MR imaging of the ischiopubic synchondrosis.

The ischiopubic synchondrosis (IPS) is a temporary joint, occurring in childhood prior to fusion of the ischial and pubic bones. On conventional radiographs this tumor-like appearance is a well known normal anatomic variant, however, there are no reports in the literature of the appearance of IPS on MRI. Therefore the purpose of this study was to evaluate typical magnetic resonance features of the IPS. All pelvic MRIs from 1/1992 to 4/1998 of children ranging in age from 4 to 16 years, who were scanned for reasons other than bone disorders, were retrospectively investigated. Twenty-eight children were included and the morphologic appearance of IPS on MRI was evaluated. Seventeen (61%) of these 28 children had the following findings of IPS on MRI. Listed in order of frequency we found signal alteration of the ischiopubic fusion zone [hyperintense on T(2) with fat-saturation (89%) or STIR (74%), hypointense on T(1) (71%)], fibrous "bridging" (68%) [hypointense band on all sequences in perpendicular orientation to the axis of the inferior pubic ramus], fusiform swelling (68%), signal alteration of the adjacent soft tissue (57%) and irregular margins (56%). In 10 children contrast enhanced scans were available for evaluation, showing contrast enhancement of the bone marrow in 83.3% and of the adjacent soft tissue in 66.7%. Fusiform swelling of the ischiopubic fusion zone, signal alteration and contrast enhancement of both the bone marrow and the adjacent soft-tissue are characteristic features of the IPS on MRI, which may be due to mechanical stress at this temporary joint. These features are nonspecific and may resemble tumor, infection or trauma. Fibrous "bridging" was the only finding on MRI, which has not been described for any other entity and thus, it seems to be a characteristic MRI-feature.

Acute renal failure in children. An ultrasonographic-clinical study.

Acute renal failure (ARF) may be due to obstructive uropathy or renal parenchymal disease. Twenty-five children with acute renal failure secondary to renal parenchymal disease underwent ultrasonographic examination of the kidneys. Changes of renal size and cortical echogenicity were correlated with renal function. All patients presented with bilaterally enlarged kidneys with the exception of those in the neonatal age group (12%). Improvement in renal function resulted in normalization of renal size. With regard to cortical echogenicity two groups were formed. Group A comprised 11 patients whose kidneys had the same echogenicity as the liver, while in group B the kidneys were more echogenic (14 patients). Cortical echogenicity was always increased. Determination of creatinine levels showed a statistically significant difference between group A (3.32 mg% +/- 1.40 S.D.) and group B (5.95 mg% +/- 1.96 S.D.), p less than 0.001. Changes in renal function were paralleled by rapid changes in renal size and cortical echogenicity.

[The sonographic differential diagnosis of supra and infra diaphragmatic processes (author's transl)]. / Sonographische Differentialdiagnose supra- und infradiaphragmaler Prozesse.

The sonographic features and differential diagnosis of 95 supra and infra diaphragmatic processes are described. Sonographic demonstration of the diaphragm permits definite differentiation between simple and loculated pleural effusions from periparenchymatous fluid collections in the abdomen.

[Bronchopulmonary dysplasia: X-ray patterns and grading according to stages (author's transl)]. / Die bronchopulmonale Dysplasie--Röntgensymptomatik und Stadieneinteilung.

Bronchopulmonary dysplasia, first described by Northway in 1967 as a separate entity, was graded into four stages. Basing on thoracic x-ray films of 14 newborn and prematurely born infants an attempt has been made to analyse the x-ray patterns of signs characterising bronchopulmonary dysplasia and to establish a relation between the x-ray signs and the four stages. With few exceptions the various radiologic signs were seen in all stages, although with varying incidence. It follows that x-ray visualisation of the thorax yields limited pointers only to the actual stage of the disease. Roentgenography is the method of choice (in connection with the pattern of clinical signs) for diagnosing bronchopulmonary dysplasia and should be also employed for controlling the course of the disease and for the identification of eventual complications.

[Ultrasound in gall bladder diagnosis (author's transl)]. / Sonographische Gallenblasendiagnostik.

An analysis of the ultrasound findings in 104 selected patients with suspected gall bladder disease showed a high accuracy of 92%. Limiting factors in the use of ultrasound are anatomical variations, high position of the gall bladder, which prevents demonstration of the gall bladder. The primary use of ultrasound is in the demonstration of radiologically invisible gall bladders. In our clinical material 58% had stones, with occlusion of the cystic duct as a cause, in 29% there was malignant disease in the porta hepatis, with evidence of bile obstruction amongst those patients in whom there was no radiological opacification of the gall bladder.

[Radiological examination of the thoracic organs for persistent foetal circulation (author's transl)]. / Röntgenuntersuchung der Thoraxorgane bei persistierender fetaler Zirkulation.

The radiological changes seen on chest x-rays of five children with persistent foetal circulation are analysed. There is inconstant cardiac enlargement and a reticulo-nodular appearance of the lungs, indicating interstitial oedema with heart failure. The value of the chest x-ray consists mainly in excluding a pulmonary or a characteristic cardiac abnormality as a cause of dyspnoea; it does not provide direct diagnostic information.

[The angiographic diagnosis and differential diagnosis of inflammatory disease of bones and soft tissues (a report concerning 40 cases) (author's transl)]. / Angiographische Diagnose und Differentialdiagnose bei Entzündungen des Knochens und der Weichteile (Ein Bericht über 40 Fälle).

The angiographic appearances of inflammatory disease of bones and soft tissues was analysed in 40 patients. The angiographic findings in inflammation of bone (28 patients) differed greatly, from normal findings (14.2%), moderate angiographic changes corresponding to the severity of the inflammatory process (32.1%), marked changes in the arterial, capillary and venous beds (42.9%) and significant local staining with little peripheral reaction (10.7%). Soft tissue inflammation on the other hand showed increased vascularity in all cases. A typical angiogram was found in 50% of cases and shows the following characteristics: vascularity as compared with the surroundings is usually increased and may be extensive, far more so than is found surrounding vascular bone foci; the contrast staining is usually ill-defined and the veins in the late phase are increased in calibre. Early venous filling is common and should not be regarded as a sign of malignancy. In 17.5% of patients the angiogram simulated a tumour; in four patients (10%) a false positive diagnosis of tumour was made, in two (5%) a tumour could not be excluded and in one case a benign tumour was diagnosed because of localised staining. None of the angiograms which had been interpreted incorrectly showed typical pathological vessels, which are the most important tumour criteria.

[Sonography of the upper abdomen in cystic fibrosis (author's transl)]. / Oberbauchsonographie bei zystischer Fibrose (CF).

Ultrasound scans of the upper abdomen were carried out in fifty patients with cystic fibrosis (age 2 to 26 years). 38% showed an abnormal hepatic sonogram. On eight occasions it was possible to confirm these changes by a liver biopsy. In 14% there was homogenous increase in liver echoes. 22% showed an non-homogeneous liver structure due to fibrotic and cirrhotic changes and cholangitis. Four of these patients had splenomegaly due to portal hypertension. 85% of the pancreatic scans which could be evaluated showed small pancreases with high echoes. Cholelithiasis was not present in any. Sonography of the upper abdomen is the method of choice for evaluating the liver, biliary system, pancreas and spleen.

[Sonography in traumatic rupture of the gallbladder and liver: a case report (author's transl)]. / Der Einsatz der Sonographie bei traumatischer Gallenblasen- und Leberruptur: Ein Fallbericht.

The practicability of using ultrasonography in the evaluation of traumatic rupture of the gallbladder and liver is demonstrated on the basis of a case report. The presence of a subphrenic fluid collection was detected by means of this procedure and the increase in fluid was accurately determined by regular follow-up control examinations. This report eventually led to successful operation. Sonographic postoperative follow-up control examinations showed extensive perihepatic scars in the subdiaphragmatic region.

[Familial juvenile nephronophthisis--a cause of chronic renal failure in childhood]. / Die familiäre juvenile Nephronophthise--eine Ursache des chronischen Nierenversagens im Kindersalter.

Familial juvenile nephronophthisis (FJN) represents an important cause of chronic renal insufficiency in the first two decades of life. Its frequency is reported to vary between 7 and 20% of all cases of terminal renal failure in childhood. Usually the onset is insidious, with polyuria, polydipsia and anaemia being the main clinical features. The diagnosis is based on clinical, laboratory and pathological findings. The purpose of our report is to emphasize the importance of this pathological entity with respect to the clinical symptoms and signs and diagnostic approach on the basis of the case reports of four patients.

[The diagnostic scope of ultrasonography in renal pathology (author's transl)]. / Der Informationsumfang des Ultraschallverfahrens bei pathologischen Nierenprozessen.

The accuracy of ultrasonography in the diagnosis of different pathological renal conditions is evaluated. Correlations were established to the findings on intravenous urography and selective angiography. Ultrasonography is suitable for the determination of the exact size and site of the kidney and, therefore, should be used routinely in the follow-up of renal transplant recipients. The ability to differentiate between solid and cystic lesions is of partcular value. Moreover, perirenal changes are easily recognizable. The limits of B-mode sonography lie in the interpretation of central expanding lesions with a diameter of under 3 cm. This non-invasive method should be used selectively in the diagnosis of renal disease, whereas angiography should be limited to the classification of equivocal ultrasound findings and in the case of solid tumours.

[The Löfgren syndrome: acute sarcoidosis (author's transl)]. / Das Löfgren-Syndrom: Die akute Form der Sarkoidose.

Report on 3 cases of acute sarcoidosis, the Löfgren syndrome. 3 signs: skin changes like erythema nodosum, widening of the hilus due to enlarged lymphglands and arthralgias. Diagnostically this has to be separated from maligant systemic disease and deserves, therefore, the special interest of the radiologist.

[The radiological morphology of neonatal pneumonia (author's transl)]. / Die Röntgenmorphologie der Neugeborenenpneumonie.

71 chest X-rays of newborns with pneumonia were analysed in respect ot pathologic changes. The main radiologic symptoms were localized, coarse spotted, striated and homogeneous shadows. Inconstantly interstitial structures were found in addition as a direct sign for the inflammatory infiltration. In a high percentage different kinds of overinflation and irregular aeration were demonstrated as indirect signs. The differentiation to Hyaline membranes is easy usually. In some neonates the exclusion of a cardiac-shunt especially with decompensation, the evaluation of a pulmonary bleeding or wet lung can be difficult. In these cases the clinical report in combination with the radiologic findings will lead to a correct diagnosis.

[Most frequent causes, complications and differential diagnosis of neonatal respiratory distress in chest x-ray]. / Häufigste Ursachen, Komplikationen und Differentialdiagnose neonataler Atemstörungen im Röntgenbild.

The radiologic changes of the chest X-ray of 270 newborns with respiratory distress were analyzed. In cases of Hyaline Membranes the chest X-ray showed finely granular evenly disseminated structures combined with signs of hypoventilation. Localized, patchy, streaky, homogenous and reticulonodular shadows were found in cases of pneumonia and hemorrhage. Hyperinflation were an additional sign for an inflammatory disease. This symptom was also demonstrated in pulmonary bleeding, but was less common. The bilateral interstitial augmentation of the pulmonary structure in combination with cardiomegaly was mainly a symptom for cardial insufficiency and transient tachypnea. The differentiation between fine granular and reticulo-nodular structures should create no problem if the chest X-ray if of good quality. Extrapulmonary air collections were found in a high percentage in the course of artificial ventilation as a consequence of the "baro-trauma." The radiologic diagnosis of BPD was no problem. The value of the chest X-ray lies in the demonstration of a pulmonary cause for the respiratory distress, in the demonstration of complications and in the radiological observation of the disease.

[Hemorrhage of the lung of Newborns and its differential diagnosis]. / Die Lungenblutung des Neugeborenen im Thoraxröntgen und ihre Differentialdiagnose.

Chest x-rays of 17 newborns suffering from hemorrhage of the lung were analysed with special respect to kind of shadow and translucency. Most significant findings were fine-grained, coarse-spotted, striated, and homogeneous shadows, indicating the hemorrhage. Differentiation of hyaline membranes in most cases is easy, whereas difficulties are arising for differentiation of hemorrhage and interstitial edema in cardiac decompensation and especially in shunt-heart defects. Differentiation with respect to pneumonic infiltrations is not possible except in white lungs, although signs of emphysema are giving indirect indication to a pneumonic infiltration. chest x-rays are very useful to find out shadows, to differentiate other reasons of a respiratory distress syndrome, and for follow-up investigations.