Pediatrics Flashcards
Cloverleaf skull ddx
- thanatophoric dysplasia
- Apert syndrome (brachycephaly, syndactyly
- Crouzon syndrome (brachycephaly, 1st arch structures maxilla/mandible hypoplasia, hydrocephalus, Chiari 1, coarctation, rhizomelia short central bones, exophthalmos)
Agenesis of the corpus callosum associations
- Dandy-Walker spectrum
- hydrocephalus
- Chiari Il malformations
- encephaloceles
- porencephaly
- holoprosencephaly
- polymicrogyria
- trisomy 13, 15, and 18
Double bubble sign ddx
- duodenal atresia
- annular pancreas
- obstruction by Ladd’s bands
- midgut volvulus
additional imaging evaluation with upper GI series is needed if the patient has a noncharacteristic clinical presentation.
absent cavum septum pellucidum ddx
- congenital hydrocephalus
- hydranencephaly
- porencephaly
- holoprosencephaly spectrum
- schizencephaly
- Chiari 2 malformation
Cavum septum pellucidum is always visualised between 18 and 37 weeks. Closes after 37 weeks as septum pellucidi fuse in most people.
lemon skull ddx
Chiari 2 malformation +/- spina bifida
think of the frontal bones being pinched, squeezing cerebellum out foramen magnum, and popping spinal canal contents out the back of the spine
banana cerebellum ddx
Chiari 2 malformation +/- spina bifida
think of the frontal bones being pinched, squeezing cerebellum out foramen magnum, and popping spinal canal contents out the back of the spine
radial ray malformation ddx
- VACTERL association
- trisomy 18 (Edward syndrome, look for rocker bottom feet, choroid plexus cysts)
- diabetic embryopathy
- isolated
- Holt-Oram syndrome: Cardiac septal defects with upper extremity abnormalities
- thrombocytopenia-absent radius (TAR) syndrome: Thumbs are present
- Fanconi anemia
- teratogens: Valproic acid
Nasal lesion in an infant ddx
- nasal glioma (extend through patent foramen cecum in ant cranial fossa, but separate from brain tissue, nonenhancing, diffusion restrict)
- nasal dermoid/epidermoid (nonenhancing, may contain fat)
- infantile hemangioma (vascular)
- encephalocele
- dacrocystocele
Big f#cking mass in the abdomen ddx (child)
- neuroblastoma
- nephroblastoma
- lymphoma
- hepatoblastoma
- mesenchymal hamartoma
- sarcoma
Choanal atresia associations
- CHARGE (coloboma, heart defect, atresia of choana, retarded growth, genitourinary anomalies, ear anomalies)
- Crouzon
- DiGeorge
- Treacher Collins
- fetal alcohol syndrome
CHARGE syndrome most common association
Pediatric chest tumor ddx
- inflammatory myofibroblastic tumor (aka inflammatory pseudotumor, benign, most common primary lung mass, calcified, lower lobe, T2 bright myxoid)
- Neuroblastoma (posterior mediastinum, calcify, MIBG avid)
- Ewing sarcoma (includes Askin tumor)
- Pleuropulmonary blastoma (can look like CPAM, involve pleura, don’t invade chest wall)
- lymphoma
- rhabdomyosarcoma
Remember, however, that a round density in the lung parenchyma on CXR is almost always round pneumonia in kids, and a common trick to make you call a mass lesion
neonatal bowel obstruction (proximal) ddx
- malrotation w/midgut volvulus
- duodenal atresia, web, annular pancreas
- jejunal atresia
neonatal bowel obstruction (distal) ddx
- Hirschprung disease
- meconium plug syndrome
- meconium ileus
- ileal, colonic, anal atresia
Abdominal pain in an older child ddx
- appendicitis (and its mimic mesenteric adenitis)
- adhesions
- intussusception
- inguinal hernia
- Meckel diverticulum
- midgut volvulus
- distal intestinal obstruction syndrome (adults and kids non compliant with pancreatic enzymes)
things to think about when reviewing any imaging…
Intramedullary spinal cord mass ddx
- ependymoma (hemosiderin caps)
- astrocytoma (identical imaging to ependymoma)
- lymphoma
- hemangioblastoma
- cavernoma
always assess relationship to dura and spinal cord to place tumor and narrow ddx
