Tomografía computarizada fetal de baja dosis para diagnosticar displasias óseas / Low-dose computed tomography to diagnose fetal bone dysplasias

Presentamos un caso de displasia cleidocraneal diagnosticado en la semana 25 de gestación mediante tomografía computarizada (TC) de baja dosis fetal. La sospecha era de displasia ósea grave debido al percentil bajo en los huesos largos y la apariencia ecográfica de craneosinostosis. La TC no demostró alteraciones incompatibles con la vida. La dosis efectiva de la prueba fue de 5 mSv, dentro del rango recomendado para estas exploraciones. La TC de baja dosis fetal es una técnica emergente que permite estudiar estructuras óseas con precisión a partir del segundo trimestre de gestación. En España, es legalmente posible interrumpir el embarazo en caso de malformación grave del feto incluso si se sobrepasa la semana 22 de gestación. Por tanto, ante la sospecha de una displasia ósea grave, el radiólogo debe conocer las estrategias para disminuir la dosis manteniendo una calidad diagnóstica suficiente, y conocer las estructuras óseas que debe evaluar (AU)

We present a case of cleidocranial dysplasia diagnosed by low-dose fetal computed tomography (CT) in the 25th week of gestation. Severe bone dysplasia was suspected because of the fetus’ low percentile in long bones length and the appearance of craniosynostosis on sonography. CT found no abnormalities incompatible with life. The effective dose was 5 mSv, within the recommended range for this type of examination. Low-dose fetal CT is a new technique that makes precision study of the bony structures possible from the second trimester of pregnancy. In Spain, abortion is legal even after the 22nd week of gestation in cases of severe fetal malformations. Therefore, in cases in which severe bone dysplasia is suspected, radiologists must know the strategies for reducing the dose of radiation while maintaining sufficient diagnostic quality, and they must also know which bony structures to evaluate (AU)

Low-dose computed tomography to diagnose fetal bone dysplasias. / Tomografía computarizada fetal de baja dosis para diagnosticar displasias óseas.

We present a case of cleidocranial dysplasia diagnosed by low-dose fetal computed tomography (CT) in the 25th week of gestation. Severe bone dysplasia was suspected because of the fetus' low percentile in long bones length and the appearance of craniosynostosis on sonography. CT found no abnormalities incompatible with life. The effective dose was 5 mSv, within the recommended range for this type of examination. Low-dose fetal CT is a new technique that makes precision study of the bony structures possible from the second trimester of pregnancy. In Spain, abortion is legal even after the 22nd week of gestation in cases of severe fetal malformations. Therefore, in cases in which severe bone dysplasia is suspected, radiologists must know the strategies for reducing the dose of radiation while maintaining sufficient diagnostic quality, and they must also know which bony structures to evaluate.

Musculoskeletal imaging in pediatric emergencies: the basics through three clinical scenarios. / Imagen musculoesquelética en la urgencia pediátrica. Lo esencial a través de tres escenarios clínicos.

A high percentage of the pediatric imaging studies requested during calls are related to musculoskeletal disease. Since bones and joints in children are immature, constantly growing and remodeling, they have physiological and anatomical peculiarities that make it necessary to use an approach specific for pediatric patients. In this article, we use three clinical scenarios (limping, fractures, and musculoskeletal infections) to summarize and transmit the concepts that are essential in emergency musculoskeletal imaging in children.

Imagen musculoesquelética en la urgencia pediátrica. Lo esencial a través de tres escenarios clínicos / Musculoskeletal imaging in pediatric emergencies: the basics through three clinical scenarios

La patología musculoesquelética pediátrica representa un alto porcentaje de los estudios solicitados al radiólogo de guardia. Al tratarse de huesos y articulaciones inmaduros, en constante crecimiento y remodelación, presentan peculiaridades fisiológicas y anatómicas propias que condicionan la necesidad de un abordaje específico para la edad pediátrica. Mediante tres escenarios clínicos (cojera, fracturas e infecciones osteoarticulares) hemos querido resumir y transmitir los conceptos esenciales de la radiología musculoesquelética en la urgencia pediátrica (AU)

A high percentage of the pediatric imaging studies requested during calls are related to musculoskeletal disease. Since bones and joints in children are immature, constantly growing and remodeling, they have physiological and anatomical peculiarities that make it necessary to use an approach specific for pediatric patients. In this article, we use three clinical scenarios (limping, fractures, and musculoskeletal infections) to summarize and transmit the concepts that are essential in emergency musculoskeletal imaging in children (AU)

[Unusual imaging findings of Ewing sarcoma in the childhood]. / Manifestaciones radiológicas infrecuentes del sarcoma de Ewing en la infancia.

OBJECTIVES: To review the cases of Ewing's sarcoma (ES) diagnosed in children at our hospital from 1995 to 2005 and to analyze uncommon imaging signs at diagnosis or during the course of the disease. MATERIAL AND METHODS: We reviewed the cases of 21 patients with ES (12 boys and 9 girls) diagnosed between the ages of 2 and 14 years. We analyzed the types of presentation, the imaging findings (plain-films, CT, and MRI), and the patients' evolution. All cases were confirmed at histological study. RESULTS: The following uncommon manifestations were found in 11 patients: 2 vertebral, one cervical, and one dorsal ES that initially manifested as spinal cord compression and as a mediastinal mass, respectively; 2 sacral ES with ascending epidural masses; 1 mandibular ES; 1 costal ES with hemorrhagic cerebral metastases; 3 extraskeletal (thigh, buttocks, and pelvis minor) ES with bone metastases at diagnosis: the first two had spinal cord and nerve compression due to vertebral metastases; 2 ES had benign-appearing radiological findings (cortical lesion of the radius with osseous remodeling of the ulna and an expanding multilocular lesion of the fibula). CONCLUSIONS: Although ES is the second most common malignant bone tumor in children, its unusual imaging findings are less well known. More than half (52.4 %) of our last 21 patients presented some of these manifestations at diagnosis or during follow-up, so radiologists should be aware of them and include ES in the prebiopsy diagnostic possibilities.

Manifestaciones radiológicas infrecuentes del sarcoma de Ewing en la infancia / Unusual imaging findings of Ewing sarcoma in the childhood

Objetivos: revisión de los sarcomas de Ewing (SE) infantiles diagnosticados desde 1995 hasta el 2005 en nuestro hospital, analizando las manifestaciones infrecuentes en el momento del diagnóstico o en su evolución. Material y métodos: estudio retrospectivo de 21 pacientes con SE (12 varones y 9 mujeres) diagnosticados entre los 2 y 14 años. Análisis de sus formas de presentación, hallazgos radiológicos (radiografía, tomografía computarizada y resonancia magnética) y evolución. Todos los casos tienen confirmación anatomopatológica. Resultados: 11 pacientes tuvieron las manifestaciones infrecuentes siguientes: 2 SE vertebrales, 1 cervical y 1 dorsal que se iniciaron con compresión medular y masa mediastínica, respectivamente; 2 SE sacros con masa epidural ascendente; 1 SE de localización mandibular; 1 SE costal con metástasis cerebral hemorrágica; 3 SE extraesqueléticos (muslo, glúteo y pelvis menor) con metástasis óseas al diagnóstico, los 2 primeros con compresión medular y radicular por metástasis vertebrales; 2 SE con manifestaciones radiológicas de benignidad (lesión cortical del radio incurvando al cúbito y aspecto insuflante multiloculado del peroné). Conclusiones: aunque el SE es el segundo tumor óseo maligno más frecuente de la infancia, sus manifestaciones infrecuentes son menos conocidas. Más de la mitad (52,4 %) de nuestros últimos 21 casos han presentado alguna de estas manifestaciones al diagnóstico o en su evolución, que deben conocerse para incluir al SE como posibilidad diagnóstica prebiopsia (AU)

Objectives: to review the cases of Ewing's sarcoma (ES) diagnosed in children at our hospital from 1995 to 2005 and to analyze uncommon imaging signs at diagnosis or during the course of the disease. Material and methods: we reviewed the cases of 21 patients with ES (12 boys and 9 girls) diagnosed between the ages of 2 and 14 years. We analyzed the types of presentation, the imaging findings (plain-films, CT, and MRI), and the patients' evolution. All cases were confirmed at histological study. Results: the following uncommon manifestations were found in 11 patients: 2 vertebral, one cervical, and one dorsal ES that initially manifested as spinal cord compression and as a mediastinal mass, respectively; 2 sacral ES with ascending epidural masses; 1 mandibular ES; 1 costal ES with hemorrhagic cerebral metastases; 3 extraskeletal (thigh, buttocks, and pelvis minor) ES with bone metastases at diagnosis: the first two had spinal cord and nerve compression due to vertebral metastases; 2 ES had benign-appearing radiological findings (cortical lesion of the radius with osseous remodeling of the ulna and an expanding multilocular lesion of the fibula). Conclusions: although ES is the second most common malignant bone tumor in children, its unusual imaging findings are less well known. More than half (52.4 %) of our last 21 patients presented some of these manifestations at diagnosis or during follow-up, so radiologists should be aware of them and include ES in the prebiopsy diagnostic possibilities (AU)

Large choledochocoele: difficulties in radiological diagnosis.

BACKGROUND: A choledochocoele is a dilatation of the intramural portion of the distal common bile duct within the duodenal wall. It usually presents with recurrent crises of right upper quadrant pain, hyperamylasaemia or jaundice. MATERIALS AND METHODS: We present a 12-year-old boy with a choledochocoele that was missed on several US examinations despite its large size. RESULTS: Findings on US, IV cholangiography, upper gastrointestinal contrast studies, ERCP and surgery are shown. The histological findings as well as the usual differential diagnosis are discussed.