Paediatrics Flashcards
Monoventricle, thalami and basal ganglia are fused?
Alobar Holoprosencephaly
Addition: Most severe form.
**No falx or corpus callosum
Complete absence of cleavage with “pancake” of anterior cerebral tissue, crescent-shaped anterior monoventricle communicating with large dorsal cyst,** fused thalami**
Multilocular fluid filled mass with internal septations at the the posterior triangle?
Cystic hygroma
Nb - Associated with turners and hydrops/downs
T2 bright. Doesnt enhance. No internal flow.
Difference and similarities between Epidermoid cyst and arachnoid cyst
Both - CSF density on CT, can occupy CPA, homogeneous.
Epidermoid - Restricts diffusion. Hyperintensity on FLAIR
Complete opacification of the maxillary sinus, peripheral enhancemen, expanded sinus with smooth remodeling of walls?
Mucocoele
Nb - Ostium of given sinus is occluded thus complete opacification.
*- Doesn’t extend beyond the cavity. *
- **Expands cavity and can cause bone thinning. **
Associated with* CF and prior trauma*
Peripheral enhancment allows differentiate from neoplasm
Low attenuation mass in the sinus that expands the cavity and extends into the meatus ?
Antrochonal polyp/Solitary Sinonasal Polyp
*Nb - T2 bright and also peripheral enhancement. *
Typically doesn’t completely opacify the sinus
Solitary ‘dumbell shaped-‘ polypoid mass fills maxillary antrum, then spills through enlarged maxillary ostium and infundibulum or accessory ostium into nasal cavity
Seizures, atrophy of hippocampus and high T2/FLAIR signal?
Mesial temporal sclerosis
Intraventricular lobulated mass in trigone of lateral ventricle. Smooth, large and small foci of calcification on CT. Lateral ventricle is dilated?
Choroid plexus papilloma
Hyperdense on CT.
Iso on T1 and hyperintense on T2.
**Intense homogenous enhancement. **
Nb in adults - occur predominantly in 4th ventricle
Mass in the inferior 4th ventricle of child with hypointensity on T1 and foci of high T2 signal ?
Ependymoma
4th ventricle mass (± indistinct interface with floor of 4th ventricle)
Fine, stippled Ca⁺⁺ common (50%)
± cysts, hemorrhage
Hydrocephalus common
Hetergenous Signal as Ca2+/Blood products
- overall T1 iso/hypointense and T2 hyerpintense
Anterolateral extension through recess(es) into CPA cistern
Posteroinferior extension through foramen of Magendie into cisterna magna
Erosive soft tissue mass in the middle ear ?
Cholesteatoma
Nb - its termed ‘Congenital’ if less than < 5yrs.
Isointense T1 and hyperintense T2
Resticts diffusion
Congenital cholesteatoma are less destructive.
Non- erosive soft tissue mass in the middle ear ?
Choleterol granuloma
Nb - Cystic strucutres with Blood and cholesterol =** High T1 and T2.**
If located in petrous apex can be aggressive
What brain tumour is found in Tuberous Sclerosis?
Subependymal giant cell astrocytoma (SEGA)
aka Intraventricular astrocytoma of tuberous sclerosis complex (TSC
Enlarging, enhancing foramen of Monro mass in patient with TSC
Tuberous sclerosis is triad of
-facial angiofibromas
-seizures
-mental retardation
Cortical/subcortical TUBERS
- expand overlying gyri, low on CT,
- can have cystic and Ca2+ transformation.
DDX - TORCH namely toxo and CMV can cause periventricular Ca2+
Highly vascular mass in nasopharynx eroding the medial ptyergoid plates and arising from sphenopalatine fossa?
Juvenile angiofibroma
Supplied by the internal maxillary artery. Embolise it.
Pineal mass in boy with precocious puberty?
Germinoma
Pineal mass with Central localized Ca⁺⁺ & bithalamic extension
Nb Germinoma and Pineoblastoma difficult to differentiate on imaging.
Can be Suprasellar mass with diabetes insipidus (DI)
Child with large, heterogeneous hyperdense pineal mass with peripheral Ca⁺⁺
Pineoblastoma
**Scattered (“exploded”) Ca⁺⁺ rather **than localized (“engulfed”) Ca⁺⁺ in germinoma
Differentiate a medulloblastoma from a pilocytic astrocytoma in the posterior cranial fossa
Medulloblastoma
Midline 4th ventricular mass in 1st decade of life
Hyperattenuating (CT)
diffusion restricting (MR)
PCA -
Cystic cerebellar mass with enhancing mural nodule
Enlarged optic nerve/chiasm/tract with variable enhancement
Hypo/Isodense. Ca2+ often
Distinguishing features if ADEM?
Post viral. Young adults or children
Demyelination with bilateral asymmetrical T2/FLAIR hyperintensities (confluent or punctuate).
Thalamic involvement and cranial nerves (not typcial MS)
Dramatic response with steorids
Chondrocalcinosis, premature OA changes and dark pigmentation in skin, particularly the ears?
Alkaptonuria / oschronosis
Nb Can be diagnosed in infancy - nappies stained black from urine.
AR condition. Excessive levels of homogentisic acid (HGA), affinity to accumulate in connective tissues.
Calcification and destruction intervertebral discs.
History of epilepsy, young, temporal lobe lesion, multi-cystic lesion?
Dysembryoplastic neuroepithelia tumours (DNET)
**Nb - Multiple cysts in the lesion ‘bubbly’ **.
Lack of oedema or enhancement is typical
DDX for a temporal lobe lesion and epilepsy -
—Ganglioglioma (not bubbly, can be cystic and usually enhance)
Baby, developmental delay, normal head size but diffuse white matter abnormalities with a stripey ‘trigoid’ appearance
Metachromatic Leukodystrophy
**Normal head size **
Most common leukodystrophy. Trigoid or butterfly appearance.
Spares subcortical u fibres
Baby under 6 months old, RUQ mass, cardiomegaly ?
Haemangioendothelioma (aka Infantile hepatic haemangiomas (IHH))
**Fine calcifications. **
Often found on foetal antenatal scans!!!
Can be solitary or multiple
Nb - behave like giant haemangioma on imaging -
Heterogenous on US, peripheral enhancement with gradual filling in on CT, flow voids on MRI.
can cause significant R-L heart shunting.
AFP + Endothelial growth factor is elevated.
Thrombocytopenia due to platelet trapping
Nb - not like adult epitheliod haemangioendothelioma
Painless abdominal mass, 6 year old child. US - large well defined solid heterogenous liver mass with raised AFP?
Hepatoblastoma
Coarse calcification
Precocious puberty is highly specific but rare.
Most common malignant hepatic tumour of childhood.
Young adolescents = HCC
Associated with* Beckwith Wiedemann syndrome. *
Can invade the vessels
Large abdominal mass in neonate, with respiratory compromise. Multicystic and enhancing septations.
Mesenchymal hamartoma
Benign tumour. Sheer size can cause diaphragms splinting.
No Ca2+ or haemmorhage.
May grow rapidly, leading to compartment syndrome, respiratory distress, rarely heart failure
AFP may be moderately elevated
Imaging: Multiloculated large cystic mass in 70%;
Neonatal jaundice, normal US and 6 and 24 hours HIDA scan show no excretion?
Biliary atresia
US - sometimes shows echogenic ‘triangular cord’ structure in the porta hepatis which is pathogonomic
DDx - Neonatal hepatitis - 6 or 24 hours HIDA will show bowel uptake
Nb
Hepatic activity after 5 minutes and no bowel activity after 6 and 24 hours
Main causes for Neonatal distal intestinal obstruction with microcolon?
A. Meconium Ileus
Meconium impacted at the terminal ileum. Linked to CF.
On WSCE - outlines meconium pellets obstructing terminal ileum.
B. Ileal atresia
On WSCE - Blind end of contrast column in ileum = Ileal atresia
C. Total colonic Hirschsprung disease
Main causes of neonatal distal intestinal obstruction with small distal /left colon?
A. Meconium plug syndrome (neonatal small left colon)
Nonpathological transient functional obstruction at the proximal descending colon**.
+/- if water souble contrast isnt therapeutic then - Rectal biopsy to exclude long segment HD
B. Colonic atresia
WSCE - blind ending small caliber distal colon (can be more proximal)
C. Hirschsprung’s disease
WSCE - Classically short rectosigmoid segment = small calibre rectum and dilated sigmoid (rectosigmoid ration <1).
Long segment - Transition zone from the small distal colon to the dilated proximal colon
**suction biopsy below this transition point.
Older child with distal intestinal obstruction or right iliac fossa pain/mass and normal appendix. Bilateral upper zone bronchiectasis ?
Distal intestinal obstruction syndrome
Secondary to CF
Older child meconium ileus equivalent
3 year old RUQ mass, hilar mass displacing the pancreatic head and causing intrahepatic duct dilatation. CT shows retroperitoneal lymphadenopathy?
Rhabdomyosarcoma
Most commonly arise form the CBD.
Expansile intraductal biliary mass in young child
Dilated intrahepatic bile ducts caused by downstream biliary obstruction
DDx - Choledochal cyst
Lobular liver mass in young patient with a central fibrous scar that doesn’t enhance?
Fibrolamellar carcinoma
Central scar (low T1 and T2 as fibrous) that doesn’t enhance or Ca2+ in scar help differentiate from FNH
Sacular dilatation of the proximal large intrahepatic biliary ducts, alongside focal strictures (beaded apperance) ?
Caroli Disease (Type V choledochal cyst)
AR disease linked with medullary sponge kidney, ARPKD and ADPKD and significant risk of cholangiocarcinoma
Port wine stain, recurrent seizures, Gyral cortical calcification and leptomeningeal enhancement ?
Sturge-Weber syndrome
Cerebral lobar atrophy with cortical/subcortical Ca⁺⁺ leptomeningeal enhancement
enlarged ipsilateral choroid plexus
What is the most common type of tracheoesophageal fistula ?
Type C
Type A - No/Absent TOF, just oesophageal atresia (9%)
Type B - oesophageal atresia with a fistula between the proximal pouch and the trachea
**Type C - oesophageal atresia with a fistula from the trachea or the main bronchus (Level of carina) to the distal oesophageal segment (80%)
**
Type D is oesophageal atresia with both proximal and distal fistulas
Type H - Isolated TOF with no oesophageal atresia.
Present later in life with recurrent URTIs
C and D: Gas in stomach & bowel
A and B: Gasless stomach & bowel
US measurements to Dx pyloric stenosis ?
Single wall thickness - 3mm
Pyloric transverse diameter: > 13 mm
Pyloric length - > 15mm
Pyloric volume > 1.4cm3