[Hepatic alveolar echinococcosis: a rare cause of recurrent, surgically curable abdominal pain in children]. / L'échinococcose alvéolaire hépatique : une cause exceptionnelle de douleurs abdominales récurrentes, chirurgicalement curable, chez l'enfant.

Hepatic alveolar echinococcosis is a rare parasitic zoonosis, potentially lethal in childhood. It is due to Echinococcosis multilocularis whose larva insidiously develops in the liver. We report the case of a 13-year-old girl, living in the Vosges Mountains, followed for recurrent abdominal pain, with recent worsening. Diagnosis of alveolar echinococcosis was immediately suspected based on the liver ultrasound scan and then confirmed by imaging (CT scan, NMR) and serology. A curative surgical treatment (segmentectomy) was performed 3 months after diagnosis, under oral albendazole treatment, maintained for at least 2 years. Hepatic alveolar echinococcosis usually has a negative prognosis, except if diagnosed early, which allows rapid surgical treatment, as in our patient.

Voiding ultrasonography: evaluation of the detection of vesicoureteral reflux based on the review of digital ultrasound clips.

PURPOSE: To evaluate the accuracy of voiding urosonography (VUS) compared to X-ray voiding cystoureterography (VCUG) for the detection and grading of vesicoureteral reflux (VUR) by standardised reading of digital clips obtained from VUS and digital images from VCUG. MATERIALS AND METHODS: Approval by the ethics committee was obtained, and written, informed consent was given. 130 children (94 girls and 36 boys, mean age of 4.4 years) underwent VUS using Levovist (Schering, Germany) prior to VCUG. Digital VUS clips and digital VCUG images were reviewed by two groups of two radiologists. Results were mainly analysed in terms of reno-ureteral units (RUUs). Intra and interobserver reproducibility was estimated by calculation of kappa coefficient. Calculation of sensitivity and specificity of VUS was made in comparison with VCUG. RESULTS: Intraobserver reproducibility was good to moderate for the detection of VUR using VUS (kappa = 0.67 and 0.53 for each reviewer respectively) and good for the grading of reflux (kappa = 0.64 and 0.70). Interobserver reproducibility was excellent for the detection and grading of VUR using VCUG (kappa = 0.89 and 0.91) but good to moderate for VUS (kappa = 0.73 and 0.51). Compared to VCUG, sensitivity and specificity of VUS for the detection of VUR were 62.7 % and 83.4 %. Concordance for grading was moderate, with a higher grading using VUS. CONCLUSION: Real-time evaluation and diagnosis based on the review of VUS digital clips is achievable. However, there is a need for standardisation of digital records if a second reading by another radiologist or consideration by urologists is needed. Recent advances in US technology and the use of second-generation contrast agents would be promising to improve the feasibility, reproducibility and accuracy of the method.

[Sonocystography: a new method for the diagnosis and follow-up of vesico-ureteric reflux in children]. / L'écho-cystographie: une nouvelle méthode de détection et de suivi du reflux vésico-rénal chez l'enfant.

Vesicoureteral reflux (VUR) is a common finding in children presenting with acute urinary infection, with a frequency ranging from 20 to 50%. If radiological retrograde cystography still remains the standard technique, sonocystography now appears as a valuable alternative method, due to the properties of recent ultrasound contrast agents and the wide use of harmonic imaging. The analysis of the literature and the experience acquired by the authors during a clinical trial allow summarizing the current data on this new technique. Because of its accuracy, it may replace radiological cystography in the detection of VUR in girls, the follow-up in both boys and kids, and the management of recurrent infection in children presenting with normal radiological cystography.

Osteochondroma after pediatric hematopoietic stem cell transplantation: report of eight cases.

Eight children developed osteochondroma (OS) at a mean of 88 months after hematopoietic stem cell transplantation (HSCT). The mean age at HSCT was 56 months (12-84). This represents a cumulative incidence of 20% among patients less than 18 years of age transplanted from 1981 to 1997. These eight patients underwent allogeneic (n = 2) or autologous (n = 6) transplantation for either acute leukemia (n = 6) or neuroblastoma (n = 2) after a conditioning regimen including TBI (n = 7) or a combination of Bu and CY. OS was multiple in seven patients and solitary in one. Eight lesions were resected and all were benign. Four children received growth hormone before diagnosis of OS, but there was no clinical, radiological or histological difference between those who did not. Univariate analysis showed an increased rate associated only with autologous HSCT, with a 31.7% probability of a new OS at 12 years after HSCT. Osteochondroma should be added to the other adverse effects of HSCT in children.

[Pheochromocytoma in children]. / Les phéochromocytomes chez l'enfant.

Pheochromocytoma is rare in children. A wide varieties of lesions are observed and diagnosis, often made late, is based on urinary catecholamine assay. Magnetic resonance imaging provides the best morphological information. The disease is usually benign and prognosis is good. Familial forms of pheochromocytoma and pheochromocytoma associated with ischemia-induced bone lesions must be emphasized.

Misleading leads: focal xanthogranulomatous pyelonephritis in childhood.

Xanthogranulomatous pyelonephritis is a morphologic variant of pyelonephritis. Focal disease is very rare and can be misdiagnosed.

Compensatory renal growth post fetal nephrectomy in the rabbit.

Compensatory renal growth post-nephrectomy is well documented both clinically and experimentally. However, little is known about the capacity for compensatory growth in utero. We performed unilateral nephrectomy in fetal rabbits and studied the growth of the contralateral kidney. Thirty fetal rabbits underwent in utero uninephrectomies at day 25 of gestation. On gestational day 28, all the fetuses were delivered by cesarean section and the ratios kidney weight/body weight of the operated fetuses were compared to those of control littermates. The kidneys were then analysed by histology. A significant increase in renal weight was observed. The histological study of the remaining kidneys indicated a statistically significant increase of the glomerular area which confirmed the renal hypertrophy. This experiment demonstrates the capacity for the rabbit to develop in utero compensatory renal growth.

Painful scoliosis.

In case of painful scoliosis, a search for etiologic factors in the vertebral spinal canal and adjacent structures should be made. MRI with Gadolinium is useful to look for various pathology in and around the spine in particular of spinal cord. CT scanning is indispensible for bony details. Thus CT and MRI are complementary in evaluation of pathology of spine in any modern imaging centers.

Giant cell tumor of bone in children and adolescents.

Giant cell tumor of bone rarely affects children, in whom it is usually located in a metaphysis in contrast to the predominantly epiphyseal localization in adults. Five cases are reported, two at the femur, two at the fibula and one at the tibia. Plain film radiography and computed tomography are the most informative imaging studies. The differential diagnosis is with aneurysmal bone cyst and, in metaphyseal-epiphyseal forms, with chondroblastoma. Treatment usually consists in curettage of the tumor followed by filling of the cavity; however, more extensive resection is required in some cases.

[Diagnosis using x-ray computed angiotomography of an iliac artery aneurysm in an infant]. / Diagnostic par angiotomodensitométrie d'un anévrysme de l'artère iliaque chez un nourrisson.

The authors describe an infant with an aneurysm of the right iliac artery, associated with three sites involving the inferior mesenteric artery and its first two branches, most likely related to an episode of chicken pox. Helical angiography with computed tomography, performed with a continuous-rotation scanner, allowed precise assessment of the lesions, in particular those affecting the inferior mesenteric artery.

[The diagnosis of mediastinal lymphangioma in children]. / Diagnostic des lymphangiomes médiastinaux chez l'enfant.

On the basis of personal observation of four cases, the authors discuss the diagnostic aspects in this disease. Before birth, the diagnosis should be made by echography. After birth, magnetic resonance imaging scanning (IRM) is the method showing two types of cystic lymphangioma; a monomorphic and a polymorphic type. IRM is particularly valuable for the assessment of the extent of the disease all the more so as these tumours are often infiltrating. One should also recognise cervicomediastinal lymphangiomas which are more frequent in the very young and in whom the diagnosis is easy but one should not ignore the mediastinal component and those lymphangiomas which are purely mediastinal.