Flashcards in pediatricradiologyflash Deck (231):
Heart shape in transposition of great vessels and tetralogy of Fallot
TOGV: Narrow cardiac base. Egg on string. TOF: Boot shape.
Medial malleolus. Distal tibia metaphysis. Tibia plafond extension
Precursor to Wilms tumor
Nephroblastomatosis (primitive rests of cells with tumor potential)
Salter Harris III fracture of anterolateral tibia epiphysis. Seen in older children and adolescents. Distal physis fuses medial to lateral. Lateral distal tibia prone to avulsion injuries.
Abdominal tumors associated with Beckwith- Wiedemann syndrome
Wilms tumor. Hepatoblastoma. Adrenal cortical carcinoma
Objective sign of active congestion. increased pulmonary blood flow. and over-circulation
Diameter of right interlobar pulmonary artery (PA) is greater than trachea
Acute hydrops of the gallbladder
Markedly enlarged. tender gallbladder with a thin wall. Acute acalculous cholecystitis causes less gallbladder distention with wall thickening.
Acyanotic Heart Disease With Increased Pulmonary Vascularity
VSD. ASD. PDA
Adrenal calcifications and associated disease?
Adrenal neuroblastoma: Fine. punctate calcifications. Calcified adrenal hemorrhage: coarse calcifications
Age group for intussusception?
Peaks at age 2
Age group for Wilm's tumor and neuroblastoma?
Birth to 5 years
Anterior mediastinal masses
4Ts and a C: Thyroid (ectopic thyroid is often mentioned. never seen. Terrible lymphadenopathy. Teratoma. Thymoma. Cystic hygroma
ASD heart chamber changes
RA and RV enlargement.
Bilateral right-sidedness: Absent spleen. Bilateral three-lobed lung. Bilateral superior vena cava.
Pulmonary blood flow in tetralogy of fallot
Decreased blood flow to left lung.
LA connected to RV. RA connected to LV.
Beckwith Wiedemann syndrome triad
Macroglossia. Omphalocele. Visceromegaly.
Bezoars may consist of
Hair (trichobezoar). Milk products (lactobezoar). Vegetable material (phytobezoar). Cloth.
Biliary atresia HIDA scan results?
Liver uptake of radionuclide without bowel excretion. Gallbladder is not seen.
Biliary atresia ultrasound findings
Gallbladder is small or absent. Normal gallbladder in 20% of patients. Triangular echogenic atretic biliary plate measures greater than 4 mm along anterior wall of right portal vein.
Bilious vomiting in infants aged 2 months to 2 years
Midgut volvulus. Small bowel obstruction. Intussusception
Lined with respiratory epithelium and filled with mucoid liquid. Occur in lung parenchyma or mediastinum. Subcarinal location is common. Some are connected to bronchial tree and are air filled.
Damage to structurally immature lung by oxygen and positive pressure ventilation.
Calcification in Wilm's tumor and neuroblastoma?
Neuroblastoma calcification is common. Wilms tumor calcification is uncommon.
Causes of lobar collapse in children
Common: Mucus plugging in postoperative and asthmatic patients. Uncommon: Extrinsic masses such as lymph nodes (tuberculosis. infections. or lymphoma) or bronchogenic cysts.
Causes of Ascites in Older infants and children
Liver disease. Nephrotic syndrome. Portal vein obstruction. Traumatic intestinal injury. Peritonitis. Hypoproteinemia. Pancreatitis. Ruptured abdominal cyst. Intestinal lymphangiectasia. GI ischemia. Bile duct perforation.
Causes of Ascites in the newborn
Hydrops fetalis. Chylous ascites. Urinary tract obstruction. Iatrogenic (line perforation). Intestinal perforation (necrotizing enterocolitis).
Causes of childhood Focal Alveolar Consolidation
Bacterial pneumonia: Streptococcus pneumoniae. Mycobacterium. Staphylococcus. Haemophilus influenzae. Nonbacterial infection: Tuberculosis. Actinomycosis. Pulmonary infarction. Pulmonary contusion.
Causes of childhood Miliary Nodules
Infection: Tuberculosis, Histoplasmosis, Viral. Idiopathic pulmonary hemosiderosis. Metastatic disease.
Acute and chronic causes of childhood Parahilar Peribronchial Opacity
Acute (infection): Viral, Mycoplasma, Chlamydia, Pertussis. Chronic: Asthma, Cystic fibrosis, Immunologic deficiency disease, Chronic aspiration
Causes of Colonic Obstruction
Meconium plug syndrome (small left colon). Hirschsprung disease. Functional megacolon. Ectopic (imperforate) anus. Colon atresia/stenosis. Inflammatory stricture. Volvulus. Trauma. Neoplasm.
Causes of Duodenal Obstruction
Atresia/stenosis/diaphragm. Annular pancreas. Duodenal band. Midgut volvulus. Hematoma. Neoplasm (duodenum. pancreas. liver). Peptic ulcer disease.
Causes of Echogenic Renal Pyramids
Normal neonate. Tamm-Horsfall proteinuria. Sickle-cell disease. Hypercalciuria. Renal tubular acidosis. Medullary sponge kidney. Hyperparathyroidism. Drugs (furosemide. steroids. vitamin D). Prolonged immobilization. Bartter syndrome. Williams syndrome. Autosomal recessive polycystic kidney disease. Storage diseases. Glycogen-storage disease type 1A. Hurler mucopolysaccharidosis. Lesch-Nyhan syndrome. Oxalosis.
Causes of Gastric Obstruction
Atresia/antral diaphragm. Duplication cyst. Pylorospasm. Hypertrophic pyloric stenosis. Gastritis/ulcer disease. Volvulus. Microgastria.
Causes of more distal abdominal obstruction presenting in the newborn include
Ileal and colonic atresia. Aganglionosis (Hirschsprung's disease).
Causes of multiple Renal Cysts
Multicystic dysplastic kidney. Polycystic kidney disease. Glomerulocystic disease. Medullary cystic disease (juvenile nephronophthisis). Tuberous sclerosis. Turner syndrome. von Hippel-Lindau disease. Zellweger syndrome. Beckwith-Wiedemann syndrome. Meckel-Gruber syndrome.
Causes of Pediatric Esophageal Obstruction
Congenital atresia/stenosis. Web/diverticulum. Foreign body. Stricture (peptic, caustic). Extrinsic compression (cysts, neoplasms, vascular). Achalasia.
Causes of pediatric Unilateral Obstructive Emphysema
Bronchial foreign body. Mucous plug. Congenital lobar emphysema. Bronchial stenosis/atresia. Tuberculosis. Vascular anomalies. Mediastinal masses.
Causes of single Renal Cyst
Simple cyst. Caliceal diverticulum. Abscess. Multilocular cystic nephroma.
Causes of Small Intestinal Obstruction
Atresia/stenosis. Meconium ileus. Incarcerated hernia. Intussusception. Perforated appendicitis. Regional enteritis. Posttraumatic hematoma/stricture.
Causes of Unilateral Renal Enlargement
Hydronephrosis. Duplication anomaly. Compensatory hypertrophy. Crossed fused ectopia. Multicystic dysplastic kidney. Renal abscess. Renal neoplasm. Renal vein thrombosis.
Caustic esophagitis with stricture usually results from
Alkaline substanceingestion: sodium hydroxide, potassium hydroxide (lye), alkaline disk batteries. Acids produce more superficial burns.
Chest Wall Masses
Malignant: Ewing sarcoma, Primitive neuroectodermal tumor (Askin tumor), Neuroblastoma, Leukemia, Lymphoma, Rhabdomyosarcoma. Benign: Osteochondroma, Aneurysmal bone cyst, Mesenchymal hamartoma, Langerhans cell histiocytosis, Fibrous dysplasia, Hemangioma, Lymphangioma, Teratoma, Abscess, Calcifying fibrous pseudotumor, Osteoid osteoma.
Children with hemihypertrophy have a predilection for what tumors?
Wilms tumor. Hepatoblastoma.
Congenital malformations of intraor extrahepatic bile ducts. May present with jaundice, pain, right upper quadrant mass. Most common is type 1: fusiform or saccular dilation of common bile duct below the cystic duct.
Findings of an anterior pneumothorax
Increased lucency of hemithorax. Increased sharpness of mediastinal border.
2 forms of aorta coarctation
Juxtaductal (adult) type lies at or just distal to the ductus arteriosus. Preductal (infantile, rare) form generally is a long-segment narrowing.
Coarctation of aorta associated cardiac anomalies
Bicuspid aortic valve. PDA. VSD.
Common abdominal masses of 1 month to 2-year-olds?
Wilms tumor. Neuroblastoma. Mass from intussusception.
Common causes of bilateral lung hyperexpansion
Asthma. Bronchiolitis. Cystic fibrosis.
Common complications of esophageal atresia repair
Anastomotic strictures (40%). Anastomotic leakage (14% to 21%). Recurrent fistula (3% to 14%). Esophageal dysmotility. GER.
Complete transposition of the great vessels (D-transposition)
Most common form of cyanotic congenital heart disease with increased pulmonary blood flow. Positions of aorta and PA are reversed. Aorta arises anteriorly from RV. PA arises posteriorly from LV. VSD, ASD, or PDA allow for survival.
Congenital Hutch diverticulum
Adjacent to ureterovesical junction. Increased incidence of VUR.
Congenital pulmonary hypoplasia
Hypoplasia or absence of ipsilateral pulmonary artery. Sometimes associated with tetralogy of Fallot or persistent truncus arteriosus.
Rare cause of obstruction of venous emptying into LA. Pulmonary veins empty into a common vein incorporated into the LA. Partial membrane creates an extra chamber along the posterosuperior LA.
Corrected transposition of the great vessels (L-transposition)
Ventricular inversion with functional correction of transposition. Blood circulates through RA to LV to PA to lungs to LA to RV to aorta to body. Anatomic RV functions as LV and vice versa. Aorta lies anteriorly and to the left hence L-transposition.
VP shunt tip fluid collection causing shunt malfunction.
CT findings of acute appendicitis
Distended appendix greater than 6mm. Fatty infiltration (stranding). Appendicolith (20-40%). Complications of perforation: fluid collections and free air.
Cystic adenomatoid malformation
Congenitallung lesion containing dysplastic adenomatous tissue with communicating cysts of variable sizes. Vary from solid lesion to multiple tiny cysts to large, thin-walled cysts. May mimic congenital lobar emphysema. Cysts can enlarge leading to respiratory distress. Usually are unilateral and can affect any portion of the lung.
Dermoid versus teratoma
Dermoids contain only ectodermal elements. Teratomas contain elements from all dermal layers.
Describe course of umbilical artery catheter?
Enters umbilical artery, Proceeds caudad in iliac vessels, Ascends left of midling in abdominal aorta.
Describe course of umbilical vein catheter?
Pass into left portal vein through ductus venosus and into inferior vena cava.
Cardiac apex lies to the right of the spine. Levocardia is the normal position of the cardiac apex.
Right-sided rotation of heart. RA and RV become more posterior. LA and LV lie anterior. Chamber inversion does not occur.
Thymic aplasia. Absence of parathyroid glands. Cardiovascular anomalies. Faulty development of third and fourth pharyngeal pouches.
Distinguishers of neuroblastoma from Wilm's tumor?
More common in neuroblastoma: Calcification. Spinal involvement. Nodal encasement.
Distinguishes GI duplication cyst from Mesenteric and omental cysts at ultrasound
Cyst wall has a single layer rather than a double layer (gut signature) seen with GI duplication cysts.
Distinguishing ileal atresia from meconium ileus
Air-fluid levels in the dilated small bowel are more commonly seen with ileal atresia. Ileal atresia is corrected surgically whereas meconium ileus is often treated with water-soluble contrast enema.
Male pseudohermaphroditism. Glomerular disease. Wilms tumor.
Malformed, enlarged tricuspid valve that is displaced downward. Atrialization of RV. Severe TR. Atrial right-to-left shunting results in cyanosis in the more severely affected patients.
Echogenicity of neonatal renal cortex
Approximates or exceeds liver echogenicity
Favorable neuroblastoma features
Intrathoracic. Less than 12 months old.
Foregut. midgut. and hindgut boundaries?
Midgut extends from ampulla of Vater (2nd portion duodenum) to midtransverse colon. Foregut, bowel proximal to ampulla of Vater. Hindgut, bowel distal to midtransverse colon.
Common condition in childhood. Spasm of puborectalis muscle. Prominence of puborectalis sling. Patients can hold large volumes of stool in colon.
GI cystic masses
Duplication cyst. Mesenteric cyst. Meconium pseudocyst. Lymphangioma. Appendiceal abscess.
Helps distinguish obstructive emphysema from compensatory hyperinflation?
Obstructive emphysema generally results in diminished size of pulmonary vessels due to compression and hypoxia-induced reflex arterial spasm. In compensatory hyperinflation pulmonary vessels are normal or even increased in size.
Hemangioendothelioma possible complications
High-output cardiac failure. Hemorrhage. Jaundice. Hemolytic anemia. Thrombocytopenia (Kasabach-Merritt syndrome) sequestration of platelets. DIC.
Hepatic adenomas are rare in childhood but have been reported in association with
Fanconi anemia. Glycogen-storage disease type 1. Hurler disease. Severe combined immunodeficiency.
Hepatic hemangioendothelioma features?
Benign. Most diagnosed within first 6 months of life. Hepatomegaly and high-output congestive heart failure are common. May present with platelet sequestration (Kasabach-Merritt syndrome) or DIC.
Hepatobiliary cystic masses
Gallbladder hydrops. Choledochal cyst. Mesenchymal hamartoma. Abscess/parasitic cyst.
Occurs in children under the age of 5 years. May extend into portal veins, hepatic veins, and inferior vena cava. Prematurity is a risk factor. Usually well-circumscribed, solitary mass. May be multifocal.
Hepatoblastoma routes of spread
Local: Portal vein. Hepatic vein. IVC. Lymph nodes. Diaphragm. Peritoneum. Remote: Lungs.
Hepatoblastoma occurs at what age and with what syndromes?
Early childhood, presenting before 3 years of age. Beckwith-Wiedemann syndrome. Familial adenomatous polyposis.
Epidermolysis bullosa effect on esophagus
Hereditary condition. Inflammatory skin and mucosal lesions that can heal with fibrosis. May result esophageal stricture.
Hirschsprung disease features
Contracted aganglionic distal colon. Abnormal peristalsis and inability to effectively evacuate colon. Rectum is always involved. Extent of proximal involvement varies. Colon caliber transition more common in older infants. Tortuosity or corrugation of narrowed aganglionic segment of the colon is commonly seen. Diagnosis made with rectal biopsy. Necrotizing enterocolitis is an uncommon but serious complication.
How long does it take for gas to reach the rectum in a normal newborn?
May take up to 24 hrs. Occurs by 12 h in most healthy infants.
Hydrometrocolpos versus hematometrocolpos
Both are congenital vaginal obstructions. Hydrometrocolpos anechoic fluid in the newborn. Hematometrocolpos echogenic blood in the adolescent.
Hypertrophic pyloric stenosis features:
Common between 2 and 10 weeks of age. Hypertrophy of pyloric muscle. 4 mm or more in thickness. Pyloric channel elongated beyond 15 mm.
Hypoplastic right heart
Tricuspid atresia. Usually with pulmonary atresia or stenosis. Underdeveloped RV. Common features are small RV with right-to-left shunting through an ASD causing cyanosis.
Imaging sequence of at risk infants (neonate to 3 years) for suspected pyelonephritis?
Nuclear scan with 99mTc -DMSA or 99mTc-GH. If positive, ultrasound and or voiding cystourethrogram.
Imperforate or ectopic anus
Range from simple membranous anal atresia to arrest of colon as it descends through puborectalis sling. Fistula formation may occur to genital or urinary tract.
Contrast enema with cecum not in the right lower quadrant, suspect
Malrotation or malfixation of midgut.
In a neonate a right-sided aortic arch may be inferred if
Carina is midline or to the left.
In a neonate buckling of the trachea is
Normal. Occurs during expiration.
In a neonate decreased pulmonary vascularity, though difficult to detect may be seen in
severe pulmonic stenosis or atresia.
In a neonate the ideal position of the endotracheal tube is at the level of
Inferior margins of the clavicles.
Neonate with low lung volumes and fine lung opacities with air bronchograms
Hyaline membrane disease. Group B b-hemolytic streptococcal pneumonia.
In children, infarction of the spleen may occur in
Sickle cell anemia. Leukemia. Gaucher disease. Cardiac valvular disease.
In neonates, pulmonary vessels can be seen peripherally only as far as
Medial third of lungs.
Common causes of GI bleeding in neonates
Necrotizing enterocolitis. Milk allergy. Enterocolitis that sometimes accompanies Hirschsprung disease.
In the newborn, prolonged jaundice (over 2 weeks) is most commonly due
Neonatal hepatitis. Biliary atresia.
Infants with increased lung volumes and fine lace-like strands or cysts.
Pulmonary interstitial emphysema. Bronchopulmonary dysplasia.
Neonate with increased lung volumes and localized lung opacity.
Neonate with increased lung volumes with multiple coarse areas (strand-like densities following bronchovascular patterns).
Meconium aspiration. Retained fetal fluid (TTN).
Infant GER is best imaged with
Nuclear scintigraphy. Tc-99m sulfur colloid formula (best sensitivity)
Generally occur after 6 months of age. Most are ileocolic and the cause is idiopathic. Treatment is water-soluble or air enema reduction. Contraindicationsto enema reduction: Free air, Signs of peritonitis. Recurrent intussusception occurs in 5% to 10% of cases.
Unilateral hyperexpansion of one or two lobes in children, common causes
Aspirated foreign body. Hilar nodes compressing bronchus.
Hyperinflated lung findings
Flattening or inversion of diaphragm. Widening of rib interspaces. Larger retrosternal and retrocardiac clear spaces.
Lung disease correlate with gestational age: Near term (34-37 weeks) and term (38-42 weeks)
Retained fetal fluid. Aspiration syndromes, including meconium aspiration. Persistent pulmonary hypertension.
Lung disease correlate with gestational age: Premature (24-34 weeks)
Immature lung. Hyaline membrane disease. Persistent pulmonary hypertension.
Malignant Wilms tumor spread
Local: Renal vein. Inferior vena cava. Perirenal lymph nodes. Contiguous invasion of liver. Remote: Lungs. Liver. Bone.
Duodenal-jejunal junction is not properly fixed by ligament of Treitz. Results in duodenal obstruction by peritoneal bands or twisting of duodenum (midgut volvulus).
Intrauterine fetal distress can lead to passage of meconium. Aspirated meconium particles cause obstruction of small peripheral bronchioles. Results in areas of subsegmental atelectasis and areas of overdistension. Coarse reticulonodular or nodular appearance of lungs.
Meconium aspiration radiographic findings.
Increased lung volumes. Patchy perihilar opacities.
Meconium ileus features
Earliest manifestation of cystic fibrosis. Thick meconium plugs can't pass through ileocecal valve. Multiple dilated loops of small intestine. Bubbly intestinal contents represent retained meconium. Often treated with water-soluble contrast enema.
Intrauterine intestinal perforation from bowel obstruction or ischemia. Extruded meconium mayh calcify. Scattered amorphous or curvilinear calcifications throughout peritoneum. Snowstorm ultrasound appearance.
Meconium plug syndrome also known as small left colon syndrome
Transient functional immaturity and abnormal peristalsis of distal colon. Normal to dilated proximal colon filled with meconium. Empty distal descending colon. More common in normal large infants and infants of diabetic mothers. Often treated with rectal stimulation or saline enemas.
Megacystis-microcolon-hypoperistalsis (MMH) syndrome
Disorder of smooth muscle in urinary and GI tract. Almost exclusively in girls. Insufficient abdominal muscles. Very large dysfunctional bladder. Bladder exstrophy may occur: Widened pubic symphysis. Splaying of pelvic bones. Decreased peristalsis leads to poor evacuation of colon.
Self-limiting, usually viral inflammatory condition of mesenteric lymph nodes Normal appendix. Cluster of large right lower quadrant lymph nodes.
Microgastria occurs with
GI atresias. VACTERL syndrome. Polysplenia/asplenia syndromes.
Middle mediastinum mass (an abnormality for each organ)
Esophagus: Duplication cyst. Great vessels: Aneurysm. Hila: Large lymph nodes (Leukemia, Lymphoma, Tuberculosis). Trachea: Bronchogenic cysts. Pericardium: Cyst
Midgut volvulus vascular compromise
Superior mesenteric vessels: vein before artery.
Most Common Causes of GI Tract Obstruction by Age. 0-1 month:
Congenital anomalies: Atresia/stenosis, Malrotation/volvulus, Hirschsprung disease. Meconium plug/small left colon syndrome. Meconium ileus.
Most Common Causes of GI Tract Obstruction by Age. 1-5 months:
Most Common Causes of GI Tract Obstruction by Age. 3 years and older
Perforated appendicitis. Adhesions. Regional enteritis.
Most Common Causes of GI Tract Obstruction by Age. 5 months - 3 years
Most common childhood tumors to metastasize to liver (descending order)
Neuroblastoma. lymphoma. leukemia. and Wilms tumor.
Most GI duplication cysts are asymptomatic except for those that
Contain ectopic gastric or pancreatic tissue. May ulcerate or hemorrhage.
Most of the time the right lung hilum is lower than the left. but it is never
Syndrome with multiple nonossifying fibromas along with cafe-au-lait spots
Necrotizing enterocolitis (NEC)
Occurs in premature and newborn infants. Thought to be infection and or ischemia of the gut. Findings: Dilated bowel loops. Pneumatosis intestinalis (air in wall of the bowel). Portal venous gas. Free air. Later may develop strictures, commonly in the colon. Treatment: Withholding feedings. Administering antibiotics. Blood transfusions.
Neonatal hepatitis HIDA scan results?
Poor liver uptake.
Neonate to 2 months with bilious vomiting
Midgut volvulus. Small bowel obstruction. Bowel atresia in newborn. Hirschsprung disease
Neonate to 2 months with nonbilious vomiting
Overfeeding Chalasia (gastroesophageal reflux). Pyloric stenosis.
Neonates at risk for TTN or retained fetal fluid
Neonates with tracheobronchial obstruction. Cesarean section delivered neonates.
Primitive metanephric blastema thought to be precursor of Wilms tumor. Commonly seen in neonate kidneys. Normally regress by 4 months of age. Bilateral lobulated and enlarged kidneys. Marked compression and stretching of pelvicaliceal structures. Large echogenic and lobular kidneys. May demonstrate diffuse hypoechoic cortical thickening. Nephrogenic rests are generally cortical, hypoechoic, low attenuationand T1 hypointense.
Arise along axis of sympathetic nerves (paraspinal). 66% are abdominal. Intraspinal involvement is common. Majority occur between 6 months and 5 years. Present with weight loss. irritability. fever. and/or anemia. Frequently show stippled calcification. Poor prognosis with abdominal involvment in patients over 1 year of age. MIBG avid.
Nonbilious vomiting in infants aged 2 months to 2 years the possibilities include:
Often just GER. Infections: Meningitis. Urinary tract infection.
Nonvisualized kidney causes
Congenital absence. Surgically removed. Ectopic kidney. Multicystic dysplastic kidney. Renal artery thrombosis. Renal vein thrombosis. Tumor.
Normal or decreased lung volumes and fine granular opacities (ground glass) with air bronchograms.
Hyaline membrane disease (RDS and HMD). Group B b-hemolytic streptococcal pneumonia
Of the talar and calcaneal joint coalitions which is rarest
Older children develop adrenal hemorrhage as a result of
Accidental and nonaccidental trauma. Meningococcemia. Anticoagulant therapy.
Multiple enchondromas generally presentingÿin childhood. Generaly asymptomatic. Risk ofÿmalignant transformation.
Ostium secundum versus ostium primum atrial septal defects?
Ostium secundum: Most common type of ASD. Occurs centrally at foramen ovale. Ostium primum: Endocardial cushion defect. Commonly occurs in trisomy 21.
Overcirculation. increased arterial flow. and increased vascularity suggest
Increased pulmonary venous pressure. Commonly caused by left heart failure. Progressed from dilated veins to indistinct pulmonary vessels to interstitial edema to alveolar edema and pleural effusions.
PDA heart chamber changes
Enlarged LA, LV, PA, and proximal Aorta.
Pediatric neoplasms that cause caval tumor thrombus.
Wilms tumor. Hepatoblastoma.
Persistence of fetal circulation after birth is called
Persistent pulmonary hypertension.
Plain film findings of intussusception?
Abdominal mass. Signs of bowel obstruction: dilated bowel and air-fluid levels.
Bilateral left-sidedness: Multiple spleens. Bilateral bilobed lungs. Interrupted inferior vena cava with azygos continuation. Biliary atresia
Possible Causes of childhood Bilateral Lung Hyperinflation
Diffuse peripheral obstruction: Viral bronchitis/bronchiolitis. Asthma. Cystic fibrosis. Immunologic deficiency diseases. Chronic aspiration. Graft versus host disease. Central obstruction: Extrinsic (Vascular anomalies, Mediastinal masses). Intrinsic (Tracheal foreign body, Tracheal neoplasm/granuloma).
Possible routes of neuroblastoma spread
Local: Lymph nodes and extensive nodal masses. Invasion of neuroforamina. Encasement of great vessels. Remote: Bone. Liver. Central nervous system (extradural space and orbit)
Posterior mediastinum mass (T. E. N)
Tuberculosis (Pott's disease) or any spinal infection. Extramedullary hematopoiesis (almost always in adults). Neurogenic tumors: Neuroblastoma. Ganglioneuroma. Neurofibroma. Neurenteric cyst.
Posterior urethral valve findings
Most common cause of urethral obstruction in males. Dilated posterior urethra. Bladder wall thickening and trabeculation. VUR.
Premature infant mechanical ventilation complications
Pulmonary interstitial emphysema. Pneumomediastinum. Pneumothorax. Pneumopericardium.
Presacral childhood masses
Sacrococcygeal teratoma. Neuroblastoma. Rhabdomyosarcoma. Sacral chordoma. Anterior sacral meningocele. Neuroenteric cyst.
Primary megaureter versus refluxing megaureter?
Primary megaureter: Contracted ureterovesical junction. Refluxing megaureter: widely patent ureterovesical junction.
Primary Vesicoureteral reflux (VUR) is caused by
Short. submucosal tunnel of distal ureter at ureterovesical junction. Faulty valve.
Prune belly (Eagle-Barrett) syndrome
Almost exclusively in males. Absent or deficient abdominal musculature. Large, vertically oriented urinary bladder. Severe hydronephrosis and ureterectasis. Cryptorchidism. Urethral dysfunction leading to functional bladder obstruction. Urachal remnants.
Rare condition. Dilated lymphatics within lung interstitium. Diffuse reticular or reticulonodular lung opacities. May cause chylothorax. May have hyperinflated lungs and pleural effusions.
Lung tissue lacking a bronchial connection. Supplied by abnormal artery from descending aorta. Extralobar (covered by own pleura). Intralobar (covered by adjacent lung pleura). Triangular or oval-shaped mass in inferomedial lung. Left side more common. Ma become secondarily infected.
Radiographic signs of a patent ductus arteriosus in an infant
Enlarging heart and liver. Increasing pulmonary vascularity.
Renal/adrenal cystic masses
Hydronephrosis. Renal cysts. Multicystic dysplastic kidney. Adrenal hemorrhage (resolving).
16% arise in genitourinary system. Occur at any pediatric age group. Arise from skeletal muscle mesenchyme. Most common lower urinary tract tumor. Prostate gland in boys. Vagina in girls.
Rhabdomyosarcoma routes of spread?
Local: Direct invasion of adjacent viscera. Retroperitoneal lymph nodes. Remote: Lungs. Bones. Liver.
Right-sided aortic arch congenital heart disease associations
Truncus arteriosus. Tetralogy of Fallot.
Risk factors for neonatal adrenal hemorrhage.
Large babies. Obstetric trauma. Neonatal sepsis. Hypoxia.
Often large. May extend externally from region of coccyx. Usually deforms sacrococcyx. Frequently contains calcifications (tooth).
Seventy percent of abdominal and pelvic masses in neonates originate in what organs?
Genitourinary tract. Urinary masses: Hydronephrosis (UPJ and UVJ obstruction and reflux). Multicystic kidneys. Genital masses: Hydrometrocolpos. Ovarian cysts.
Signs of increased pulmonary arterial flow include:
Enlarged central vessels. Equalization of vessel size between upper and lower lungs on erect film.
Osteochondrosis of inferior patella at tendon insertion. Results from persistent traction at cartilaginous junction of developing inferior patella. Usually occurs preteen or teen-age boys. Similar to Osgood-Schlatter disease (occurs at developing tibial tuberosity at tendon insertion).
Single large kidney causes
Tumor. Renal vein thrombosis. Pyelonephritis. Abscess. Hematoma. Obstruction or reflux.
Single small kidney causes
Congenital hypoplastic kidney (renal artery stenosis). Postinfectious nephropathy. Reflux.
Visceral situs inversus
Reversed viscera. Stomach on right. Liver on left.
Normal position of viscera.
Sources of Diffusely Hazy or Reticular Lungs in the Neonate
Decreased lung volumes: Poor inspiration. Hyaline membrane disease. Normal to increased lung volumes: Retained fluid. Aspiration (amniotic fluid/meconium). Pneumonia. Pulmonary edema. Pulmonary lymphangiectasia
Sources of Multiple childhood Patchy Lung Opacities
Infection: Staphylococcus. Mycoplasma. Fungal. Opportunistic organisms. Aspiration. Hydrocarbon ingestion. Near drowning. Immune-mediated pneumonitis. Milk allergy. Hypersensitivity pneumonitis. Pulmonary hemorrhage. Pulmonary edema
Split pleural sign
Enhancement of parietal and visceral pleura displaced by low-density fluid. Suggests empyema.
Such high-output hydronephrosis is rare but may be seen with
Bartter syndrome. Diabetes insipidus. Psychogenic water drinking.
Superior mesenteric vein and artery relative positions in intestinal malrotation.
Normally superior mesenteric vein is right of artery. In malrotation vein is anterior or left of artery.
Surfactant deficiency disease features
Most common cause of respiratory distress in neonates. Most common in premature infants and term infants of diabetic mothers. Low lung volumes. Fine granular opacities. Air bronchograms extend to lung periphery.
Surgical causes of abdominal pain in children?
Incarcerated hernia. Intussusception. Appendicitis. Midgut volvulus.
Acquired hypoplastic lung following severe obliterative bronchiolitis. Air trapping causes little change in lung size on expiration (different from congenital hypoplastic lung).
Tetralogy of Fallot
High VSD. Pulmonary stenosis (usually infundibular. with or without valvular stenosis). Right ventricular hypertrophy. Aorta overrides VSD.
Aortic arch frequently cannot be seen in a neonate. Its position must be inferred from the position of the
Carina. Carina normally overlies the right pedicles with a left aorta arch.
Initial examination to identify a bleeding Meckel diverticulum
Findings in VSD
PA enlargement. Increased pulmonary vascularity. Cardiomegaly.
Ideal location for tip of the umbilical venous catheter
in the right atrium
Length of the kidney should be no greater than ________ vertebral bodies.
4-4.5 vertebral bodies.
Most common anomaly to cause diminished pulmonary vascularity and is most common cause of cyanotic congenital heart disease.
Tetralogy of Fallot.
Most common benign liver tumor encountered in infancy
Common causes of cholelithiasis in children
Sickle cell disease. Congenital obstructive anomalies of the biliary tract. Total parenteral nutrition. Furosemide treatment. Dehydration. Hemolytic anemia. Short gut syndrome.
Common causes of pleural effusion in children
Infection. Congestive heart failure (if unilateral. always on the right). Chronic renal disease.
Most common causes of distal small bowel obstruction in the neonate
Ileal atresia. Meconium ileus.
Most common childhood malignant tumor of the small intestine.
Most common childhood ovarian tumor
Most common malignancies to involve the chest wall in children
Ewing sarcoma. Primitive neuroectodermal tumor (Askin tumor).
Most common pancreatic pediatric endocrine tumor is
Benign islet cell adenoma (insulinoma).
Most common posterior mediastinal mass in a child
Neurogenic tumor: Neuroblastoma. Ganglioneuroma. Neurofibroma.
Most common pulmonary mass in children is
Pseudomass caused by spherical pneumonia
Most common renal tumor in neonate
Mesoblastic nephroma. Usually considered benign. Metastasis can occur.
Most common soft tissue tumor in children
Most common tumor in newborns
Most common type of cardiac malposition
Only part of the airway not seen on a neonatal plain film
Plain film findings of acute appendicitis
Appendicolith (10%). Free fluid in right lower quadrant (separation o colon from properitoneal fat line). Sentinel loop of bowel (air-fluid level) in right lower quadrant. Scoliosis with concavity to the right (splinting).
Terminal ileum has a nodular appearance in children due to
Normal lymphoid tissue of Peyer's patches.
Thymus may be seen in some children up to the age
of 4-5 years
Umbilical arterial line tip may be at
L4-5 (bifurcation of the aorta). T8 above the diaphragm
Fat babies are seen in
To make diagnosis of hyaline membrane disease, you must see granular opacities where?
All the way out to the edge of the lungs.
Toxoplasmosis. Rubella. Cytomegalic inclusion disease. Herpes. Syphilis
Total anomalous pulmonary venous return (TAPVR)
Pulmonary veinsreturn blood to right side of the heart via: RA. Coronary sinus. Systemic vein. Type 1 anomaly is the snowman heart: . Large, inverted U-shaped vessel empties into superior vena cava.
Two common causes of nonbilious infantile vomiting
GER. Hypertrophic pyloric stenosis.
Two large kidneys DDx:
Polycystic disease. Hydronephrosis (Neurogenic bladder. Posterior urethral valves). Leukemia. Lymphoma. Sickle cell disease. Glycogen storage disease. Amyloidosis. Bilateral Wilms' tumor. Acute glomerulonephritis. Acquired immune deficiency syndrome (AIDS).
Two of the more common underlying etiological factors predisposing to hyaline membrane disease.
Prematurity. Maternal diabetes.
Two small kidneys DDx:
Reflux nephropathy. Postinfectious nephropathy.
Ultrasound findings of appendicitis?
Noncompressible appendix greater than 6mm in width. Blood flow may be increased.
Upper and lower pole moiety bladder insertions of duplicating collecting system
Upper pole ectopically inserts below normal insertion and may form ureterocele. Lower pole inserts at normal location but often refluxes.
Asymptomatic vesicourachal diverticula (obliterated of urachus ends). Urachal sinus, patent urachus extending from urinary bladder to umbilicus.
Saccular dilated segment of distal ureter. Invaginates into bladder lumen. May cause urinary obstruction.
Vascularity of a newborn becomes much easier to see in the lateral two-thirds of the lung under what conditions
Vascular congestion due to congestive heart failure or over-circulation(left-to-right shunts).
Vertebra plana causes
MELTS. Metastasis. Myeloma (rare in children). Ewing?s sarcoma. LCH. Leukemia. Lymphoma. Trauma. Tuberculous osteomyelitis. Steroid use.
VUR grading system and treatment
Grade I: reflux of ureter (low dose antibiotics). Grade II: reflux of ureter. pelvis. calyces (low dose antibiotics). Grade III: reflux of collecting system with mild dilation (low dose antibiotics). Grade IV: reflux of collecting system with moderate dilation (surgery). Grade V: reflux of collecting system with severe dilation (surgery).
Wilms tumor. Aniridia. Genitourinary abnormalities. Mental retardation.
What causes ductus bump in a neonate and when does is disappear?
Superimposition of main pulmonary artery, left pulmonary artery, and ductus arteriosus. Disappears usually by day 3 of life.
When should repeat film in suspected round pneumonia be obtained to ensure resolution?
Most common causes of 3rd and 4th portion duodenal obstructions.
Duodenal diaphragm. Malrotation with midgut volvulus or obstructing peritoneal band.
Wilm's tumor features?
Intrarenal tumor. Peak incidence between 2 and 5 years. Hematuria 20%. Uncommonly calcify.