PediatricRad Flashcards
Heart shape in transposition of great vessels and tetralogy of Fallot
TOGV: Narrow cardiac base. Egg on string. TOF: Boot shape.
Pilon Fracture
Medial malleolus. Distal tibia metaphysis. Tibia plafond extension
Precursor to Wilms tumor
Nephroblastomatosis (primitive rests of cells with tumor potential)
Tillaux fracture
Salter Harris III fracture of anterolateral tibia epiphysis. Seen in older children and adolescents. Distal physis fuses medial to lateral. Lateral distal tibia prone to avulsion injuries.
Abdominal tumors associated with Beckwith- Wiedemann syndrome
Wilms tumor. Hepatoblastoma. Adrenal cortical carcinoma
Objective sign of active congestion. increased pulmonary blood flow. and over-circulation
Diameter of right interlobar pulmonary artery (PA) is greater than trachea
Acute hydrops of the gallbladder
Markedly enlarged. tender gallbladder with a thin wall. Acute acalculous cholecystitis causes less gallbladder distention with wall thickening.
Acyanotic Heart Disease With Increased Pulmonary Vascularity
VSD. ASD. PDA
Adrenal calcifications and associated disease?
Adrenal neuroblastoma: Fine. punctate calcifications. Calcified adrenal hemorrhage: coarse calcifications
Age group for intussusception?
Peaks at age 2
Age group for Wilm’s tumor and neuroblastoma?
Birth to 5 years
Anterior mediastinal masses
4Ts and a C: Thyroid (ectopic thyroid is often mentioned. never seen. Terrible lymphadenopathy. Teratoma. Thymoma. Cystic hygroma
ASD heart chamber changes
RA and RV enlargement.
Asplenia syndrome
Bilateral right-sidedness: Absent spleen. Bilateral three-lobed lung. Bilateral superior vena cava.
Pulmonary blood flow in tetralogy of fallot
Decreased blood flow to left lung.
Atrioventricular discordance
LA connected to RV. RA connected to LV.
Beckwith Wiedemann syndrome triad
Macroglossia. Omphalocele. Visceromegaly.
Bezoars may consist of
Hair (trichobezoar). Milk products (lactobezoar). Vegetable material (phytobezoar). Cloth.
Biliary atresia HIDA scan results?
Liver uptake of radionuclide without bowel excretion. Gallbladder is not seen.
Biliary atresia ultrasound findings
Gallbladder is small or absent. Normal gallbladder in 20% of patients. Triangular echogenic atretic biliary plate measures greater than 4 mm along anterior wall of right portal vein.
Bilious vomiting in infants aged 2 months to 2 years
Midgut volvulus. Small bowel obstruction. Intussusception
Bronchogenic cysts
Lined with respiratory epithelium and filled with mucoid liquid. Occur in lung parenchyma or mediastinum. Subcarinal location is common. Some are connected to bronchial tree and are air filled.
Bronchopulmonary Dysplasia
Damage to structurally immature lung by oxygen and positive pressure ventilation.
Calcification in Wilm’s tumor and neuroblastoma?
Neuroblastoma calcification is common. Wilms tumor calcification is uncommon.
Causes of lobar collapse in children
Common: Mucus plugging in postoperative and asthmatic patients. Uncommon: Extrinsic masses such as lymph nodes (tuberculosis. infections. or lymphoma) or bronchogenic cysts.
Causes of Ascites in Older infants and children
Liver disease. Nephrotic syndrome. Portal vein obstruction. Traumatic intestinal injury. Peritonitis. Hypoproteinemia. Pancreatitis. Ruptured abdominal cyst. Intestinal lymphangiectasia. GI ischemia. Bile duct perforation.
Causes of Ascites in the newborn
Hydrops fetalis. Chylous ascites. Urinary tract obstruction. Iatrogenic (line perforation). Intestinal perforation (necrotizing enterocolitis).
Causes of childhood Focal Alveolar Consolidation
Bacterial pneumonia: Streptococcus pneumoniae. Mycobacterium. Staphylococcus. Haemophilus influenzae. Nonbacterial infection: Tuberculosis. Actinomycosis. Pulmonary infarction. Pulmonary contusion.
Causes of childhood Miliary Nodules
Infection: Tuberculosis, Histoplasmosis, Viral. Idiopathic pulmonary hemosiderosis. Metastatic disease.
Acute and chronic causes of childhood Parahilar Peribronchial Opacity
Acute (infection): Viral, Mycoplasma, Chlamydia, Pertussis. Chronic: Asthma, Cystic fibrosis, Immunologic deficiency disease, Chronic aspiration
Causes of Colonic Obstruction
Meconium plug syndrome (small left colon). Hirschsprung disease. Functional megacolon. Ectopic (imperforate) anus. Colon atresia/stenosis. Inflammatory stricture. Volvulus. Trauma. Neoplasm.
Causes of Duodenal Obstruction
Atresia/stenosis/diaphragm. Annular pancreas. Duodenal band. Midgut volvulus. Hematoma. Neoplasm (duodenum. pancreas. liver). Peptic ulcer disease.
Causes of Echogenic Renal Pyramids
Normal neonate. Tamm-Horsfall proteinuria. Sickle-cell disease. Hypercalciuria. Renal tubular acidosis. Medullary sponge kidney. Hyperparathyroidism. Drugs (furosemide. steroids. vitamin D). Prolonged immobilization. Bartter syndrome. Williams syndrome. Autosomal recessive polycystic kidney disease. Storage diseases. Glycogen-storage disease type 1A. Hurler mucopolysaccharidosis. Lesch-Nyhan syndrome. Oxalosis.
Causes of Gastric Obstruction
Atresia/antral diaphragm. Duplication cyst. Pylorospasm. Hypertrophic pyloric stenosis. Gastritis/ulcer disease. Volvulus. Microgastria.
Causes of more distal abdominal obstruction presenting in the newborn include
Ileal and colonic atresia. Aganglionosis (Hirschsprung’s disease).
Causes of multiple Renal Cysts
Multicystic dysplastic kidney. Polycystic kidney disease. Glomerulocystic disease. Medullary cystic disease (juvenile nephronophthisis). Tuberous sclerosis. Turner syndrome. von Hippel-Lindau disease. Zellweger syndrome. Beckwith-Wiedemann syndrome. Meckel-Gruber syndrome.
Causes of Pediatric Esophageal Obstruction
Congenital atresia/stenosis. Web/diverticulum. Foreign body. Stricture (peptic, caustic). Extrinsic compression (cysts, neoplasms, vascular). Achalasia.
Causes of pediatric Unilateral Obstructive Emphysema
Bronchial foreign body. Mucous plug. Congenital lobar emphysema. Bronchial stenosis/atresia. Tuberculosis. Vascular anomalies. Mediastinal masses.
Causes of single Renal Cyst
Simple cyst. Caliceal diverticulum. Abscess. Multilocular cystic nephroma.
Causes of Small Intestinal Obstruction
Atresia/stenosis. Meconium ileus. Incarcerated hernia. Intussusception. Perforated appendicitis. Regional enteritis. Posttraumatic hematoma/stricture.
Causes of Unilateral Renal Enlargement
Hydronephrosis. Duplication anomaly. Compensatory hypertrophy. Crossed fused ectopia. Multicystic dysplastic kidney. Renal abscess. Renal neoplasm. Renal vein thrombosis.
Caustic esophagitis with stricture usually results from
Alkaline substanceingestion: sodium hydroxide, potassium hydroxide (lye), alkaline disk batteries. Acids produce more superficial burns.
Chest Wall Masses
Malignant: Ewing sarcoma, Primitive neuroectodermal tumor (Askin tumor), Neuroblastoma, Leukemia, Lymphoma, Rhabdomyosarcoma. Benign: Osteochondroma, Aneurysmal bone cyst, Mesenchymal hamartoma, Langerhans cell histiocytosis, Fibrous dysplasia, Hemangioma, Lymphangioma, Teratoma, Abscess, Calcifying fibrous pseudotumor, Osteoid osteoma.
Children with hemihypertrophy have a predilection for what tumors?
Wilms tumor. Hepatoblastoma.
Choledochal cysts
Congenital malformations of intraor extrahepatic bile ducts. May present with jaundice, pain, right upper quadrant mass. Most common is type 1: fusiform or saccular dilation of common bile duct below the cystic duct.
Findings of an anterior pneumothorax
Increased lucency of hemithorax. Increased sharpness of mediastinal border.
2 forms of aorta coarctation
Juxtaductal (adult) type lies at or just distal to the ductus arteriosus. Preductal (infantile, rare) form generally is a long-segment narrowing.
Coarctation of aorta associated cardiac anomalies
Bicuspid aortic valve. PDA. VSD.
Common abdominal masses of 1 month to 2-year-olds?
Wilms tumor. Neuroblastoma. Mass from intussusception.
Common causes of bilateral lung hyperexpansion
Asthma. Bronchiolitis. Cystic fibrosis.
Common complications of esophageal atresia repair
Anastomotic strictures (40%). Anastomotic leakage (14% to 21%). Recurrent fistula (3% to 14%). Esophageal dysmotility. GER.
Complete transposition of the great vessels (D-transposition)
Most common form of cyanotic congenital heart disease with increased pulmonary blood flow. Positions of aorta and PA are reversed. Aorta arises anteriorly from RV. PA arises posteriorly from LV. VSD, ASD, or PDA allow for survival.
Congenital Hutch diverticulum
Adjacent to ureterovesical junction. Increased incidence of VUR.
Congenital pulmonary hypoplasia
Hypoplasia or absence of ipsilateral pulmonary artery. Sometimes associated with tetralogy of Fallot or persistent truncus arteriosus.
Cor triatriatum
Rare cause of obstruction of venous emptying into LA. Pulmonary veins empty into a common vein incorporated into the LA. Partial membrane creates an extra chamber along the posterosuperior LA.
Corrected transposition of the great vessels (L-transposition)
Ventricular inversion with functional correction of transposition. Blood circulates through RA to LV to PA to lungs to LA to RV to aorta to body. Anatomic RV functions as LV and vice versa. Aorta lies anteriorly and to the left hence L-transposition.
CSF Pseudocyst
VP shunt tip fluid collection causing shunt malfunction.
CT findings of acute appendicitis
Distended appendix greater than 6mm. Fatty infiltration (stranding). Appendicolith (20-40%). Complications of perforation: fluid collections and free air.
Cystic adenomatoid malformation
Congenitallung lesion containing dysplastic adenomatous tissue with communicating cysts of variable sizes. Vary from solid lesion to multiple tiny cysts to large, thin-walled cysts. May mimic congenital lobar emphysema. Cysts can enlarge leading to respiratory distress. Usually are unilateral and can affect any portion of the lung.
Dermoid versus teratoma
Dermoids contain only ectodermal elements. Teratomas contain elements from all dermal layers.
Describe course of umbilical artery catheter?
Enters umbilical artery, Proceeds caudad in iliac vessels, Ascends left of midling in abdominal aorta.
Describe course of umbilical vein catheter?
Pass into left portal vein through ductus venosus and into inferior vena cava.
Dextrocardia
Cardiac apex lies to the right of the spine. Levocardia is the normal position of the cardiac apex.
Dextroversion
Right-sided rotation of heart. RA and RV become more posterior. LA and LV lie anterior. Chamber inversion does not occur.
DiGeorge syndrome
Thymic aplasia. Absence of parathyroid glands. Cardiovascular anomalies. Faulty development of third and fourth pharyngeal pouches.
Distinguishers of neuroblastoma from Wilm’s tumor?
More common in neuroblastoma: Calcification. Spinal involvement. Nodal encasement.
Distinguishes GI duplication cyst from Mesenteric and omental cysts at ultrasound
Cyst wall has a single layer rather than a double layer (gut signature) seen with GI duplication cysts.
Distinguishing ileal atresia from meconium ileus
Air-fluid levels in the dilated small bowel are more commonly seen with ileal atresia. Ileal atresia is corrected surgically whereas meconium ileus is often treated with water-soluble contrast enema.
Drash syndrome
Male pseudohermaphroditism. Glomerular disease. Wilms tumor.
Ebstein anomaly
Malformed, enlarged tricuspid valve that is displaced downward. Atrialization of RV. Severe TR. Atrial right-to-left shunting results in cyanosis in the more severely affected patients.
Echogenicity of neonatal renal cortex
Approximates or exceeds liver echogenicity
Favorable neuroblastoma features
Intrathoracic. Less than 12 months old.
Foregut. midgut. and hindgut boundaries?
Midgut extends from ampulla of Vater (2nd portion duodenum) to midtransverse colon. Foregut, bowel proximal to ampulla of Vater. Hindgut, bowel distal to midtransverse colon.
Functional megacolon
Common condition in childhood. Spasm of puborectalis muscle. Prominence of puborectalis sling. Patients can hold large volumes of stool in colon.
GI cystic masses
Duplication cyst. Mesenteric cyst. Meconium pseudocyst. Lymphangioma. Appendiceal abscess.
Helps distinguish obstructive emphysema from compensatory hyperinflation?
Obstructive emphysema generally results in diminished size of pulmonary vessels due to compression and hypoxia-induced reflex arterial spasm. In compensatory hyperinflation pulmonary vessels are normal or even increased in size.
Hemangioendothelioma possible complications
High-output cardiac failure. Hemorrhage. Jaundice. Hemolytic anemia. Thrombocytopenia (Kasabach-Merritt syndrome) sequestration of platelets. DIC.
Hepatic adenomas are rare in childhood but have been reported in association with
Fanconi anemia. Glycogen-storage disease type 1. Hurler disease. Severe combined immunodeficiency.
Hepatic hemangioendothelioma features?
Benign. Most diagnosed within first 6 months of life. Hepatomegaly and high-output congestive heart failure are common. May present with platelet sequestration (Kasabach-Merritt syndrome) or DIC.
Hepatobiliary cystic masses
Gallbladder hydrops. Choledochal cyst. Mesenchymal hamartoma. Abscess/parasitic cyst.
Hepatoblastoma features
Occurs in children under the age of 5 years. May extend into portal veins, hepatic veins, and inferior vena cava. Prematurity is a risk factor. Usually well-circumscribed, solitary mass. May be multifocal.
Hepatoblastoma routes of spread
Local: Portal vein. Hepatic vein. IVC. Lymph nodes. Diaphragm. Peritoneum. Remote: Lungs.
Hepatoblastoma occurs at what age and with what syndromes?
Early childhood, presenting before 3 years of age. Beckwith-Wiedemann syndrome. Familial adenomatous polyposis.
Epidermolysis bullosa effect on esophagus
Hereditary condition. Inflammatory skin and mucosal lesions that can heal with fibrosis. May result esophageal stricture.
Hirschsprung disease features
Contracted aganglionic distal colon. Abnormal peristalsis and inability to effectively evacuate colon. Rectum is always involved. Extent of proximal involvement varies. Colon caliber transition more common in older infants. Tortuosity or corrugation of narrowed aganglionic segment of the colon is commonly seen. Diagnosis made with rectal biopsy. Necrotizing enterocolitis is an uncommon but serious complication.
How long does it take for gas to reach the rectum in a normal newborn?
May take up to 24 hrs. Occurs by 12 h in most healthy infants.
Hydrometrocolpos versus hematometrocolpos
Both are congenital vaginal obstructions. Hydrometrocolpos anechoic fluid in the newborn. Hematometrocolpos echogenic blood in the adolescent.
Hypertrophic pyloric stenosis features:
Common between 2 and 10 weeks of age. Hypertrophy of pyloric muscle. 4 mm or more in thickness. Pyloric channel elongated beyond 15 mm.
Hypoplastic right heart
Tricuspid atresia. Usually with pulmonary atresia or stenosis. Underdeveloped RV. Common features are small RV with right-to-left shunting through an ASD causing cyanosis.
Imaging sequence of at risk infants (neonate to 3 years) for suspected pyelonephritis?
Nuclear scan with 99mTc -DMSA or 99mTc-GH. If positive, ultrasound and or voiding cystourethrogram.
Imperforate or ectopic anus
Range from simple membranous anal atresia to arrest of colon as it descends through puborectalis sling. Fistula formation may occur to genital or urinary tract.
Contrast enema with cecum not in the right lower quadrant, suspect
Malrotation or malfixation of midgut.