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Paediatric Images. Case Book of Differential Diagnosis.
  1. KIERAN MCHUGH, Consultant radiologist

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    Paediatric Images. Case Book of Differential Diagnosis. By E Blank. (Pp 1260; £142.) Lippincott-Raven Publishers, 1997. ISBN 0-316-09991-0.

    There are over 1000 images in this large book covering the whole spectrum of childhood illnesses. Some of the radiological examinations are no longer performed, such as pneumoencephalography, but it seems likely that such studies are included for historical interest. Each case contains a detailed history, biochemical and other laboratory data, radiological images, and a final diagnosis or diagnoses.

    There are too many deficiencies to recommend this book. To begin with, the title is misleading as no differential diagnostic possibilities are ever considered in the text. Little or no justification is made for any diagnosis, and yet in some cases diagnostic accuracy is debatable. A true differential diagnostic approach would have strengthened the text. For example, a number of neuroradiological cases could have been caused by non-accidental injury—an important diagnosis to consider and exclude for obvious reasons. The chapter grouping and organisation are somewhat unusual—for example, the larynx, pharynx, and oropharynx sections contain only one case each and the abdominal wall section (chapter) has just two cases. The first chapter is entitled “Skull and brain”, the second “Brain” yet both include similar cases with computed tomography or magnetic resonance brain images. More significantly, the chapter on the urinary tract places too much emphasis on intravenous urography with no nuclear medicine studies whatsoever—serious omission considering the particular importance of isotope studies in modern paediatric urology. The chapter on the “Normal skeleton” includes disorders such as Perthé’s disease and osteochondritis dissecans. The single greatest weakness, however, is the excess of unnecessary and frequently irrelevant information in the form of historical, biochemical, and laboratory data. Better editing could have helped in this regard. In addition, according to the author, some laboratory errors are deliberately included in the text but it is not clear when they appear or what relevance they have.

    The radiology images overall are of good quality. Arrows on selected radiographs would have helped identify some of the more subtle abnormalities. Myelography is no longer contemplated in the diagnosis of discitis nor angiography to diagnose a hepatoblastoma. Many ultrasound images are reversed with a white background, which is no longer the convention.

    The author has achieved what he set out to do, to present many fascinating paediatric stories and images “free of opinion and pronouncement”. There is a commendable meticulousness throughout the text. Many of the cases are interesting and worth browsing through; however, the book is not topical nor is the intended target audience clearly defined.