1998 YEAR BOOK OF P.R.
CURRENT PROBLEMS OF PEDIATRIC RADIOLOGY
1998 Year Book of Pediatric Radiology Vol. 10
© County Teaching Hospital, Miskolc 1998
 
Published by Borsod County Teaching Hospital Miskolc, Hungary
 
 
Editor: Bela Lombay M.D.
Chief, Department of Pediatric Radiology, County Teaching Hospital, Miskolc

 Editorial
10 years old YEAR BOOK of P.R.
 

10 years is a very short time in the age of a scientificjournal but a very "long" time for the writers, editors and other contributors. 10 years ago, at the birth of the book, the main goal was to establish an international journal which can give opportunity for pediatric radiologists mainly from eastern Europe to publish their scientific papers and views in an international language because only one officialjournal, the "Pediatric Radiology" existed on this topic in the world. The so called "Year Book" as a form of journal, we thought would give opportunity for a more liberate publication style about our daily practices and problems.

The "delivery" was not easy, it took about two years (1987-1989) for authorities of an Eastern European "Bureaucratic Office" in Hungary to be absolutely convinced that this journal in English language would serve only professional goals and there was no hidden bad intention of the editor with this publication.

I would think that this book can keep the original aim and will be more and more popular not only in Hungary but in other places of the world.

In summary, in the last nine years 95 scientific papers and case reports were published and 65 of them came from Hungarian authors. In addition several other publications, articles (about people, institutes, congresses) were published.

By the time a volume of the book is completed, normally in May of each year, just before the Congress of European Society of Pediatric Radiology is held, the editor had already started to think about the next issue's contents, the possible authors and sponsors. Fortunately till this time, it has been successful and for this, I would like to seize the opportunity to thank all the authors and members of the editorial board for their contributions. Special thanks to Dr. Alex Akoto Yeboah, who started as our resident from Ghana and had since become a well trained radiologist, for thé language editoring and to Janos Lovaszik, leader of the Press of the Borsod County Teaching Hospital in Miskolc for the high level technical work.

Last but not least many thanks to our sponsors, a special thanks also, to the Schering Hungary Co. for the continuous support.

B. Lombay  
INSTRUCTIONS FOR CONTRIBUTORS TO THE NEXT ISSUES

Manuscripts must be submitted in English to the Editor* every year before December 31.
Authors are asked to send two copies of the manuscript as follows:

 

Original papers should not exceed 6-8 manuscript pages and 6-8 illustrations, case notes, short reports, "unsolved" cases: 2-3 pages and 2-3 illustrations, comments, briefs, portraits: 1-2 pages and 1-2 illustrations, others (history, institutes, etc.) 2-4 pages and 2-4 illustrations.

Form of manuscript should be similar to that of other international journals e.g. Pediatric Radiology. We are awaiting papers related to all the field of pediatric radiology. We are also waiting for your opinions and proposals in connection with this journal. This journal can not pay any fee to the authors and members of the Editorial Board. It is a non-profit making publication and will be sold at cost price only.
 

* Address: Bela Lombay M.D. Dept. of Radiology, Child Health Center, 3501 Miskolc, POB. 188. Hungary  


CONTENTS

EDITORIAL  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
10 years old Year Book of Pediatric Radiology
INSTRUCTIONS for contributors to the next issues

POINT OF VIEW  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . .  3
Hyperechoic renal pyramids in chilren. A review
Navarro O., Daneman A.

CENTRAL NERVOUS SYSTEM IMAGING. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  11,19
Hyperechogenicity of the spinal arachnoid space. A new observation for the pathogenesis of neonatal posthemorrhagic hydrocephalus Rudas G., Almassy Zs., Papp B., Varga E., Meder U., Taylor G. . . . 11

The value of low field MRA in the diagnosis of pediatric stroke. A comparison of DSA and MRA studies
Lombay B., Velkey I., Yeboah A.

ENDOCRINE SYSTEM IMAGING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
McCune Albright syndrome. Case report
Sagodi L., Ladanyi E., Borbas E., Solyom E.

ABDOMINAL IMAGING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33, 43, 49
New insights in diagnosis and treatment of intussusception in children
Kramer P.P.G.

Diagnosis of intraabdominal complication in ventriculoperitoneal shunt of children with hydrocephalus
Poremba B., Nyari E., Kiss A., Lombay B.

Imaging of neonatal hepatic hemangioma
Kis E., Verebelyi T., Varkonyi I., Kovi R., Machay T., Mattyus I.

SKELETAL IMAGING  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Another case of congenital osteogenesis imperfecta with radiological metamorphosis
Kozlowski K., Swiatkowski J., Zarek S.

TECHNICAL NOTE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  61, 67
Panoramic ultrasound imaging in pediatric patients
Harkanyi Z.

Ultrasound guided percutaneous renal biopsy using an automatie "GUN" biopsy system
Szabo L., Lombay B., Bajusz I., Jako I., Losonczi K.

THE CASE OF THE YEAR  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . . . . . . . 71
Esophagus perforation mimicking esophagus developmental anomaly in a newborn baby
Nyari E., Varadi K., Szuts A., Kispal E., Kiss A.

BOOK REVIEW  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Pädiatrische Sonographie (Pediatric Ultrasonography) (Cornelia Schroder and Hans C. Oppermann)
Lombay B.

CONGRESS  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
34. Congress of the Society of German Pediatric Radiology
Schläffer E.

FOUNDATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

PICTURE ARCHIVING SYSTEM OF THE EDITOR  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80

INDEX (Volume 1-10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83  


1998 Year Book of Pediatric Radiology Vol. 10                                                 CENTRAL NERVOUS SYSTEM
© County Teaching Hospital, Miskolc 1998                                                                             IMAGING
 

HYPERECHOGENICITY OF THE SPINAL ARACHNOID SPACE.
A NEW OBSERVATION FOR THE PATHOGENESIS OF NEONATAL POSTHAEMORRHAGIC HYDROCEPHALUS
Rudas G.,1 Almássy Z.,1 Papp B.,1 Varga E.,1 Meder U.,1 Taylor G.2
Semmelweis University School of Medicinel, Budapest and Harvard Medical School,2 Boston

Abstract

Ultrasonogram of spinal arachnoid space and cerebrospinal fluid content of 31 infants ( 16 normal and 15 sick: 10 posthaemorrhagic hydrocephalus /PHH/ and 5 postinfectious hydrocephalus /PIH/) between the ages of 2-28 days of life were examined. Echogenicity of the dorsal (DAS) and ventral arachnoidal spáces (VAS) were evaluated in longitudinal and axial scans. In the normal group we found echofree VAS and DAS in 15 patients and only one had a slightly echogenic DAS. Among 10 PHH patients only two were normal and in 8 had increased echogenicity of the DAS. In one patient with infectious disease both arachnoid DAS and VAS was echogenic and in two other patients the DAS was hyperechogenic. Our findings indicate that "sludge" formation in the DAS leads to the alteration of the CSF circulation and might have a role: ( 1 ) in the pathogenesis of the PHH; (2) might explain false negative results (pressure, protein and blood conteint, etc.) of the lumbar puncture (Lp); (3) can explain the unsuccessful therapeutic LP drainage of the CSF in order to decrease the hydrocephalus.

Key words: hyperechogenic spinal arachnoid space, pathogenesis of hydrocephalus, newborn spinal canal.
Gabor Rudas M.D. 2nd Dept. of Pediatrics
Semmelweis Medical University Tűzoltó u. 7-9. 1094 Budapest, Hungary


THE VALUE OF LOW FIELD MRA IN THE DIAGNOSIS OF PEDIATRIC ISCHEMIC STROKE. A COMPARISON OF DSA AND MRA STUDIES
Lombay B.1, Velkey I.2, Yeboah A.1
County Teaching Hospital, Department of Diagnostic Imaging1 and Child Health Center2, Miskolc

Abstract

A comparative study is given on 10 children suffering from ischemic stroke. In all children the ischemic lesions were confirmed by CT scans. The patients underwent both Digital Subtraction Angiography (DSA) and low field MRA. In five cases of stenotic or occlusive changes the MRA correlated well with DSA findings. However 3 cases of moyamoya disease, 1 case of arterial spasm and I case of stenotic change were not shown on MRA. MRA can be a valuable alternative modality to DSA in occlusion of major intracerebral arteries.

Key words: ischemic stroke in children, low field MRA, DSA in children
Bela Lombay M.D. Ph.D. Department of Pediatric Radiology,
County Teaching Hospital
3501 Miskolc, POBox 188. Hungary


ULTRASOUND GUIDED PERCUTANEOUS RENAL BIOPSY USING AN AUTOMATIC
"GUN" BIOPSY SYSTEM
Szabó L.,1Lombay B.,2 Bajusz I.,1 Jako I.,1 Losonczi K.1
Borsod County Teaching Hospital, Child Health Centre, Pediatric Nephrology1, and Pediatric Radiology2, Miskolc, Hungary

Abstract

With an automatic gun biopsy system and ultrasound guidance, 17 percutaneous renal biopsy were performed in 17 children. Adequate tissue for diagnosis was obtained in all 17 patients. One child had an asymptomatic subcapsular hematoma as a complication. The technique and the advantages of this procedure are reported. The use of ultrasound guided automatic gunshot biopsy system is a s,afe and efficient method for performing renal biopsies in children.

Key words: Renal biopsy in children, Biopsy technique, Ultrasonic diagnosis
Laszlo Szabo M.D. Ph.D. Department of Pediatric Nephrology
Child Health Center, PoBox 188 3501 Miskolc, Hungary


POINT OF VIEW
HYPERECHOIC RENAL PYRAMIDS IN CHILDREN: A REVIEW
Navarro O. and Daneman A.
Department of Diagnostic Imaging, Hospital for Sick Children and the University of Toronto

Abstract

The detection of hyperechoic renal pyramids in children has become a frequent finding as sonography is widely used in the evaluation of pediatric patients for renal and non-renal pathologies. This article reviews and illustrates some of these conditions and attempts to analyze the mechanism for the hyperechogenicity in each group of conditions.

Key words: hyperechoic renal pyramids, medullary nephrocalcinosis, children
Dr. Oscar Navarro, Dr. Alan Daneman
Department of Diagnostic Imaging Hospital for Sick Children and the University of Toronto,
Toronto, Ont. M5G 1x8, Canada


INTRAABDOMINAL COMPLICATIONS OF VENTRICULO-PERITONEAL SHUNT IN CHILDHOOD
Poremba B.,1 Nyari E.,2Kiss A.,1 Lombay B.2
Borsod-A-Z County Teaching Hospital, Department of Pediatric Surgery1 and Pediatric Radiology2, Miskolc

Abstract

63 children with ventriculo-peritoneal shunt were investigated by different imaging modalities to recognize the rate and the main reasons of abdominal complications. Eleven of them had some intergrowth such as inguinal hernia and/or hydrocele (9 cases), bowel perforation (2 cases), CSF pseudocyst (1 case) and liver abscess (1 case). Abdominal plain film, ultrasonography, occasionally CT has important role for the correct diagnosis of the complications.

Key words: ventriculo-peritoneal shunt, hydrocephalus, shunt complication.
Beata Poremba M.D. Department of Pediatric Surgery BAZ County Teaching Hospital
3501 Miskolc. PoBox I 88 Hungary


IMAGING OF NEONATAL HEPATIC HEMANGIOMA
Kis É., Verebély T., Várkonyi I., Kövi R., Machay T., Máttyus I.
First Department of Pediatrics of Semmelweis Medical University, Budapest

Abstract

Three infants with hepatic hemangioma are presented. Ultrasonography showed the lesion in two cases. One of them was a cavernous hemangioma with marked arteriovenous shunt which was seen by Color Doppler US and helical CT studies. In the other patient Color Doppler US and CT was not characteristic and biopsy (histology) verified the diagnosis. In the third baby with congenital adrenal hyperplasia, surgical procedure revealed the hemangioma. Previous diagnostic imaging modalities (US, CT) could not detect the lesion.

Key words: liver hemangioma, hemangioendothelioma, neonate, ultrasound
Eva Kis M.D. Semmelweis Medical University
First Dept. of Pediatrics Bokay str. 53 1083 Budapest, Hungary


TECHNICAL NOTE
PANORAMIC ULTRASOUND IMAGING IN PEDIATRIC PATIENTS
Harkanyi, Z.
Department of Radiology, Heim Pál Children's Hospital, Budapest

Abstract

Panoramic ultrasound imaging is a complementary method to demonstrate ultrasound studies. The goal is to cover longer regions in order to document pathology and to measure the size of the organs and lesions. The large field of view helps in communication regarding the ultrasound findings and in the comparison with other radiological modalities.
In this technical note we summarize our preliminary experiences obtained using panoramic ultrasound in pediatric patients in different age groups.

Key words: panoramic ultrasound, small parts pediatric u1trasound
Zoltan Harkanyi M.D. Ph.D. Department of Radiology
Heim Pal Children's Hospital 1089 Budapest, Üll?i str. 86, Hungary


ABDOMINAL IMAGING
NEW INSIGHTS IN DIAGNOSIS AND TREATMENT OF INTUSSUSCEPTION IN CHILDREN
Kramer P.P.G.
Department of Radiology, Wilhelmina Childrens' Hospital, Utrecht

Abstract

Diagnostic imaging modalities and treatment of intussusception in children are discussed. Author presents his experiences about the role of abdominal plain film, ultrasonography and colon enema in the diagnosis and reduction of intussusception. Complication, recurrence and mortality of the diseases and the characteristic of intussusception in cystic fibrosis are also discussed.

Key words: intussusception in children, diagnosis, treatment of intussusception
Peter P.G. Kramer M.D. Department of Radiology
Wilhelmina Children's Hospital 3501 CA Utrecht, Holland


SKELETAL IMAGING
ANOTHER CASE OF CONGENITAL OSTEOGENESIS IMPERFECTA WITH RADIOLOGICAL "METAMORPHOSIS"
Kozlowski K,1Swiatkowski J,2 Zarek S3
Department of Radiology Royal Alexandra Hospital for Children, Sydney, Australia1 and Departments of Radiology2 and Orthopedic Surgery3, Orthopaedic Institute, Warsaw, Poland

Abstract

A patient with radiographic manifestations consistent with severe type of osteogenesis imperfecta (in Maroteaux classification) or subtype IIB (in Sillence classification) at birt is reported.
At the age of 12 years, there has been marked regression of the changes giving a picture of osteogenesis imperfecta type I.
Classification and prognostication should be very careful in newborns with OI.

Key words: Osteogenesis Imperfecta
Dr. K. Kozlowski New Children's Hospital
PO Box 3SIS Parramatta, NSW 2124 Australia


THE CASE OF THE YEAR
ESOPHAGUS PERFORATION MIMICKING ESOPHAGUS DEVELOPMENTAL
ANOMALY IN A NEWBORN BABY
Nyari E., Varadi K., Szüts A., Kispal E., Kiss Á.
Department of Pediatric Radiology, Neonatology, Otölaryngology and Surgery, County Teaching Hospital, Miskolc

Abstract

A newborn baby with esophageal perforation is presented. Fluoroscopy, contrast swallowing and esophagoscopy all together leaded to the correct diagnosis. Developmental disorders e.g. esophageal duplication, esophagopharyngeal diverticulum may be taken into consideration in the differential diagnosis.

Key words: esophagus perforation, neonatal esophagus
Edit Nyari M.D. Department of Pediatric Radiology
County Teaching Hospital PoBox 188 3501 Miskolc, Hungary


ENDOCRINE SYSTEM IMAGING
McCUNE ALBRIGHT SYNDROME. CASE REPORT
Sagodi L.,1 Ladanyi E.,2 Borbas E.,2 and Solyom E.1
Borsod County Teaching Hospital, Department of Pediatric Endocrinology1 and Pediatric Radiology2 Miskolc

Abstract

We present precocious puberty in a case of a two year old girl. We summarize the diagnostic and differential diagnostic problems of peripheral precocious puberty in details. On the basis of examinations, though bone lesions is missen in the background of precocious puberty, McCune Albright syndrome was observed. The early precocious process significantly reduced, the volume and function of ovaries decreased on the effect of aromatase inhibitor, but it seems that there won't be a total recovery. Beside gonadal disorder we didn't find any other endocrine anomaly.

Key words: McCune Albright syndrome, peripheral precocious puberty, gonadotropin independent puberty, activated Gs protein, aromatase inhibitor, overactive cyclic AMP.
László Ságodi M.D. Ph.D. Borsod County Teaching Hospital
Child Health Center, Szentpéteri kapu 72, POBox 188 3501 Miskolc, Hungary