     
    Omental cyst
    Dirk Schaper, V Hofmann. Omental cyst. PedRad [serial online] vol 3, no. 12.
    URL: www.PedRad.info/?search=20031212124919


     

    Which diagnosis have other collegues guessed?


    • IRDS
      Votes: 1 (2 %)


    • Pneumothorax with pneumomediastinum
      Votes: 28 (80 %)


    • Pneumonia
      Votes: 1 (2 %)


    • Child abuse
      Votes: 1 (2 %)


    • Ebstein anomaly
      Votes: 4 (11 %)


    • Ingestion of batteries
      Votes: 4 (6 %)


    • Residual metallic tube after prior endoscopic laparatomy (appendectomy at the age of 9)
      Votes: 2 (3 %)


    • Bowel perforation and ileus secondary to ingestion of magnets
      Votes: 17 (29 %)


    • Foreign body on film in case of a salmonella induced enteritis
      Votes: 0 (0 %)


    • Pilocytic astrocytoma
      Votes: 8 (11 %)


    • Hemangioblastoma
      Votes: 0 (0 %)


    • Ependymoma
      Votes: 2 (2 %)


    • Medulloblastoma
      Votes: 2 (2 %)


    • Astrocytoma
      Votes: 0 (0 %)


    • Medulloblastoma
      Votes: 1 (1 %)


    • Pineoblastoma
      Votes: 14 (16 %)


    • Rathke cyst
      Votes: 1 (1 %)


    • Craniopharyngeoma
      Votes: 0 (0 %)


    • Connatal neuroblastoma
      Votes: 1 (1 %)


    • Multicystic nephroblastoma
      Votes: 0 (0 %)


    • Adrenal hemorrhage
      Votes: 12 (12 %)


    • Hemorrhagic renal cyst
      Votes: 1 (1 %)


    • Omental cyst
      Votes: 11 (9 %)


    • Mesenterial cyst
      Votes: 7 (5 %)


    • Intestinal duplicature
      Votes: 3 (2 %)


    • Ascites
      Votes: 1 (0 %)



        Total answers: 122

     
    Omental cyst
    Dirk Schaper, V Hofmann. Omental cyst. PedRad [serial online] vol 3, no. 12.
    URL: www.PedRad.info/?search=20031212124919


     

    Medical Dictionary
    Search in medical dictionary for
    Or type in a keyword
    ( Provided by The On-Line Medical Dictionary )




    1 = less interesting)
     
    Omental cyst
    Dirk Schaper, V Hofmann. Omental cyst. PedRad [serial online] vol 3, no. 12.
    URL: www.PedRad.info/?search=20031212124919


     


    Go to the top of the page   ID: 20031026194110 Original case in english  More links about this topic on Pubmed (PubMed Reader)
    Add this case to your RSS feeder: Subscribe to RSS feed Add to Yahoo Add to Google Add to AOL Add to Furl Subscribe to Feed Burner feed

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    Discussion
     
    Hemophilic arthropathy (MRI findings)
    Wolfgang Hirsch, S Horneff. Hemophilic arthropathy (MRI findings). PedRad [serial online] vol 3, no. 10.
    URL: www.PedRad.info/?search=20031026194110


     
     Pediatric Radiology CasesImages to this case: There are MRI-images available for this case. [ MRI ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    Wolfgang Hirsch, S. Horneff (Leipzig/Halle)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    N/A  

     
     Pediatric Radiology CasesGender:

    N/A  

     
     Pediatric Radiology CasesRegion-Organ:

    N/A  

     
     Pediatric Radiology CasesMost likely etiology:

    N/A  

     
     Pediatric Radiology CasesHistory:

    After trauma: Swelling in the traumatized joint, no fever, no pain, but a feeling of pressure and decreased range of movement.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease :

    Factor XIII or Factor IX deficiency, in serious cases <1% of the normal value.

    After hemorrhage, usually resoprtion, hypertrophy of the synovia, hyperplasia. Possibly widening of the synovia and cartilage.

    Hemosiderine deposition in the synovia.

    Late findings: Destruction of cartilage. Resorption in the lamella. Cyst formation with hemorrhagic rests, collagen or gelatinous tissue.  

     
     Pediatric Radiology CasesRadiological findings:


    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Large lucency surrounds the superior mediastinum with lucency crossing midline. Subtle lucency is also seen inferior and lateral of the right lung base at the costophrenic angle and hemidiaphragm.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Large lucency surrounds the superior aspect of the anterior mediastinum with elevation of the thymic shadow.




    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Frontal radiograph of the knees demonstrate bilateral pedunculated bony excrescence with cortical continuity and well-defined margins. The peduncles are oriented away from the knee joints.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Lateral radiograph of the right knee demonstrates pedunculated bony excrescence with cortical continuity and well-defined margins.






    MRI 1 <- view MRI 1

    MRI 1: T1 weighted coronal image demonstrates a pedunculated bony excrescence with cortical continuity and well-defined margins at the lateral aspect of the distal femoral metaphasis. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.






    MRI 2 <- view MRI 2

    MRI 2: T2 weighted axial image demonstrates pedunculated bony excrescences with cortical continuity and well-defined margins at the medial aspect of the proximal tibia and lateral aspect of the proximal fibula. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.






    MRI 3 <- view MRI 3

    MRI 3: T2 weighted coronal image demonstrates a pedunculated bony excrescence with cortical continuity and well-defined margins at the lateral aspect of the distal femoral metaphasis. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.






    MRI 4 <- view MRI 4

    MRI 4: Proton density (PD) weighted coronal image demonstrates a pedunculated bony excrescence with cortical continuity and well-defined margins at the lateral aspect of the distal femoral metaphasis. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.




    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Echogenic foreign body.




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Echogenic, segmented foreign body.




    OP-Situs 1 <- view OP-Situs 1

    OP-Situs 1: Introperative findings of a small bowel perforation.



    OP-Situs 2 <- view OP-Situs 2

    OP-Situs 2: Foreign body intraoperative



    OP-Situs 3 <- view OP-Situs 3

    OP-Situs 3: Foreign body in situ



    X-Ray 1 <- view X-Ray 1

    X-Ray 1: KUB: Tablet / rod like metallic foreign body in the right lower abdomen.




    Extensive, mostly cystic, partly solid infratentorial brain tumor with consecutive occlusion hydrocephalus and signs of intracranial pressure.


    MRI 1 <- view MRI 1

    MRI 1: T2 weighted sequences with signal intense tumor and perifocal edema intracerebellar.





    MRI 2 <- view MRI 2

    MRI 2: FLAIR with partly signal intense and partly almost liquor intense tumor areas cerebellar. The IV. ventricle is occluded.





    MRI 3 <- view MRI 3

    MRI 3: T1 weighted image with hypointense tumor.





    MRI 4 <- view MRI 4

    MRI 4: T1 weighted image with contrast. Partly contrast enhancement in the solid areas and in the margins of the cysts.





    MRI 5 <- view MRI 5

    MRI 5: T1 weighted image with contrast, sagital view.





    MRI 6 <- view MRI 6

    MRI 6: T1 weighted image with contrast, coronal view.




    MRI 1 <- view MRI 1

    MRI 1: T2-TSE transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
    T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas.






    MRI 2 <- view MRI 2

    MRI 2: T2-TSE transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
    T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas.






    MRI 3 <- view MRI 3

    MRI 3: T2-TSE transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
    T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas.






    MRI 4 <- view MRI 4

    MRI 4: T2-TSE sagital: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
    T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas. In the sagital sequences considerable compression of the 4th ventricle, vermis cerebelli and the right cerebellar hemisphere from cranial by the tumor. The brainstem is shifted towards ventral and the aqueduct is completely closed. As much as 1 cm wide, protein rich/hemorrrhagic subdural hygroma laying on the Tentorium and continuing occipital till the interhemispheric cleavage. In the sagital sequences total occlusion of the Foramen magnum by parts of the cerebellar tonsils, which reach caudal till the level of the intervertebral disc of T2/T3.







    MRI 5 <- view MRI 5

    MRI 5: FLAIR-Sequence: In the FLAIR-Sequences present tumor areas strong hyperintense.






    MRI 6 <- view MRI 6

    MRI 6: FLAIR-Sequence: In the sagital sequences considerable compression of the 4th ventricle, vermis cerebelli and the right cerebellar hemisphere from cranial by the tumor.
    The brainstem is shifted towards ventral and the aqueduct is completely closed.

    In the sagital sequences total occlusion of the Foramen magnum by parts of the cerebellar tonsils, which reach caudal till the level of the intervertebral disc of T2/T3.






    MRI 7 <- view MRI 7

    MRI 7: FLAIR-Sequece transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate in the FLAIR-Sequences present tumor areas strong hyperintense.






    MRI 8 <- view MRI 8

    MRI 8: T1 TSE tra with contrast: After contrast application moderate inhomogeneous and in the already signal rich tumor areas peripheral contrast enhancement.






    MRI 9 <- view MRI 9

    MRI 9: T1 TSE tra: After contrast application moderate inhomogeneous and in the already signal rich tumor areas peripheral contrast enhancement.






    MRI 11 <- view MRI 11

    MRI 11: T1-TSE: After contrast application moderate inhomogeneous and in the already signal rich tumor areas peripheral contrast enhancement. As much as 1 cm wide, protein rich/hemorrrhagic subdural hygroma laying on the Tentorium and continuing occipital till the interhemispheric cleavage. Distinct increased dural enhancement supratentorial bilateral.





    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: 9th day of life: At the upper pole of the left kidney, a well defined, about 54 x 32 x 34 mm measuring tumor is identified, which displaces the kidney caudally. The tumor contains heterogenous, echogenic and hypoechoic areas. Doppler sonography shows no perfusion.




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Normal renal parenchyma in a caudally displaced left kidney.




    Ultrasound 3 <- view Ultrasound 3

    Ultrasound 3: Follow-up after 19 days postpartum. At the left upper renal pole, a well defined tumor is again identified, which decreased in size (36 x 20 x 24 mm), containing echogenic and hypoechoic areas.


    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Lower abdominal longitudinal slice. Retrovesical fluid without inner echo. Majority is rather supravesical. A change in position affected the distribution of the fluid minimally.




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Longitudinal slice of the left upper quadrant. Echo-free fluid with no relation to the organ. After the patient was repositioned, only a limited fluid distribution in the abdomen.




    OP-Situs 1 <- view OP-Situs 1

    OP-Situs 1: Laparoscopic assissted removal of the pathological finding





    OP-Situs 2 <- view OP-Situs 2

    OP-Situs 2: Specimen


    MRI 1 <- view MRI 1

    MRI 1: Knee Joint: Hemorrhage with proof of fluid in the suprapatellar recessus. (T2-TIRM sag).




    MRI 2 <- view MRI 2

    MRI 2: Knee Joint: T1-SE after contrast with fat saturation: Hypertrophy of the synovia, hyperplasia. Some widening of the synovia onto the cartilage.




    MRI 3 <- view MRI 3

    MRI 3: Shoulder Joint: T2-GE. Hemosiderin deposition in the Synovia.




    MRI 4 <- view MRI 4

    MRI 4: Knee Joint: T2-TIRM: Late cartilaginous destruction. Resorption at the border lamella. Cystic development with hemorrhagic rest, collagen, or gelatinous tissue. (Arrows)




    MRI 5 <- view MRI 5

    MRI 5: Upper Ankle Joint: T2-TIRM: Cartilaginous destruction. Resorption at the border lamella. Cystic development with hemorrhagic rest, collagen, or gelatinous tissue.




    MRI 6 <- view MRI 6

    MRI 6: Elbow: DESS: Cartilaginous destruction. Resorption at the border lamella. Cystic development with hemorrhagic rest, collagen, or gelatinous tissue.




    MRI 7 <- view MRI 7

    MRI 7: Upper Ankle Joint: T2-TIRM: Marrow edema with contrast uptake near the articulation, probably after intraossic hemorrhage.




    MRI 8 <- view MRI 8

    MRI 8: Knee: T2-TIRM: Marrow edema with contrast uptake near the articulation, probably after intraossic hemorrhage.




    MRI 9 <- view MRI 9

    MRI 9: Upper Ankle Joint: T2-TIRM: Marrow edema with contrast uptake near the articulation, probably after intraossic hemorrhage. The talus on the right side shows small dissicated osteochondrosis.




    MRI 10 <- view MRI 10

    MRI 10: Upper Ankle Joint: T1-SE after contrast with fat saturation: Marrow edema with contrast uptake near the articulation, probably after intraossic hemorrhage.




    MRI 11 <- view MRI 11

    MRI 11: Upper Ankle Joint: T2-TIRM: Arthrotic marginal spikes and joint incongruencies.




    MRI 12 <- view MRI 12

    MRI 12: T2-GE with FS: Elbow Joint: Metaphyseal widening (due to inflammatory hyperemia)




    MRI 13 <- view MRI 13

    MRI 13: Pseudotumor in the soft tissues. T2-TIRM and T1-SE after contrast and fat saturation (arrows)

     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    N/A  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings:

    rheumatoid arthritis.  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other :

    Even through constant substitution, hemorrhages cause change in the joints after 14 years of age.  

     
     Pediatric Radiology CasesComments of the author about the case:

    Pettersson-Score (X-Ray 0-13 points)

    Osteoporosis
    yes: 1

    Epiphyseal widening
    yes: 1

    Irregular subchondral bone surface
    incomplete: 1
    complete: 2

    Joint gap:
    Gap > 1mm: 1
    Gap < 1mm 2

    Subchondral cysts
    1 cyst: 1
    More than 1 cyst: 2

    Erosions of the joint's edges
    yes: 1

    Incongruence of the joint's edges
    slight: 1
    increased: 2

    Joint deformity (i.e. dislocated)
    slight: 1
    increased: 2


    NUSS-SCORE (MRI 0-13 points):

    Hemorrhage
    slight: 1
    moderate: 2
    large: 3

    Hemosiderin
    present: 1

    Synovia hypertrophy
    slight: 1
    moderate: 2
    large: 3

    Subchondral cysts/erosion
    1 cyst and partial surface erosion: 1
    > 1 cyst and partial surface erosion: 2
    > 1 cyst and complete surface erosion: 3

    Cartilage defects
    < 50%: 1
    >/= 50%: 2
    complete: 3  

     
     Pediatric Radiology CasesFirst description / History:

    N/A  

     
     Pediatric Radiology CasesLiterature:

    N/A  

     
     Pediatric Radiology CasesKeywords:

    hemorrhage, hemophilia, hemophil, hemophilic, arthropathia, arthropathy, hemophilic arthropathy  

     
     Pediatric Radiology Cases Cite this article:

    Wolfgang Hirsch, S Horneff. Hemophilic arthropathy (MRI findings). PedRad [serial online] vol 3, no. 10.
    URL: www.PedRad.info/?search=20031026194110  

     
     Pediatric Radiology Cases Read similar articles: hemophilic arthropathy&type=1-17">corresponding keywords
    in the same field:
    or in the region:
    or in the tissue/organ:
    or with the etiology:
     
     Pediatric Radiology CasesImages to this case: There are MRI-images available for this case. [ MRI ] View all modalities [ All ]   
     
    Hemophilic arthropathy (MRI findings)
    Wolfgang Hirsch, S Horneff. Hemophilic arthropathy (MRI findings). PedRad [serial online] vol 3, no. 10.
    URL: www.PedRad.info/?search=20031026194110


     

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    Hemophilic arthropathy (MRI findings)
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    Hemophilic arthropathy (MRI findings)  
     
    Hemophilic arthropathy (MRI findings)
    Wolfgang Hirsch, S Horneff. Hemophilic arthropathy (MRI findings). PedRad [serial online] vol 3, no. 10.
    URL: www.PedRad.info/?search=20031026194110


     

    Which diagnosis have other collegues guessed?


    • IRDS
      Votes: 1 (2 %)


    • Pneumothorax with pneumomediastinum
      Votes: 28 (80 %)


    • Pneumonia
      Votes: 1 (2 %)


    • Child abuse
      Votes: 1 (2 %)


    • Ebstein anomaly
      Votes: 4 (11 %)


    • Ingestion of batteries
      Votes: 4 (6 %)


    • Residual metallic tube after prior endoscopic laparatomy (appendectomy at the age of 9)
      Votes: 2 (3 %)


    • Bowel perforation and ileus secondary to ingestion of magnets
      Votes: 17 (29 %)


    • Foreign body on film in case of a salmonella induced enteritis
      Votes: 0 (0 %)


    • Pilocytic astrocytoma
      Votes: 8 (11 %)


    • Hemangioblastoma
      Votes: 0 (0 %)


    • Ependymoma
      Votes: 2 (2 %)


    • Medulloblastoma
      Votes: 2 (2 %)


    • Astrocytoma
      Votes: 0 (0 %)


    • Medulloblastoma
      Votes: 1 (1 %)


    • Pineoblastoma
      Votes: 14 (16 %)


    • Rathke cyst
      Votes: 1 (1 %)


    • Craniopharyngeoma
      Votes: 0 (0 %)


    • Connatal neuroblastoma
      Votes: 1 (1 %)


    • Multicystic nephroblastoma
      Votes: 0 (0 %)


    • Adrenal hemorrhage
      Votes: 12 (12 %)


    • Hemorrhagic renal cyst
      Votes: 1 (1 %)


    • Omental cyst
      Votes: 11 (9 %)


    • Mesenterial cyst
      Votes: 7 (5 %)


    • Intestinal duplicature
      Votes: 3 (2 %)


    • Ascites
      Votes: 1 (0 %)


    • Rheumatoid arthritis
      Votes: 2 (1 %)


    • Multifocal bacterial arthritis
      Votes: 0 (0 %)


    • Hemophilic arthropathy
      Votes: 13 (9 %)


    • Arthritis fugax
      Votes: 1 (0 %)


    • Multifocal psoriarthritis
      Votes: 0 (0 %)


    • Neuropathic arthropathy at leprosy
      Votes: 1 (0 %)



        Total answers: 139

     
    Hemophilic arthropathy (MRI findings)
    Wolfgang Hirsch, S Horneff. Hemophilic arthropathy (MRI findings). PedRad [serial online] vol 3, no. 10.
    URL: www.PedRad.info/?search=20031026194110


     

    Medical Dictionary
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    Hemophilic arthropathy (MRI findings)
    Wolfgang Hirsch, S Horneff. Hemophilic arthropathy (MRI findings). PedRad [serial online] vol 3, no. 10.
    URL: www.PedRad.info/?search=20031026194110


     


    Go to the top of the page   ID: 20030819114534 Original case in english  More links about this topic on Pubmed (PubMed Reader)
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    Discussion
     
    Perthes disease (Necrosis of the femoral head)
    A Nordwig, H Hetschko. Perthes disease (Necrosis of the femoral head). PedRad [serial online] vol 3, no. 8.
    URL: www.PedRad.info/?search=20030819114534


     
     Pediatric Radiology CasesImages to this case: There are X-Ray-images available for this case. [ X-Ray ] There are Ultrasound-images available for this case. [ Ultrasound ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    A. Nordwig, H. Hetschko (Halle)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    6 Years  

     
     Pediatric Radiology CasesGender:

    Male  

     
     Pediatric Radiology CasesRegion-Organ:

    N/A  

     
     Pediatric Radiology CasesMost likely etiology:

    N/A  

     
     Pediatric Radiology CasesHistory:

    6 year old male, intermittend pain in the right hip for 8 months, occasional limping; Physical therapy for 3 months.
    Examination of the right hip presented the following results:
    - shortened leg
    - palpatory pain in the groin and trochanter major
    - Drehmann-sign positive
    - extension / flexion: 0 / 10 / 120
    - abduction / adduction: 25 / 0 / 30
    - outer rotation / inward rotation: 20 / 0 / 20  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease :

    The causes for aseptic bone necrosis of the femoral head are not known. In children, the most common illness is Perthes-Calves disease. Of the spontaneous necroses, mostly children between teh age of 3 and 7 years are afflicted, boys more often than girls. Familial occurance has been noted. Perthes-Calves disease is also seen in combination with the hip dysplasia as early as in the 2nd year of life. Here, the causes can be many: vacular damage and epiphyseal damage through repositional trauma.

    The most commonly used staging criteria:
    a.) Joint space increased
    b.) Epiphysis increased in density and flattened.
    c.) Fragmentation
    d.) Newly formed bone.

    The grade of affliction was categorized by Cattarall:
    I) ventral area of the epiphysis, no sequesters
    II) half of the epiphysis is afflicted, seqester seen, small metaphyseal lesions
    III) 3/4 of the epiphysis is afflicted, large sequester seen, diffuse metaphyseal lesions
    IV) Complete epiphysis is sequestered, dramatic affliction of the metaphyseal region.  

     
     Pediatric Radiology CasesRadiological findings:


    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Large lucency surrounds the superior mediastinum with lucency crossing midline. Subtle lucency is also seen inferior and lateral of the right lung base at the costophrenic angle and hemidiaphragm.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Large lucency surrounds the superior aspect of the anterior mediastinum with elevation of the thymic shadow.




    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Frontal radiograph of the knees demonstrate bilateral pedunculated bony excrescence with cortical continuity and well-defined margins. The peduncles are oriented away from the knee joints.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Lateral radiograph of the right knee demonstrates pedunculated bony excrescence with cortical continuity and well-defined margins.






    MRI 1 <- view MRI 1

    MRI 1: T1 weighted coronal image demonstrates a pedunculated bony excrescence with cortical continuity and well-defined margins at the lateral aspect of the distal femoral metaphasis. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.






    MRI 2 <- view MRI 2

    MRI 2: T2 weighted axial image demonstrates pedunculated bony excrescences with cortical continuity and well-defined margins at the medial aspect of the proximal tibia and lateral aspect of the proximal fibula. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.






    MRI 3 <- view MRI 3

    MRI 3: T2 weighted coronal image demonstrates a pedunculated bony excrescence with cortical continuity and well-defined margins at the lateral aspect of the distal femoral metaphasis. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.






    MRI 4 <- view MRI 4

    MRI 4: Proton density (PD) weighted coronal image demonstrates a pedunculated bony excrescence with cortical continuity and well-defined margins at the lateral aspect of the distal femoral metaphasis. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.




    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Echogenic foreign body.




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Echogenic, segmented foreign body.




    OP-Situs 1 <- view OP-Situs 1

    OP-Situs 1: Introperative findings of a small bowel perforation.



    OP-Situs 2 <- view OP-Situs 2

    OP-Situs 2: Foreign body intraoperative



    OP-Situs 3 <- view OP-Situs 3

    OP-Situs 3: Foreign body in situ



    X-Ray 1 <- view X-Ray 1

    X-Ray 1: KUB: Tablet / rod like metallic foreign body in the right lower abdomen.




    Extensive, mostly cystic, partly solid infratentorial brain tumor with consecutive occlusion hydrocephalus and signs of intracranial pressure.


    MRI 1 <- view MRI 1

    MRI 1: T2 weighted sequences with signal intense tumor and perifocal edema intracerebellar.





    MRI 2 <- view MRI 2

    MRI 2: FLAIR with partly signal intense and partly almost liquor intense tumor areas cerebellar. The IV. ventricle is occluded.





    MRI 3 <- view MRI 3

    MRI 3: T1 weighted image with hypointense tumor.





    MRI 4 <- view MRI 4

    MRI 4: T1 weighted image with contrast. Partly contrast enhancement in the solid areas and in the margins of the cysts.





    MRI 5 <- view MRI 5

    MRI 5: T1 weighted image with contrast, sagital view.





    MRI 6 <- view MRI 6

    MRI 6: T1 weighted image with contrast, coronal view.




    MRI 1 <- view MRI 1

    MRI 1: T2-TSE transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
    T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas.






    MRI 2 <- view MRI 2

    MRI 2: T2-TSE transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
    T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas.






    MRI 3 <- view MRI 3

    MRI 3: T2-TSE transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
    T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas.






    MRI 4 <- view MRI 4

    MRI 4: T2-TSE sagital: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
    T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas. In the sagital sequences considerable compression of the 4th ventricle, vermis cerebelli and the right cerebellar hemisphere from cranial by the tumor. The brainstem is shifted towards ventral and the aqueduct is completely closed. As much as 1 cm wide, protein rich/hemorrrhagic subdural hygroma laying on the Tentorium and continuing occipital till the interhemispheric cleavage. In the sagital sequences total occlusion of the Foramen magnum by parts of the cerebellar tonsils, which reach caudal till the level of the intervertebral disc of T2/T3.







    MRI 5 <- view MRI 5

    MRI 5: FLAIR-Sequence: In the FLAIR-Sequences present tumor areas strong hyperintense.






    MRI 6 <- view MRI 6

    MRI 6: FLAIR-Sequence: In the sagital sequences considerable compression of the 4th ventricle, vermis cerebelli and the right cerebellar hemisphere from cranial by the tumor.
    The brainstem is shifted towards ventral and the aqueduct is completely closed.

    In the sagital sequences total occlusion of the Foramen magnum by parts of the cerebellar tonsils, which reach caudal till the level of the intervertebral disc of T2/T3.






    MRI 7 <- view MRI 7

    MRI 7: FLAIR-Sequece transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate in the FLAIR-Sequences present tumor areas strong hyperintense.






    MRI 8 <- view MRI 8

    MRI 8: T1 TSE tra with contrast: After contrast application moderate inhomogeneous and in the already signal rich tumor areas peripheral contrast enhancement.






    MRI 9 <- view MRI 9

    MRI 9: T1 TSE tra: After contrast application moderate inhomogeneous and in the already signal rich tumor areas peripheral contrast enhancement.






    MRI 11 <- view MRI 11

    MRI 11: T1-TSE: After contrast application moderate inhomogeneous and in the already signal rich tumor areas peripheral contrast enhancement. As much as 1 cm wide, protein rich/hemorrrhagic subdural hygroma laying on the Tentorium and continuing occipital till the interhemispheric cleavage. Distinct increased dural enhancement supratentorial bilateral.





    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: 9th day of life: At the upper pole of the left kidney, a well defined, about 54 x 32 x 34 mm measuring tumor is identified, which displaces the kidney caudally. The tumor contains heterogenous, echogenic and hypoechoic areas. Doppler sonography shows no perfusion.




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Normal renal parenchyma in a caudally displaced left kidney.




    Ultrasound 3 <- view Ultrasound 3

    Ultrasound 3: Follow-up after 19 days postpartum. At the left upper renal pole, a well defined tumor is again identified, which decreased in size (36 x 20 x 24 mm), containing echogenic and hypoechoic areas.


    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Lower abdominal longitudinal slice. Retrovesical fluid without inner echo. Majority is rather supravesical. A change in position affected the distribution of the fluid minimally.




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Longitudinal slice of the left upper quadrant. Echo-free fluid with no relation to the organ. After the patient was repositioned, only a limited fluid distribution in the abdomen.




    OP-Situs 1 <- view OP-Situs 1

    OP-Situs 1: Laparoscopic assissted removal of the pathological finding





    OP-Situs 2 <- view OP-Situs 2

    OP-Situs 2: Specimen


    MRI 1 <- view MRI 1

    MRI 1: Knee Joint: Hemorrhage with proof of fluid in the suprapatellar recessus. (T2-TIRM sag).




    MRI 2 <- view MRI 2

    MRI 2: Knee Joint: T1-SE after contrast with fat saturation: Hypertrophy of the synovia, hyperplasia. Some widening of the synovia onto the cartilage.




    MRI 3 <- view MRI 3

    MRI 3: Shoulder Joint: T2-GE. Hemosiderin deposition in the Synovia.




    MRI 4 <- view MRI 4

    MRI 4: Knee Joint: T2-TIRM: Late cartilaginous destruction. Resorption at the border lamella. Cystic development with hemorrhagic rest, collagen, or gelatinous tissue. (Arrows)




    MRI 5 <- view MRI 5

    MRI 5: Upper Ankle Joint: T2-TIRM: Cartilaginous destruction. Resorption at the border lamella. Cystic development with hemorrhagic rest, collagen, or gelatinous tissue.




    MRI 6 <- view MRI 6

    MRI 6: Elbow: DESS: Cartilaginous destruction. Resorption at the border lamella. Cystic development with hemorrhagic rest, collagen, or gelatinous tissue.




    MRI 7 <- view MRI 7

    MRI 7: Upper Ankle Joint: T2-TIRM: Marrow edema with contrast uptake near the articulation, probably after intraossic hemorrhage.




    MRI 8 <- view MRI 8

    MRI 8: Knee: T2-TIRM: Marrow edema with contrast uptake near the articulation, probably after intraossic hemorrhage.




    MRI 9 <- view MRI 9

    MRI 9: Upper Ankle Joint: T2-TIRM: Marrow edema with contrast uptake near the articulation, probably after intraossic hemorrhage. The talus on the right side shows small dissicated osteochondrosis.




    MRI 10 <- view MRI 10

    MRI 10: Upper Ankle Joint: T1-SE after contrast with fat saturation: Marrow edema with contrast uptake near the articulation, probably after intraossic hemorrhage.




    MRI 11 <- view MRI 11

    MRI 11: Upper Ankle Joint: T2-TIRM: Arthrotic marginal spikes and joint incongruencies.




    MRI 12 <- view MRI 12

    MRI 12: T2-GE with FS: Elbow Joint: Metaphyseal widening (due to inflammatory hyperemia)




    MRI 13 <- view MRI 13

    MRI 13: Pseudotumor in the soft tissues. T2-TIRM and T1-SE after contrast and fat saturation (arrows)


    -

    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Hip sonography, ventral. Irregular contours, right femoral head with irregular echo pattern with areas of high echogenicity and low echogenicity. Femoral head is altogether lower in height. Epiphyseal gap is fuzzy with increased echogenicity. Slight joint effusion to the right.

    -



    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Hip sonography, ventral. Right and left sides for comparison.

    -


    X-Ray 1 <- view X-Ray 1

    X-ray 1: Enlargened right joint space. Flattened, increased density in the head, somewhat fragmented. The femoral neck is "chunky" and widened (Image and diagnosis from the Insitute for Radiology, City Hospital Martha-Maria in Halle-Dölau)


     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    N/A  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings:

    Particularly at the beginning of the illness, arthritis of various origin; i.e. Coxitis fugax as well as enchondral dysostosis.  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other :

    Possibility of a periodic illness over many years.  

     
     Pediatric Radiology CasesComments of the author about the case:

    N/A  

     
     Pediatric Radiology CasesFirst description / History:

    N/A  

     
     Pediatric Radiology CasesLiterature:

    N/A  

     
     Pediatric Radiology CasesKeywords:

    Legg-Calve-Perthes disease, juvenile Osteochondronecrosis, Head of the Femur, Hip, femur head, Perthes disease, AVN, avascular necrosis, aseptic bone necrosis, limping, hip pain, knee pain, arthritis  

     
     Pediatric Radiology Cases Cite this article:

    A Nordwig, H Hetschko. Perthes disease (Necrosis of the femoral head). PedRad [serial online] vol 3, no. 8.
    URL: www.PedRad.info/?search=20030819114534  

     
     Pediatric Radiology Cases Read similar articles: arthritis&type=1-17">corresponding keywords
    in the same field:
    or in the region:
    or in the tissue/organ:
    or with the etiology:
     
     Pediatric Radiology CasesImages to this case: There are X-Ray-images available for this case. [ X-Ray ] There are Ultrasound-images available for this case. [ Ultrasound ] View all modalities [ All ]   
     
    Perthes disease (Necrosis of the femoral head)
    A Nordwig, H Hetschko. Perthes disease (Necrosis of the femoral head). PedRad [serial online] vol 3, no. 8.
    URL: www.PedRad.info/?search=20030819114534


     

    Search similar cases in:
    More links about this topic on Pubmed  More links about this topic on Yahoo  More links about this topic on Altavista  More links about this topic on MSN  More links about this topic on Google  More links about this topic on Fireball

    Peer-reviewed Radiology Search



    Perthes disease (Necrosis of the femoral head)
    Other cases by these authors:

    Search Kraig J. Lage in Medline Kraig J. Lage (1)   
    Search Roland Talanow in Medline Roland Talanow (25)   
    Search K. Gerlach in Medline K. Gerlach (21)   
    Search Dirk Schaper  in Medline Dirk Schaper (15)   
    Search G. Hahn in Medline G. Hahn (38)   
    Search G. Hahn in Medline G. Hahn (38)   
    Search A. Nordwig in Medline A. Nordwig (20)   
    Search S. Jess in Medline S. Jess (1)   
    Search H. Hetschko in Medline H. Hetschko (3)   
    Search Dirk Schaper in Medline Dirk Schaper (59)   
    Search V. Hofmann in Medline V. Hofmann (17)   
    Search Wolfgang Hirsch in Medline Wolfgang Hirsch (33)   
    Search S. Horneff in Medline S. Horneff (1)   
    Search A. Nordwig in Medline A. Nordwig (20)   
    Search H. Hetschko in Medline H. Hetschko (3)   

    Perthes disease (Necrosis of the femoral head)  
     
    Perthes disease (Necrosis of the femoral head)
    A Nordwig, H Hetschko. Perthes disease (Necrosis of the femoral head). PedRad [serial online] vol 3, no. 8.
    URL: www.PedRad.info/?search=20030819114534


     

    Which diagnosis have other collegues guessed?


    • IRDS
      Votes: 1 (2 %)


    • Pneumothorax with pneumomediastinum
      Votes: 28 (80 %)


    • Pneumonia
      Votes: 1 (2 %)


    • Child abuse
      Votes: 1 (2 %)


    • Ebstein anomaly
      Votes: 4 (11 %)


    • Ingestion of batteries
      Votes: 4 (6 %)


    • Residual metallic tube after prior endoscopic laparatomy (appendectomy at the age of 9)
      Votes: 2 (3 %)


    • Bowel perforation and ileus secondary to ingestion of magnets
      Votes: 17 (29 %)


    • Foreign body on film in case of a salmonella induced enteritis
      Votes: 0 (0 %)


    • Pilocytic astrocytoma
      Votes: 8 (11 %)


    • Hemangioblastoma
      Votes: 0 (0 %)


    • Ependymoma
      Votes: 2 (2 %)


    • Medulloblastoma
      Votes: 2 (2 %)


    • Astrocytoma
      Votes: 0 (0 %)


    • Medulloblastoma
      Votes: 1 (1 %)


    • Pineoblastoma
      Votes: 14 (16 %)


    • Rathke cyst
      Votes: 1 (1 %)


    • Craniopharyngeoma
      Votes: 0 (0 %)


    • Connatal neuroblastoma
      Votes: 1 (1 %)


    • Multicystic nephroblastoma
      Votes: 0 (0 %)


    • Adrenal hemorrhage
      Votes: 12 (12 %)


    • Hemorrhagic renal cyst
      Votes: 1 (1 %)


    • Omental cyst
      Votes: 11 (9 %)


    • Mesenterial cyst
      Votes: 7 (5 %)


    • Intestinal duplicature
      Votes: 3 (2 %)


    • Ascites
      Votes: 1 (0 %)


    • Rheumatoid arthritis
      Votes: 2 (1 %)


    • Multifocal bacterial arthritis
      Votes: 0 (0 %)


    • Hemophilic arthropathy
      Votes: 13 (9 %)


    • Arthritis fugax
      Votes: 1 (0 %)


    • Multifocal psoriarthritis
      Votes: 0 (0 %)


    • Neuropathic arthropathy at leprosy
      Votes: 1 (0 %)


    • Epiphysiolysis capitis femoris
      Votes: 5 (3 %)


    • Ewing-sarcoma of the femoral epyphysis
      Votes: 1 (0 %)


    • Dysplasia epiphysaria punktata
      Votes: 1 (0 %)


    • Perthes disease
      Votes: 18 (10 %)


    • Osteosarcoma
      Votes: 1 (0 %)



        Total answers: 165

     
    Perthes disease (Necrosis of the femoral head)
    A Nordwig, H Hetschko. Perthes disease (Necrosis of the femoral head). PedRad [serial online] vol 3, no. 8.
    URL: www.PedRad.info/?search=20030819114534


     

    Medical Dictionary
    Search in medical dictionary for
    Or type in a keyword
    ( Provided by The On-Line Medical Dictionary )




    1 = less interesting)
     
    Perthes disease (Necrosis of the femoral head)
    A Nordwig, H Hetschko. Perthes disease (Necrosis of the femoral head). PedRad [serial online] vol 3, no. 8.
    URL: www.PedRad.info/?search=20030819114534


     


    Go to the top of the page   ID: 20030606191500 Original case in english  More links about this topic on Pubmed (PubMed Reader)
    Add this case to your RSS feeder: Subscribe to RSS feed Add to Yahoo Add to Google Add to AOL Add to Furl Subscribe to Feed Burner feed

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    Discussion
     
    Hypertrophic pyloric stenosis
    Dirk Schaper, V Hofmann. Hypertrophic pyloric stenosis. PedRad [serial online] vol 3, no. 6.
    URL: www.PedRad.info/?search=20030606191500


     
     Pediatric Radiology CasesImages to this case: There are Ultrasound-images available for this case. [ Ultrasound ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    Dirk Schaper, V. Hofmann (Halle/S.)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    4 Weeks  

     
     Pediatric Radiology CasesGender:

    N/A  

     
     Pediatric Radiology CasesRegion-Organ:

    N/A  

     
     Pediatric Radiology CasesMost likely etiology:

    N/A  

     
     Pediatric Radiology CasesHistory:

    4 week-old infant, continuing postnatal spitting up; in the course, increased vomiting, afterwards swelled vomiting.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease :

    N/A  

     
     Pediatric Radiology CasesRadiological findings:


    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Large lucency surrounds the superior mediastinum with lucency crossing midline. Subtle lucency is also seen inferior and lateral of the right lung base at the costophrenic angle and hemidiaphragm.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Large lucency surrounds the superior aspect of the anterior mediastinum with elevation of the thymic shadow.




    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Frontal radiograph of the knees demonstrate bilateral pedunculated bony excrescence with cortical continuity and well-defined margins. The peduncles are oriented away from the knee joints.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Lateral radiograph of the right knee demonstrates pedunculated bony excrescence with cortical continuity and well-defined margins.






    MRI 1 <- view MRI 1

    MRI 1: T1 weighted coronal image demonstrates a pedunculated bony excrescence with cortical continuity and well-defined margins at the lateral aspect of the distal femoral metaphasis. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.






    MRI 2 <- view MRI 2

    MRI 2: T2 weighted axial image demonstrates pedunculated bony excrescences with cortical continuity and well-defined margins at the medial aspect of the proximal tibia and lateral aspect of the proximal fibula. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.






    MRI 3 <- view MRI 3

    MRI 3: T2 weighted coronal image demonstrates a pedunculated bony excrescence with cortical continuity and well-defined margins at the lateral aspect of the distal femoral metaphasis. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.






    MRI 4 <- view MRI 4

    MRI 4: Proton density (PD) weighted coronal image demonstrates a pedunculated bony excrescence with cortical continuity and well-defined margins at the lateral aspect of the distal femoral metaphasis. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.




    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Echogenic foreign body.




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Echogenic, segmented foreign body.




    OP-Situs 1 <- view OP-Situs 1

    OP-Situs 1: Introperative findings of a small bowel perforation.



    OP-Situs 2 <- view OP-Situs 2

    OP-Situs 2: Foreign body intraoperative



    OP-Situs 3 <- view OP-Situs 3

    OP-Situs 3: Foreign body in situ



    X-Ray 1 <- view X-Ray 1

    X-Ray 1: KUB: Tablet / rod like metallic foreign body in the right lower abdomen.




    Extensive, mostly cystic, partly solid infratentorial brain tumor with consecutive occlusion hydrocephalus and signs of intracranial pressure.


    MRI 1 <- view MRI 1

    MRI 1: T2 weighted sequences with signal intense tumor and perifocal edema intracerebellar.





    MRI 2 <- view MRI 2

    MRI 2: FLAIR with partly signal intense and partly almost liquor intense tumor areas cerebellar. The IV. ventricle is occluded.





    MRI 3 <- view MRI 3

    MRI 3: T1 weighted image with hypointense tumor.





    MRI 4 <- view MRI 4

    MRI 4: T1 weighted image with contrast. Partly contrast enhancement in the solid areas and in the margins of the cysts.





    MRI 5 <- view MRI 5

    MRI 5: T1 weighted image with contrast, sagital view.





    MRI 6 <- view MRI 6

    MRI 6: T1 weighted image with contrast, coronal view.




    MRI 1 <- view MRI 1

    MRI 1: T2-TSE transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
    T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas.






    MRI 2 <- view MRI 2

    MRI 2: T2-TSE transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
    T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas.






    MRI 3 <- view MRI 3

    MRI 3: T2-TSE transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
    T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas.






    MRI 4 <- view MRI 4

    MRI 4: T2-TSE sagital: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
    T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas. In the sagital sequences considerable compression of the 4th ventricle, vermis cerebelli and the right cerebellar hemisphere from cranial by the tumor. The brainstem is shifted towards ventral and the aqueduct is completely closed. As much as 1 cm wide, protein rich/hemorrrhagic subdural hygroma laying on the Tentorium and continuing occipital till the interhemispheric cleavage. In the sagital sequences total occlusion of the Foramen magnum by parts of the cerebellar tonsils, which reach caudal till the level of the intervertebral disc of T2/T3.







    MRI 5 <- view MRI 5

    MRI 5: FLAIR-Sequence: In the FLAIR-Sequences present tumor areas strong hyperintense.






    MRI 6 <- view MRI 6

    MRI 6: FLAIR-Sequence: In the sagital sequences considerable compression of the 4th ventricle, vermis cerebelli and the right cerebellar hemisphere from cranial by the tumor.
    The brainstem is shifted towards ventral and the aqueduct is completely closed.

    In the sagital sequences total occlusion of the Foramen magnum by parts of the cerebellar tonsils, which reach caudal till the level of the intervertebral disc of T2/T3.






    MRI 7 <- view MRI 7

    MRI 7: FLAIR-Sequece transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate in the FLAIR-Sequences present tumor areas strong hyperintense.






    MRI 8 <- view MRI 8

    MRI 8: T1 TSE tra with contrast: After contrast application moderate inhomogeneous and in the already signal rich tumor areas peripheral contrast enhancement.






    MRI 9 <- view MRI 9

    MRI 9: T1 TSE tra: After contrast application moderate inhomogeneous and in the already signal rich tumor areas peripheral contrast enhancement.






    MRI 11 <- view MRI 11

    MRI 11: T1-TSE: After contrast application moderate inhomogeneous and in the already signal rich tumor areas peripheral contrast enhancement. As much as 1 cm wide, protein rich/hemorrrhagic subdural hygroma laying on the Tentorium and continuing occipital till the interhemispheric cleavage. Distinct increased dural enhancement supratentorial bilateral.





    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: 9th day of life: At the upper pole of the left kidney, a well defined, about 54 x 32 x 34 mm measuring tumor is identified, which displaces the kidney caudally. The tumor contains heterogenous, echogenic and hypoechoic areas. Doppler sonography shows no perfusion.




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Normal renal parenchyma in a caudally displaced left kidney.




    Ultrasound 3 <- view Ultrasound 3

    Ultrasound 3: Follow-up after 19 days postpartum. At the left upper renal pole, a well defined tumor is again identified, which decreased in size (36 x 20 x 24 mm), containing echogenic and hypoechoic areas.


    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Lower abdominal longitudinal slice. Retrovesical fluid without inner echo. Majority is rather supravesical. A change in position affected the distribution of the fluid minimally.




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Longitudinal slice of the left upper quadrant. Echo-free fluid with no relation to the organ. After the patient was repositioned, only a limited fluid distribution in the abdomen.




    OP-Situs 1 <- view OP-Situs 1

    OP-Situs 1: Laparoscopic assissted removal of the pathological finding





    OP-Situs 2 <- view OP-Situs 2

    OP-Situs 2: Specimen


    MRI 1 <- view MRI 1

    MRI 1: Knee Joint: Hemorrhage with proof of fluid in the suprapatellar recessus. (T2-TIRM sag).




    MRI 2 <- view MRI 2

    MRI 2: Knee Joint: T1-SE after contrast with fat saturation: Hypertrophy of the synovia, hyperplasia. Some widening of the synovia onto the cartilage.




    MRI 3 <- view MRI 3

    MRI 3: Shoulder Joint: T2-GE. Hemosiderin deposition in the Synovia.




    MRI 4 <- view MRI 4

    MRI 4: Knee Joint: T2-TIRM: Late cartilaginous destruction. Resorption at the border lamella. Cystic development with hemorrhagic rest, collagen, or gelatinous tissue. (Arrows)




    MRI 5 <- view MRI 5

    MRI 5: Upper Ankle Joint: T2-TIRM: Cartilaginous destruction. Resorption at the border lamella. Cystic development with hemorrhagic rest, collagen, or gelatinous tissue.




    MRI 6 <- view MRI 6

    MRI 6: Elbow: DESS: Cartilaginous destruction. Resorption at the border lamella. Cystic development with hemorrhagic rest, collagen, or gelatinous tissue.




    MRI 7 <- view MRI 7

    MRI 7: Upper Ankle Joint: T2-TIRM: Marrow edema with contrast uptake near the articulation, probably after intraossic hemorrhage.




    MRI 8 <- view MRI 8

    MRI 8: Knee: T2-TIRM: Marrow edema with contrast uptake near the articulation, probably after intraossic hemorrhage.




    MRI 9 <- view MRI 9

    MRI 9: Upper Ankle Joint: T2-TIRM: Marrow edema with contrast uptake near the articulation, probably after intraossic hemorrhage. The talus on the right side shows small dissicated osteochondrosis.




    MRI 10 <- view MRI 10

    MRI 10: Upper Ankle Joint: T1-SE after contrast with fat saturation: Marrow edema with contrast uptake near the articulation, probably after intraossic hemorrhage.




    MRI 11 <- view MRI 11

    MRI 11: Upper Ankle Joint: T2-TIRM: Arthrotic marginal spikes and joint incongruencies.




    MRI 12 <- view MRI 12

    MRI 12: T2-GE with FS: Elbow Joint: Metaphyseal widening (due to inflammatory hyperemia)




    MRI 13 <- view MRI 13

    MRI 13: Pseudotumor in the soft tissues. T2-TIRM and T1-SE after contrast and fat saturation (arrows)


    -

    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Hip sonography, ventral. Irregular contours, right femoral head with irregular echo pattern with areas of high echogenicity and low echogenicity. Femoral head is altogether lower in height. Epiphyseal gap is fuzzy with increased echogenicity. Slight joint effusion to the right.

    -



    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Hip sonography, ventral. Right and left sides for comparison.

    -


    X-Ray 1 <- view X-Ray 1

    X-ray 1: Enlargened right joint space. Flattened, increased density in the head, somewhat fragmented. The femoral neck is "chunky" and widened (Image and diagnosis from the Insitute for Radiology, City Hospital Martha-Maria in Halle-Dölau)



    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: filled stomach, presentation of the pylorus with thickened walls.

     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    N/A  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings:

    N/A  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other :

    Sonographically and clinically typical pyloric hypertrophy. Diagnosis was supported Intraoperatively.  

     
     Pediatric Radiology CasesComments of the author about the case:

    With high-resolution ultrasound devices, one obtains images that schematically resemble the earlier contrast media representations, Bishop's well-known "umbrella sign" is seen on this image, but now with additional information reagarding the suroounding tissue. Or do you disagree?  

     
     Pediatric Radiology CasesFirst description / History:

    N/A  

     
     Pediatric Radiology CasesLiterature:

    N/A  

     
     Pediatric Radiology CasesKeywords:

    Pyloric hypertrophy, increasing projectile vomiting, hypertrophic pyloric stenosis, hypertrophic pylorus stenosis, pylorus stenosis, pyloric stenosis  

     
     Pediatric Radiology Cases Cite this article:

    Dirk Schaper, V Hofmann. Hypertrophic pyloric stenosis. PedRad [serial online] vol 3, no. 6.
    URL: www.PedRad.info/?search=20030606191500  

     
     Pediatric Radiology Cases Read similar articles: pyloric stenosis&type=1-17">corresponding keywords
    in the same field:
    or in the region:
    or in the tissue/organ:
    or with the etiology:
     
     Pediatric Radiology CasesImages to this case: There are Ultrasound-images available for this case. [ Ultrasound ] View all modalities [ All ]   
     
    Hypertrophic pyloric stenosis
    Dirk Schaper, V Hofmann. Hypertrophic pyloric stenosis. PedRad [serial online] vol 3, no. 6.
    URL: www.PedRad.info/?search=20030606191500


     

    Search similar cases in:
    More links about this topic on Pubmed  More links about this topic on Yahoo  More links about this topic on Altavista  More links about this topic on MSN  More links about this topic on Google  More links about this topic on Fireball

    Peer-reviewed Radiology Search



    Hypertrophic pyloric stenosis
    Other cases by these authors:

    Search Kraig J. Lage in Medline Kraig J. Lage (1)   
    Search Roland Talanow in Medline Roland Talanow (25)   
    Search K. Gerlach in Medline K. Gerlach (21)   
    Search Dirk Schaper  in Medline Dirk Schaper (15)   
    Search G. Hahn in Medline G. Hahn (38)   
    Search G. Hahn in Medline G. Hahn (38)   
    Search A. Nordwig in Medline A. Nordwig (20)   
    Search S. Jess in Medline S. Jess (1)   
    Search H. Hetschko in Medline H. Hetschko (3)   
    Search Dirk Schaper in Medline Dirk Schaper (59)   
    Search V. Hofmann in Medline V. Hofmann (17)   
    Search Wolfgang Hirsch in Medline Wolfgang Hirsch (33)   
    Search S. Horneff in Medline S. Horneff (1)   
    Search A. Nordwig in Medline A. Nordwig (20)   
    Search H. Hetschko in Medline H. Hetschko (3)   
    Search Dirk Schaper in Medline Dirk Schaper (59)   
    Search V. Hofmann in Medline V. Hofmann (17)   

    Hypertrophic pyloric stenosis  
     
    Hypertrophic pyloric stenosis
    Dirk Schaper, V Hofmann. Hypertrophic pyloric stenosis. PedRad [serial online] vol 3, no. 6.
    URL: www.PedRad.info/?search=20030606191500


     

    Which diagnosis have other collegues guessed?


    • IRDS
      Votes: 1 (2 %)


    • Pneumothorax with pneumomediastinum
      Votes: 28 (80 %)


    • Pneumonia
      Votes: 1 (2 %)


    • Child abuse
      Votes: 1 (2 %)


    • Ebstein anomaly
      Votes: 4 (11 %)


    • Ingestion of batteries
      Votes: 4 (6 %)


    • Residual metallic tube after prior endoscopic laparatomy (appendectomy at the age of 9)
      Votes: 2 (3 %)


    • Bowel perforation and ileus secondary to ingestion of magnets
      Votes: 17 (29 %)


    • Foreign body on film in case of a salmonella induced enteritis
      Votes: 0 (0 %)


    • Pilocytic astrocytoma
      Votes: 8 (11 %)


    • Hemangioblastoma
      Votes: 0 (0 %)


    • Ependymoma
      Votes: 2 (2 %)


    • Medulloblastoma
      Votes: 2 (2 %)


    • Astrocytoma
      Votes: 0 (0 %)


    • Medulloblastoma
      Votes: 1 (1 %)


    • Pineoblastoma
      Votes: 14 (16 %)


    • Rathke cyst
      Votes: 1 (1 %)


    • Craniopharyngeoma
      Votes: 0 (0 %)


    • Connatal neuroblastoma
      Votes: 1 (1 %)


    • Multicystic nephroblastoma
      Votes: 0 (0 %)


    • Adrenal hemorrhage
      Votes: 12 (12 %)


    • Hemorrhagic renal cyst
      Votes: 1 (1 %)


    • Omental cyst
      Votes: 11 (9 %)


    • Mesenterial cyst
      Votes: 7 (5 %)


    • Intestinal duplicature
      Votes: 3 (2 %)


    • Ascites
      Votes: 1 (0 %)


    • Rheumatoid arthritis
      Votes: 2 (1 %)


    • Multifocal bacterial arthritis
      Votes: 0 (0 %)


    • Hemophilic arthropathy
      Votes: 13 (9 %)


    • Arthritis fugax
      Votes: 1 (0 %)


    • Multifocal psoriarthritis
      Votes: 0 (0 %)


    • Neuropathic arthropathy at leprosy
      Votes: 1 (0 %)


    • Epiphysiolysis capitis femoris
      Votes: 5 (3 %)


    • Ewing-sarcoma of the femoral epyphysis
      Votes: 1 (0 %)


    • Dysplasia epiphysaria punktata
      Votes: 1 (0 %)


    • Perthes disease
      Votes: 18 (10 %)


    • Osteosarcoma
      Votes: 1 (0 %)


    • Pyloric hypertrophy
      Votes: 12 (6 %)


    • Eosinophilic Gastritis
      Votes: 1 (0 %)


    • Crohn's disease of the Duodenum
      Votes: 1 (0 %)


    • Stomach carcinoma
      Votes: 1 (0 %)



        Total answers: 180

     
    Hypertrophic pyloric stenosis
    Dirk Schaper, V Hofmann. Hypertrophic pyloric stenosis. PedRad [serial online] vol 3, no. 6.
    URL: www.PedRad.info/?search=20030606191500


     

    Medical Dictionary
    Search in medical dictionary for
    Or type in a keyword
    ( Provided by The On-Line Medical Dictionary )




    1 = less interesting)
     
    Hypertrophic pyloric stenosis
    Dirk Schaper, V Hofmann. Hypertrophic pyloric stenosis. PedRad [serial online] vol 3, no. 6.
    URL: www.PedRad.info/?search=20030606191500


     


    Go to the top of the page   ID: 20030603161946 Original case in english  More links about this topic on Pubmed (PubMed Reader)
    Add this case to your RSS feeder: Subscribe to RSS feed Add to Yahoo Add to Google Add to AOL Add to Furl Subscribe to Feed Burner feed

    Bookmark and Share


    Discussion
     
    Stress fracture of the proximal tibia
    Dirk Schaper, V Hofmann. Stress fracture of the proximal tibia. PedRad [serial online] vol 3, no. 6.
    URL: www.PedRad.info/?search=20030603161946


     
     Pediatric Radiology CasesImages to this case: There are X-Ray-images available for this case. [ X-Ray ] There are MRI-images available for this case. [ MRI ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    Dirk Schaper, V. Hofmann (Halle/S.)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    8 Years  

     
     Pediatric Radiology CasesGender:

    Female  

     
     Pediatric Radiology CasesRegion-Organ:

    N/A  

     
     Pediatric Radiology CasesMost likely etiology:

    N/A  

     
     Pediatric Radiology CasesHistory:

    8 year old turk girl with pain in the right tibia for about 14 days. No trauma could be remembered. No nightly pain. When stressed, pain began and worsening. Discrete pasty swelling over the right proximal tibia. Local pain on pressure, no redness. No inflammatory/infectious clinical signs.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease :

    N/A  

     
     Pediatric Radiology CasesRadiological findings:


    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Large lucency surrounds the superior mediastinum with lucency crossing midline. Subtle lucency is also seen inferior and lateral of the right lung base at the costophrenic angle and hemidiaphragm.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Large lucency surrounds the superior aspect of the anterior mediastinum with elevation of the thymic shadow.




    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Frontal radiograph of the knees demonstrate bilateral pedunculated bony excrescence with cortical continuity and well-defined margins. The peduncles are oriented away from the knee joints.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Lateral radiograph of the right knee demonstrates pedunculated bony excrescence with cortical continuity and well-defined margins.






    MRI 1 <- view MRI 1

    MRI 1: T1 weighted coronal image demonstrates a pedunculated bony excrescence with cortical continuity and well-defined margins at the lateral aspect of the distal femoral metaphasis. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.






    MRI 2 <- view MRI 2

    MRI 2: T2 weighted axial image demonstrates pedunculated bony excrescences with cortical continuity and well-defined margins at the medial aspect of the proximal tibia and lateral aspect of the proximal fibula. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.






    MRI 3 <- view MRI 3

    MRI 3: T2 weighted coronal image demonstrates a pedunculated bony excrescence with cortical continuity and well-defined margins at the lateral aspect of the distal femoral metaphasis. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.






    MRI 4 <- view MRI 4

    MRI 4: Proton density (PD) weighted coronal image demonstrates a pedunculated bony excrescence with cortical continuity and well-defined margins at the lateral aspect of the distal femoral metaphasis. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.




    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Echogenic foreign body.




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Echogenic, segmented foreign body.




    OP-Situs 1 <- view OP-Situs 1

    OP-Situs 1: Introperative findings of a small bowel perforation.



    OP-Situs 2 <- view OP-Situs 2

    OP-Situs 2: Foreign body intraoperative



    OP-Situs 3 <- view OP-Situs 3

    OP-Situs 3: Foreign body in situ



    X-Ray 1 <- view X-Ray 1

    X-Ray 1: KUB: Tablet / rod like metallic foreign body in the right lower abdomen.




    Extensive, mostly cystic, partly solid infratentorial brain tumor with consecutive occlusion hydrocephalus and signs of intracranial pressure.


    MRI 1 <- view MRI 1

    MRI 1: T2 weighted sequences with signal intense tumor and perifocal edema intracerebellar.





    MRI 2 <- view MRI 2

    MRI 2: FLAIR with partly signal intense and partly almost liquor intense tumor areas cerebellar. The IV. ventricle is occluded.





    MRI 3 <- view MRI 3

    MRI 3: T1 weighted image with hypointense tumor.





    MRI 4 <- view MRI 4

    MRI 4: T1 weighted image with contrast. Partly contrast enhancement in the solid areas and in the margins of the cysts.





    MRI 5 <- view MRI 5

    MRI 5: T1 weighted image with contrast, sagital view.





    MRI 6 <- view MRI 6

    MRI 6: T1 weighted image with contrast, coronal view.




    MRI 1 <- view MRI 1

    MRI 1: T2-TSE transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
    T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas.






    MRI 2 <- view MRI 2

    MRI 2: T2-TSE transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
    T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas.






    MRI 3 <- view MRI 3

    MRI 3: T2-TSE transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
    T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas.






    MRI 4 <- view MRI 4

    MRI 4: T2-TSE sagital: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
    T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas. In the sagital sequences considerable compression of the 4th ventricle, vermis cerebelli and the right cerebellar hemisphere from cranial by the tumor. The brainstem is shifted towards ventral and the aqueduct is completely closed. As much as 1 cm wide, protein rich/hemorrrhagic subdural hygroma laying on the Tentorium and continuing occipital till the interhemispheric cleavage. In the sagital sequences total occlusion of the Foramen magnum by parts of the cerebellar tonsils, which reach caudal till the level of the intervertebral disc of T2/T3.







    MRI 5 <- view MRI 5

    MRI 5: FLAIR-Sequence: In the FLAIR-Sequences present tumor areas strong hyperintense.






    MRI 6 <- view MRI 6

    MRI 6: FLAIR-Sequence: In the sagital sequences considerable compression of the 4th ventricle, vermis cerebelli and the right cerebellar hemisphere from cranial by the tumor.
    The brainstem is shifted towards ventral and the aqueduct is completely closed.

    In the sagital sequences total occlusion of the Foramen magnum by parts of the cerebellar tonsils, which reach caudal till the level of the intervertebral disc of T2/T3.






    MRI 7 <- view MRI 7

    MRI 7: FLAIR-Sequece transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate in the FLAIR-Sequences present tumor areas strong hyperintense.






    MRI 8 <- view MRI 8

    MRI 8: T1 TSE tra with contrast: After contrast application moderate inhomogeneous and in the already signal rich tumor areas peripheral contrast enhancement.






    MRI 9 <- view MRI 9

    MRI 9: T1 TSE tra: After contrast application moderate inhomogeneous and in the already signal rich tumor areas peripheral contrast enhancement.






    MRI 11 <- view MRI 11

    MRI 11: T1-TSE: After contrast application moderate inhomogeneous and in the already signal rich tumor areas peripheral contrast enhancement. As much as 1 cm wide, protein rich/hemorrrhagic subdural hygroma laying on the Tentorium and continuing occipital till the interhemispheric cleavage. Distinct increased dural enhancement supratentorial bilateral.





    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: 9th day of life: At the upper pole of the left kidney, a well defined, about 54 x 32 x 34 mm measuring tumor is identified, which displaces the kidney caudally. The tumor contains heterogenous, echogenic and hypoechoic areas. Doppler sonography shows no perfusion.




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Normal renal parenchyma in a caudally displaced left kidney.




    Ultrasound 3 <- view Ultrasound 3

    Ultrasound 3: Follow-up after 19 days postpartum. At the left upper renal pole, a well defined tumor is again identified, which decreased in size (36 x 20 x 24 mm), containing echogenic and hypoechoic areas.


    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Lower abdominal longitudinal slice. Retrovesical fluid without inner echo. Majority is rather supravesical. A change in position affected the distribution of the fluid minimally.




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Longitudinal slice of the left upper quadrant. Echo-free fluid with no relation to the organ. After the patient was repositioned, only a limited fluid distribution in the abdomen.




    OP-Situs 1 <- view OP-Situs 1

    OP-Situs 1: Laparoscopic assissted removal of the pathological finding





    OP-Situs 2 <- view OP-Situs 2

    OP-Situs 2: Specimen


    MRI 1 <- view MRI 1

    MRI 1: Knee Joint: Hemorrhage with proof of fluid in the suprapatellar recessus. (T2-TIRM sag).




    MRI 2 <- view MRI 2

    MRI 2: Knee Joint: T1-SE after contrast with fat saturation: Hypertrophy of the synovia, hyperplasia. Some widening of the synovia onto the cartilage.




    MRI 3 <- view MRI 3

    MRI 3: Shoulder Joint: T2-GE. Hemosiderin deposition in the Synovia.




    MRI 4 <- view MRI 4

    MRI 4: Knee Joint: T2-TIRM: Late cartilaginous destruction. Resorption at the border lamella. Cystic development with hemorrhagic rest, collagen, or gelatinous tissue. (Arrows)




    MRI 5 <- view MRI 5

    MRI 5: Upper Ankle Joint: T2-TIRM: Cartilaginous destruction. Resorption at the border lamella. Cystic development with hemorrhagic rest, collagen, or gelatinous tissue.




    MRI 6 <- view MRI 6

    MRI 6: Elbow: DESS: Cartilaginous destruction. Resorption at the border lamella. Cystic development with hemorrhagic rest, collagen, or gelatinous tissue.




    MRI 7 <- view MRI 7

    MRI 7: Upper Ankle Joint: T2-TIRM: Marrow edema with contrast uptake near the articulation, probably after intraossic hemorrhage.




    MRI 8 <- view MRI 8

    MRI 8: Knee: T2-TIRM: Marrow edema with contrast uptake near the articulation, probably after intraossic hemorrhage.




    MRI 9 <- view MRI 9

    MRI 9: Upper Ankle Joint: T2-TIRM: Marrow edema with contrast uptake near the articulation, probably after intraossic hemorrhage. The talus on the right side shows small dissicated osteochondrosis.




    MRI 10 <- view MRI 10

    MRI 10: Upper Ankle Joint: T1-SE after contrast with fat saturation: Marrow edema with contrast uptake near the articulation, probably after intraossic hemorrhage.




    MRI 11 <- view MRI 11

    MRI 11: Upper Ankle Joint: T2-TIRM: Arthrotic marginal spikes and joint incongruencies.




    MRI 12 <- view MRI 12

    MRI 12: T2-GE with FS: Elbow Joint: Metaphyseal widening (due to inflammatory hyperemia)




    MRI 13 <- view MRI 13

    MRI 13: Pseudotumor in the soft tissues. T2-TIRM and T1-SE after contrast and fat saturation (arrows)


    -

    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Hip sonography, ventral. Irregular contours, right femoral head with irregular echo pattern with areas of high echogenicity and low echogenicity. Femoral head is altogether lower in height. Epiphyseal gap is fuzzy with increased echogenicity. Slight joint effusion to the right.

    -



    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Hip sonography, ventral. Right and left sides for comparison.

    -


    X-Ray 1 <- view X-Ray 1

    X-ray 1: Enlargened right joint space. Flattened, increased density in the head, somewhat fragmented. The femoral neck is "chunky" and widened (Image and diagnosis from the Insitute for Radiology, City Hospital Martha-Maria in Halle-Dölau)



    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: filled stomach, presentation of the pylorus with thickened walls.


    X-Ray 1 <- view X-Ray 1

    X-ray 1: Lower thigh in two planes, no signs of fracture, discrete opaque bands in the proximalen tibia.






    X-Ray 2 <- view X-Ray 2

    X-ray 2: Lower thigh a. p.: After 14 more days, spindle-shaped callous, horizontal opaque band with dispersed bone structure






    MRI 1 <- view MRI 1

    MRT 1: In the T1 weighted image, expanded zone of reduced signal, inhomogenic spotty signal reduction, strongly inhomogenic signal increase in T2. Hypodense interruption of the bone's contour. Distinct soft-tissue edema.



     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    N/A  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings:

    Osteomyeltitis, Bone tumor  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other :

    After bed rest, condition improved. No further symptoms. Normal gait.

    A stress fracture in children is rather uncommon. The tibia is often seen, followed by the mid-foot bones, femur, fibula and pelvis. This is more common in females. Typically, the slow progression of pain over a longer period of time is seen. Mostly athletes are afflicted.
    X-ray diagnostics with conventional images is often not sufficient, especially since Osteomyelitis and bone tumors must be excluded differentially. An MRI makes sense and allows staging.
    Therapy depends on the degree of the damage, the time of diagnosis as well as the localization. It spans from bed-rest to surgical repair.  

     
     Pediatric Radiology CasesComments of the author about the case:

    Because of the clinical and laboratory course as well as the obvious placement as a Grade 4 lesion in MRI, we found this to be a stress fracture and treated it conservatively.  

     
     Pediatric Radiology CasesFirst description / History:

    N/A  

     
     Pediatric Radiology CasesLiterature:

    12. Medline: Medline
    Fredericson, M., Bergmann,A.G., Hoffmann,K.L. et al.
    Tibial stress reaction in runners. Correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system.
    Am J Sports Med 23 (1995) 472-481

    13. Medline: Medline
    de la Cuadra, P., Albinana,J.
    Pediatric stress fractures
    Int Orthop 2000;24(1):47-9

    14. Medline: Medline
    Mitchell,A.D., Grimer,R.J., Davies,A.M.
    Double-stress fracture of the tibia in a ten-year-old child.
    J Pediatr Orthop B 1999 Jan;8(1):67-8  

     
     Pediatric Radiology CasesKeywords:

    Stress fracture, swelling, increasing leg pain, fracture, proximal tibia  

     
     Pediatric Radiology Cases Cite this article:

    Dirk Schaper, V Hofmann. Stress fracture of the proximal tibia. PedRad [serial online] vol 3, no. 6.
    URL: www.PedRad.info/?search=20030603161946  

     
     Pediatric Radiology Cases Read similar articles: proximal tibia&type=1-17">corresponding keywords
    in the same field:
    or in the region:
    or in the tissue/organ:
    or with the etiology:
     
     Pediatric Radiology CasesImages to this case: There are X-Ray-images available for this case. [ X-Ray ] There are MRI-images available for this case. [ MRI ] View all modalities [ All ]   
     
    Stress fracture of the proximal tibia
    Dirk Schaper, V Hofmann. Stress fracture of the proximal tibia. PedRad [serial online] vol 3, no. 6.
    URL: www.PedRad.info/?search=20030603161946


     

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    Stress fracture of the proximal tibia
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    Stress fracture of the proximal tibia  
     
    Stress fracture of the proximal tibia
    Dirk Schaper, V Hofmann. Stress fracture of the proximal tibia. PedRad [serial online] vol 3, no. 6.
    URL: www.PedRad.info/?search=20030603161946


     

    Which diagnosis have other collegues guessed?


    • IRDS
      Votes: 1 (2 %)


    • Pneumothorax with pneumomediastinum
      Votes: 28 (80 %)


    • Pneumonia
      Votes: 1 (2 %)


    • Child abuse
      Votes: 1 (2 %)


    • Ebstein anomaly
      Votes: 4 (11 %)


    • Ingestion of batteries
      Votes: 4 (6 %)


    • Residual metallic tube after prior endoscopic laparatomy (appendectomy at the age of 9)
      Votes: 2 (3 %)


    • Bowel perforation and ileus secondary to ingestion of magnets
      Votes: 17 (29 %)


    • Foreign body on film in case of a salmonella induced enteritis
      Votes: 0 (0 %)


    • Pilocytic astrocytoma
      Votes: 8 (11 %)


    • Hemangioblastoma
      Votes: 0 (0 %)


    • Ependymoma
      Votes: 2 (2 %)


    • Medulloblastoma
      Votes: 2 (2 %)


    • Astrocytoma
      Votes: 0 (0 %)


    • Medulloblastoma
      Votes: 1 (1 %)


    • Pineoblastoma
      Votes: 14 (16 %)


    • Rathke cyst
      Votes: 1 (1 %)


    • Craniopharyngeoma
      Votes: 0 (0 %)


    • Connatal neuroblastoma
      Votes: 1 (1 %)


    • Multicystic nephroblastoma
      Votes: 0 (0 %)


    • Adrenal hemorrhage
      Votes: 12 (12 %)


    • Hemorrhagic renal cyst
      Votes: 1 (1 %)


    • Omental cyst
      Votes: 11 (9 %)


    • Mesenterial cyst
      Votes: 7 (5 %)


    • Intestinal duplicature
      Votes: 3 (2 %)


    • Ascites
      Votes: 1 (0 %)


    • Rheumatoid arthritis
      Votes: 2 (1 %)


    • Multifocal bacterial arthritis
      Votes: 0 (0 %)


    • Hemophilic arthropathy
      Votes: 13 (9 %)


    • Arthritis fugax
      Votes: 1 (0 %)


    • Multifocal psoriarthritis
      Votes: 0 (0 %)


    • Neuropathic arthropathy at leprosy
      Votes: 1 (0 %)


    • Epiphysiolysis capitis femoris
      Votes: 5 (3 %)


    • Ewing-sarcoma of the femoral epyphysis
      Votes: 1 (0 %)


    • Dysplasia epiphysaria punktata
      Votes: 1 (0 %)


    • Perthes disease
      Votes: 18 (10 %)


    • Osteosarcoma
      Votes: 1 (0 %)


    • Pyloric hypertrophy
      Votes: 12 (6 %)


    • Eosinophilic Gastritis
      Votes: 1 (0 %)


    • Crohn's disease of the Duodenum
      Votes: 1 (0 %)


    • Stomach carcinoma
      Votes: 1 (0 %)


    • Osteomyelitis
      Votes: 3 (1 %)


    • Ewing sarcoma
      Votes: 3 (1 %)


    • Stress fracture
      Votes: 8 (4 %)


    • Enchondroma
      Votes: 1 (0 %)


    • Hemangioma
      Votes: 1 (0 %)



        Total answers: 196

     
    Stress fracture of the proximal tibia
    Dirk Schaper, V Hofmann. Stress fracture of the proximal tibia. PedRad [serial online] vol 3, no. 6.
    URL: www.PedRad.info/?search=20030603161946


     

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    Stress fracture of the proximal tibia
    Dirk Schaper, V Hofmann. Stress fracture of the proximal tibia. PedRad [serial online] vol 3, no. 6.
    URL: www.PedRad.info/?search=20030603161946


     


    Go to the top of the page   ID: 20030519223650 Original case in english  More links about this topic on Pubmed (PubMed Reader)
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    Discussion
     
    Congenital diaphragmatic hernia (CDH), left
    Dirk Schaper. Congenital diaphragmatic hernia (CDH), left. PedRad [serial online] vol 3, no. 5.
    URL: www.PedRad.info/?search=20030519223650


     
     Pediatric Radiology CasesImages to this case: There are X-Ray-images available for this case. [ X-Ray ] There are OP-Situs-images available for this case. [ OP-Situs ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    Dirk Schaper (Halle/S.)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    Newborn  

     
     Pediatric Radiology CasesGender:

    N/A  

     
     Pediatric Radiology CasesRegion-Organ:

    N/A  

     
     Pediatric Radiology CasesMost likely etiology:

    N/A  

     
     Pediatric Radiology CasesHistory:

    Birth in outside clinic after a normal course of pregnancy. Prenatal sonography was without abnormal findings. Postnatally, there was a missing respiratory sound on the left. Radiological diagnostics were ordered. Transfer to the pediatric department in stable general condition without respiration.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease :

    The lung of the afflicted side is almost always hypoplastic.  

     
     Pediatric Radiology CasesRadiological findings:


    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Large lucency surrounds the superior mediastinum with lucency crossing midline. Subtle lucency is also seen inferior and lateral of the right lung base at the costophrenic angle and hemidiaphragm.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Large lucency surrounds the superior aspect of the anterior mediastinum with elevation of the thymic shadow.




    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Frontal radiograph of the knees demonstrate bilateral pedunculated bony excrescence with cortical continuity and well-defined margins. The peduncles are oriented away from the knee joints.





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Lateral radiograph of the right knee demonstrates pedunculated bony excrescence with cortical continuity and well-defined margins.






    MRI 1 <- view MRI 1

    MRI 1: T1 weighted coronal image demonstrates a pedunculated bony excrescence with cortical continuity and well-defined margins at the lateral aspect of the distal femoral metaphasis. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.






    MRI 2 <- view MRI 2

    MRI 2: T2 weighted axial image demonstrates pedunculated bony excrescences with cortical continuity and well-defined margins at the medial aspect of the proximal tibia and lateral aspect of the proximal fibula. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.






    MRI 3 <- view MRI 3

    MRI 3: T2 weighted coronal image demonstrates a pedunculated bony excrescence with cortical continuity and well-defined margins at the lateral aspect of the distal femoral metaphasis. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.






    MRI 4 <- view MRI 4

    MRI 4: Proton density (PD) weighted coronal image demonstrates a pedunculated bony excrescence with cortical continuity and well-defined margins at the lateral aspect of the distal femoral metaphasis. The bone marrow and surrounding soft tissue demonstrate normal signal intensity.




    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Echogenic foreign body.




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Echogenic, segmented foreign body.




    OP-Situs 1 <- view OP-Situs 1

    OP-Situs 1: Introperative findings of a small bowel perforation.



    OP-Situs 2 <- view OP-Situs 2

    OP-Situs 2: Foreign body intraoperative



    OP-Situs 3 <- view OP-Situs 3

    OP-Situs 3: Foreign body in situ



    X-Ray 1 <- view X-Ray 1

    X-Ray 1: KUB: Tablet / rod like metallic foreign body in the right lower abdomen.




    Extensive, mostly cystic, partly solid infratentorial brain tumor with consecutive occlusion hydrocephalus and signs of intracranial pressure.


    MRI 1 <- view MRI 1

    MRI 1: T2 weighted sequences with signal intense tumor and perifocal edema intracerebellar.





    MRI 2 <- view MRI 2

    MRI 2: FLAIR with partly signal intense and partly almost liquor intense tumor areas cerebellar. The IV. ventricle is occluded.





    MRI 3 <- view MRI 3

    MRI 3: T1 weighted image with hypointense tumor.





    MRI 4 <- view MRI 4

    MRI 4: T1 weighted image with contrast. Partly contrast enhancement in the solid areas and in the margins of the cysts.





    MRI 5 <- view MRI 5

    MRI 5: T1 weighted image with contrast, sagital view.





    MRI 6 <- view MRI 6

    MRI 6: T1 weighted image with contrast, coronal view.




    MRI 1 <- view MRI 1

    MRI 1: T2-TSE transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
    T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas.






    MRI 2 <- view MRI 2

    MRI 2: T2-TSE transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
    T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas.






    MRI 3 <- view MRI 3

    MRI 3: T2-TSE transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
    T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas.






    MRI 4 <- view MRI 4

    MRI 4: T2-TSE sagital: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate with strong hyperintense and inhomogeneous hypointense areas from the Pineal body to the tentorial notch, compressing the cerebellum and reaching untill the cerebellopontine angle to the right. In the
    T2- and T1-weighted sequences evidence of fluid level in the hyperintense lobulated tumor areas. In the sagital sequences considerable compression of the 4th ventricle, vermis cerebelli and the right cerebellar hemisphere from cranial by the tumor. The brainstem is shifted towards ventral and the aqueduct is completely closed. As much as 1 cm wide, protein rich/hemorrrhagic subdural hygroma laying on the Tentorium and continuing occipital till the interhemispheric cleavage. In the sagital sequences total occlusion of the Foramen magnum by parts of the cerebellar tonsils, which reach caudal till the level of the intervertebral disc of T2/T3.







    MRI 5 <- view MRI 5

    MRI 5: FLAIR-Sequence: In the FLAIR-Sequences present tumor areas strong hyperintense.






    MRI 6 <- view MRI 6

    MRI 6: FLAIR-Sequence: In the sagital sequences considerable compression of the 4th ventricle, vermis cerebelli and the right cerebellar hemisphere from cranial by the tumor.
    The brainstem is shifted towards ventral and the aqueduct is completely closed.

    In the sagital sequences total occlusion of the Foramen magnum by parts of the cerebellar tonsils, which reach caudal till the level of the intervertebral disc of T2/T3.






    MRI 7 <- view MRI 7

    MRI 7: FLAIR-Sequece transversal: Ca. 6 x 4 x 4,2 cm large inhomogeneous infiltrate in the FLAIR-Sequences present tumor areas strong hyperintense.






    MRI 8 <- view MRI 8

    MRI 8: T1 TSE tra with contrast: After contrast application moderate inhomogeneous and in the already signal rich tumor areas peripheral contrast enhancement.






    MRI 9 <- view MRI 9

    MRI 9: T1 TSE tra: After contrast application moderate inhomogeneous and in the already signal rich tumor areas peripheral contrast enhancement.






    MRI 11 <- view MRI 11

    MRI 11: T1-TSE: After contrast application moderate inhomogeneous and in the already signal rich tumor areas peripheral contrast enhancement. As much as 1 cm wide, protein rich/hemorrrhagic subdural hygroma laying on the Tentorium and continuing occipital till the interhemispheric cleavage. Distinct increased dural enhancement supratentorial bilateral.





    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: 9th day of life: At the upper pole of the left kidney, a well defined, about 54 x 32 x 34 mm measuring tumor is identified, which displaces the kidney caudally. The tumor contains heterogenous, echogenic and hypoechoic areas. Doppler sonography shows no perfusion.




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Normal renal parenchyma in a caudally displaced left kidney.




    Ultrasound 3 <- view Ultrasound 3

    Ultrasound 3: Follow-up after 19 days postpartum. At the left upper renal pole, a well defined tumor is again identified, which decreased in size (36 x 20 x 24 mm), containing echogenic and hypoechoic areas.


    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Lower abdominal longitudinal slice. Retrovesical fluid without inner echo. Majority is rather supravesical. A change in position affected the distribution of the fluid minimally.




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Longitudinal slice of the left upper quadrant. Echo-free fluid with no relation to the organ. After the patient was repositioned, only a limited fluid distribution in the abdomen.




    OP-Situs 1 <- view OP-Situs 1

    OP-Situs 1: Laparoscopic assissted removal of the pathological finding





    OP-Situs 2 <- view OP-Situs 2

    OP-Situs 2: Specimen


    MRI 1 <- view MRI 1

    MRI 1: Knee Joint: Hemorrhage with proof of fluid in the suprapatellar recessus. (T2-TIRM sag).




    MRI 2 <- view MRI 2

    MRI 2: Knee Joint: T1-SE after contrast with fat saturation: Hypertrophy of the synovia, hyperplasia. Some widening of the synovia onto the cartilage.




    MRI 3 <- view MRI 3

    MRI 3: Shoulder Joint: T2-GE. Hemosiderin deposition in the Synovia.




    MRI 4 <- view MRI 4

    MRI 4: Knee Joint: T2-TIRM: Late cartilaginous destruction. Resorption at the border lamella. Cystic development with hemorrhagic rest, collagen, or gelatinous tissue. (Arrows)




    MRI 5 <- view MRI 5

    MRI 5: Upper Ankle Joint: T2-TIRM: Cartilaginous destruction. Resorption at the border lamella. Cystic development with hemorrhagic rest, collagen, or gelatinous tissue.




    MRI 6 <- view MRI 6

    MRI 6: Elbow: DESS: Cartilaginous destruction. Resorption at the border lamella. Cystic development with hemorrhagic rest, collagen, or gelatinous tissue.




    MRI 7 <- view MRI 7

    MRI 7: Upper Ankle Joint: T2-TIRM: Marrow edema with contrast uptake near the articulation, probably after intraossic hemorrhage.




    MRI 8 <- view MRI 8

    MRI 8: Knee: T2-TIRM: Marrow edema with contrast uptake near the articulation, probably after intraossic hemorrhage.




    MRI 9 <- view MRI 9

    MRI 9: Upper Ankle Joint: T2-TIRM: Marrow edema with contrast uptake near the articulation, probably after intraossic hemorrhage. The talus on the right side shows small dissicated osteochondrosis.




    MRI 10 <- view MRI 10

    MRI 10: Upper Ankle Joint: T1-SE after contrast with fat saturation: Marrow edema with contrast uptake near the articulation, probably after intraossic hemorrhage.




    MRI 11 <- view MRI 11

    MRI 11: Upper Ankle Joint: T2-TIRM: Arthrotic marginal spikes and joint incongruencies.




    MRI 12 <- view MRI 12

    MRI 12: T2-GE with FS: Elbow Joint: Metaphyseal widening (due to inflammatory hyperemia)




    MRI 13 <- view MRI 13

    MRI 13: Pseudotumor in the soft tissues. T2-TIRM and T1-SE after contrast and fat saturation (arrows)


    -

    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Hip sonography, ventral. Irregular contours, right femoral head with irregular echo pattern with areas of high echogenicity and low echogenicity. Femoral head is altogether lower in height. Epiphyseal gap is fuzzy with increased echogenicity. Slight joint effusion to the right.

    -



    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Hip sonography, ventral. Right and left sides for comparison.

    -


    X-Ray 1 <- view X-Ray 1

    X-ray 1: Enlargened right joint space. Flattened, increased density in the head, somewhat fragmented. The femoral neck is "chunky" and widened (Image and diagnosis from the Insitute for Radiology, City Hospital Martha-Maria in Halle-Dölau)



    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: filled stomach, presentation of the pylorus with thickened walls.


    X-Ray 1 <- view X-Ray 1

    X-ray 1: Lower thigh in two planes, no signs of fracture, discrete opaque bands in the proximalen tibia.






    X-Ray 2 <- view X-Ray 2

    X-ray 2: Lower thigh a. p.: After 14 more days, spindle-shaped callous, horizontal opaque band with dispersed bone structure






    MRI 1 <- view MRI 1

    MRT 1: In the T1 weighted image, expanded zone of reduced signal, inhomogenic spotty signal reduction, strongly inhomogenic signal increase in T2. Hypodense interruption of the bone's contour. Distinct soft-tissue edema.




    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Postnatal X-Ray of the thorax and abdomen, multiple air-filled structures in the left hemithoracic area, widening of the intercostal spaces, displacement of the mediastinum to the right, relatively air-depleted abdomen.






    X-Ray 3 <- view X-Ray 3

    X-Ray 3: Postoperative X-Ray, not completely expanded lung, obvious border of thorax and abdomen through the diaphragm.






    OP-Situs 3 <- view OP-Situs 3

    OP-Situs 3: Intraoperative condition after opening the abdomen.





    OP-Situs 4 <- view OP-Situs 4

    OP-Situs 4: Intraoperative condition with probe in the defect.




    OP-Situs 5 <- view OP-Situs 5

    OP-Situs 5: Everted organs are shown.


     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    N/A  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings:

    Pulmonary cyst, CCAM  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other :

    In stable general condition, the left diaphragmal hernia was closed. There was a sufficiently placed, ventral diaphragmal border. Stress-free closing without patch.  

     
     Pediatric Radiology CasesComments of the author about the case:

    N/A  

     
     Pediatric Radiology CasesFirst description / History:

    N/A  

     
     Pediatric Radiology CasesLiterature:

    15. Medline: Medline
    Downard CD, Jaksic T, Garza JJ, Dzakovic A, Nemes L, Jennings RW, Wilson JM.
    Analysis of an improved survival rate for congenital diaphragmatic hernia.
    J Pediatr Surg 2003 May;38(5):729-32  

     
     Pediatric Radiology CasesKeywords:

    congenital, diaphragmatic hernia, eventration, hypoplastic lung, congenital diaphragmatic hernia, absent breathing sounds  

     
     Pediatric Radiology Cases Cite this article:

    Dirk Schaper. Congenital diaphragmatic hernia (CDH), left. PedRad [serial online] vol 3, no. 5.
    URL: www.PedRad.info/?search=20030519223650  

     
     Pediatric Radiology Cases Read similar articles: absent breathing sounds&type=1-17">corresponding keywords
    in the same field:
    or in the region:
    or in the tissue/organ:
    or with the etiology:
     
     Pediatric Radiology CasesImages to this case: There are X-Ray-images available for this case. [ X-Ray ] There are OP-Situs-images available for this case. [ OP-Situs ] View all modalities [ All ]   
     
    Congenital diaphragmatic hernia (CDH), left
    Dirk Schaper. Congenital diaphragmatic hernia (CDH), left. PedRad [serial online] vol 3, no. 5.
    URL: www.PedRad.info/?search=20030519223650


     

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    Congenital diaphragmatic hernia (CDH), left
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