PEDIATRIC RADIOLOGY

Card Set Information

Author:
crapeanglr
ID:
14046
Filename:
PEDIATRIC RADIOLOGY
Updated:
2010-04-12 14:28:04
Tags:
peds pediatric pediatrics radiology imaging
Folders:

Description:
Pediatrac imaging differentials and pearls for the oral radiology boards
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user crapeanglr on FreezingBlue Flashcards. What would you like to do?


  1. DDx: Bilateral lung opacities in a newborn
    "SPERM"

    • 1.SDD - granular opac, dec lung vol, not present in full term
    • 2.Pneumonia - streaky opac, can have pleural fluid
    • 3.Edema - streaky opac, uncommon - TAPVR w/ obstruction
    • 4.RFF - streaky, linear opac, can have pleural fluid, should quickly clear
    • 5.Meconium aspiration - patchy, heterogenous, inc lung vol, occ.PTX
  2. Humeral head ossification centers appear at what age?
    36 weeks gestation
  3. DDx: Unilateral lucent thorax in a newborn/first week of life
    • -a.PTX
    • -b.CLE /CLH - usually upperlobe, compressed adj lung
    • -c.CPAM - as a large cyst (Type I)
    • -d. Bronchial Stenosis
    • -e. Absent pectoralis on one side
  4. DDx: Unilateral bubbly thorax in a newborn
    • a.CDH - usually left and posterior
    • b.CPAM - looks like CDH, but bowel gas normal
    • c.PIE - later if on high pressure vent
  5. DDx: Unilateral opaque thorax in a newborn
    • a.Atalectasis - agenesis, NG towards opac
    • b.Pleural effusion - NG away from opac
    • c.Congenital mass
    • d.CLE (early)
  6. DDx: Congenital thoracic malformations
    • Parenchymal anomalies (pulmonary sequestration, CPAM)
    • Foregut anomalies (bronchogenic cyst)
    • Airway anomalies (bronchial atresia, CLE)
  7. CPAM types
    • Type I - Few big cysts
    • Type II - Lots of small cysts
    • Type III - Solid

    Not prognostically indicative, do not affect management
  8. DDx: Diffuse lung opacities in a one week old infant
    "PAPE"

    • Pneumonia
    • Atelectasis
    • Pulm Hemorrhage
    • Edema (PDA)
  9. DDx: Diffuse opacities in a one month old infant
    "ABE"

    • Atelectasis
    • BPD
    • Edema
  10. UAC placement
    inferior to aortic arch and superior to renals
  11. UVC placement
    junction of ivc and right atrium
  12. Diffuse branching lucencies, intubated patient
    PIE - pulmonary interstitial emphysema
  13. 5 entities to be concerned about in a pediatric airway
    "BERCH"

    • Bacterial tracheitis - subglottic narrowing with soft tissue plaques, emergent airway management
    • Epiglottitis - thumb shaped epiglottis, aryepiglottic thickening, , emergent airway management
    • Retropharyngeal abscess/phlegmon
    • Croup - subglottic tracheal narrowing
    • Hemangioma - asymmetric tracheal narrowing
  14. Aryepiglottic folds on lateral film of neck should be less than?
    4mm
  15. Stridor worse when quiet, exaggerated tracheal narrowing on expiration
    tracheomalacia
  16. DDx: Wheezing
    • 1. Airways Disease
    • Reactive Airways Disease (RAD)
    • Viral respiratory infection
    • 2. Airway compression
    • Mass
    • Vascular ring
    • 3. Foreign body aspiration

    Main role of chest film is to rule out 2 and 3
  17. MUST assess on EVERY peds chest film?
    Trachea (Airway) and Ribs
  18. Two techniques to help in evaluating for foreign body if suspected
    • 1. Bilateral decubitus chest radiographs
    • 2. Fluoroscopy - same concept

    Assess for persistent hyperinflation due to air trapping
  19. DDx: Round chest mass in a child
    RAG BCS Tumor

    • Infection (#1)
    • round pneumonia - will usually be sick to help diff from real mass
    • abscess
    • granuloma
    • Congenital
    • bronchogenic cysts - water density
    • CPAM - can have air fluid level
    • sequestration
    • Neoplasms (exceedingly rare)
  20. DDx: Bilateral airspace disease in kids
    • 1.Pus (pneumonia)
    • High fever
    • Atypical/opportunistic
    • 2.Water (edema)
    • Cardiogenic (cardiomegaly)
    • Noncardiogenic - acute glomerulonephritis, smoke inhalation, near-drowning, neurogenic
    • Hydrocarbon ingestion
    • 3.Blood (hemorrhage)
    • Idiopathic pulmonary hemosiderosis (IPH)
    • Goodpasture’s, Wegener’s, blood dysrasias
  21. DDx: Anterior mediastinal mass in children
    • Lymphoma
    • Germ cell tumors (benign & malignant)
    • Lymphatic malformation (“cystic hygroma”)
    • Rare thymic lesions
    • -thymic cyst
    • -thymoma (adults)
    • -thymolipoma
  22. DDx: Fluid density anterior mediastinal mass in a child
    • Teratoma
    • Thymic cyst
    • Lymphatic malformation - classic if very extensive into neck or axilla
  23. DDx: Middle mediastinal mass in a child
    • 1.Foregut duplication cyst
    • Bronchogenic cyst - subcarinal
    • Esophageal duplication cyst - adj to esophagus
    • 2.Adenopathy
    • Inflammatory > malignant
  24. DDx: Posterior mediastinal mass in a child
    • 1.Neurogenic tumor (90%)
    • 2.Other
    • -a.Hernia
    • -b.Adenopathy
    • -c.Osteomyelitis/diskitis
    • -d.Extramedullary hematopoesis
    • -e.Vascular
  25. Neurogenic tumors in kids: more aggressive or less aggressive with age???
    Less aggressive with age:

    • 1.Neuroblastoma (younger child, malignant tumor)
    • 2.Ganglioneuroblastoma (in between)
    • 3.Ganglioneuroma (older child, benign tumor)
  26. DDx: Extrapulmonary thoracic masses in kids
    • Malignant
    • Mets - Neuroblastoma, leukemia, lymphoma
    • Primary - Ewings and Askin tumors; less often osteosarc and rhabdomysarcoma
    • Benign
    • Soft tissue tumors - Lymphangioma, lipoma, hemangioma
    • Benign bone tumors - EG, fibrous dysplasia, osteochondroma
    • Infection (including osteomyelitis)
  27. Flattened vertebral bodies, short ribs, curved femurs, lethal dysplasia
    Thanatophoric dysplasia

    "telephone receiver" femurs
  28. –Posterior scalloping of vert. bodies
    –Narrowing interpedicular distances
    –Tombstone iliac wings
    -Frontal bossing
    • Achondroplasia
    • •Most common short-limbed dwarfism
    • •Autosomal dominant
    • •Often sporadic
  29. –Osteopenia
    –Multiple fractures
    -Accordian ribs
    -Wormian bones
    • - Osteogenesis Imperfecta
    • DDx:
    • -Leukemia
    • -Rickets
    • -NAT
  30. - Micromelia - diffuse shortening of extremities
    - Lethal
    - Spine poorly mineralized
    Achondrogenesis
  31. –Normal spine
    –Small thorax
    –respiratory distress
    –Handlebar clavicles
    –Trident acetabulum
    Asphyxiating Thoracic Dystrophy
  32. –Clavicles total or partially absent
    –Wormian bones
    –Widened pubic symphysis
    Cleidocranial Dysplasia
  33. –Vertebral body beaking
    –Widened ribs
    –Madelung deformity
    -Thick skull
    • Mucopolysaccharidoses
    • •Lysosomal storage disorders
    • –Hurlers and Hunters Syndrome - Anterior inferior vertebral beaking
    • –Morquio Syndrome - Anterior and middle vertebral beaking
  34. DDx: Stippled epiphyses
    • •Chondrodysplasia punctata
    • •Multiple epiphyseal dysplasia
    • •Fetal alcohol/ warfarin exposur
  35. DDx: of Amniotic Band Syndrome
    • •Amniotic band
    • •Thermal injury
    • •Thromboembolic disease
  36. DDx: Hip joint effusion
    • •Septic arthritis
    • •Toxic synovitis
    • •Hemarthrosis –trauma, hemophilia
    • •Arthropathy
  37. Joint erosions, Soft-tissue swelling, osteopenia, accelerated skeletal maturation
    •Ankylosis is late finding
    • Juvenile Chronic Arthritis
    • DDx: Klippel-Feil
  38. Highly specific fractures for non-accidental trauma
    • –Metaphyseal corner fractures
    • –Posterior rib fractures
    • –Scapular fractures
    • –Sternal fractures
  39. •Idiopathic AVN of femoral head
    •Age 4-8 years
    Legg-Calve-Perthes Disease
  40. DDx: Bilateral femoral head AVN
    • - Steroids
    • - Sickle Cell
    • NOT usually LCP Dz
  41. Widened epiphysis of femoral head neck, 25% bilateral, teenagers
    • SCFE
    • •Emergent finding-orthopedic surgery should be notified
    • •Pre-teen to early teenagers
    • •More common in obese children
    • •Salter I fracture
  42. •Metaphyseal Lucent Bands
    Think leukemia
  43. –Osteopenia/cortical thinning
    –Periosteal reaction
    –Soft tissue masses
    –Pathologic fractures
    –Lytic lesion with benign periostitis
    EG
  44. Increased risk of DDH with:
    • females,
    • Caucasian,
    • breech delivery
  45. Tibia vara
    •Medial tibial metaphyseal beaking
    •Beak is depressed, irregular and fragmented
    •Late –medial physeal narrowing, with possibly early medial fusion
    Blount's disease
  46. DDx: Demineralization and metaphyseal splaying
    • Rickets
    • Hypophosphatasia
  47. Flat or anteriorly downward pointing calcaneous
    Equinus calcaneous

    Hind and forefoot varus with EC = clubfoot
  48. •Premature Infants brain pathology
    • –Intracranial hemorrhage - caudothalamic groove
    • –Periventricular leukomalacia
    • –Intracerebellerhemorrhage
  49. •Term Infants
    • –Hemorrhage
    • •Extra-axial
    • –Subarachnoid
    • –Subdural (birth trauma)
    • •Parenchymal Hemorrhage
    • –Choroid, thalamus, subpial region
    • –Hypoxic-Ischemic Encephalopathy
  50. Germinal matrix grading system
    • 1. Subependymal hemorrhage
    • 2. Hemorrhage plus blood in non-dilated ventricles
    • 3. Hemorrhage plus blood in dilated ventricles
    • 4. Intraparenchymal, subependymal and intraventricular hemorrhage
  51. Periventricular Leukomalacia stages
    • •Early –often normal
    • •Two weeks -echogenicity of periventricular white matter
    • •Three weeks –cystic encephalomalacia
    • •Late –cerebral atrophy, ventricular enlargement

    DDx –Periventricular blush - normal finding - Ill-defined borders - Echogenicity < Choroid
  52. –Increased echogenicity
    –Loss of gyral-sulcal interfaces
    –Slit-like ventricles
    Hypoxic-ischemic encephalopathy

    • DDx:
    • –cerebritis, edema, hemorrhage
  53. Cystic focus adjacent to lateral ventricle, but more anterior than PVL
    Coarctation of the lateral ventricle

    Normal finding
  54. •CSF collection in abnormal split in leptomeninges
    •No communication with CSF or ventricles
    Arachnoid cyst
  55. Cystic structure in the midline of the brain in an infant should always be evaluated with?
    Color flow doppler
  56. •Fistulous connection between cerebral arteries and midline prosencephalic vein
    Vein of Galen malformation
  57. •Complete or partial absence of the interhemispheric commissural fibers
    •US findings
    –Partial/complete absence of corpus callosum
    –Widely separated, parallel lateral ventricles
    –Ventriculomegaly(colpocephaly)
    –Radiallyarranges gyri/sulc
    Dysgenesis of the corpus callosum
  58. •Failure of midline cleavage of the brain
    holoprosencephaly
  59. Lack of septum pallucidum on ultrasound
    Septo-optic Dysplasia
  60. DDx: Focus of hypoechogenicity in the spinal cord in a newborn on US
    • -Ventriculus Terminalis - normal, stable
    • –Syrinx
    • –Transient dilation of central canal - normal, disappears in first few weeks of life
  61. DDx: Renal masses in children
    • Wilms’ tumor - 87% of renal masses in kids, 5-10% b/l
    • Rhabdoid tumor
    • Clear cell sarcoma
    • Renal cell carcinoma
    • Congenital mesoblastic nephroma - under 6 mos most likely, benign solid tumor
    • Pyelonephritis/lobar nephronia
    • Multilocular cystic nephroma
    • Misc: angiomyolipoma, mesenchymal masses, metastases, lymphoma
  62. Most likely mets from Wilms
    Lung then liver
  63. Which peds renal tumor likes to invade the IVC and create thrombus?
    Wilms'
  64. If B/L Wilms' tumors think of what?
    nephroblastomatosis and familial causes
  65. DDx: Multifocal Renal Masses in kids
    • Nephroblastomatosis - follow closely - (Wilms' risk)
    • Pyelonephritis
    • Lymphoma/Leukemia
    • Metastases
    • Infarcts (assoc. with sickle cell disease)
  66. How to know if a nephroblastoma has converted to Wilms?
    Has begun to enhance or has grown out of proportion to remaining lesions
  67. Well-circumscribed lesion containing variable sized cysts surrounded by fibrous capsule
    Multilocular Cystic Nephroma

    • Bimodal age and sex distribution
    • –Boys < 4
    • –Girls 4-20
    • -women > 40
  68. DDx: Adrenal masses
    • Neuroblastoma - 10% of pediatric malignant tumors, lift aorta off spine char.
    • Adrenal hemorrhage - MC neonatal mass, should resolve with time, can be solid
    • Teratoma
    • Adrenal carcinoma
    • Pheochromocytoma
  69. Irregular extra-renal mass, lifts bladder and aorta
    Density less than adjacent tissues
    No definable capsule
    Midline extension, encases vessels
    Calcifications 85%
    Neuroblastoma
  70. Most common mets from Neuroblastoma
    Liver, Bone
  71. Best nucs test for neuroblastoma mets
    MIBG
  72. DDx: Pediatric Hepatic Masses
    • Hepatoblastoma -90% elevated AFP, <5 yrs
    • Hepatocellular carcinoma - 50/50 elevated AFP, >5 yrs of age
    • Hemangioendothelioma - infants, heart failure, diffusely infiltrative
    • Mesenchymal hamartoma - never AFP, 4mos-2yrs, cystic
  73. DDx: Pediatric Pelvic Masses
    • Ovarian cysts
    • Hematocolpos
    • Ovarian tumors
    • Neuroblastoma
    • Rhabdomyosarcoma
    • Sacrococcygeal Teratoma
    • Lymphoma
  74. DDx: Cystic Abdominal Masses
    • Abscess
    • Pseudocyst
    • Duplication cyst
    • Urachal/Meckel’s/Omphalomesenteric
    • Lymphatic malformation - can look like an abscess
    • Blood
    • (consider bladder, ovarian cyst in pelvis)
  75. Most abdominal masses in children are what in origin?
    Renal - 50%
  76. Heterogenous enlarged kidney in a pediatric patient
    • Think pyelonephritis, abscess can be seen on U/S as well
    • Look for cortical scarring on DMSA
  77. Reflux grading system
  78. Most common cause of UPJ in childhood
    • UPJ obstruction - associated with other urinary abnormalities
    • Must differentiate from MCDK
  79. Most common cause of urethral obstruction in boys
    • posterior urethral valve
    • US: thick bladder wall with bilateral pelvocaliectasis, +/-urine ascites
    • VCUG: dilated posterior urethra, trabeculated bladder, reflux in 50%
  80. DDx: Unilateral renal enlargement in pediatric patient
    • Hydronephrosis
    • Pyelonephritis
    • Renal vein thrombosis - echogenic heterogenously enlarged kidney
    • Wilms’ or other tumor
    • Renal duplication
    • Compensatory hypertrophy
    • Multicystic dysplastic kidney
  81. DDx: Bilateral renal enlargement
    • “Medical renal disease”
    • –Nephroticsyndrome
    • –Acute glomerulonephritis
    • –Acute hypoxic ischemic injury
    • –Hemolytic-uremic Syndrome
    • ARPCKD
    • ADPCKD
    • Nephroblastomatosis
    • Bilateral Wilms’ tumor
    • Leukemia/lymphoma
    • Bilateral hydronephrosis
    • Bilateral pyelonephritis
    • Bilateral renal vein thrombosis
    • Bilateral duplication
    • Beckwith-Weidemannsyndrome
  82. DDx: Renal cystic disease
    • Solitary simple renal cyst
    • Calycealdiverticulum
    • Multicysticdysplastic kidney
    • ARPCKD
    • ADPCKD
    • Medullary cystic disease
    • -Juvenile nephronopthisis
    • -MedullarySponge Kidney
    • Syndromes
    • -Tuberous sclerosis
    • -von Hippel-Lindau
    • -Zellweger
    • Cystic neoplasms
    • -Multilocularcystic nephroma
    • -Other tumors (necrotic)
  83. Small dysmorphic kidney in the pelvis
    Renal ectopia, can be cross-fused
  84. Weigert Meyer Rule
    • Upper Pole - Obstructs - Connect Inferior and Medial (UIM)
    • Lower Pole - Refluxes (drooping lily on VCUG) - Connects Superior and Lateral (LSL)
  85. Most common renal anomaly
    Horseshoe kidney
  86. Increased risk of what masses with horseshoe kidney
    • Wilms - kids
    • TCC - adults
  87. DDx: Bladder Masses in kids
    • Hematoma
    • Rhabdomyosarcoma - most common ST sarcoma in children
    • Ureterocele
    • Cystitis with asymmetric/focal bladder wall
    • Fibroepithelialpolyp (of posterior urethra)
    • Foreign body/Bladder stone
  88. DDx: Early filling defect on VCUG
    • Prolapsing ureterocele
    • Diverticulum
    • Bladder Mass (polyp or neoplasm)
    • Hemmorhage
  89. Drooping lily sign
    • Lower pole reflux in a duplicated collecting system
  90. 1.absent abdominal wall musculature
    2.cryptorchidism
    3.GU anomalies
    • Prune-Belly or "Eagle-Barrett" Syndrome
    • 99% male
    • Imaging:
    • •tortuous dilated ureters
    • •vesicoureteral reflux
    • •dilated prostatic urethra
  91. Dilated proximal esophagus, NG won't pass, but there's bowel gas noted; baby can't handle secretions
    Think tracheoesophageal fistula

    • Associated findings on prenatal ultrasound
    • –Polyhydramnios after 20 weeks
    • –Intrauterine growth restriction (IUGR)
    • –Nonvisualized or small fetal stomach
  92. Proximal esophageal pouch no bowel gass
    Esophageal atresia without fistula
  93. Shaggy air pouch around trachea
    • Perforation Pseudodiverticulum
    • Traumatic perforation usually due to ET tube
  94. DDx: recurrent pneumonia in pediatric patient
    • - H or N type tracheoesophageal fistula
    • –GE reflux and aspiration
    • –Aspirated foreign body
    • –Immunodeficiency
    • –Cystic fibrosis
    • –Infected congenital pulmonary anomaly
  95. VACTERL associations
    • V Vertebral Segmentation Anomalies
    • A Atresia of Anus or Duodenum
    • C Cardiac : VSD, PDA, TOF
    • T Tracheal-Esophageal Fistula
    • E Esophageal atresia
    • R Renal Anomalies
    • L Limb anomalies (radial ray)
  96. TEF repair complications
    • Poor esophageal motility
    • Anastomoticstricture
    • Esophageal leak
    • GE reflux
    • Recurrent fistula
    • Tracheomalacia
  97. "caterpillar stomach sign"
    • Hypertrophic pyloric stenosis
    • - US Thickness of wall > 3mm]
    • - US Channel length > 14mm
  98. DDx: Double bubble sign
    "D-MADS"

    • •Duodenal atresia
    • •Malro with Midgut Volvulus
    • •Annular Pancreas
    • •Duodenal Web
    • •Severe duodenal stenosis
  99. Location of defect / umbilical cord with gastroschisis and omphalocele
    • gastroschisis - defect to right of midline umbilical cord
    • omphalocele - cord inserts at apex of protruding bowel/mass
  100. Acquired duodenal obstructions
    "IRIS"

    • Intramural Hematoma
    • Radiation Injury
    • Intussusception
    • Superior Mesenteric Artery Syndrome
  101. DDx: Prenatal cystic abdominal mass
    "HCC MODEL"

    • Hydronephrosis
    • Choledochal cyst
    • Cystic teratoma

    • Meconium pseudocyst
    • Ovarian cyst
    • Enteric duplication cyst - gut signature, can bleed or cause intuss.
    • Duodenal atresia
    • Lymphatic malformation

  102. DDx: Biliary emesis
    • Malrotation with midgut volvulus
    • Jejunal or ileal atresia
    • Meconium ileus
    • Other distal obstruction
  103. Congenital Distal Bowel Obstruction
    "IF HAM"

    • Ileal Atresia–Microcolon, small caliber distal ileum
    • Functional Immaturity of the Colon–Meconium plugs, (+/_ small left colon, abrupt transition at splenic flexure), distendable rectum
    • Hirschsprungs–Narrow rectum, cone shaped transition, normal rectosigmoid index should be >1
    • Anorectal Malformation - usually some sacral deformity, poss. presacral mass, VACTERL assoc.
    • Meconium Ileus–Microcolon, meconium obstructs terminal ileum
  104. DDx: calcifications in the neonatal/pediatric abdomen/pelvis
    "MAIN G"

    • -Meconium peritonitis
    • -Adrenal hemorrhage
    • -Infectious sequelae
    • -Neoplasm
    • -Gallstone
  105. DDx: Bubbly lucencies in the abdomen of a newborn
    • Normal stool with normal bowel gas pattern
    • Meconium ileus
    • –Bubbles in right abdomen (air mixed with meconium in the terminal ileum) with proximal bowel obstruction
    • Necrotizing enterocolits
    • –Bubbles of air below the bowel mucosa
    • –/+ crescentic air between the bowel serosa and bowel wall muscle
    • –/+ Portal venous gas
    • –/+ Free air from perforation
  106. DDx: Microcolon, unused fetal colon
    • •Meconium Ileus
    • •Jejunal < Ileal Atresia
    • •Total Colonic Hirschsprungs (uncommon)
  107. DDx: Multiple lucent skull lesions
    • •Eosinophilic granuloma
    • –< age 5years multiple
    • •Lymphoma
    • •Metastatic disease
    • –Neuroblastoma
  108. •Multiple lytic lesions skull with a beveled edge–Outer table > inner table; Vertebra plana C6; floating teeth
    Eosinophilic granuloma/ LCH
  109. Anterior urethral obstruction
    • •Stricture
    • –Congenital
    • –Acquired
    • •Anterior Urethra Valves
    • •Anterior Urethral Diverticulum
  110. Classic target lesions on T2 MR imaging
    Plexiform neurofibroma of NF1
  111. Generalized osteosclerosis in kids
    • •Osteopetrosis
    • •Physiologic sclerosis of the newborn (normal)
    • •Hypervitaminosis A or D
    • •Renal osteodystrophy / hypercalcemia
    • •Healing rickets
    • •Pycnodysostosis (micrognathic)
    • •Hypothyroid
    • •Osteopathia striata
  112. multiple enchondromas in the bones
    Ollier's disease
  113. multiple enchondromas + venous malformation with poss.phleboliths
    Maffucci's sydrome
  114. DDx: Permeative process of the bone in a kid
    "OLEO"

    • •Osteomyelitis
    • •Lymphoma
    • •Ewing's sarcoma
    • •Osteosarcoma
  115. fluid fluid levels on MR in a distal femur mass with soft tissue involvement
    • teleangiectatic osteosarcoma
    • -common lung mets
    • -can calcify
  116. Findings of Classic Dandy Walker Malformation
    "CReATE"

    • Complete or partial vermian agenesis
    • Retrocerebellar cyst communicating with the fourth ventricle
    • Absence of the falx cerebelli
    • Torcular elevation above the lambda
    • Enlarged posterior fossa

What would you like to do?

Home > Flashcards > Print Preview