The Scintigraphic Drooping Lily Sign.

The "drooping lily" sign is identified on intravenous urography or voiding cystourethrography in patients with a duplicated renal collecting system and refers to inferolateral displacement of a functioning lower pole moiety by an obstructed upper pole collecting system. In this case, a 2-month-old girl with a prenatal diagnosis of hydronephrosis was found to have a "scintigraphic drooping lily" sign on Tc-dimercaptosuccinic acid renal scan. Evaluation with ultrasound and voiding cystourethrography confirmed a duplicated collecting system and obstructed upper pole moiety. Correlation with anatomic imaging can help avoid mistaking the scintigraphic "drooped" lower pole for an inferiorly positioned normal kidney.

Ultrasonography of the adolescent female pelvis.

Ultrasound of the adolescent female pelvis is the imaging method of choice for most medical problems presenting with symptoms and signs referable to this area. Recognizing the transition from child to mature female and its manifestations are crucial in directing the workup and interpreting the sonographic findings. A description of the normal anatomy and physiology of the pelvic organs is followed by a discussion of the clinical and imaging findings in primary and secondary amenorrhea, pelvic pain, and pelvic masses.

Diagnosis of rare association of orthotopic multicystic dysplasia with crossed fused renal ectopia.

Orthotopic multicystic dysplastic kidney with crossed fused ectopia is a rare congenital anomaly. This congenital anomaly may give an appearance of a solitary kidney morphology during the initial imaging evaluation. A solitary kidney should be carefully evaluated for the presence of duplication, horseshoe configuration, or crossed renal ectopy. Vesicoureteral reflux is a common finding associated with a multicystic dysplastic kidney. We present an infant with an orthotopic multicystic dysplastic kidney and an inferiorly placed crossed fused ectopic kidney. The presence of a complex congenital anomaly may warrant further evaluation with cross-sectional imaging to depict the anatomy and structure.

Imaging of neonatal child abuse with an emphasis on abusive head trauma.

Child abuse and neglect is a serious clinical and socioeconomic problem that is sometimes underestimated. One of the most devastating forms is abusive head trauma. This review addresses the radiological workup in cases of suspected child abuse. The use of all modalities, and their advantages and disadvantages, is discussed. A special section is devoted to the radiological report in cases of child abuse, as a clinical record and a legal document.

Fractures in biliary atresia misinterpreted as child abuse.

Bone fractures in children without a history of injury are highly suspicious for child abuse. Biliary atresia is a disorder associated with metabolic bone disease, and there are numerous reports of osteopenia, rickets, and/or fractures in this population. We report 3 cases of children with biliary atresia who had bony fractures as well as osteopenia whose caretakers were investigated for child abuse. Pediatricians should be aware of an increased incidence of fractures and overall prevalence of bone disease in this population.

Physiologic subperiosteal new bone formation: prevalence, distribution, and thickness in neonates and infants.

OBJECTIVE: The objective of our study was to determine the prevalence, distribution, and thickness of physiologic subperiosteal new bone formation in neonates and infants. MATERIALS AND METHODS: High-detail postmortem skeletal radiologic surveys of 101 neonates and infants who had died from sudden infant death syndrome were reviewed. The average age at the time of death was 2.6 months (range, 2 weeks-8 months 2 weeks). The location, distribution, and thickness of subperiosteal new bone formation of the long bones were noted and measured with an ocular magnification system. RESULTS: subperiosteal new bone formation was identified in 35 infants (35%), all of whom were between 1 and 4 months of age. The prevalence of subperiosteal new bone formation involving one or more bones was 37% for ages 1-2 months, 55% for ages 2-3 months, and 35% for ages 3-4 months. subperiosteal new bone formation involved the tibia in 29 infants (bilateral involvement in 19) and the femurs in 14 infants (bilateral involvement in 11). The humerus was a site of subperiosteal new bone formation in 12 infants; the ulna, in seven infants; and the radius, in two infants. The thickness of the subperiosteal new bone formation was never more than 1.8 mm, and the average thickness for the various long bones ranged from 0.7 to 0.9 mm. CONCLUSION: Our results suggest that subperiosteal new bone formation is a common finding in infants 1-4 months of age. It is potentially an abnormal finding in neonates (CI = 0.0, 0.007) and in infants older than 4 months of age (CI = 0.0, 0.003). A thickness of 2 mm or more in subperiosteal new bone formation is likely to be abnormal and should prompt further diagnostic evaluation.

Detection of rib fractures in an abused infant using digital radiography: a laboratory study.

PURPOSE: To assess the diagnostic performance of digital radiography using charge-coupled device (CCD) technology in the detection of rib fracture in infant abuse. MATERIALS AND METHODS: Four fractured posterior rib arcs and eight normal ribs removed at autopsy from a 10-month-old abused infant were radiographed using a CCD prototype, four clinical film-screen systems, and direct-exposure film. Each rib was viewed with these six systems in nine different projections. The resultant 648 images were assessed for probability of fracture (0-100%) by four pediatric radiologists. The calculated area under the resultant ROC curves (A(z)) for the CCD was compared with those obtained with direct-exposure, high-detail, medium and fast film-screen radiographic systems. RESULTS: The mean A(z) for the CCD (0.937) fell within the range of the high-detail systems (0.934-0.940) and was significantly higher (p < 0.05) than the medium and fast system (0.861 and 0.858, respectively). Despite a lower spatial resolution than direct-exposure film (7 line pairs per millimeter vs. > 20 line pairs per millimeter) the CCD performance was comparable (A(z) = 0.944 vs. 0.937). The similar performance can be explained by the higher contrast resolution of the digital technology. CONCLUSION: This study indicates that in the ex vivo setting, digital radiology can perform comparably to high-detail film-screen imaging. The findings suggest that digital radiography has the potential to replace film-screen imaging in the evaluation of inflicted skeletal injury in infants.