[Echographic aspects of cerebral sulci in the ante- and perinatal period]. / Aspects échographiques des sillons cérébraux à la période anté et péri-natale.

70 fetuses (10 to 37 weeks) and 30 full term infants were examined by ultrasound (U.S.). Anatomic correlations were made with frontal, axial and sagittal sections of 43 fetal and 3 neonatal brains. At 12 weeks gestational age (w.g.a.) only the inter hemispheric fissure is seen by U.S. The sylvian fissure (21 w.g.a.), the callosal sulcus (21 w.g.a.), the parieto-occipital sulcus (25 w.g.a.), the calcarine fissure (25 w.g.a.), the cingulate sulcus (26 w.g.a.) and the collateral sulcus (25-27 w.g.a.) are visualized rather late with in-utero U.S. The other sulci are more difficult to see. The peripheral location of these sulci contributes to the difficulty encountered in their visualization. The morphology of the sylvian fissure is quite characteristic on U.S. imaging and can be used to estimate the gestational age of the fetus. Compared to the embryological development there is a 2-4 weeks delay between the first infolding of the brain and the visualization of a sulcus by U.S. Abnormal sulcal patterns can be recognized based on the normal appearance for each gestational age. Sulcal anomalies are quite specific in holoprosencephaly, lissencephaly, micropolygyry, schizencephaly, agenesis of the corpus callosum. Silhouetting of the sulci may occur if the parenchymal echogenicity is sufficiently increased that the sulci no longer stand out (ischemia, tumors, encephalitis). Thickening of the sulci occurs in subdural hematomas, external hydrocephalus, meningitis and toxoplasmosis.

[Isolated tuberculous involvement of a posterior vertebral arch. Value of x-ray computed tomography and puncture under ultrasonography for the diagnosis. Apropos of a case]. / Atteinte tuberculeuse isolée d'un arc vertébral postérieur. Intérêt de la tomodensitométrie et de la ponction sous échographie pour le diagnostic. A propos d'un cas.

A case relative to an isolated tuberculous lesion of a vertebral arch associated with a paravertebral abscess is reported. The authors insist on the rarity of this location. They underline the role of the computed tomography for the positive diagnosis and the precise extent of lesions and the interest of the biopsy under ultrasonography for the bacteriological and histological diagnosis.

[Renal oncocytoma. Contribution of echography and computed tomography to the preoperative diagnosis. Apropos of a case]. / L'oncocytome rénal. Apport de l'échographie et de la tomodensitométrie au diagnostic pré-opératoire. A propos d'un cas.

In a case of renal oncocytoma studied by new imaging procedures mainly sonography and CT, the authors after a complete literature review propose an accurate approach to the pre-operative diagnosis which would lead in the future to a more conservative surgery in such neoplasms.

[Acute stress ulcer in an abusing family]. / Ulcère aigu de stress dans une famille maltraitante.

The authors report one case of a 3 1/2 year-old battered boy, with acute giant stress ulcer on the lesser curvature of the stomach. Hematemesis was the presenting symptom. Diagnosis was established after fiberoptic endoscopy and upper G.I. radiological study. After a 3 weeks cimetidine treatment and psycho-affective nursing, the ulcer disappeared almost completely. To our knowledge, a stress ulcer occurring in a battered child has not been reported as yet.

[Clinical and radiological findings in 203 cases of delayed resorption of pulmonary fluid (author's transl)]. / Analyse clinique et radiologique de 203 cas de retards de résorption du liquide intrapulmonaire.

Among 1 186 neonates admitted consecutively to the Post-Royal intensive care Unit, 203 had respiratory distress, a chest roentgenogram typical of delayed resorption of lung fluid, and no other findings. Mean gestational age (GA) was 33 weeks and mean birth-weight (BW) was 1 948 g. Hood oxygen alone was used in 129 cases and intubation-ventilation-PEEP in 74 cases (46 of which were intubated before admission). The occurrence of radiological features was similar in ventilated and non-ventilated neonates : ground-glass pattern (70-80% of the cases), increased vascular markings (70-76%) enlarged right fissure (45%), thin lateral pleural density (24%) and normal cardio-thoracic ratio. The analysis of other prognostic factors showed that ventilated neonates had a significantly lower birth weight (1 689 g versus 2 097 g) and a significantly younger gestational age (31.9 versus 33.6). The study of DAa02 in non-ventilated neonates demonstrated wide individual variations, and the possibility of an early normal DAa02 but also of a late abnormal DAa02, with the associated risks of early hyperoxia or prolonged oxygen needs. In ventilated neonates, the mean duration of intubation was 4 days 13 hours; this duration decreased as the birth-weight rose. In view of the major role of BW and GA, the Port-Royal team advocates the direct admission to a neonatal intensive care unit of neonates with delayed resorption of lung fluid and a BW under 2 000 g. In this way, Pa02 can be closely monitored and artificial ventilation is readily available.

[Intraperitoneal bladder rupture (author's transl)]. / Rupture intra-péritonéale de vessie.

On-duty radiologists should keep in mind some peculiar circumstances leading to intraperitoneale bladder rupture without fracture of pelvic bones. It is thus possible to identify the classical pattern of dog's ears topping the bladder, on the abdomen plain film, and the diagnosis may be confirmed by intravenous urography. An illustration is given by the reported case: a young man, after drinking too much, received a kick into the lap, followed by a severe pain and total urinary retention with a flat bladder.

[Cellulitis of the leg as the presentation of pandiaphysitis in the child (author's transl)]. / Cellulite de jambe, révélatrice de pandiaphysite chez l'enfant.

The authors report 6 cases of acute osteomyelitis of the leg, presenting with a very severe subcutaneous cellulitis and progressing to sub-periosteal abscess, then pandiaphysitis with major bone destruction at the 15th day, despite antibiotics. However, all these children recovered without sequelae, apart from one case. Early diagnosis was difficult and treatment started after an excessive delay in the majority of cases. If it can be performed on an emergency basis, Technetium bone scan is useful in making the diagnosis. In the absence of the type of examination, any case of severe subcutaneous cellulitis in a child must be considered as a potential osteomyelitis and treated as such.

[Radiological examination of the thorax and abdomen in new-born babies with Rhesus incompatibility (author's transl)]. / Intérêt de l'examen radiologique thoraco-abdominal chez le nouveau-né atteint d'incompatibilité Rhésus.

The results of radiological examination of the thorax and abdomen were studied in premature babies with Rhesus incompatibility. In the 53 cases where Rhesus incompatibility was the only abnormal finding, various measurements were made on the radiological images: cardiothoracic index, liver and spleen, distances between the digestive tract loops and the thoracic wall. The same measurements were made in two groups of premature babies, born at the same period of gestation, who acted as controls. The most frequently observed thoracic abnormality was interstitial edema with hypervascularization (50% of the moderate forms) which was present in 14 of the 18 severe cases. Total opacity of both lung fields was noted with the same frequency in the severe forms with anasarca as in the moderate forms without clinical edema. The cardiothoracic index was increased in 40% of the moderate cases and in all severe cases (normal values for premature babies of 30 to 36 weeks: 0.48 +/- 0.04). Pleural effusions were present in 20% of the moderate, and 6 out of 18 severe cases. Abdominal organ measurements in the two control groups were as follows: --premature babies (34 to 36 weeks): --liver: 47 mm +/- 5.3, --spleen: 11.5 mm +/- 2.1, --distance between loops and wall: 7.1 mm +/- 1.4. --premature babies (30 to 33 weeks): --liver: 41 mm +/- 4.7, --spleen: 10.4 mm +/- 3.4, --distance between loops and wall: 6.4 mm +/- 1.2. The babies with Rhesus incompatibility had hepatosplenomegaly which was constant in all severe cases but present in only 70% of moderate cases, an increased distance between the digestive loops and the thoracic wall in all severe forms, and in 15% of moderate forms without clinical ascites. Normal radiological images developed after about 5 days for thoracic signs, and between 7 and 10 days for abdominal signs. Complete recovery occurred in all cases, even severe, except one case, where Rhesus incompatibility was the only abnormality. In 22 cases, Rhesus incompatibility was associated with another disorder: in 12 cases a hyaline membrane was present which radically changed the prognosis (8 deaths secondary to this infection out of a total of 12 deaths). Apart from the study of the Rhesus abnormality, a systematic examination of the size of the liver and the spleen, and measurements of the distances between digestive tract loops and thoracic wall in the first thoraco-abdominal radiological image in a premature baby, can be of diagnostic value for intraperitoneal infections and eflusions of the new-born.

Renal abscess in children. A rare but important radiological diagnosis.

As in adults, renal abscess in children mimicks a tumoral syndrome. Renal abscess, although infrequent, should however be kept in mind because it is important to make an early diagnosis. The reason is simply that the treatment fo the two conditions is so different. Furthermore, an early accurate diagnosis avoids unnecessary investigations, such as arteriography, as well as unnecessary surgery. Four cases are reported in which the diagnosis of abscess was obtained by correlating both clinical and radiological findings. In only one case was arteriography performed and this was after treatment and it was normal. For an early diagnosis intravenous urography is of paramount importance. It shows a tumoral radiological pattern; in the context of clinical signs of suppuration (high fever, high leucocyte count and variably a urinary tract infection). The radiological findings suggest the diagnosis of abscess. On treatment the rapid regression and disappearance of the various clinical, laboratory, and radiological findings confirms the diagnosis of renal abscess.