Painful sclerosis of the medial end of the clavicle.

Pain and swelling of the medial end of the clavicle may be associated with radiographic sclerosis. The commonest causes are osteoarthritis, infection and condensing osteitis of the clavicle. Distinguishing between these clinically and radiologically can be difficult but computed tomography (CT) and magnetic resonance imaging (MRI) are often useful for their differentiation. In this review, the typical imaging features of these conditions are presented with an emphasis on the CT and MRI appearances. These are correlated with clinical features, which together should enable a confident diagnosis to be made.

Diagnostic value of the chest radiograph in asymptomatic neonates with a cardiac murmur.

AIM: To establish the diagnostic accuracy and diagnostic usefulness of the chest radiograph in asymptomatic neonates with cardiac murmurs. PATIENTS AND METHODS: The chest radiographs of 68 asymptomatic neonates with cardiac murmurs were analysed retrospectively. The radiographs were anonymized and then evaluated for the presence or absence of cardiac disease by six radiologists, three who regularly interpret neonatal chest radiographs and three who do so infrequently. The eventual diagnosis for each neonate and the impact of the chest radiograph and original report on patient management were established by review of the clinical case notes. RESULTS: The results for each observer were expressed in 2 x 2 contingency tables and statistical analysis was performed using Fisher's exact test. The radiologists who were experienced in reporting neonatal chest radiographs achieved statistically significant results (P=0.003, P=0.002 and P=0.007) compared with those who were less experienced (P=0.13, P=0.16 and P=0.09). Review of the case notes established that the chest radiograph and original report did not influence clinical management in any of the 68 cases studied. CONCLUSIONS: Radiologists who frequently report neonatal chest radiographs achieve high accuracy in differentiating cardiac from non-cardiac disease. However, inaccuracies are unavoidable as radiological evidence of cardiac disease is often not present. A false-positive result could cause undue anxiety while a false-negative report could result in the omission of further investigations. Furthermore, a chest radiograph is unlikely to provide the definitive diagnosis. Chest radiographs did not appear to influence patient management in this study and cannot be recommended in the initial evaluation of the asymptomatic neonate with a heart murmur.

Subcutaneous granuloma annulare: four cases and review of the literature.

Subcutaneous granuloma annulare (SGA) produces benign nodules in otherwise healthy children. The histology of the lesions may be indistinguishable from rheumatoid nodules. However, in children the lesion of SGA is not accompanied by connective-tissue disease. We report 4 patients with SGA. There were three girls and one boy ranging in age from 4 to 15 years. All the children presented with a solitary lesion on the lower limb. A cutaneous lesion was also present in case 4. In only one patient (case 4) was there a history of trauma. There was no relevant past medical history. Routine laboratory tests were normal (including ESR and auto-immune profile). A computed tomography (CT) scan with intravenous contrast was performed in all patients. The CT features were those of soft tissue masses of variable attenuation and enhancement with inconsistent infiltration into surrounding fat. There appear to be no specific CT features which distinguish this benign lesion from a more sinister one. Excisional biopsy was performed in all cases. In children, SGA should be included in the differential diagnosis of soft-tissue masses, particularly in the lower extremity.