Page 18 Flashcards
Most specific finding in pulmonary artery sling?
abnormal architecture of the central airways (low carina and inverted T shape of the central airways)
Most important complication of Kawasaki?
coronary artery aneurysms
Enlargement of the main and left PAs w/o increaed pulmonary vasclarity should represent what condition?
pulmonary valve stenosis
Posterior indentation on an esophagram is associated with what condition?
double aortic arch, retroesophageal subclavian artery, or circumflex aorta (pag anterior indentation, pulmonary artery sling)
Pleuropulmonary blastoma often arises from ?
congenital lung cyst
What lung is hypoplastic in TOF
left
How do you differentiate Swyer-James lung from a congenitally hypoplastic lung?
air trapping is present in Swyer-James (changes very little in size between inspiration and expiration)
Which side of pulmonary agenesis has an increased association with other congenital malformations?
right pulmonary agenesis
What is the only exception to the rule that “the lung that changes the least in volume between inspiration and expiration is the abnormal lung”?
mild congenital pulmonary hypoplasia
2 phases of BPD:
- edematous phase - hazy pattern is the mc pattern; no dysplasia in this phase, so it has been suggested to use the term leaky lung syndrome is suggested
- bubbly phase - overdistension of some alveoli while some remain atelectatic; CT findings: atelectasis, mosaic, air trapping
What does VACTERL stand for?
Vertebral defects, Anal atresia, Cardiac defects, Tracheo-esophageal fistula, Renal anomalies, and Limb abnormalities
What is usually the earliest manifestation of cystic fibrosis?
meconium ileus
In which conditions do coronary artery aneurysm occur in children?
periarteritis nodosa or mucocutaneous LN syndrome
What are the types of esophageal atresia?
with a fistula extending obliquely from the trachea just above the carina to the DISTAL esophageal pouch (Type 1; mc)
isolated esophageal atresia (type 2) with a tracheoesophageal fistula but without esophageal atresia (type 3) with a fistula from the PROXIMAL esophageal pouch to the trachea (type 4) with fistulae arising from both the proximal and distal pouches (type 5) - Caffey’s
How is gastric volvulus classified
organoaxial - stomach rotated along its longitudinal axis mesoaxial - rotates about a line perpendicular to the cardiopyloric line
Measurement of pyloric muscle in pylorospasm vs hypertrophic pyloric stenosis?
<3 mm in pylorospasm and 3mm or > in HPS
Classic clinical triad of choledochal cyst?
jaundice, pain, RUQ mass
Where does the Meckel diverticulum arise?
ileum (80 cm from the ileocecal valve)
Modality of choice / Gold standard in the diagnosis of hypertrophic pyloric stenosis?
US
High-flow vascular anomalies of the liver and other organs?
infantile hemangioendothelioma (hemangioma) and AVM
Most helpful discriminant in the diagnosis of HPS?
muscle thickness
Imaging hallmark of microgastria?
small midline stomach with significant reflux into a megaesophagus
Where is the gastrinoma triangle located?
right of SMA, bounded superiorly by the confluence of the cystic and common bile ducts, inferiorly by the junction of the second and third portions of the duodenum, and medially by the junction of the head and body of the pancreas
Single most important US sign of an inflamed appendix?
noncompressible, blind-ending tubular structure with a transverse diameter measuring >6 mm
Best indicator of pancreatic injury at CT
unexplained peripancreatic fluid
Most specific radiographic sign of appendicitis?
appendicolith
Most frequent CT finding associated with bowel rupture and mesenteric injury
unexplained peritoneal fluid
see VUR grading in GU notes
More common laterality of cryptochordism
right
Bladder dysfunction
detrussor hyperreflexia - above the level of the pons (Dunnick: above the sacral segments but below the pons ang detrussor hyperreflexia. Pag above the pons or usually cortex, uninhibited bladder/nonneurogenic neurogenic bladder/Hinmann syndrome) detrusor-sphincter dyssynergia detrusor areflexia - sacral spinal cord or peripheral nerves
Syndromes associated with multiple bladder diverticula
Ehlers-Danlos, Williams’, Menkes’, and prune belly
PUV types
Type I - sail-like flaps of tissue arising at the base of the prostatic urethra below the verumontanum (Dunnick: MC type)
Type II - “valve”; actually non-obstructive mucosal folds (Dunnick: proximal leaflets, probably acquired)
Type III - membrane caused by incomplete canalization in the region of the urogenital diaphragm (Dunnick: iris diaphragm across distal prostatic urethra)
2 syndromes in which megacystis is a prominent feature
prune belly and megacystic-microcolon-hypoperistalsis syndrome
Nonshadowing cerebral and hepatic calcifications are the most typical US findings?
congenital toxoplasmosis
In what malignant renal tumor is bone mets common?
clear-cell sarcoma
Mildest form of holoprosencephaly??
septo-optic dysplasia
What malignant renal tumor is associates with brain mets and second intracranial primaries?
rhabdoid tumor
On which side is neuroblastoma more frequent?
right
3 main types of tracheal agenesis
Type 1 - absent upper trachea and connection of the lower trachea to the esophagus
Type 2 (mc) - common bronchus connecting the bilateral main bronchi to the esophagus
Type 3 - independent bilateral main bronchi arising from the esophagus
3 main types of pulmonary underdevelopment
- lung agenesis - absence of bronchus, PA, and lung 2. lung aplasia - (+) rudimentary bronchus; lack PA and lung 3. lung hypoplasia - hypoplastic bronchial tree and PA with variable amount of lung
3 categories of pulmonary TB?
primary, miliary, reactive/postprimary
Proximal interruption of the PA is seen more commonly on which side?
right (interrupted prox PA is characteristically located on the contralateral side of the aortic arch)
Lung agenesis is more common on which side?
left
Most sensitive & reliable sign in the diff. of hydrocephalus from atrophy?
temporal horns have enlarged commensurately with the bodies of the lateral ventricles
Most reliable sign of hydrocephalus?
enlargement of the anterior and posterior recesses of the 3rd ventricle
Most leukodystrophies involve the central WM in a symmetric fashion. What disease is the exception?
Canavan disease
Best known variant in the foot?
accessory navicular
Overall shortening of the extremities?
micromelia
Relative shortening of the radii, ulnae, tibiae, and fibulae?
mesomelia
Relative shortening of the femurs and humeri?
rhizomelia
Relative shortening of the bones of hands and feet?
acromelia
What conditions that cause skeletal dysplasias present with abnormally dense bones?
pyknodysostosis and osteopetrosis
What conditions that cause skeletal dysplasias present with osteopenia?
rickets, hypophosphatasia, and osteogenesis imperfecta
Initial radiographic finding in rickets
loss of mineralization of the zone of provisional calcification
Most vulneralble site for early radiographic changes in JIA?
wrist
Squaring of the femoral condyles, multiple erosions, widened intercondylar notch, and squaring of the patella?
hemarthrosis
Cardinal feature of OI?
increased bone fragility
Brant: Hallmark of OI?
osteoporosis
Of the different types of vascular rings, which produce the most severe symptoms?
double aortic arch
