Paeds Flashcards
Newborn periosteal reaction differentials
Physiological growth TORCH infection Prostaglandin therapy Neuroblastoma mets Healing fractures, abuse Caffey disease (infantile cortical hyperostosis)
Permeative bone lesion child < 5 yrs
Osteomyelitis
Langerhans cell histiocytosis
Neuroblastoma metastasis
Permeative bone lesion child > 5 yrs
Ewing sarcoma
Lymphoma or leukemia
Osteomyelitis
Langerhans cell histiocytosis
Focal sclerotic lesions in children
Osteoid osteoma
Chronic osteomyelitis
Stress fracture
Osteosarcoma
Stress fracture common sites
Tibia
Fibula
Metatarsals
Calcaneus
Multifocal bone lesions
Multifocal osteomyelitis LCH Metastatic disease Multiple hereditary exostoses Enchondromatosisi (Ollier and Maffucci) Polyostotic fibrous dysplasia Neurofibromatosis
Osteosarcoma associations
Hereditary retinoblastoma
Li-Fraumeni syndrome
Previous radiation therapy
McCune Albright syndrome
Polyostotic fibrous dyaplasia
Cafe au lait spots
Endocrine abnormalities
3 types of extremity shortening
Rhizomelic - proximal shortening (humerus, femur) - Acondroplasia and thanatophiric dwarfism
Mesomelic - middle narrowing (radius-ulna, tibua-fibula) - rare
Acromelic - distal shortening - asphyxiating thoracic dystrophy
Achondroplasia
Most common short-limbed dwarfism
Autosomal dominant
Heterozygous form demonstrates clinical manifestations, homozygous form is lethal
Rhizomelic limb shortening Craniofacial disproportion Enlarged skull Small skull base Small foramen magnum and jugular foramina Vertebral bodies are short and decreased AP diameter Tall disk spaces Decreased interpedicular distance (narrower inferior lumbar spine) Short pedicles (spinal stenosis) Metaphyseal flaring Short iliac bones Horizontal acetabular roof
Mucopolysaccharidoses aka dysostosis multiplex
Hereditary disorders manifested by defects in lysosomal enzymes
E.g. Hunter, Hurler, and Morquio syndromes
Vertebral bodies: Oval and beak extending from anterior cortex (more prominent in lumbar)
Focal kyphosis (gibbous deformity) at thoracolumbar junction
Clavicles and ribs: Thickened. Ribs narrower posteromedially giving “canoe paddle” appearance
Pelvis: Iliac wings tall and flared
Acetabuli: Shallow (increased angles)
Femoral heads dysplastic and femoral necks are gracile with coxa valga
Hands: Tapering of metacarpal bones
Pituitary fossa: J-shaped appearance
Osteogenesis Imperfecta
Group of 8 different genetic disorders that result in formation of abnormal type 1 collagen
Causes osteopenia and propensity for fracture
Types 1-5 autosomal dominent
Types 6-8 Autosomal recessive
Osteopetrosis
Osteoclasts are defective in resorbing and remodeling bone causing dense sclerosis
Total bone calcium stores are increased, serum calcium levels are paradoxically low
Superimposed rickets are not uncommon
Pancytopenia from lack of normal marrow space
Skull base thickened and encroachment upon cranial nerves common
Causes of increased acetabular angle
DDH
Neuromuscular disorder
Downs syndrome
Skeletal dysplasia including achondroplasia
Proximal Focal Femoral Deficiency
Congenital disorder consisting of a range of hypoplasias to the absence of proximal portions of femur
Often associated with varus deformity, ipsilateral fibular hemimelia and deformity of foot
Hip joint effusion causes in paeds
Septic arthritis
Toxic synovitis
Ininfectious arthritis
Legg Calve Perthes disease
Legg Calve Perthes xray appearance
Asymmetric, small, ossified femoral epiphysis
Widening of joint space (from joint effusion or synovial hypertrophy)
Subchondral linear lucency (cresent sign)
Femoral epiphysis fragmentation, areas of increased sclerosis and lucency and loss of height
Coxa magna
Rickets disease causes
Dietary deficiency
Malabsorption
Renal disease
Lack of end organ response
Mimickers of soft tissue mass
Fibromatosis coli
Myositis ossificans
Post traumatic fat necrosis/ subcutaneous granuloma annulare
Chronic foreign body
4 types of vascular malformations
Simple malformation - Capillary, Lymphatic, venous, arteriovenous
Combined malformations
Malformations of named vessels
Malformations associated with other anomalies (Klippel Trenaunay, Parkes weber, Sturge weber, Maffucci, CLOVES and proteus)
NF1 xray features
Anterior tibial bowing
Pseudoarthrosis of distal fibula
Scoliosis
Gauchers
AVN of femoral neck
H-shaped vertebra
Bone infarcts
Erlenmeyer flask shaped femurs
Caudal regression syndrome
Spectrum of sacral and or coccyx agenesis
Associated with maternal diabetes, VACTERL and Currarino Triads syndromes, OEIS (omphalocele, extrophy of the coaca, imperforate anus and spinal defect) complex
Radial dysplasia
Absence of hypoplasia of the radius, usually with missing thumb
Differentials - VACTERL, Holt-Oram, Fanconi Anemia, Thrombocytopenia Absent Radius
Blounts (tibia vara)
Varus angulation at medial aspect of proximal tibia
Seen AFTER age 2
Often bilateral
Medial metaphysis will be depressed and an osseous outgrowth classically develops
Fragmentation and beaking of medial tibial metaphysis
Lucent metaphyseal bands
LINE Leukemia Infection (TORCH) Neuroblastoma mets Endocrine (rickets, Scurvy)
Meconium aspiration stats
Pneumothorax in 20-40%
Meconium stained amniotic fluid occurs in 10-15% but meconium aspiration syndrome develops in less than 5% of them
