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Radiology > Pediatric > Flashcards

Pediatric Flashcards

1
Q

Bandlike lucencies on chest radiograph

A

Pulmonary interstitial emphysema

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2
Q

Ropy opacities on chest radiograph

A

Meconium aspiration

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3
Q

Granular opacities on premature chest radiograph

A

Surfactant deficiency disease

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4
Q

VACTERL

A 
V: vertebral anomalies
A: imperforate anus
C: cardiac anomalies
TE: tracheoesophageal fistula or esophageal atresia
R: renal anomalies
L: limb and ray anomalies
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5
Q

Infarcted spleen

A

Sickle cell anemia

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6
Q

Weigert-Meyer Rule

A

Duplicated collecting systems.

Upper moiety inserts inferomedially into the bladder, and is prone to obstruction and ureterocele formation.

Lower moiety inserts superolaterally into the bladder, and is prone to reflux.

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7
Q

Cobra head sign

A

Suggests ureterocele on ultrasound or intravenous pyelogram

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8
Q

Keyhole sign

A

Posterior urethral valves

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9
Q

Tibia vara

A

Blounts disease

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10
Q

Neuroblastoma Stage 4S

A

Less than 1 year old

Distal metastases confined to skin, liver, bone marrow (not bone cortex)

Excellent prognosis

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11
Q

Neuroblastoma appearance

A

Age: less than 2 years old

Calcifies 90%

Encases vessels (doesn’t invade)

Poorly marginated

Metastasizes to bone

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12
Q

Wilm’s appearance

A

Usually around 4 years old (never before 2 months)

Rarely calcifies (<10%)

Invades vessels (doesn’t encase)

Well-circumscribed

Doesn’t usually metastasize to bone

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13
Q

Croup

A

Barky “croupy” cough

Parainfluenza virus

Steeple sign on radiograph

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14
Q

Steeple sign on radiograph

A

Croup

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15
Q

Thumb sign

A

Epiglottitis

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16
Q

Exudative tracheitis radiograph findings

A

Linear soft tissue filling defect in airway

6-10 years old

Staphylococcus aureus

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17
Q

PHACES Syndrome

A 
P: posterior fossa (Dandy Walker)
H: hemangiomas
A: arterial anomalies 
C: coarctation of aorta, cardiac defects
E: eye abnormalities
S: subglottic hemangioma
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18
Q

Subglottic hemangioma radiograph findings

A

Asymmetric subglottic narrowing

in contradistinction to steeple sign, which is bilateral

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19
Q

Retropharyngeal abscess radiograph findings

A

Massive retropharyngeal soft tissue thickening

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20
Q

Meconium aspiration radiograph findings

A

Ropy appearance

Hyperinflation with areas of alternating atelectasis

Pneumothorax in 20 to 40% of cases

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21
Q

Transient tachypnea of the newborn

A

Clinical history: C-section, maternal sedation, maternal diabetes

Findings: coarse interstitial markings and fluid in fissures. Lung volume is normal to increased.

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22
Q

“Post term baby”

A

Meconium aspiration

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23
Q

“C-section”

A

Transient tachypnea of the newborn

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24
Q

“Maternal sedation”

A

Transient tachypnea of the newborn

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25
Q

Premature infant

A

Surfactant deficiency disease

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26
Q

Neonatal pneumonia (beta-hemolytic strep) radiograph findings

A

Low long volumes, granular opacities often will have pleural effusion

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27
Q

Neonatal pneumonia (non-beta hemolytic strep) radiograph findings

A

Patchy, asymmetric perihilar densities

Hyperinflation

Full-term baby

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28
Q

“Bandlike opacities”

A

Bronchopulmonary dysplasia (chronic lung disease)

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29
Q

Croup: Age

A

6 months - 3 years (peak 1 year)

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30
Q

Croup: Main Radiologic Features

A

Steeple Sign: loss of the normal shoulders (lateral convexities) of the subglottic trachea

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31
Q

Croup: Cause

A

Viral (Most common parainfluenza)

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32
Q

Most common cause of acute airway obstruction in young kids.

A

Croup

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33
Q

Epiglottitis: Age

A

3.5 years (now also seen in teenagers)

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34
Q

Epiglottitis: Main radiologic features

A

Thumb Sign (lateral X-ray): marked enlargement of epiglottis

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35
Q

When looking for Thumb Sign of epiglottitis, what “fake out” do you need to watch for, and how would you tell the difference?

A

Omega Esophagus: caused by oblique imaging. Look for thickened aryepiglottic folds to distinguish.

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36
Q

Epiglottitis: Cause

A

H. influenza

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37
Q

Epiglottitis: prognosis

A

Can kill! Death by asphyxiation from aryepiglottic folds (NOT epiglottis!)

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38
Q

Croup: Prognosis

A

Usually self-limiting.

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39
Q

Exudative Tracheitis: Age

A

6-10 years

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40
Q

Exudative Tracheitis: main radiologic features

A

Linear soft tissue filling defect (a membrane) seen within airway

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41
Q

Exudative Tracheitis: cause

A

Staph A

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42
Q

Exudative Tracheitis: prognosis

A

Serious, possibly deadly (although uncommon condition)

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43
Q

Retropharyngeal Cellulitis and Abscess: age

A

6 months- 12 months

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44
Q

Retropharyngeal Cellulitis and Abscess: main radiologic features

A

Lateral X-ray: massive retropharyngeal soft tissue thickening.

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45
Q

Retropharyngeal Cellulitis and Abscess: When looking for characteristic retropharyngeal soft tissue thickening, what is a possible fake out on X-ray? And how would you differentiate from the real thing?

A

Real world: can get pseudothickening when neck not truly lateral. To differentiate, repeat with an extended neck.

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46
Q

Retropharyngeal Cellulitis and Abscess: what is the possible fake out on CT?

A

More lateral, low density suppurative node.

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47
Q

Subglottic Hemangioma: main radiologic feature

A

Loss of ONE of the shoulders of the subglottic trachea (compared to Steeple Sign of croup, which has loss of both shoulders)

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48
Q

Most common soft tissue mass in the trachea

A

Hemangioma

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49
Q

Most common location of tracheal hemangioma

A

Subglottic

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50
Q

Subglottic Hemangioma: which side favored?

A

Left

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51
Q

Subglottic Hemangioma: associated with what other mass? (And what %?)

A

Cutaneous hemangioma (50%)

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52
Q

Subglottic Hemangioma: associated with what syndrome? (And what %?)

A

PHACES syndrome (7%)

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53
Q

What is PHACES syndrome?

A 
Posterior fossa (Dandy Walker)
Hemangiomas
Arterial anomalies
Coarctation of the aorta, cardiac defects
Eye abnormalities
Subglottic hemangiomas
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54
Q

What 2 conditions are you looking for on frontal neck radiographs & how do you tell them apart?

A

Croup: Steeple Sign (loss of both shoulders)

Subglottic Hemangioma: loss of ONE shoulder

**If you can’t tell, look at the history. Cough, fever–think croup.

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55
Q

What 4 conditions are you looking for on lateral neck radiographs?

A

Epiglottitis,
Retropharyngeal Abscess,
Tonsils (adenoids),
Exudative Tracheitis

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56
Q

True or False: If the ordering Dr. suspects epiglottitis, you should have them bring the kid to x-ray for a lateral view.

A

False. Do not bring the kid to you. Have them do a portable.

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57
Q

Retropharyngeal Abscess: main radiographical feature

A

Retropharyngeal soft tissue too thick:
>6 mm at C2 or
>22 mm at C6

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58
Q

Retropharyngeal Abscess: Next step after lateral X-ray

A

CT

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59
Q

Retropharyngeal Abscess: Aside from the thickened retropharyngeal tissue, what else must be assessed on CT?

A

Mediastinum for “Danger Zone” extension.

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60
Q

Tonsils: Age they are first seen

A

About 3-6 months

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61
Q

Tonsils: Age they get big (not when first seen)

A

About 1-2 years

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62
Q

Tonsils: how big is too big?

A

Too big when encroach on the airway

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63
Q

Meconium Aspiration: Cause

A

Usually secondary to stress (hypoxia)

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64
Q

Meconium Aspiration: preterm, term, or post-term?

A

Term or POST term

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65
Q

Meconium Aspiration: 3 main radiologic features

A
  1. “Ropy appearance” of asymmetric lung densities
  2. Hyperinflation (aka increased lung volume) w/areas of atelectasis
  3. Pneumothorax (20-40% of cases)
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66
Q

Transient Tachypnea of the Newborn: 3 classic histories

A

C-section,
Maternal sedation,
Maternal Diabetes

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67
Q

Transient Tachypnea of the Newborn: Timing of findings (onset, peak, resolution)

A

Onset: 6 hours
Peak: day 1
Resolved by: day 3

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68
Q

Transient Tachypnea of the Newborn: lung volumes

A

Normal to Increased

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69
Q

Transient Tachypnea of the Newborn: radiologic features

A

Coarse interstitial marking & fluid in fissures

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70
Q

Surfactant Deficient Disease (SDD, RDS, Hyaline membrane disease): preterm, term, or post-term?

A

Pre-term

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71
Q

Surfactant Deficient Disease (SDD, RDS, Hyaline membrane disease): lung volumes

A

Low lung volumes

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72
Q

Most common cause of death in premature newborns.

A

Surfactant Deficient Disease (SDD, RDS, Hyaline membrane disease)

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73
Q

Surfactant Deficient Disease (SDD, RDS, Hyaline membrane disease): main radiologic features

A

Low lung volumes & granular opacities. NO PLEURAL EFFUSION! (that’s B-hemolytic pneumonia)

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74
Q

True or False: A normal plain film at 6 hours excludes SDD (RDS).

A

True.

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75
Q

Surfactant Replacement Therapy: radiographic features post treatment

A

Lung volumes get better, opacities clear centrally. Bleb-like lucencies (can mimic PIE)

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76
Q

Surfactant Replacement Therapy: increases risk of what? (2 things)

A

Pulmonary hemorrhage, PDA

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77
Q

Neonatal Pneumonia (NOT B-hemolytic Strep): main radiographic findings

A

Patchy, asymmetric perihilar densities; hyperinflation.

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78
Q

Neonatal Pneumonia (not B-hemolytic Strep): preterm, term, or post-term?

A

Term

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79
Q

Neonatal Pneumonia (B-hemolytic Strep): more common in preterm, term, or post-term?

A

More common in preterm than full term (but not exclusive).

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80
Q

Most common type of Pneumonia in newborns.

A

Neonatal Pneumonia (B-hemolytic Strep)

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81
Q

Neonatal Pneumonia (B-hemolytic Strep): main radiographic features

A
  1. LOW lung volumes (other pneumonias are high),
  2. Granular opacities (also in SDD)
  3. Pleural Effusion often (NOT in SDD)
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82
Q

Persistent Pulmonary Hypertension (persistent fetal circulation): causes

A

Primary (it just is), or secondary from hypoxia (meconium aspiration, Pneumonia, etc)

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83
Q

True or False: You can see persistent pulmonary hypertension on a CXR.

A

False. You can see the cause, but not the actual hypertension. That’s just ridiculous. 😝

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84
Q

Chest Buzzword: “Post term baby”

A

Meconium aspiration

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85
Q

Chest Buzzword: “c-section”

A

Transient tachypnea

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86
Q

Chest Buzzword: “maternal sedation”

A

Transient tachypnea

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87
Q

Chest Buzzword: premature

A

SDD/RDS

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88
Q

Conditions with HIGH lung volumes

A

Meconium Aspiration,
Transient Tachypnea,
Neonatal Pneumonia (not B-hemolytic strep)

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89
Q

Conditions with LOW lung volumes

A 
SDD,
Neonatal Pneumonia (B-hemolytic Strep)

(note: other pneumonias have high lung volumes)

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90
Q

Two conditions caused by ventilation in the NICU

A 
Pulmonary Interstitial Emphysema,
Bronchopulmonary Dysplasia (chronic lung disease)
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91
Q

Pulmonary Interstitial Emphysema (PIE): cause

A

Ventilation (air escapes alveoli, ends up in interstitium & lymphatics)

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92
Q

Pulmonary Interstitial Emphysema (PIE): age of occurrence

A

FIRST week of life

Note: BPD > 2 weeks

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93
Q

Pulmonary Interstitial Emphysema (PIE): CXR appearance

A

“Linear lucencies” (buzzword)

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94
Q

“Linear lucencies” on CXR

A

Pulmonary Interstitial Emphysema (PIE)

95
Q

Pulmonary Interstitial Emphysema (PIE) is a warning sign for what condition?

A

Impending pneumothorax

96
Q

Pulmonary Interstitial Emphysema (PIE): what can mimic appearance?

A

Surfactant therapy

97
Q

Pulmonary Interstitial Emphysema (PIE): treatment

A

Put them affected side down &/or switch ventilation methods

98
Q

Pulmonary Interstitial Emphysema (PIE): rare-but-possible progression

A

Can progress to large cystic mass. Can even cause mediastinal mass effect. (Zebra!!)

99
Q

Chronic Lung Disease (Bronchopulmonary Dysplasia): classic history

A

Tiny (<1000g),
Premature (<32 weeks),
Prolonged ventilation

100
Q

Chronic Lung Disease (Bronchopulmonary Dysplasia): Age

A

> 2 weeks old

Note: PIE in 1st week

101
Q

Chronic Lung Disease (Bronchopulmonary Dysplasia): radiographic features

A

“BAND LIKE OPACITIES” (buzzword)

After 2 weeks old, get hazy lungs.
After few months, coarseness & give bubble-like lucencies.

102
Q

Pulmonary Hypoplasia: secondary causes (3 major categories)

A
  1. Decreased hemilaminectomy-thoracic volume.
  2. Decreased vascular supply.
  3. Decreased fluid.
103
Q

Pulmonary Hypoplasia: of the 3 major categories of secondary causes, which is the most common?

A

Decreased hemi-thoracic volume

104
Q

Primary differentials for decreased hemi-thoracic volume leading to secondary Pulmonary Hypoplasia.

A

Congenital diaphragmatic hernia (w/bowel in the chest) or other space occupying mass—most common.

Also can be neuroblastoma or sequestration.

105
Q

Potter Sequence

A

Causes secondary pulmonary hypoplasia due to decreased fluid. Refers to no kidneys-> no pee-> no fluid -> hypoplastic lungs.

106
Q

True or False: Radiographs are a passable way to differentiate between intralobar and extralobar bronchopulmonary sequestration.

A

False. You cannot tell the difference between these radiographically.

(Note: age of presentation is best practical way to differentiate.)

107
Q

Bronchopulmonary Sequestration: which is more common, intralobar or extralobar (give percentages)?

A

Intralobar more common (75%)

Extralobar (25%)

108
Q

Bronchopulmonary Sequestration, Intralobar: age of presentation

A

Adolescent or adult

Note: extralobar in infants

109
Q

Bronchopulmonary Sequestration, Intralobar: chief presenting complaint

A

Recurrent Pneumonia in adolescent or adult (bacteria migrates in from pores of Kohn)

110
Q

Bronchopulmonary Sequestration, Intralobar: site most commonly affected (radiographic findings)

A

Left lower lobe, posterior segment (2/3s).

Uncommon in upper lobes & rarely associated w/other developmental anomalies.

111
Q

Bronchopulmonary Sequestration: which has a pleural cover, intralobar or extralobar? (And can you see it radiographically?)

A

Extralobar. (No, it cannot be seen radiographically.)

112
Q

Bronchopulmonary Sequestration, Exralobar: age of presentation

A

Infant

Note:intralobar adolescent or adult

113
Q

Bronchopulmonary Sequestration, Exralobar: clinical history

A

Infant with respiratory compromise due to associated anomalies

114
Q

Bronchopulmonary Sequestration, Exralobar: does it usually get infected?

A

No. Rarely gets infected because it has its own pleural covering.

115
Q

Bronchopulmonary Sequestration, Extralobar: can rarely have a patent channel to where?

A

Stomach or distal esophagus (sometimes described as part of a bronchopulmonary foregut malformation.)

116
Q

Bronchogenic Cysts: radiographic features

A

Solitary, unilocular, NO GAS (if you see gas, think infection).

Typically incidental.

117
Q

Congenital Cystic Adenomatoid Malformation (CCAM/CPAM): region typically affected

A

Usually only one lobe (no lobar preference).

118
Q

Congenital Cystic Adenomatoid Malformation (CCAM/CPAM): name the types

A

Type 1: cystic
Type 2: in the middle
Type 3: solid.

119
Q

Congenital Cystic Adenomatoid Malformation (CCAM/CPAM): communicate with the airway?

A

Yes. They fill with air.

120
Q

Congenital Cystic Adenomatoid Malformation (CCAM/CPAM): prognosis and treatment

A

Most (like 90%) spontaneously decrease in size in 3rd trimester, but tiny risk of malignant transformation, so recommend surgical excision.

121
Q

Congenital Cystic Adenomatoid Malformation (CCAM/CPAM): what if you see a systemic arterial feeder (one off the aorta) going to the CCAM?

A

Then it’s not a CCAM. It’s a sequestration. :)

122
Q

Congenital Lobar Emphysema (Congenital Lobar Overinflation): radiographic findings

A

Lucent, hyper-expanded lobe on CXR

123
Q

Congenital Lobar Emphysema (Congenital Lobar Overinflation): site preference

A

Left Upper Lobe (40%)

124
Q

Congenital Lobar Emphysema (Congenital Lobar Overinflation): treatment

A

Lobectomy

125
Q

Congenital Lobar Emphysema (Congenital Lobar Overinflation): The name says “Emphysema,” but it’s not. Why?

A

Actually just air-trapping secondary to a bronchial anomaly.

126
Q

You are shown a series of CXRs. First has opacity in left upper lung. Second shows opacity resolved. Following X-ray shows lobe getting more and more lucent until it’s actually pushing the heart over. Diagnosis?

A

Congenital Lobar Emphysema (Congenital Lobar Overinflation).

127
Q

Congenital Diaphragmatic Hernia: most common type (and location)

A

Bochdalek type, typically back/posterior and left.

B–Bochdalek, Back

128
Q

Congenital Diaphragmatic Hernia: usually left posterior. If on right, what is it associated with?

A

GBS Pneumonia

129
Q

Congenital Diaphragmatic Hernia: prognosis most closely related to what factor?

A

Mortality rate related to Degree of pulmonary hypoplasia

130
Q

Congenital Diaphragmatic Hernia: common associated condition

A

Most have congenital heart disease

131
Q

True or False: malrotation is rare with congenital diaphragmatic hernias.

A

False. Essentially all are malrotated.

132
Q

You are shown a study with the NG tube curving into the chest. Diagnosis?

A

Congenital Diaphragmatic Hernia

133
Q

You are shown a study with Left Upper Lung Lobe affected. Top differentials?

A

Congenital Lobar Emphysema (1st).

CCAM (no lobar preference, so possible)

134
Q

You are shown a study with Left Lower Lung Lobe affected. Top differentials?

A

Sequestration (first).

Congenital Diaphragmatic Hernia (favors that side, too).

135
Q

Newborn w/congenital heart disease. Lesion left lower lobe. Diagnosis?

A

Extralobar Sequestration

136
Q

10 year old with recurrent Pneumonia. Lesion left lower lung lobe. Diagnosis?

A

Intralobar Sequestration

137
Q

Peds chest, viral infection: radiographic findings

A

“Peribronchial edema” (buzzword),
Dirty/busy hilum,
Hyperinflation,
Subsegmental atelectasis.

138
Q

Peds chest: which is more common (regardless of age), bacterial or viral infection?

A

Viral. By far.

139
Q

Round Pneumonia: primary differential/fake out

A

Mass. Sneaky fuckers try to trick you into thinking kid has a mass. Don’t get a CT to exclude cancer if it fits criteria for around Pneumonia. Just get a follow-up X-ray.

140
Q

Round Pneumonia: age

A

Younger than 8 years old. (“They love to show this and try to trick you into thinking it’s a mass. Younger than 8, think round Pneumonia, round pneumonia, round pneumonia…”)

141
Q

Round Pneumonia: most common agent

A

S. pneumonia

142
Q

Round Pneumonia: why does it happen?

A

Don’t have good collateral ventilation pathways

143
Q

Round Pneumonia: radiographic features

A

Solitary, posterior lower lobes

144
Q

6 year old boy. CXR shows solitary mass in posterior lower left lobe. Next step?

A

Follow-up X-ray. Don’t get CT to exclude cancer because probably round Pneumonia. (Younger than 8)

145
Q

Swyer James: radiographic features

A

Unilateral lucent lung. Affected lobe smaller than normal (NOT hyper-expanded).

146
Q

Swyer-James: usually occurs after what event?

A

Viral lung infection in childhood resulting in post-infectious obliterative bronchiolitis.

147
Q

Peds chest, Papillomatosis: radiographic findings

A

Multiple lung nodules which demonstrate cavitation. (Can look like LCH, but trachea is also involved.)

148
Q

Peds chest, Papillomatosis: cause

A

Perinatal HPV

149
Q

Peds chest, Papillomatosis: cancer risk?

A

2% chance of squamous cell cancer

150
Q

Peds chest, Papillomatosis: true or False–manipulation can lead to dissemination.

A

True.

151
Q

Sickle Cell/Acute Chest: age

A

2-4 years usually (can be any age)

152
Q

Leading cause of death in sickle cell patients

A

Acute Chest

153
Q

Sickle Cell/Acute Chest: radiographic features

A

Opacities in the CXR of kid with sickle cell

(Sickle cell findings:
big heart,
bone infarcts–esp humoral head,
H-shaped vertebra–look on lateral.)

154
Q

Radiographic findings of patient with sickle cell.

A

big heart,
bone infarcts–esp humoral head,
H-shaped vertebra–look on lateral.

155
Q

Bronchial Foreign Body: radiographic findings (and why)

A

Air trapping (key concept)!!
Lung looks more lucent.
Remains lucent when put affected side down.
Fluoro: mediastinum shifts AWAY from affected side on expiration.

156
Q

Cystic Fibrosis: pathophysiology

A

Sodium pump doesn’t work. Thick secretions. Poor pulmonary clearance. Recurrent infections.

157
Q

Cystic fibrosis: radiographic findings pertaining to chest

A

Bronchiectasis (starts cylindrical and progresses to varicoid.)
UPPER LOBE predominance (less in lower lobes).
Hyperinflation.
Pulmonary Arterial Hypertension.
Mucus plugging (finger in glove sign).

(Note: Primary Ciliary Dyskinesia has LOWER LOBE bronchiectasis.)

158
Q

Cystic fibrosis: site predominance in chest

A

Upper Lobe predominance (less in lower lobes)

159
Q

Cystic fibrosis: what is Finger in Glove Sign?

A

Mucus plugging in chest

160
Q

Cystic fibrosis: effect on fertility

A

Men are infertile. Missing vas deferens.

Note: Primary Ciliary Dyskinesia men are infertile because tails don’t work.

161
Q

What condition could these indicate?

  1. Fatty replaced pancreas on CT.
  2. Abdominal Films with constipation.
  3. Biliary cirrhosis (blockage of intrahepatoc bike ducts) and resulting portal hypertension.
A

Cystic fibrosis.

162
Q

Primary Ciliary Dyskinesia: pathophysiology

A

Cilia don’t work. Can’t clear lungs. Recurrent infections.

163
Q

Primary Ciliary Dyskinesia: radiographic findings

A

Bronchiectasis.
LOWER LOBES.
Kartageners (situs inversus) in 50%.

(NOTE: CF has bronchiectasis of UPPER lobes)

164
Q

Primary Ciliary Dyskinesia: effect on fertility

A 
Men infertile (tails broken).
Women subfertile (cilia needed to transport egg)
165
Q

Pleuropulmonary Blastoma: age

A

1-2 year old

166
Q

Pleuropulmonary Blastoma: radiographic features

A

Right-sided BFM, pleural based, NO CHEST WALL/RIB INVASION! No calcifications.

(Note: Askin tumors often have rib invasion)

167
Q

Pleuropulmonary Blastoma: types

A

Cystic, mixed, solid

168
Q

Pleuropulmonary Blastoma: prognosis/behavior by type

A

Cystic: more in <1 year old & more benign.

Solid: can have mets in bone & brain.

(Mixed: no data provided)

169
Q

Pleuropulmonary Blastoma: preferred site

A

Right side

170
Q

Pleuropulmonary Blastoma: common concurrent lesion

A

Multilocular cystic nephroma (10% of the time)

171
Q

Pleuropulmonary Blastoma: top look-alike differential

A

CCAM

172
Q

Umbilical Venous Catheter: describe pathway

A 
Umbilical v, 
L portal v, 
ductus venosus, 
hepatic v, 
IVC
173
Q

Umbilical Venous Catheter: ideal spot

A

IVC-Right Atrium junction

174
Q

Umbilical Venous Catheter: where do you NOT want it to end up

A

Don’t lodge it in the portal vein. Can infarct the liver!

175
Q

Umbilical Artery Catheter: pathway

A

Umbilicus,
Umbilical artery,
Iliac artery,
Aorta

176
Q

Umbilical Artery Catheter: major risk factor and how to avoid it

A

Renal Arterial thrombosis .

Avoid renal arteries by going high (T8-10) or low (L3-5)

177
Q

Between Umbilical Venous Catheter and Umbilical Artery Catheter, which goes straight up, and which goes down and then up?

A

UVC: straight up.
UAC: down then up

178
Q

Anterior mediastinal mass: 6 major differentials

A 
Normal thymus,
Thymic rebound,
Lymphoma,
Germ cell tumor:    
   teratoma, 
   seminoma, 
   NSGCT
179
Q

Things that make you think thymus is a cancer?

A

Abnormal size for patient age.
Heterogenous.
Calcification.
Compression of airway or vessels.

180
Q

“Sail sign”

A

Triangular shape of thymus

Note: not same as spinnaker sail sign–when pneumomediastinum lifts up the thymus

181
Q

Normal thymus: ages when it is pretty big

A

Pretty big in kids Less than 5 years, and especially infants.

182
Q

What is thymic rebound

A

In times of acute stress (Pneumonia, radiation, chemo, burns), thymus shrinks. In recovery phase, rebounds to normal and sometimes LARGER than before. Can be PET avid during rebound.

183
Q

During Thymic rebound, is thymus PET avid or not?

A

Can be PET avid during rebound

184
Q

Most common abnormal mediastinal mass in children (older children and teenagers)

A

Lymphoma

185
Q

Best way to decide thymus vs lymphoma

A

Age.

Under 10- usually thymus.
Over 10-usually lymphoma.
Approx 10- look for cervical lymph nodes to make you think lymphoma

186
Q

In deciding thymus vs lymphoma, what is the age cutoff and which differential applies to which age group?

A

Under 10- usually thymus.
Over 10-usually lymphoma.
Approx 10- look for cervical lymph nodes to make you think lymphoma

187
Q

Is calcification common or uncommon in lymphoma?

A

Calcification is UNCOMMON in untreated lymphoma.

If see calcification in untreated lesion, think teratoma.

188
Q

Complications of mediastinal lymphoma (4 answers).

A

Compression of SVC,
Compression of pulmonary veins,
Compression of airway,
Pericardial effusion

189
Q

3 types of germ cell tumors in differentials for anterior mediastinal mass.

A

Teratoma,
Seminoma,
NSGCT

190
Q

Mediastinal teratoma: radiographic features

A

Large mass from/next to thymus.
Mostly cystic,
With Fat and Calcium

191
Q

Mediastinal seminoma : radiographic features

A

Large mass from/next to thymus.
Bulky, lobulated.
“Straddles the midline”

192
Q

Mediastinal NSGCT: radiographic features

A

Large mass from/next to thymus.
Big and ugly!
Hemorrhage and necrosis!
Can get crazy and invade lung.

193
Q

Risk factor for extra-gonadal germ cell tumors

A

Klinefelter’s Syndrome (300x risk of getting a GCT)

194
Q

Middle mediastinal mass: differentials (3)

A

Lymphadenopathy,
Bronchogenic duplication cyst,
Enteric duplication cyst.

(Note: neuroenteric duplication cyst is posterior mediastinum!!)

195
Q

Middle mediastinal mass: lymphadenopathy–most common causes

A

Granulomatous disease (TB or fungal) or lymphoma

196
Q

Mediastinal mass: duplication cysts–3 types and their locations

A

Bronchogenic: middle,
Enteric: middle,
Neuroenteric: posterior

197
Q

Expected attenuation for each type of duplication cyst.

A

All are water attenuation.

198
Q

Bronchogenic duplication cyst: Specific location

A

Middle mediastinum, close to trachea or bronchus

199
Q

Enteric duplication cyst: Specific location

A

Middle mediastinum (but lower than bronchogenic), close to the esophagus

200
Q

Posterior mediastinal mass: 5 major differentials (plus 1 bonus differential)

A 
Neuroblastoma,
Ewing Sarcoma,
Askin Tumor,
Neuroenteric (duplication) cyst,
Extramedullary Hematopoiesis

(Also Wilms, which mets to lungs more than neuroblastoma)

201
Q

Most common posterior mediastinal mass in child under 2.

A

Neuroblastoma

202
Q

Thoracic vs abdominal neuroblastoma: which has better prognosis?

A

Thoracic neuroblastoma has a better outcome.

203
Q

True or False: neuroblastoma may involve ribs and vertebral bodies.

A

True.

204
Q

Askin tumor is now considered part of the _______ spectrum.

A

Ewing sarcoma

Sometimes called a Ewing sarcoma of the chest wall.

205
Q

Askin tumor: tendency to displace or invade adjacent structures? (Pick one)

A

Tends to displace early on. Can invade when get big, but higher tendency to displace.

206
Q

Askin tumor: radiographic appearance

A

Heterogenous, solid parts will enhance, displace adjacent structures rather than invade (until big, then may invade).

207
Q

Neuroenteric cyst: associated with what condition(s)

A

Vertebral anomalies (Scoliosis!)

208
Q

Neuroenteric cyst: does it communicate with CSF?

A

NO! It does NOT communicate with CSF.

209
Q

Neuroenteric cyst: radiographic features

A

Associated with vertebral anomalies (scoliosis),
Does NOT communicate with CSF,
Well demarcated,
Water density

210
Q

Extramedullary hematopoiesis: who gets it?

A

Patients with myeloproliferatove disorders or bone marrow infiltration (including sickle cell)

211
Q

Extramedullary hematopoiesis: most common manifestation

A

Big spleen and liver

212
Q

Extramedullary hematopoiesis: big spleen and liver is most common manifestation, but what is the less common appearance?

A

Paraspinal masses: bilateral, smooth, sharply delineated, soft tissue density

213
Q

A kid with anterior mediastinal mass suspected to be lymphoma. Assume Hodgkin’s or NHL?

A

Assume hodgkin’s because it’s 4x more common than NHL.

Hodgkins involves thymus 90% of the time.

214
Q

Does Hodgkin’s lymphoma involve the thymus?

A

Hodgkins involves thymus 90% of the time.

215
Q

Thymic rebound: what history might make you start thinking this?

A

Got off chemo,” or “got off corticosteroids,” or other stressor.

216
Q

Strategy, Anterior mediastinal mass w/soft tissue density and kinda homogenous. Differentials?

A

Lymphoma or hyperplasia

217
Q

Strategy, Anterior mediastinal mass w/fat density. Differentials?

A

Germ cell tumor

218
Q

Strategy, Anterior mediastinal mass w/water density. Differentials?

A

Congenital things, lymphangiomas

219
Q

Strategy, Posterior mediastinal mass: first and most important piece of information to narrow the list

A

Age!

Under 10-think malignant
Over 10-think benign

220
Q

Strategy, Posterior mediastinal mass: over 10 years old, round mass. Differentials?

A

Ganglioneuromas, neurofibromas

221
Q

Strategy, Posterior mediastinal mass: kid over 10, cystic mass and scoliosis.

A

Neuroenteric cyst

222
Q

Strategy, Posterior mediastinal mass: kid over 10, coarse bone trabeculation with adjacent mass (or history of anemia). Differential?

A

Extramedullary hematopoiesis

223
Q

Stately: BFM in chest of a kid. 2 differentials and how to most rapidly distinguish.

A

Askin tumor (AGE 10+!! Eaten up rib)

Pleuropulmonary Blastoma (AGE <2)

224
Q

Esophageal atresia/TE fistula: 2 classic ways of showing it

A
  1. Frontal CXR, NG tube stopped in upper neck.

2. Fluoro lateral, blind-ending sac or communication with tracheal tree.

225
Q

Esophageal atresia/TE fistula: 3 subtypes described in the book (there are 5, but 3 high yield) and approx frequency

A

N-type Fistula (85%),
Esophageal Atresia w/o fistula (10%),
H-type Atresia (1%)

226
Q

Esophageal atresia/TE fistula: most common subtype

A

N-type fistula (blind-end esophagus, distal esophagus hooks up to trachea.)

227
Q

Esophageal atresia/TE fistula: excessive air in stomach. Which type?

A

H-type Atresia (but can also be N type)

228
Q

Esophageal atresia/TE fistula: NO air in stomach. Which type?

A

Esophageal Atresia

229
Q

Esophageal atresia/TE fistula: what specific non-airway finding must be described prior to surgery?

A

Presence of a right arch (4%) must be described prior to surgery. Changes the approach!

230
Q

How many of the defined anomalies are required to diagnose VACTERL association?

A

Three. (So keep looking if you find 1 or 2.)

231
Q

What is VACTERL? (General terms, not what it stands for)

A

List of associated anomalies that often occur together. When you find one, look for more on this list.

232
Q

What are the anomalies in VACTERL and each one’s frequency?

A 
Vertebral anomalies (37%),
Anal (imperforate anus) (63%),
Cardiac (77%),
TE-Tracheoesophageal fistula or Esophageal Atresia (40%),
Renal (72%),
Limb (radial ray) (58%)
233
Q

Which organs most commonly affected by VACTERL association?

A

Heart (77%) and kidneys (72%)

234
Q

VACTERL: true or False. If both limbs involved, then both kidneys involved. If one limb, then usually one kidney.

A

True.

Radiology (8 decks)

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