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Pseudotumours of the paediatric liver
ABSTRACTS tion in conditions affecting the elbow due to its multiplanar imaging capability and demonstration of soft tissue detail. Osteochondritis dissecans and haemophilic arthropathy have been the main indications in children. In addition to imaging osteochondritis dissecans, we have used M R for evaluation of dislocation of the radial head. Design: retrospective. Subjects and Method." A series of five patients have been studied. In young children, use o f general anaesthesia permits the use of longer sequences. The elbow to be studied is placed at the centre o f the field of view. A variety of imaging sequences have been used including T1W spin echo and gradient echo in axial, coronal and sagittal planes, using a knee coil. Scans were made on an 0.5T GE Signa. Results: The developing cartilaginous cap of the radial head epiphysis is well shown by M R and its shape can help to distinguish a congenital from a traumatic aetiology. M R shows the pathological anatomy of the dislocation particularly elegantly, providing our prthopaedic surgeons with important information aiding in patient management. Congenital dislocation for example has important implications for restoration of function. Conclusion: Radial head deformities in children are well demonstrated by MRI. M R has given additional information which has assisted in patient management.
P S E U D O T U M O U R S OF THE PAEDIATRIC LIVER P. A. KANE, D. V. HUGHES, R. WILLIAMS and J. B. K A R A N I
Departments of Radiology and Institute of Liver Studies, King's College Hospital, London Introduction: The diagnosis of liver tumours on computed tomography depends upon differential attenuation coefficients and enhancement patterns. Its sensitivity in defining tumours is well established but there remain a variety of conditions of differing prognosis that mimic these patterns presenting a "pseudotumour" appearance. Design: This work is a retrospective review of our experience. Subject and Method." We present our experience of this phenomena as a tertiary referral liver centre. A common illustrative example is hepatic steatosis but in the paediatric age group less well recorded causes include the spbingolipidoses, tyrosinaemia, atpha-l-antitrypsin deficiency, intrahepatic arterio-portal shunts and following chemotherapy. These cases are discussed with analysis of the physiological mechanisms responsible and a review of the literature. Conclusion: Potential mis-interpretation of the imaging in such benign disease highlights the need for an integrated strategy in the assessment of parenchymal hepatic disease in the paediatric population.
BRASSIERES ARE NECESSARY DURING BARIUM ENEMAS G. K A P L A N and N. RIDLEY
769
ENT Surgeon. Complications can however arise. Pre-endoscopic C.T. to assess the anatomy/anatomical variants of the paranasal sinuses can aid the endoscopistin avoiding complications. The poster highlights some of these variants and their relevance to the endoscopist. Design: Coronal C.T. scans were performed pre sinus endoscopy and important anatomical variants highlighted. Method." Coronal 5ram cuts were performed on a G E HP9000S Scanner with the patient prone using a 20 ~ gantry tilt, from the frontaI sinuses to the sphenoid sinuses. 200 scans were reviewed retrospectively. Results. Important anatomical variants include Hallers air cells, (11%) hypoplastic maxillary antra (0.5%), chonchae bullosae (22%), hypertrophied turbinates (12.5%), supra-orbital extension of the ethmoids (0.5%), and thinned margins to the ethmoids (2%) and cribriform plate (5.5%), and septal deviation or bony spurs (29%). Conclusion: Coronal C.T. is an excellent way of showing the anatomy of the sinuses pre endoscopy. It can show soft tissue and bony anatomy. It is important to recognise these normal variants pre-endoscopy and highlight the findings of the endoscopist, to avoid possible complications.
EPIDURAL ABSCESS OF CERVICAL SPINE: M R FINDINGS IN 6 CASES I. M. LANG, D. HUGHES, J. P. R. JENKINS and F. M c K E N N A
Department of Radiology, Hope Hospital, Salford, Manchester Introduction." Spinal Epidural Abscess is an uncommon clinical entity. The cervical spine is the least frequent site. The presentation is non specific, neurological signs may be absent and delayed diagnosis results in serious sequelae. M R imaging is now accepted as the imaging modality of choice in the evaluation of potential infection of the spine, allowing appropriate treatment. Design: Retrospective study of 6 patients with cervical epidural abscess using M R imaging. Subject and Methods: M R imaging was performed on 4 patients using 1T apparatus and 2 patients using 0.5T apparatus. A variety of sequences were used. Gadolinium enhanced imaging was used in 4 out o f 6 cases. Follow up scans were carried out in 5 out o f 6. Results: Clinical Findings: 4 male and 2 female with age range 20 to 49 years. 4 were infected with staph.aureus and 2 with M. Tuberculosis. In all patients the cervical spine was involved. 5 out of 6 patients were managed conservatively. MR Imaging." A spectrum of signal and enhancement patterns were seen ranging from homogeneous enhancement to peripheral enhancement. Examples will be presented on the poster. Conclusion: Early MRI is indicated if cervical epidural abscess is suspected. There are variable appearances on MR. Monitoring with follow up scans allows conservative management.
Northwick Park Hospital, Harrow Diagnostic radiology contributes 90% of ionising radiation from man made sources. Barium enemas constitute only 0.9% of radiological examinations but contributes 14% of the man made dose. Breast tissue, especially before the menopause, is very sensitive to the induction of cancer by ionising radiation. We have noticed that often the breasts were visible on the flexure views of barium enemas. We reviewed retrospectively 100 consecutive barium enemas in female patients under the age of 65 years. 60% had both breasts visible on the flexures. In 23%, only the left breast was visible on the splenic flexure, and in 1% the right breast was visible on the hepatic flexure. In 16% the breasts were not visible on the radiographs at all. Twenty three of the patients were under 40. In 12 of these patients (52%) both breasts were visible on the flexures while in 4 patients (17%) the breast was only visible on the splenic flexure, and 7 patients (30%) had neither breast visible. Unnecessary radiation of the breast during barium enemas is undesirable and should be avoided if possible. We suggest that this may be done very simply by adjusting the barium enema instruction form - requesting that all female patients wear a brassiere.
THE ROLE OF C O M P U T E D T O M O G R A P H Y (CT) OF THE PARANASAL SINUSES TO SHOW THE ANATOMY OF NORMAL VARIANTS PRIOR TO SINUS ENDOSCOPY S. KHAN*, A. LYNN*. S. DESAlt, S. FAHMY~
Queen Elizabeth H Hospital, Department of *Radiology and ~ENT, Herts, tDepartment of Radiology, King's College Hospital, London Introduction: Sinus endoscopy is an important diagnostic tool to the
APPLICATIONS OF THE ULTRASONIC URETERIC JET PHENOMENON J. H. C. LI, W. C. G. PEH, C. LAM and L. L. Y. LEONG
Department of Diagnostic Radiology, The University of Hong Kong and Queen Mary Hospital, Hong Kong Introduction: The ureteric jet phenomenon is well recognized during gray-scale ultrasound of the bladder, and is enhanced by colour Doppler. Our study aims to illustrate the applications of this phenomenon in patients with various urological problems. Subjects and Methods: Between January 1993 and May 1994, the ultrasonic identification of ureteric jets, sometimes supplemented by colour Doppler, provided clinically useful information in 10 symptomatic patients. All cases were examined prospectively. Results: The ureteric jet helped confirm presence of a non-obstructing stone at the distal end of the ureter in one patient, exclude complete ureteric obstruction in another patient, identify insertion sites of ectopic ureters in two patients, localize a bladder tumour adjacent to the vesico-ureteric orifice in one patient, differentiate post-ureteric implantation mucosal swellings from other bladder lesions in four patients and confirm a small nodular mucosal lesion to be the ureteric papilla rather than tumour in a patient with gross haematuria. Conclusion: The ureteric jet can be detected easily and non-invasively using ultrasound. It confirms the exact site of the vesico-ureteric orifice, demonstration ureteric patency and may help clarify suspicious bladder lesions. Recognition of the jet phenomenon provides useful additional information during routine ultrasound examination of the urinary tract.
P S E U D O T U M O U R S OF THE PAEDIATRIC LIVER P. A. KANE, D. V. HUGHES, R. WILLIAMS and J. B. K A R A N I
Departments of Radiology and Institute of Liver Studies, King's College Hospital, London Introduction: The diagnosis of liver tumours on computed tomography depends upon differential attenuation coefficients and enhancement patterns. Its sensitivity in defining tumours is well established but there remain a variety of conditions of differing prognosis that mimic these patterns presenting a "pseudotumour" appearance. Design: This work is a retrospective review of our experience. Subject and Method." We present our experience of this phenomena as a tertiary referral liver centre. A common illustrative example is hepatic steatosis but in the paediatric age group less well recorded causes include the spbingolipidoses, tyrosinaemia, atpha-l-antitrypsin deficiency, intrahepatic arterio-portal shunts and following chemotherapy. These cases are discussed with analysis of the physiological mechanisms responsible and a review of the literature. Conclusion: Potential mis-interpretation of the imaging in such benign disease highlights the need for an integrated strategy in the assessment of parenchymal hepatic disease in the paediatric population.
BRASSIERES ARE NECESSARY DURING BARIUM ENEMAS G. K A P L A N and N. RIDLEY
769
ENT Surgeon. Complications can however arise. Pre-endoscopic C.T. to assess the anatomy/anatomical variants of the paranasal sinuses can aid the endoscopistin avoiding complications. The poster highlights some of these variants and their relevance to the endoscopist. Design: Coronal C.T. scans were performed pre sinus endoscopy and important anatomical variants highlighted. Method." Coronal 5ram cuts were performed on a G E HP9000S Scanner with the patient prone using a 20 ~ gantry tilt, from the frontaI sinuses to the sphenoid sinuses. 200 scans were reviewed retrospectively. Results. Important anatomical variants include Hallers air cells, (11%) hypoplastic maxillary antra (0.5%), chonchae bullosae (22%), hypertrophied turbinates (12.5%), supra-orbital extension of the ethmoids (0.5%), and thinned margins to the ethmoids (2%) and cribriform plate (5.5%), and septal deviation or bony spurs (29%). Conclusion: Coronal C.T. is an excellent way of showing the anatomy of the sinuses pre endoscopy. It can show soft tissue and bony anatomy. It is important to recognise these normal variants pre-endoscopy and highlight the findings of the endoscopist, to avoid possible complications.
EPIDURAL ABSCESS OF CERVICAL SPINE: M R FINDINGS IN 6 CASES I. M. LANG, D. HUGHES, J. P. R. JENKINS and F. M c K E N N A
Department of Radiology, Hope Hospital, Salford, Manchester Introduction." Spinal Epidural Abscess is an uncommon clinical entity. The cervical spine is the least frequent site. The presentation is non specific, neurological signs may be absent and delayed diagnosis results in serious sequelae. M R imaging is now accepted as the imaging modality of choice in the evaluation of potential infection of the spine, allowing appropriate treatment. Design: Retrospective study of 6 patients with cervical epidural abscess using M R imaging. Subject and Methods: M R imaging was performed on 4 patients using 1T apparatus and 2 patients using 0.5T apparatus. A variety of sequences were used. Gadolinium enhanced imaging was used in 4 out o f 6 cases. Follow up scans were carried out in 5 out o f 6. Results: Clinical Findings: 4 male and 2 female with age range 20 to 49 years. 4 were infected with staph.aureus and 2 with M. Tuberculosis. In all patients the cervical spine was involved. 5 out of 6 patients were managed conservatively. MR Imaging." A spectrum of signal and enhancement patterns were seen ranging from homogeneous enhancement to peripheral enhancement. Examples will be presented on the poster. Conclusion: Early MRI is indicated if cervical epidural abscess is suspected. There are variable appearances on MR. Monitoring with follow up scans allows conservative management.
Northwick Park Hospital, Harrow Diagnostic radiology contributes 90% of ionising radiation from man made sources. Barium enemas constitute only 0.9% of radiological examinations but contributes 14% of the man made dose. Breast tissue, especially before the menopause, is very sensitive to the induction of cancer by ionising radiation. We have noticed that often the breasts were visible on the flexure views of barium enemas. We reviewed retrospectively 100 consecutive barium enemas in female patients under the age of 65 years. 60% had both breasts visible on the flexures. In 23%, only the left breast was visible on the splenic flexure, and in 1% the right breast was visible on the hepatic flexure. In 16% the breasts were not visible on the radiographs at all. Twenty three of the patients were under 40. In 12 of these patients (52%) both breasts were visible on the flexures while in 4 patients (17%) the breast was only visible on the splenic flexure, and 7 patients (30%) had neither breast visible. Unnecessary radiation of the breast during barium enemas is undesirable and should be avoided if possible. We suggest that this may be done very simply by adjusting the barium enema instruction form - requesting that all female patients wear a brassiere.
THE ROLE OF C O M P U T E D T O M O G R A P H Y (CT) OF THE PARANASAL SINUSES TO SHOW THE ANATOMY OF NORMAL VARIANTS PRIOR TO SINUS ENDOSCOPY S. KHAN*, A. LYNN*. S. DESAlt, S. FAHMY~
Queen Elizabeth H Hospital, Department of *Radiology and ~ENT, Herts, tDepartment of Radiology, King's College Hospital, London Introduction: Sinus endoscopy is an important diagnostic tool to the
APPLICATIONS OF THE ULTRASONIC URETERIC JET PHENOMENON J. H. C. LI, W. C. G. PEH, C. LAM and L. L. Y. LEONG
Department of Diagnostic Radiology, The University of Hong Kong and Queen Mary Hospital, Hong Kong Introduction: The ureteric jet phenomenon is well recognized during gray-scale ultrasound of the bladder, and is enhanced by colour Doppler. Our study aims to illustrate the applications of this phenomenon in patients with various urological problems. Subjects and Methods: Between January 1993 and May 1994, the ultrasonic identification of ureteric jets, sometimes supplemented by colour Doppler, provided clinically useful information in 10 symptomatic patients. All cases were examined prospectively. Results: The ureteric jet helped confirm presence of a non-obstructing stone at the distal end of the ureter in one patient, exclude complete ureteric obstruction in another patient, identify insertion sites of ectopic ureters in two patients, localize a bladder tumour adjacent to the vesico-ureteric orifice in one patient, differentiate post-ureteric implantation mucosal swellings from other bladder lesions in four patients and confirm a small nodular mucosal lesion to be the ureteric papilla rather than tumour in a patient with gross haematuria. Conclusion: The ureteric jet can be detected easily and non-invasively using ultrasound. It confirms the exact site of the vesico-ureteric orifice, demonstration ureteric patency and may help clarify suspicious bladder lesions. Recognition of the jet phenomenon provides useful additional information during routine ultrasound examination of the urinary tract.