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BACKGROUND: Distal femoral physis fractures with displacement are rare injuries seen in adolescents related with high incidence of complication. They may lead to premature physeal closure consequently, to growth arrest and bone deformity. CASE REPORT: The case of a 14-year-old boy with Salter-Harris type II displaced fracture underwent surgery with open reduction has been described. CT examination with multiplanar reconstruction was used in pre-operative assessment of distal femur growth plate fracture. CONCLUSIONS: Knowledge of classification, prognosis and methods of treatment is necessary in accurate pre- and postoperative assessment of physial fractures in adolescents. CT and multiplanar reconstruction improve the understanding of patterns of injury, relative prevalence and accuracy of pre-operative planning.
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BACKGROUND: Ewing sarcoma is a malignant, small round cell bone tumor, presenting predominantly in children and adolescents. Ewing sarcoma may develop in every bone; diaphyses of long bones, ribs and flat bones are the main locations. Local and systemic clinical symptoms are nonspecific - pain, swelling, fever or ill-being. The aim of the study was to assess the role of radiography, computed tomography and magnetic resonance imaging in the analysis of bone lesions in children and young adults with Ewing sarcoma. MATERIAL/METHODS: Twenty-seven patients, aged between 1 year and 10 months, and 17 years and 2 months, with histologically verified Ewing sarcoma of the bone, referred to the Radiological Department of University Hospital No 6., John Paul II Upper Silesian Centre for Child Health Katowice, in the period from 1996 to 2007, were included in the study.Plain radiography was performed in every child, CT in 20 and MRI in 12 individuals. Tumour location, extension of the tumour, soft tissue mass, and periosteal reaction were taken into consideration in the evaluation of the lesion. In some cases, pathological features of the MRI and CT were compared. The prevalence of some radiological features was compared to the literature data. RESULTS: THE MOST COMMON SITE OF TUMOR WAS: ribs (6 children), femoral bone (6 children), pelvis (4 children) and tibia (3 children). In 2 children, a primary tumor was diagnosed in the spine (multifocal in 1 child). X-rays revealed: periosteal reaction in 17 children (63%), soft tissue involvement in 19 children (70%), permeative component in 16 children (59%), and sclerotic component in 5 children (19%). In 10 children (37%), periosteal reaction was not detected. The examination revealed: soft tissue calcifications in 7 cases (26%), a well-delineated focus of destruction within bones in 3 children (11%), cortical thickening in 4 children (15%), cortical destruction in 4 children (15%), saucerisation in 3 children (11%), bone expansion in 3 children (11%), pathological fracture in 2 children (7%), cystic component in 1 child (4%), and vertebra plana in 1 child (4%).Reaction of tumors after i.v. contrast administration, shown on CT, was visible in 16 children - it was useful for a better description of the tumor and extension of the mass within the soft tissue. All MRI examinations (12 children) showed a heterogenous mass with ill-defined borders and a violated cortex. Low signal intensity of the tumor in a T1-weighted image and high signal intensity in a T2-weighted image was shown as well. Heterogenous enhancement of signal intensity on T1-weighted images could be observed after i.v. contrast administration. MRI EXAMINATIONS SHOWED: tumor in an adjacent soft tissue in 11 children, and involvement of the epiphyseal plate or of the joint cavity in 6 children. CONCLUSIONS: X-ray and MRI are essential in diagnostics. CT examination is more useful to estimate periosteal reactions and destruction of bone and marrow cavity, especially in flat bones. However, to recognise a malignancy, it is necessary to perform a histopathological examination. In doubtful cases, the examination has to be verified as well.
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UNLABELLED: The mediastinum region may be the primary or secondary localization of neoplasms. The aim of our study was the assessment of clinical symptoms, histopathology and outcome of mediastinal tumours in children. MATERIALS AND METHODS: A group of 27 children, chosen from the group of 128 patients with malignancies, which were treated in the years 2000-2004 in the Oncology and Haematology Unit of the Paediatric Department in Katowice, has been studied. In this group there were 14 boys and 13 girls at the age between 2 and 12 years. We analysed the clinical symptoms prior to the diagnosis and the duration of these symptoms, histologic type of tumours and results of treatment. RESULTS: The primary localization in the mediastinum was diagnosed in 23 patients (85,2%) among them 15 (55,5%) of these children have been diagnosed as having Hodgkin's disease, and in 8 (29,6%) non Hodgkin's lymphoproliferative disease. Four of the children (14,8%) had mediastinal secondary localization of solid tumours (2 - neuroblastoma, 1 - carcinoma suprarenalis, 1 - carcinoma epitheliale of unknown origin). The most frequent symptoms were: fever (70,3%), weakness (66,6%), cough (55,5%), madiastinalpain (33,3%). The duration of these symptoms prior to the diagnosis was between 5 days and 182 clays. CONCLUSIONS: 1. In the group of neoplasms localized in the mediastinum, lymphoproliferative diseases are the most frequently diagnosed disorders. 2. In case of fever of unclear etiology and persistent cough, it is necessary to exclude mediastinal malignancy. 3. There is a need to improve the system of oncological education for medical students and doctors.