CH 6 Pediatric Thorax

Question 1

Neurogenic tumors

Answer 1

usually ganglioneuromas, arise posteriorly along sympathetic chain.

well-defined, hyperechoic, and have small granular calcifications. also associated with rib erosions.

neuroblastomas are the malignant form

Question 2

Neurenteric cysts

Answer 2

cysts of bowel that have failed to separate from the neural canal during development.

well-defined, thin-walled cysts in posterior chest. spinal anomaly seen higher than the lesion on x-ray. usually hypoechoic, may contain debris due to infection or hemorrhage.

Question 3

Pulmonary sequestration (bronchopulmonary foregut malformation)

Answer 3

segment of lung which does not function due to an anomalous arterial blood supply with no communication with the tracheobronchial tree.

developmental abnormality where there is accessory tracheobronchial foregut bud.

lower lobe consolidation that never clears completely

Question 4

Intralobar pulmonary sequestration

Answer 4

ACQUIRED condition where abnormal lung is enclosed in the visceral pleura of the affected lobe.

presents: young adults following pneumonia, also associated with bronchial obstruction and compromised pulmonary artery supply.

Question 5

Extralobar Pulmonary sequestration

Answer 5

CONGENITAL anomaly with pulmonary tissue with separate pleura and >60% have a diaphragmatic defect and CCAM of lungs.

Question 6

Congenital pulmonary airway malformation (CPAM)
or
Congenital cystic adenomatoid malformation (CCAM)

Answer 6

mass of abnormal bronchial and lung tissue which develops within the fetal chest.

associated with polyhydramnios and hydrops in the fetus, due to tissue impinging on the esophagus and causing fluid backup.

Question 7

Congenital pulmonary airway malformation (CPAM)
or
Congenital cystic adenomatoid malformation (CCAM)

3 types:

Answer 7

I: macrocystic- one or more large cysts measuring >2cm

II: mixed- multiple small cysts

III: microcysts- appears solid on u/s (no vascular supply) difference withpulmonary sequestration

Question 8

Pleural effusion

Answer 8

fluid in pleural cavity.

simple PE should appear anechoic and resolves with antibiotics

Question 9

*Consolidation

Answer 9

lung appears hypoechoic.

Lung tissue solidifies due to fluid or exudate, as in pneumonia

Question 10

Complicate Pleural effusion (PE)

Answer 10

usually due to bacterial infection and appear cloudy

Question 11

Bacterial PE

Answer 11

have to be drained for resolution

Question 12

*diaphragmatic hernia

Answer 12

defect in the diaphragm in which the abdominal contents herniate into the chest.
*more common on L due to liver acting as a plug.

may be congenital or acquired (trauma)

2 types: Bochdalek, morgagni

Question 13

Bochdalek hernia

Answer 13

• approx 95% of congenital diaphragmatic hernias
  affects the back (posterior)

large, assoc. with pulmonary hypoplasia, prolapsed retroperitoneal fat, spleen and left kidney.

Question 14

Morgagni hernia

Answer 14

affects the front (anterior)
small and rare
Occur later in life and bulge through sternocostal angles.

Question 15

Diaphragmatic eventration

Answer 15

congenital anomaly, abnormal elevation of diaphragmatic dome.

diaphragm composed of fibrous tissue with little or no muscle fibers. region stretches on inspiration, does not contract normally.

Question 16

diaphragmatic paralysis

Answer 16

associated with damage to the phrenic nerve after thoracic surgery.
*Transducer placed intercostal rib space, vent should be disconnected for 5-10 seconds.

Question 17

malignant rhabdomyosacrcoma

Answer 17

rare tumor arising from the diaphragmatic muscle.

Question 18

Thymus

Answer 18

gland in superior mediastinum, anterior to ao arch.
*appearance of “sail”

special lymphnoid gland of the immune system. at puberty, thymus reaches height of its use, then declines as lympnoid tissue disappears and fat and fibrous tissue appears.

Question 19

Thymic cysts

Answer 19

usually unilocular and extremely uncommon.

may occur from the angle of the mandible to the thoracic inlet, more common on the left.

symptoms include; hoarseness, dysphagia, stridor and respiratory distress in newborns.

Question 20

superior herniation of the thymus

Answer 20

into the neck is rare. intermittent migration of the thymus out of the thorax into the suprasternal region occurs during valsalva.

Question 21

cervical ectopic thymus

Answer 21

very uncommon. Thymic tissue may be found along the thymopharyngeal duct or protrude into the chest wall due to a congenital sternal defect.

Question 22

Thymus may also be involved by the following

Answer 22

hemorrhage, hemangioma, leukemia, langerhans cell histiocytosis, lipoma, lymphatic formation, malignant infiltration of lymphoma or leukemia

Question 23

which gland has the appearance of a “sail”

Answer 23

Thymus gland

Question 24

which type of diaphragmatic hernia affects the front of the diaphragm?

Answer 24

morgagni

Question 25

Extralobar pulmonary sequestration

Answer 25

more common in males, 4x more common on the left, greater than 60% of children with this anomaly have a diaphragmatic defect.