PAEDS Flashcards
1
Q
Causes of oligohydraminos
A
- bladder outlet obstruction
- renal agenesis/ dysplasia
- bilateral ureteropelvic problems
2
Q
Causes of polyhyraminos
A
GI obstruction - atresia
Secondary obstruction> diaphragmatic hernia, gastroschisis, omphalocele.
Severe CNS anomalies
Monochorionic twin syndromes ( twin-twin transfusion syndrome)
Placental abnormalities
3
Q
Foetal hydrops
A
ascites, pleural or pericardial effusion, skin thickening, polyhydramnios, placental enlargement
> immune (haemolytic anaemia) and non immune (fluid overload, shunts, arrhythmia, TORCH infection )
4
Q
Where is cephalocele located?
A
occipital skull- contains neural tissue
5
Q
Features of Chiari II
A
- Small posterior fossa
- Banana sign- flattened cerebellar hemispheres
- Lemon sign- flattened frontal bones
- Lumbar myelomeningocele
6
Q
Agenesis of corpus callosum
A
- associated with absence of SP
- dilated occipital horns of lateral ventricles, widely separated frontal horns that are parallel, midline interhemispheric cyst
-trisomy 8, 13, 18
7
Q
Septo optic dysplasia
A
absence septum pellucidum
8
Q
Vein of Galen malformation
A
AVM in pineal region
- high flow, midline cystic lesion with serpentine vessels + rim calc
results in high output cardiac failure- cause of hydrops
9
Q
Bochdalek hernia
A
COMMONER posterior, back hernia
Assoc: neural tube defects, malrotation, cardiac abnormalities
10
Q
Morgagni hernia
A
anterior, right - fat + bowel, liver herniates
11
Q
CPAM
A
- Pulmonary blood supply, connects with bronchial tree
- No lobar preference
- Can cause mediatinal shift
- Can be fluid filled
- Type I (large cysts)= commonest
- Assoc: renal agenesis, hydrops, polyhydraminos, lung ca
- Rx= lobectomy if symptomatic
12
Q
Sequestration
A
Arterial blood supply, LEFT LOWER LOBE
* Solid (not cystic cf CPAM)
* Intralobar -75%, normal lung plerua
* Extralobar- kids, own pleura, systemic drainage (IVC or azygous into RA), *can be infradiaphragmatic + mimic adrenal mass *ASSOC: CDH, CPAM, CHD, pulmonary hypoplasia, vertebral anomalies
13
Q
TGA
A
US: Parallel vessels (aorta and pulmonary trunk)
14
Q
what does VACTERL stand for?
A
vertebral, anorectal, cardiac, tracheoesophageal, renal, and limb anomalies
15
Q
Omphalocele
A
ANTERIOR abdo wall, umbilical cord inserts midline
Assoc: trisomies + cardiac abnormalities Beckwith Wiedeman
Peritoneal covering,
Contain bowel +/- liver
more common
16
Q
Gastrochiasis
A
Paraumbilical- normally right
Bowel herniates with NO PERITONEAL COVERING, teenage mothers and smokers,
No associations
17
Q
Feotal hydronephrosis
A
NORMAL <4mm <7mm over 28 weeks
ABNORMAL >7mm under 28 weeks, >10 mm over 28 weeks
18
Q
Duplex kidney
A
Upper moiety - ureterocele, ureter inserts inferior and medial
Lower moiety- reflux
19
Q
Posterior urethral valves findings
A
- keyhole appearance of posterior urethra
- enlarged and thickened bladder
20
Q
ARPKD
A
-enlarged, echogenic kidneys
- associated with pulmonary hypoplasia + Potters syndrome
- hepatic fibrosis
enlarged hyperechoic kidneys *hepatic fibrosis
> Wilms: BW, Drash, WAGR, horseshoe kidney, trisomy 18. Can have cystic variant
21
Q
Clubfoot findings
A
plantar flexed, forefoot adducted and heel inverted
22
Q
Osteogenesis imperfecta
A
- Decreased bone mineralisation
- Short long bones + bowing
- Small thorax
- Multiple rib fracture (accordion ribs), vertebral bodies, long bones. - Wormian bones in skull
- blue claeria + hearing impairment (otosclerosis)
> type I commonest form, autosomal dominant
23
Q
Thanatophoric dysplasia
A
NORMAL MINERLISATION
- severe limb shortening + bowing
- telephone receiver femurs
- plantyspondyly (flattened VB’s)
- cloverleaf skull (frontal + temporal bones protruding)
24
Q
Trisomy 21 features
A
- Increased nuchal fold (>6 mm), > sensitive + specific
- Absent/hypoplastic ossification of nasal bone.
- Cystic hygroma
- VSD, ECD, TOF.
- Echogenic bowel.
- Duodenal atresia.
- Urinary tract dilatation.
- Shortened femur and humerus.
- Clinodactyly (finger/ toe curve)
- Hypoplasia of middle phalanx of the little finger.
- 11 pairs of ribs
- scoliosis
*Hypersegmented manubrium - Sandal gap toes
XR FINDINGS:
● Hypersegmented manubrium
●Supernumerary ribs (11 pairs in 25%)
● Bell-shaped thorax
● Scoliosis
● Atlantoaxial subluxation
● Hypoplastic posterior arch of C1
● Odontoid hypoplasia/os odontoideum
● Flattening of the acetabular roof
● Metaphyseal flaring
● Elongation + tapering of ischia
● Iliac blades rotated in the coronal plane, flared ‘Mickey Mouse’ or elephant ear appearance typical
● Slipped upper femoral epiphysis
● Perthe disease
● Hypoplasia of the middle phalanx of the fifth digit of the hand
● Sandal gap sign—widening of the first metatarsal web space
25
Beckwidth-Wiedemann
* Increased risk Wilms tumor, hepatoblastoma - screening with US every 3months until 8yo, neuroblastoma + adrenocortical ca
* Hemihypertrophy, organomegaly.
* Macroglossia.
* Omphalocele.
* Perinatal hypoglycemia.
26
Trisomy 18 (Edwards syndrome)
* IUGR + polyhydramnios.
* Strawberry sign: Inward bowing of the frontal bones
* Choroid plexus cysts.
* Micrognathia (small jaw)
* Cardiac anomalies.
* Omphalocele.
* CDH
* Horseshoe kidney.
* Hydronephrosis.
* Clenched hand + overlapping fingers.
* Rocker bottom feet.
27
CHARGE syndrome
Coloboma (gap in iris or retina).
Heart defects.
Atresia of choanae.
Retardation of development.
GU anomalies.
Ear anomalies.
28
Where does JNA originate from?
sphenopalatine foramen
29
Croup XR findings
* laryngotracheobronchitis
* frontal: steeple sign > SYMMETRIC loss of normal shouldering of subglottic trachea (assymetric = haemangioma)
* lateral: “ballooning” of the hypopharynx
* *parainfluenza*
* *laryngotracheobronchitis* 6months - 4yo
30
Epiglottitis
- thumbprint sign (thickening od epiglottis and aryepiglottic folds)
*can appear pathological if imaged obliquely- omega (normal aryepiglottic folds)
*haem influenza*
31
Retropharyngeal abscess
Prevertebral soft tissue swelling
32
Bacterial tracheitis
* Older kids 6-10 yo
* Candle dripping sign: linear filling defects in the airway
* plaque-like irregularity of the tracheal wall is highly suspicious for exudative tracheitis
* subglottic narrowing (steeple sign) in a patient too old for croup
33
Tracheobronchomalacia associated?
Oesophageal atresia/ TOF
34
What causes an anterior tracheal impression and posterior oesophageal impression?
- Double aortic arch (front + back) **right indentation higher than left**
- Right sided arch + aberrant L subclavian
35
What causes only posterior oesophageal impression?
- Left arch with aberrant right subclavian
36
What causes anterior oesophageal impression?
pulmonary sling- aberrant left PA (from right pulmonary artery)
(+ posterior tracheal)
37
Features of polysplenia?
- Multiple little spleens
-i nterrupted IVC with azygos / hemiazygos continuation
- Bilobed lungs
- Hyparterial bronchi
- MIDLINE LIVER
- Bowel - malrotation
- Pancreas - truncated
- Heart - ASD, VSD, PAPVR
38
Features of asplenia?
- TAPVR (severe cyanotic heart disease)
- Absent spleen
- Trilobed lungs
- Eparterial bronchi
- Liver - normal position (can be midline or malpositioned)
- Bowel - malrotation
- AORTA TO RIGHT OF IVC, bilateral SVC
- Horseshoe kidney
39
Features of a DNET
- temporal lobe
- bubbly/ cystic appearance
- little enhancement/ oedema
40
Page kidney
Extrinsic parenchymal compression causes RAS ACTIVATION
41
What is Hurst disease?
Hemorrhagic version of ADEM
42
Features of yolk sac tumours (girls)
- commonest tumour young boys
- adolsecents
- raised AFP
- Solid +/- cystic +/- fat (can arise from dermoids)
43
Features of Leydig/ Sertoli tumours
- Solid-fibrous / cystic masses
- early teens/ pre menopausal <30yo
- secrete testosterone/ oestrogen
- AFP can be elevated (not usual)
44
Second branchial cleft cyst location?
Angle of the mandible
Displaces SCM posteriorly, displaces the ICA + IJV medially and submandibular gland anteriorly
SUBMANDIBULAR SPACE
45
Hepatoblastoma features
most common primary liver tumour < 5. Assoc: Beckwith-Wiedemann Syndrome and prematurity. Elevated AFP, calcifications, precocious puberty
46
Biliary atresia
- echogenic triangular mass in porta
- normal activity within the liver (usually after only a few minutes) ,no bowel tracer after 24hrs
47
Scaphycephaly
Sagittal suture closure (long + skinny) *COMMONEST*
assoc: Marfans
48
What is brachycephaly
Prem CORONAL / lambdoid suture
SHORT + WIDE
Harlequin eye
Unilateral subtype = more common. >ipsilateral orbit to elevate + contralateral frontal bone to protrude “frontal bossing”
49
Choroid plexus papilloma
TRIGONE (adults =th ventricle), hyderdense, homogenous enhancement
Hydrocephalus due to overproduction CSF
Choroid plexus carcinoma = commoner in kids, can have calc, heterogenous
Assoc- Li Fraumeni
50
Kartageners syndrome
situs inversus + sinusitis + bronchiectasis
51
Antrochoanal polyp features
widen the sinus ostia +smooth enlargement of affected sinus (usually maxillary)
52
Adrenoleukodystrophy
PAREITO OCCIPITAL PREDOMINANCE + splenium of CC
X linked - Male Predominant
Can Enhance & Restrict
53
RDS Features
- Low volume lungs
- Granular hazy opacification
- PREM BABY/ diabetic mums/ C sec
CF NEONATAL PNEUMONIA (also has effusions)
54
PIE Features
Consequence of RDS
> hyperinflated lungs + asymmetric bubbly and tubular lucencies
> pneumomediastinum / ptx pneumothorax/ large intrapulmonary pneumatoceles.
55
Features of CLD
Long term consequence RDS
> 02 dependency longer >28 days + failed oxygen challenge at 36 weeks post-conception
> MILD HYPERINFLATION + coarse granular opacities
56
TTN Features
- C sec, maternal diabetes/ asthma
- Pulmonary oedema + effusion + perihilar streakiness
- Resolves by 72 hrs
57
Mec ileus lung
bilateral asymmetric areas of hyperinflation + atelectasis, with ropy perihilar + coarse interstitial opacities
58
Neonatal pneumonia
- Group B strep, Ecoli, S aureus
- PROM
- low lung volumes + patchy opacities +/- pleural effusion
59
Congenital lobar overinflation
- due to bronchial extrinsic/ intrinsic compression (*bronchomalacia)
- UPPER/ MIDDLE LOBES. most commonly affects LUL
- antenatal- echoenic mass, post natal- hyperexpanded + hyperlucent, can have mass effect
60
BroncHIal atresia
-LEFT UPPER LOBE
-Mucoid impaction/ mucocele
-Distal hyperinflation/ geogrpahical lucent area of air trapping
61
Pulmonary AVM
Polycythemia, cyanosis, clubbing, haemoptysis
RIGHT > LEFT SHUNT. PARADOXICAL EMBOLI
- LOWER LOBES
60% ASSOCIATED WITH hereditary hemorrhagic telangiectasia (liver avms)
RX=* feeding artery > 3 mm =surgery, trans-catheter coil embolisation (in the feeding vessel)
62
CPAM
Dilated bronchioles
Pulmonary arterial + venous supply
NO LOBAR PREFERENCE
rx= lobectomy
HARD TO DIFFERENTIATE FROM PLUEOPULMONARY BLASTOMA
63
PAPVR
Anomalous drainage of pulmonary veins
- scimitar sign - RIGHT INFERIOR PULM VEIN DRAINING INTO RA/ IVC + HYPOLPASIA + HYPERLUCENT RLL
*ASSOCIATED WITH SINUS VENOSUS ASD*
most common = right superior pulm vein draining into SVC
> left sided PAPVR less common, vertical vein drains into brachiocephalic
64
Round pneumonia features
well defined
strep pneumonia
65
Bronchiolitis obliterans
>Post transplant/ drug reaction/ post infection
>Air trapping + Mosaic perfusion + Bronchiectasis /bronchial wall thickening
>Swyer James McLeod- small ipsilateral, hyperlucent lung + reduced vascular markings (mycoplasma, HSV)
66
Mounier-Kuhn)
Tracheobronchomegaly + bronchiectasis
67
Foreign body
EXPIRATORY IMAGING
normal lung = smaller + denser
wider + steeper structure = rRIGHT MAIN BRONCHUS
*air trapping* hyperlucent lung
remains lucent in decub (from air trapping)
>under fluoro the mediastinum will shift AWAY from affected side on expiration
68
Thymus
- triangular *NO MASS EFFECT*
- thymic rebound- PET avid, maintains thymus look
angelwing aign= PNEUMOMEDIASINUM, lifts thymus up
69
LINES
UVC: umbilical vein> left portal vein> ductus venosus > middle/left hepatic vein > supraheptic IVC *t8/9
UVA: umbilical artery > internal iliac > common iliac > aorta *T6-T10 or L3-5
70
Hypoplastic left heart
Aplastic mitral/ aortic valves/ aorta
Goes into shock/ heart failure after PDA closes, presents when PD close after 2 days, INCREASED PULMONARY VESSELS
Commonest cause HF in neonate, ACYANOTIC
Rx= Norwood procedure
Assoc: coarctation
71
Aortic coarctation
*Assoc: Tuners, Shone, bicuspid aortic valve, berry aneurysm
PRE DUCTAL = CHF + oedema, ACYANOTIC
POST DUCTAL = teenagers, hypertension
72
ASD defects
Ostium secundum= commonest, Ebsteins, fossa ovalis region
Osium primum- Downs, low in atrial septum, contigous with AV valve
Sinsus venosus- near SVC/IVC in posterior RA, assoc: PAPVR (RUL)
Coronary sinus- persistent left SVC
enlarged RA+ RV and right PA
RX Amplatzer
Endocardial cushion- Downs
*L>R shunt, right sided enlargement,
STRAIGHTNING OF L HEART BORDER, SVC not visualised
73
VSD
-Enlarged LA (double border right -hear, splaying of carina) + LV
-MEMBRANOUS IV septum
-Eisenmenger - pulmonary HTN (causes depression of LEFT MAIN BRONCHUS )
Cardiomegaly
74
PDA
Assoc- maternal rubella, prem
CHF at 7 days (pulm resistance decreases)
75
Ebstein's anomaly
CYANOTIC + DECREASED VESSELS
Apical displacement of septal + posteroinferior leaflets, causes PULMONARY VALVE OBSTRUCTION
> has hypoplastic aorta + pulmonary trunk
box shaped heart (BIG RA)
*has ASD
ELEVATED APEX
76
TOF
CYANOTIC + DECREASED VESSELS.
NO CARDIOMEGALY
- RVOT + RVH + overiding aorta + VSD
- Pentraology = VSD
Assoc: right sided arch with mirror branching, DiGeorge, VACTERL, Downs
- Boot shaped heart (uplaced apex)
- Dilated aorta
presented weeks- months after birth
77
TGA
-CYANOTIC + INCREASED VESSELS
-Narrow superior mediastinum- egg on a string,absent aortic arch on CXR
- Commonest cause cyanosis first 24 hours
-D- VENTRICULOARTERIAL DISCORDANCE *aorta anterior and to right of PA
-L- matched discordance *aorta anterior and to left of PA
-US= vessels come out in parallel
-Rx: JANTENE- PA draped over aorta
78
Truncus arterisos
Assoc: R sided arch + Di George
- single vessel overlies VSD
- Cardiomegaly + increased vessels + cyanotic
Narrow medistinum
*increased blood through pulmonary arteries at increased pressures
- Forked ribs
79
TAPVR
NORMAL HEART + INCREASED VESSELS + CYANOTIC
Supracradiac= commonest- vertical vein > left brachiocephalic *SNOWMAN SIGN
infracardiac= hepatic IVC, hepatic vein, portal vein. Increased pulm vessels (pulmonary oedema)
-needs PFO/ ASD
80
Cardiac masses
-Rhabdomyoma: Ventricles, cardiomegaly, TS, MRI - T1 isointense/ hyperintense, T2 hyperintense + hypoenhancing
-Fibroma- IV septum, central calc, T1/T2 hypointense, progressive enahncement
-Teratoma: multilocular solid/cystic pericardial mass, root of the pulmonary artery + aorta, hypoenhancing on first-pass myocardial perfusion imaging (CF hemangioma)
-Hemangioma- T2 hyperintense + avidly enhancing, any chamber, pericardial effusion
81
Normal DJ flexure position
left of L1 pedicle
82
Intusuception
Commonest = ileocolic- needs manual reduction
Bloody stools, target sign/ pseudokidney sign
Air 120 mmHg > up to 3 attempts, up to 3 minutes each.
CI= peritonitis, pneumoperitoneum, and septic shock.
83
Malrotation association
-Omalphocele/ gastrochiasis
- Duodenal web/ stenosis/atresia
- GB agenesis
Heterotaxy
- CDH
84
TOF
Assoc: oesophageal atresia, VACTERL, tracheomalacia, bronchus suis
TYPE 1 (C)=COMMONEST = PROXIMAL EA + DISTAL TOF (gas in stomach)
TYPE 2 = ISOLATED EA + N TOF (gasless)
TYPE 3 = H = ISOLATED TOF WITHOUT ATRESIA (recurrent infections)
85
Duodenal anoamly associations
-VACTERL.
-Shunts (ASD, VSD, PDA, +ECD)
-Malrotation.
-Annular pancreas
86
Meconium ileus
- Distal bowel, soap bubble appearance in RLQ, microcolon
- Rounded filling defects- contrast imaging
- CF
- Gastrograffin> used to diagnose + treat
DDX ileal/ colonic atresia- abrupt cut off and no filling defects of meconium
87
Meconium plug syndrome/ left microcolon
Transient dysfunction of aganglionic cells
CUTOFF AT SPLENIC FLEXURE
treated with enema
RF's: pre-term Mg given for pre eclampsia
88
Hirschsprung
cone shaped transition point
always involves rectum - sawtooth appearance
polyhyraminos
reverved rectosigmoid ratio <1
Down syndrome, MALE
89
Primary ciliary dyskinesia
LOWER LOBE BRONCHIECTASIS
- can have infertility
- part of Kartagener's syndrome (bronchiectasis + sinusitis + situs inversus)
90
Pleuropulmonary blastoma
commonest primary lung ca in kids
large solid/ cystic mass, no chest wall invasion, no calc (mimics CPAM)
Assoc: multilocular cystic nephroma
91
Duct dependent cardiac anomalies
Hypoplastic left heart syndrome
Severe coarctation
Interrupted arch
Pulmonary atresia
Severe Ebsteins anomaly
TGA (if no VSD)
92
Meckels facts
- 25% contain ecoptic mucosa
- Tch99m pertectenate scan
93
Manifestations of high imperforate anus?
Females- vaginal fistula
Males- posterior urethral / bladder fistula
94
Neonatal conjugated hyperbilirubinaemia
*HIDA *5 days pheorbarbitol prior
Neonatal hepatitis: delayed uptake + excretion of tracer, variable bowel activity
Biliary atresia *polypslenia + trisomy 18*- NO BOWEL ACTIVITY>24 hours, normal hepatic uptake, triangular cord sign (oblierated common hepatic duct), atretic GB, enlarged hepatic artery HA:PV ratio >0.45
RX= KASAI PROCEDURE
95
What is Alagille syndrome?
hereditary cholestasis from paucity of intrahepatic bile ducts + peripheral pulmonary stenosis.
96
Features of mesenchymal hamartoma
- Large, solid cystic mass (can look predominently solid)
- Hemorrhage/ necrosis uncommon
<2yo
- normal tumour markers
97
Infantile haemangioma / hemangioendothelioma
BENIGN *hemangioendothelioma has malignant potential
Normal AFP, raised endothelial growth factor
- High flow
- Coeliac axis enlarged, rest of aorta narrowed
- centripetal enhancement
- haemorrhage/ necrosis / calc
<1yo, can cause CHF
ASSOC: Kasabach-Merritt syndrome (anemia, thrombocytopenia, and consumptive coagulopathy)
98
Hepatoblastoma features
- RUQ calc on xr
- 5yo, elevated AFP + BHCG (precocious puberty)
- well defined, calc, hetergeneous, PV and hepatic vein invasion
- assoc: Beckwith-Wiedemann, FAP
Fetal alcohol syndrome., Wilms
99
HCC
>5YO
-usually cirrhosis (A1ATD, Wilsons, glycogen storage disorders, biliary atresia)
- fibrolamellar HCC - no underlying cirrhosis, NON ENHANCING T2 DARK SCAR, calc common
- Elevated AFP
- hetergenous mass, rapid arterial enhancement + early wash out
100
Undifferentiated embryonal sarcoma
LIVER LESION
Aggressive, 6-10
AFP NOT ELEVATED
Ill defined hypodense heterogeneous mass, cystic- hyodense, fibrous pseudocapsule
101
Sickle cell acute chest
Variable- pathology favours lower lobes > atelectasis, consolidation, pleural effusion, infarction, fat embolism
102
Askin tumour
- part of Ewings
- initially displaces structures, when big can invade
- chest wall invasion
103
Posterior mediastinal mass
Neuroblastoma = commonest. Undifferentiated
- Ganglioglioma= more benign, found in older children
104
Handlebar injury
D3 duodenal haematoma (retroperitoneal)
105
Commonest location for enteric duplication cyst?
Ileum, inner echogenic + outer hypoechoic layer
106
Commonest pancreatic mass?
Solid and Papillary Epithelial Neoplasm (SPEN)
107
Gallstones
Sickle cell
108
Monteggia fracture
midshaft ulnar fracture with a radial head dislocation
109
Galeazzi
Dislocation at the distal radio-ulnar joint + radial fracture
110
NAI Head injury indication
CT <1yo if having skeletal survery, 1- 2 if suspected skull fracture / intracranial injury
111
Staging of hydronephrosis
I: Reflux into ureter only
II: Reflux into non-dilated renal calyces, normal ureteral + calyexes
III: Reflux into renal collecting system, with blunting of the calyces
IV: Reflux into moderately dilated ureter.
V: Reflux into severely dilated and tortuous ureter.
**grades IV and V = surgical management
Grade I =reflux into ureter only,
II - reflux into pelvicalyceal system without calyceal dilatation / blunting.
Grade III-mild pelvicalyceal + ureteric dilatation, forniceal angles distinct.
Grade IV = tortuous ureter + moderate dilatation of pelvicalyceal system, blunting of the forniceal angles
Grade V = grossly dilated tortuous ureters + marked pelvicalyceal dilatation, obliteration of the forniceal angles.
112
Duplex kidney features
- Upper pole moeity prone to obstruction and has ureterocele, ureter inserts inferior + medial
- Lower pole moiety prone to reflux
**upper pole obstruction may be difficult to see on VCUG - drooping lily sign
**in girls, can cause incontinence (infrasphincteric insertion of upper moiety)
113
Location of posterior urethral valves?
Posterior/ prostatic urethra
Dilated urethra + bladder= keyhole appearance (US)
114
What is Prune Belly Syndrome?
Absent abdo muscles + undescended testes + dilated collecting system (including entire urethra)
115
Horseshoe kidney associations
- fused at INFERIOR pole
- anterior to aorta, posterior to IMA
Assoc: PUJO, duplicated ureters
- located in midline anteriorly
- Wilms, TCC, renal carcincoid
**TURNERS SYNDROME
116
Features of cross fused ectopia
- left kidney (ectopic) fuses with right kidney lower pole
>Same side of body
*ectopic kidney is inferior
- NORMAL URETERS
- commoner in males, VACTERL
117
Nephroblastomatosis
> Nephroblastomatosis = persistent rests, HYPODENSE RING/ NODULES, non enhancing, can progress to Wilms. Regular US (every 3m)
> AMLs- multiple = VHL (also has RCC's - clear cell type)
*ALPORTS- genetic, trophy + echogenic, snesorineural deafness, leiomyomas
118
Commonest renal mets in kids?
Neuroblastoma, leukaemia, lymphoma
119
Features of rhabdoid tumour?
- Subcapsular haematoma/ fluid
- Ill defined aggressive renal mass
- Can be in brain + kidneys
- Bad prognosis
120
What is the commonest RCC subtype in kids?
Transitional
121
Neuroblastoma features
Assoc: NF-1, Hirschsprung, DiGeorge, and Beckwith-Wiedeman
2-5yo
Calc, restricted diffusion, encases vessels, extends into chest, bony mets, CROSSES MIDLINE (upstages)
Staging: CT chest + MRI Head, neck, abdo, pelvis + I123MIBG + bone scan
Mets: bone and joint pain ▸ proptosis
(orbital metastases) ▸ anaemia ▸ weight loss ▸ fever
RARELY LUNG
stage IVS= best prognosis
122
Left adrenal haemorrahge
Renal vein thrombosis
123
Hydrometrocolpos
blood in uterus + vagina
Assoc: uterine didelphys
124
Varicocele
Right sided: drains directly into IVC, nutcracker syndrome, RCC, retroperitoneal fibrosis
Left- drains into left renal vein
125
What is Bell Clapper deformity?
High insertion of the tunica vaginalis on the spermatic > predisposes to torsion
126
Testicular rhabdomyosarcoma
- extratesticular
- - heterogenous solid cystic mass
- painless, heterogenous mass, 5 yo
- arises from spermatic cord, epididymus
127
Paeds testicular tumours
- YOLK SAC (embryonal cell carcinoma): diffusely enlarged, heterogenous, <2yo, elevated AFP RX: orchidectomy +/- chemo
- TERATOMA: mature subtype common in younger males, cystic with heterogeneous echoes. CT for ?mets RX= orchidectomy
- SERTOLI: ill defined, hypoechoic, assoc Peutz Jeghers/ Carney complex
-LEYDIG: small, hypoechoic, round, may have cystic areas, unilateral, high estrogen/ precocious puberty, gynaecomastia
128
Features of a utricle
- Connected to urethra, can opacify on fluoro does not extend above base of prostate (CF MULLERIAN DUCT CYST)
- Assoc: hypospadias, Prune Belly Syndrome, Downs, Unilateral Renal Agenesis.
- pear shaped
129
What is a triplanar fracture?
Distal tibia
>vertical fracture through epiphysis
>horizontal fracture through physis
>oblique fracture through metaphysis
130
What is Toddlers fracture
non displaced oblique fracture through metadiaphysis
131
Apophyseal insertion
Iliac crest: Abdominal muscles.
*(ASIS): Sartorius.
* (AIIS): Rectus femoris.
* Ischial tuberosity: Hamstrings.
* Pubic ramus: Hip adductors + gracilis.
Greater trochanter: Glut medius and minimus.
* Lesser trochanter: Iliopsoas.
132
Features of DDH
assoc: oligohydramnios, firstborn infants, girls, positive family history
ALPHA ANGLE <60 *SHALLOW
-perform XR after 6 months
- acetabular angle: should be <20 by 2 yo
133
Perthes disease
- early: subtle sclerosis femoral head, joint effusion, increased metapysel lucency
- decrased uptake bone scan
late: flattened and widened femoral head, sclerosis, widening of femoral neck, increase bone scan uptake
134
SUFE
- Type I Salter Harris fracture
- Obesity/ Afro carribean
- Pre slip: widening of growth plate with irregularity / blurring of physeal edges + demineralisation of metaphysis.
-Chronic slip: physis becomes sclerotic and metaphysis widens
- metaphyseal blanch sign= increased density of proximal metaphysis> femoral neck + displaced epiphysis.
- complication = osteonecrosis
- frog leg view
135
Specific NAI fractures
* Classic metaphyseal lesion
* Posterior rib fracture
* Scapula fracture.
* Sternum fracture.
* Spinous process fracture
**DUODENAL HEMATOMA
136
DDH
Alpha angle <60
beta angle >77
137
Septic arthritis hip xr
- Displacement / distortion of gluteal or psoas fat planes.
- Widening of the teardrop distance (space between the lateral margin of the pelvic teardrop and the medial margin of the femoral head). The teardrop is the antero-inferior acetabulum.
138
Features of CRMO
- migratory lytic and sclerotic lesions in time and space
- long bones
- no soft tissue abscess, bony sequestra or fistula
- seen in SAPHO
139
Features of JIA
- rh factor -ve
- soft tissue swelling, periarticular osteopenia, joint effusion
*pauciarticular= most common
- affects knee
- ANKYLOSIS of wrists, CMCs, c spine
- prem fusion of physis/abnormal bone growth, epiphyseal blooming
* KNEE= widened intercondylar notch, metaphyseal flaring, uniform joint space narrowing
* ELBOW= enlargement of the radial head and trochlear notch, uniform cartilage space narrowing.
* HIPS= symmetrical cartilage space narrowing, protrusio deformity, gracile appearance of the femur
*Still disease- systemic subtype (fever, anaemia, leukocytosis, hepatosplenomegaly, polyarthritis)
140
Features of achondroplasia
COMMONEST SKELETAL DYSPLASIA + CAUSE OF DWARFISM
-Narrowing IP distances in the lower spine
-Posterior scalloping VBs
- kyphosis with BULLET SHAPED VB
-Tombstone iliac wings (small _ squared)
-Flat acetabula + short femoral necks.
- Metaphyseal flaring
-Frontal bossing , midface hypoplasia, rhizomelic dwarfism (short femurs and humeri) with large trident hands (long 3rd + 4th fingers).
141
Thanatophoric dysplasia
- Flattening of VBs (platyspondyly), H-shaped+ narrowing of IP distance.
- Curved telephone receiver femurs.
- Cloverleaf-shaped skull (premature closure of sutures), large skull, small formane magnum, short ribs, long thorax + Short iliac bone, Horizontal acetabular roof, Short and broad ischial bones
NORMAL MINERALISATION
142
Clediocranial dysphlsia
*complete / partial absence clavicles*
* Wormian bones
- Delayed ossification of the skull
- Widened pubic symphysis
143
Asphyxiating thoracic dystrophy - Jeune syndrome
- Bell-shaped thorax + pulmonary dysplasia
- Short ribs - bulbous anteriorly.
- High-riding handlebar clavicle.
- Trident acetabulum small, short, flared iliac wings
- Normal vertebral bodies
144
Features of MPS
> Oval VBs with anterior beaking,
>thickened clavicles/ ribs
> undertubulated bones.
> Madelung deformity
> thickened calvarium, J-shaped sella.
> Tall, flared iliac wings
> Wide tapering metacarpal bones
* Hurlers = anterior beaking, INFERIORLY
* Morquio = anterior beaking MIDDLE portion *spinal stenosis, odontoid peg hypoplasia = commonest cause of death, jointlaxity, cloudy cornea
145
Features of rickets
- vitamin D deficiency
- affects physeal development
- cupping, fraying, splaying of the metaphysis + adjacent periosteal reaction
- enlarged anterior ribs, bowing of legs, demineralised skull
> oncogenic rickets-hemangiopericytoma/ NOF
146
Features of lead poisoning
wide sclerotic metaphyseal bands in growing long bone, does not soare fibula
147
Osteosarcoma
15-20yo, conventional intramedullary = commonest, can have skip lesions- need to image entire bone
Distal femur/ proximal tibia- around the knee
cloud like osteoid matrix + perisoteal reaction
*PAROSTEAL = POSTERIOR DISTAL FEMUR, string sign, central calc CF myositis ossificans
*PERIOSTEAL- diaphysis
*telangectasis- fluid levels
Mets: lung (PTX), bone, nodes
148
Ewings
5-20
FEMORAL (META) DIAPHYSIS/ FLAT BONES PELVIS, akso tibia, humerus, ribs
Lamellated periosteal reaction
Soft tissue mass
*BONE and lung mets
149
LCH features
- Skull: Beveled edge /punched-out lytic lesion.
- Flat bones (e.g., pelvis): Hole within a hole
- Ribs: Multiple expansile lytic lesions.
- Long bone : Permeative destruction, + wide zone of transition, lytic lesion + faint rim of sclerosis.
- Spine: vertebra plana
- Maxilla: Floating teeth.
150
Types of LCH
>Eosinophilic granuloma = localized skeletal or pulmonary involvement.
>Hand-Schüller-Christian =pituitary hypophysitis (diabetes insipidus), + exophthalmos + lytic bone lesions
>Letterer-Siwe= multisystem involvement <2yo, poor prognosis
151
Features of leukaemia
- Commonest primary paeds malignancy
- Metaphyseal lucent bands
- Generalised osteopaenia + permeative bone lesions
152
Commonest coalition
TARSAL: talocalcaneal and calcaneonavicular
HANDS: Lunotriquetral
153
NF1 Bone features
anterior tibial bowing + pseudoarthrosis distal fibula.
154
Gaucher disease MSK
BIG SPLEEN
*AVN o f the Femoral Heads
*H-Shaped Vertebra
*Bone Infarcts (lots o f them) 'Erlenmeyer Flask Shaped Femurs
155
Blounts disease
- Varus angulation of medial tibial epiphysis > osteochondrosis- leg length discrepancy
156
Madelung deformity
medial sloping of distal radius > dysplasia of the medial distal radial physis + resultant growth disturbance
157
Germinal matrix grading
CAUDOTHALAMIC GROOVE <32 WEEKS
Grade I: Hemorrhage germinal matrix
Grade II: Hemorrhage into the ventricles
Grade III: Hemorrhage into ventricles + ventriculomegaly.
Parenchymal hemorrhagic infarction: any grade
158
What are findings are seen in CC agenesis?
Midline lipoma or interhemispheric cyst
159
Schizenencphaly
- lined by grey matter *CF PORENCPHEALIC CYST*
- associated with grey matter ectopic
- assoc: septo optic dysplasia, optic nerve hypoplasia, pituitary abnormalities
160
Chiari I association
cervical syringomyelia (fusiform dilation)
161
Chiari II association
CC dysgenesis, heterotopias, sulcation abnormalities
lumbar myelomeningocele
BEAKING OF TECTUM
LOW LYING TORCULA
162
Dandy Walker malformation features
cerebllar vemis agenesis/ hypolasia + hypoplastic cerebellr hemispheres + enlarged 4th ventricle + enlarged posterior fossa
- upwards displacement of the tentorium
> inversion of torcula-lambdoid
*normal morphology and volume of cerebellar hemispheres- just displaced*
163
Fetal brain development
MYELINATION: inferior to superior, posterior to anterior, central to peripheral
- brainstem + posterior limb internal capsule last to myelinate
164
Anencephaly
-destruction of bone and brain abiove level of orbits
-frog eye appearance
- elevated AFP + polydraminos
165
Rhomboencephalosynapsis
- failure of cerebellar vermis formation
- one cerebullar lobe
- small 4th ventricle
166
Joubert
- small/absent cerebellar vermis
- Molar/ M shaped appearance of superior cerebellar preduncles
- large 4th ventricle
assoc: MCKD, retinal dysplasia, liver fibrosis
167
Blakes pouch
-cystic protursion through Magendie into cerebellar area that communicates with 4th ventricle
- vermis normal but upwardly displaced + 4th ventricle enlarged, normal torcula *hydrocephalus
168
Mega cisterna magna
- enlargement of retrobulabr CSF space
- normal vermis/ hemispheres/ torcula, no hydrocephalus
- causes displacement of cerebellar tonsils
169
What is azygous anterior cerebral artery associated with?
- Septo optic dysplasia
- Alobar holoprosencephaly
170
Proliferation failures
Hemimegalencephaly- big ventricle on big side
Ramuseens encephalitis - big ventricle on small side
171
Hydranencephaly
- Destruction of both cerebal hemispheres
- normal cerebellum
Causes: HSV, CMV, toxo
172
Adrenoleukodystrophy
- X linked
- PARIETO OCCIPITAL LOBES, can enhance + restrict
- gait + visual problems
- High T2 posterocentral white matter ( splenium + peritrigonal WM), enhancement of the leading edge of demyelination ▸ increased diffusion within abnormal areas
173
Metachromatic
- commonest leukodystrophy
- periventricular + deep WM
- subcortical U fiberes spared
174
Alexander disease
- big head
- frontal lobe predominant
- large cystic cavities in frontal + temporal regions ▸enhancement along ventricular ependyma
175
Canavan disease
- Big head
- Symmetrical white matter changes, subcortical U fibres involved, spares internal capsule
ELEVATED NAA
176
MELAS
- infarcts in non-vascular territories + symmetrical BG calc
- Mitochondrial myopathy ▸ Encephalopathy ▸ Lactic Acidosis ▸ Stroke-like episodes, parieto-occipital distribution
177
Krabbe disease
- centrum semiovale + periventricular WM PARIETO OCCIPITAL PREDOMINANCE, early sparing of subcortical U fibres
178
Crouzon's
Brachycephaly (usually)
1st Arch structures (maxilla and mandible hypoplasia).
Hydrocephalus
Chiari I
Assoc: PDA, aortic coarctation.
Short central long bones (humerus, femur) - “rhizomelia’'
179
Wilms tumour
- rim of normal renal tissue (claw sign)
-compresses structures, no invasion
- invades renal + PV
- calc uncommon
- usually does not cross midline
**can be bilateral**
- WAGR, DRASH (progressive glomerulonephritis + ambiguous external genitalia)
180
Neuroblastoma protocol
CT Chest + mri HEAD, NECK, ABDO, PELVIS + MIBG + Skeletal survey
181
Sturge Weber features
- Retardation
- Port wine stain
- Cortical atrophy
- Subcortical parenchymal calcifications
-Pial enhancement in regions affected by venous angiomatosis.
- Enlarged choroid plexus
182
NF 1 features
-Optic nerve glioma
-JPA
-Brainstem glioma
- FASIs : focal areas high T2 signal
- Sphenoid wing dysplasia,
- Posterior vertebral body scalloping.
- INFERIOR Rib notching (twisted ribbon ribs)
HYPOPLASTIC POSTERIOR ELEMENTS
-Focal gigantism.
-Cervical kyphoscoliosis,
-Neural foraminal enlargement
-Tibial bowing
-Wilms tumor
-Rhabdomyosarcoma.
- AML
- Leiomyosarcoma.
- Plexiform neurofibromes
- cafe au lait
183
NF2 Features
Multiple Inherited Schwannomas, Meningiomas, Ependymomas.
184
TS features
Seizures + rash + mental retardation
- Subependymal nodules + subcortical tubers (non enhancing)
- SEGA- enhancing mass near FOM
- AMLs
-Rhabdomyoma.
- LAM
185
Cortical desmoid features
- posteromedial distal femoral diaphysis
- avulsion of femoral insertion of medial head of gastroc/ adductor magnus
186
JIA
●● Soft tissue swelling.
●● Joint space widening
●● Periarticular osteopenia
●● Periostitis is typical and most common in the metacarpal/metatarsal bones
●● Premature closure of growth plates/accelerated skeletal maturation.
●● Ankylosis
●● Widened intercondylar notch/squared patella
●● Other typical findings include balloon epiphyses, gracile tubular bones and ribbon
ribs.
187
Blounts disease
tibial bowing, normal biochem
188
Management of bone lesions
- Osteoid osetoma= percutaneous rfa
- GCT = curettage + polymethylmethacrylate filling
- ABC= Curettage + resection
189
Carney complex
cardiac myxoma + skin pigmentation + cutaneous myxoma
190
Cleidocranial dysplasia features
DELAYED OSSIFICATION OF MIDLINE STRUCTURES
- absent clavicles
partially ossified sternum
- absent radius/ ulna
-short phalanges
- large head, persistent metopic suture, wormian bones
- delayed skull ossification
- hypoplasia of iliac bones
- wide pubic symphysis
- extra ribs
- high riding scapula
191
Uterine abnormalities
- Septate: 2 cavities but notmal fundal contour, most likely to assoc with pregnancy loss
- x2 uterine fundi, shared lower uterine segment, can have one cervix (bicornis unicollis) or two cervices (bicornis bicollis), abnormal external contour
* Uterine didelphys: Separate uteri and cervices, 75% havevaginal septum.
192
VB scalloping
POSTERIOR - syringomyelia, Marfans, Hunters, Morquio, osteogenesis impfercta, achondroplasia
ANTERIOR - Downs (+ squaring of VB bodies + pseudosubluxation atlanto odontoid peg)
193
C spine trauma
kids: <5mm for ALANTO DENTAL INTERVAL
Pseudo-subluxation at C2/3 and C3/4 (up to 4 mm)
194
CYANOTIC abnormalities
DECREASED PULM VESSELS
- cardiomegaly: Ebsteins, pulmonary atresia + intact septum
- normal heart: TOF, tricuspid atresia
INCREASED VESSELS
- x5 T's
195
LCH
Lungs: upper lobe cysts and nodules, spares costophrenic sulci, upper zone fibrosis *NORMAL/ HYPERINFLATED LUNGS*
Bones: affects skull (can have soft tissue), ribs + spine
196
Spinal cord tumours
Astrocytomas= more common, thoracic, ECCENTRIC, ill defined, patchy enhancement, hemorrhage uncommon *NF1, involves mnore of the cord
Ependymomas= second commonest, (1st in adults), C spine, spinal changes, well defined, strong heterogenous enahcnement, haemorrahge, haemosiderin cap *NF2
197
Common brain tumours
- Pilocytic astrocytoma: COMMON enhancing nodule, cystic, posterior fossa, NF1, little oedema, can involve optic pathway/ hypothalamus (commoner in pilomyxoid type), can have enhancing wall
- Ependymoma- enhancing, hetergoenous mass that can fill 4th ventricle, arises from vermis, squeezes through foramen, calc/ necosis/ hemorrhage
- Medulloblastoma: COMMONEST, typically midline/ 4th ventricle or cerebellar hemisphere laterally, hyderdense CT, low on T2, calc/ hemorrhage, low ADC, LEPTOMENINGEAL INVOLVEMENT- images whole brain + spine
*Gorlin syndrome (BCC + odontogenic cyst), Li Fraumeni, Turcot (colon polyps)
- ATRT- looks like medulloblastoma except in younger kids, LARGE HETEROGENOUS MASS CEREBELLUM, can be supratentorial *kidney tumour
- Diffuse glioma: pons/ thalamus mass, hyperintense on FLAIR
- Dysplastic cerebellar gangliocytoma (Lhermitte-Duclos)- tiger stripe appearance cerebellum, T2 hyperintense, no enhancement
- ETMR <2yo, solid mass, patchy/ little enhancement, oedema +_ significant mass effect
- MVNT- deep cortical matter/ juxtacortical, cluster of bubbles, no enhancement or mass effect
198
CORTICALLY BASED TUMOURS
PXA: temporal lobe, enhancing plial tail, solid- cystic, haemorrhage, leptomeningeal involvement
Ganglioglioma: temporal lobe, solid cystic with enhancing mural nodule, CALC, assoc: FCD
DNET: temporal/ frontal lobe, hypodense on CT, bubbly appearance, T2 bright rim, heterogenous enhancement, little enhancement/ oedema, overlying bony remodelling
DIA/ DIG - progressive head enlargement, large cystic mass with strongly enhancing mural nodules that spans more than one lobe, commonly frontal/ parietal
199
INTRAVENTRICULAR MASSES
>SEGA = TS. Wall of lateral ventricle near FOM, homogneous enhancement
> Central neurocytoma-young adult
> Choroid plexus papilloma-TRIGONE, avidly enhances HOMOGENOUSLY, calc, can become carcinoma
*choroid glioma= anterior 3rd ventricle- rare
200
Orbital pathology
-Dermoid = commonest extraconal mass, superolateral quadrant near zygomaticofrontal suture, fat-fluid level, adjacent bone scalloping
-Rhabdomyosarcoma= commonest malignancy, superior orbital tissues and can etxnd intraconally, SOFT TISSUE DENSITY, enhancement
- Optic nerve glioma- NF1, fusiform enlargement, variable enhancement
Retinoblastoma= commonest intraocular malignancy, leukokoria, nehancing mass with calc at optic nerve (triretino= bilateral masses + pineoblastoma)
Capillary hemangioma= COMMONEST MASS OVERALL, extraconal, lobulated intensely enhancing mass, flow voids
201
Bone within bone appearance
1. Normal- esp in spine.
2. Growth arrest/recovery lines.
3. Bisphosphonate therapy.
4. Sickle-cell
5. Osteopetrosis*.
6. Acromegaly*.
7. Gaucher’s
8. Heavy metal poisoning.
9. Prostaglandin E1 therapy
10. Pagets
11. Hypothyroidism- redcued skeletal maturation
202
Midline masses
- Craniopharyngioma= commoest paeds suprasellar mass- heterogenous, cystic calc, high T1 (protein), DI / growth disturbance from mass effect
- Germinoma- pineal gland > suprasellar, HOMOGENOUSLY ENHANCING MIDLINE MASS, low on T2, dark on ADC, NO cysts/ calc
- Hypothalamic hamartoma: floor of 3rdV, non enhancing, grey matter intensity, precocious puberty, between mamillary bodies and pituitary
- SUPRASELLAR- GLIOMA (from optic nerve glioma)
203
Pyknodysostosis
- delayed closure of sutures (frontal + ocipital bossing), hypoplastic facial bones, protrusion of mandible, thickened skull
- dwarf
- osteosclerosis
- short broad hands + hypoplastic nails, acro-steolysis terminal phalanges
- clavicular dysplasia
- Wormian bones
204
TORCH infections
- CMV: commonest, periventricular calc + POLYMICROGYRIA, sensorineural deafness
-Toxo: basal ganglia calc + hydrocephalus, chorioretinitis
-Rubella: high T2 in white matter, ishcaemia
HSV: haemorrhagic infarcts eith encephalomalcia
- HIV: Brain atrophy in frontal lobes
205
Turner syndrome features
Short 4th metacarpal ▸ flattening of medial tibial condyle ▸ beaked VB ▸ osteoporosis ▸ scoliosis ▸ coarctation of the aorta ▸ increased occurrence of urinary tract anomalies (e.g. horseshoe kidney) ▸ delayed skeletal maturation
*Madelung deformity
- streaky ovaries and can have ovarian tumours (dysgerminoma)
- short, cubitus valgus, webbed neck
206
Down syndrome radiology features
-flared iliac wings + flattened / horizontal acetabulae
▸ 11 pairs ribs
▸ x2 ossification centres within the manubrium sterni
▸ atlantoaxial subluxation/ instability + hypoplasia of odontoid process
▸ generalized joint laxity
▸tall vertebral bodies
▸ short hands with clinodactyly of the little finger due to a hypoplastic middle phalanx
* Associations:endocardial cushion defects and intra- and extracardiac shunts ▸ duodenal atresia /stenosis ▸ Hirschsprung’s ▸ anorectal anomalies
207
Nail patella syndrome
- clinodactyl, dystrophic nails
Posterior iliac horns
▸ absent / hypoplastic patellae
▸ hypoplastic lateral femoral condyles
▸ genu valgum
▸ hypoplastic capitellum
▸ radial head dislocation
▸ short 5th MC
208
Osteopoikilosis
Multiple sclerotic foci, especially pelvis +metaphyses of long bones ▸ parallel to the long axis of bone
209
Osteopetrosis
▸Increased skeletal density
▸WIDENED METAPHYSIS - alternating bands of lucency + sclerosis, ‘bone within a bone’
> RUGGER JERSEY SPINE
Bony sclerosis + Erlenmeyer flask deformity = osteopetrosis.
Cranial nerve palsies, anaemia
210
Homocystinuria
- enlarged epiphysis, generalised osteopenia, metaphyseal cupping, delayed ossification
- lax ligaments, lens dislocation (DOWNWARDS)
211
Marfans features
- osteopenia
- joint laxity
- VB scalloping
- atlantoaxial subluxation, INCREASED IP distance,
- protrusion acetabulae
- pes planus
- patella alta
- hallux valgus
- clubfoot
- pectus chest
- scoliosis
- aortic root dilation
*Ehlos danler- recurrent dislocation, joint bleeding, long fingers, scoliosis
212
Retinoblastoma features
- Heterogenous mass, cystic areas, calc, doppler flow, NORMAL GLOBE, commonest intraorbital mass in kids, retinal detachment +/- vitreous haemorrhage
DDX:
Coats disease: retinal telangectasia + exudate: high protein fluid, normal globe
Retinopathy of prematurity: retinal neovascularity, small globes, increased attenuation (hemorrhage)
PVHP: Y-shaped soft tissue stalk along Cloquet canal of posterior segment from optic disc to lens, small globes
213
Hypophosphotasia findings
Rickets findings + irregular lucent extensions into metaphyses
214
Metachromic leukodystrophy
-commonest type of leukodystrophy
-symmetrical periventircular WM change, particularly frontal horns
- tigroid appearance, no enhancement
215
Choledochal cysts
- Type 1 = commonest > fusiform dilation of CBD
- Type V = intrahepatic ducts = caroli disease
216
Preterm baby brain injury
*Periventricular leukomalacia - watershed areas / arterial distribution > prolonged partial asphyxia in preterm/
term babies
ANTERIOR AND LATERAL to lateral ventricles, involves centrum semiovale, trigone +occipital + temporal horns *become cystic
> PREM BABY, LOW BIRTH WEIGHT, CEREBAL PALSY
*Blush= physiologic brightness of posterosuperior periventricular WM (less than choroid)
*Acute profound asphyxia - lesions in deep grey matter, hippocampus + dorsal brain stem.
217
Types of scalp hemorrhage
1. Caput succedaneum- subcutaneous, crosses suture lines, prolonged delivery, resolves spontaneously
2. Cephalohematoma- under periosteum, limited by suture lines, outer rim can calcify, instrument/ vacum extraction, resolves within a couple of weeks, can get infected
3. Subgaleal hemorrhage- under aponeurosis, does not respect suture lines, big blood, vacuum extraction
218
Mec PLUG
- functional immaturity/ small left colon
- large infants, diabetic moms, iv mg
- calibre change at splenic flexure (should resolve after enema CF HIRSCHSPRUNGS)
219
Skull trivia
- fracture >3mm, normal suture <2mm
- diastatic fratture- commonest in lambdoid suture
- indications for surgery: depressed fracture >5mm, bleed, infection, if sinus involved
*sinus precarnii- fracture + underlying vascular malformation- dural venous sinus
NAI- depressed skull fracture/ crossing suture linesF
220
HSP / IgA vasculitis
- rash + abdo pain + <20yo, + granulocytes
- joint pain/ athralgia
- bowel wall thickening / thumbprinting> infarction/ intususception
- echogenic kidneys
221
Williams Campbell syndrome
- defect in bronchial cartilage (4-6th)
- cystic bronchiectasis
- trachea _+ main bronchi preserved
- collapse of affected segments on expiration
222
Features of Osteomyelitis in kids
- metaphysis= richest blood supply
- can get isolated discitis- direct blood supply CF ADULTS > narrowing of disc space
- LUMBAR spine commonest in kids
223
UTI Guidelines
>Atypical UTI : Seriously ill, Poor urine flow, Abdominal or bladder mass, Raised creatinine, Septicaemia, Failure to respond <48 hours, non-E. coli organisms
>Recurrent UTI:
x2 UTI upper UTI
x1 upper UTI + x1 lower
x3 lower UTI
<6 months
Responds- US within 6 weeks
Atypical- US acute infection + DMSA + mic cyst
Recurrent- same as atypical
6months- 3 years
Responds - nothing
Atypical- US acute infection + DMSA
Recurrent- US within 6 weeks + DMSA
>3yrs
Responds- nothing
Atypical - US acute
Recurrent - US weeks + DMSA
224
Dandy Walker variant
- hypoplastic cerebellar vermis + cerebellar hemispheres + dilated 4th ventricle, NORMAL torcula + normal posterior fossa
225
Klippel Feil syndrome
- congenital fusion C spine
- sprengel deformity (high riding scapula)
- Chiari I
- omovertebral bone
226
Gaucher
- splenomegaly
- obliteration of paranasal sinuses
- Erlenmeyer flask deformity
227
Thalassaemia
●● Posterior mediastinal mass-extramedullary haematopoiesis)
●● Maxillary hypertrophy and forward placement of the incisors producing ‘rodent facies’ appearance (considered pathognomic)
●● Hypoplastic paranasal sinuses and mastoid air cells
●● ‘Hair on end’ appearance with widening of diplopic spaces in the skull
●● Thinned outer skull table
●● Osteopenia with thinned cortices and coarse trabeculation
●● Mild expansion of the medullary cavities
●● Erlenmeyer flask deformity of the femora
●● ‘Bone within bone’ appearance
●● Premature fusion of the epiphyses
228
Achondroplasia
most significant complication = brain stem/cord comp due to spinal stenosis
●● Flat nasal bridge
●● Broad mandible
●● Large skull
●● Frontal bossing
●● Narrow, anteriorly displaced foramen magnum
●● Hydrocephalus
●● Decreased AP distance
●● Short, anteriorly flared, concave ribs
●● Tombstone iliac bones from squaring
●● Champagne glass pelvic inlet
●● Horizontal acetabular roof
●● Short sacrosciatic notches
●● Horizontal sacrum
●● Trident hand (divergent middle and ring fingers)
●● Short femoral necks
●● Patella baja
229
Meconium plug
Small left colon AT SPLENIC FLEXURE
pre-term neonates / diabetic mums/ IV Mg for pre eclampsia
NORMAL RECTUM
230
Tethered cord
lower lying
Assoc: lipoma, post repair myelomeningocele, thickened filum terminale
fixation/traction CAUDAL portion of spinal cord.
231
Trigonocephaly
METOPIC
Triangular appearance of skull
232
Osteochondritis dissecans
Fracture lateral aspect of medial femoral condyle
LOOSE BODIES
young teenage boys
233
Neonatal renal pelvis diameter
Normal: APRPD <4 mm < 28 weeks; <7 mm at or after 28 weeks.
Possibly abnormal: 4 to <7 mm less than 28 weeks; 7 to <10 mm at or after 28 weeks.
Abnormal**: ≥7 mm less than 28 weeks; ≥10 mm at or after 28 weeks.
234
MCDK
> MCDK- non functioning renal tissue
Multilocular cystic nephroma- enhancing setpa, bimodal distribution, mimics Wilms, can herniate into renal pelvis, *DICER1 mutation, pleuropulmonary blastoma. Often has contralateral problems
235
Mesoblastic nephroma
looks like Wilms however in younger patients <1yo, typically removed, arise from persistent mesoblastic rests. Commonest neonatal renal tumour. Can have polhydraminos + pulm hypoplasia
Likes renal sinus
236
Eisenmegers
Increased pulmonary arterial pressure = depression of L main bronchus
237
Meds that interfere with Meckels scan
Pentagastrin
H2 blockers -cimetidine
Glucagon decreases
238
False +ve Meckels scan
Appencidicitis, Intususception
Recent barium
IBD
Urinary obstruction
Duplication cyst
239
Homocystinuria
● Generalised osteoporosis
● Carpal bone abnormalities: enlarged epiphyses, epiphyseal calcification,
metaphyseal cupping and delayed ossification
● Scoliosis
● Biconcave vertebrae
240
Meckels false _ve
Ileal rotation
Hemorrhage
rapid bowel transit
241
Ameobic abscess
Right lobe, chocolate
242
Carolis disease
central dot sign
assoc: medullary sponge kidney
