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Based on experience with 22 cases of neonatal osteomyelitis in 10 years, the authors suggest these patients can be divided into two groups depending on severity of disease. Premature infants requiring umbilical catheterization and severely ill full-term infants constitute a high-risk group; signs are more overt, multifocal infection and joint involvement more frequent, and severe skeletal deformities more common. The patients in the low-risk group had much milder disease but also presented more difficulty in diagnosis because of the vagueness of the presenting signs. Radiographic examination is essential for diagnosis and follow-up of osteomyelitis, particularly limb deformities. Bone scans should be reserved for situations in which the clinical and radiographic findings are equivocal.

Two cases of fetal hydrothorax were diagnosed during ultrasound examination in asymptomatic women in the second trimester of pregnancy. One recognized at 19 weeks gestation increased in size. Thoracentesis at 24 weeks followed by continuous drainage for 7 days relieved the condition. The other diagnosed at 15 weeks resolved over the next month without interference. Each pregnancy resulted in a normal term infant. Aspiration of fetal hydrothorax should be performed when the condition appears progressive and is not associated with a major structural abnormality.

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An additional sonographic sign of gangrenous cholecystitis, namely the loss of the mucosal/gall-bladder wall echo in a setting of acute cholecystitis, is described. It was found prospectively in six patients and correlated well with the presence of mucosal/wall necrosis on histological gallbladder specimens. Other reported signs of gangrenous cholecystitis are reviewed.