Peds Flashcards
Infant with bilateral calcified orbital lesions, pineal gland lesion and drop met
Trilateral Rb
–can get bilateral calcified orbital masses, and the ‘tri’ in trilateral is pineal involvement (rare, ~5%)
–>retinal astrocytoma can be bilateral and calcify (in tuberous sclerosis) but would have ependymal tubers and no pineal/leptomeningeal involvement
Dumbbell shaped mass extending from intra-abdominal into large exophytic perineal mass in a newborn.
may have cystic elements
sacrococcygeal teratoma
–> high rate of in utero hydrops and hemorrhage –> can be controlled at birth with immediate resection of exophytic component
rhabdomyosarcoma can also present as large pelvic mass but would be older child (2-6 years) and wouldn’t extend into perineum
infantile fibrosarcoma can have solid and cystic components in a newborn but more often in head/neck and extremities
suprasellar mass in a child w/cystic components, calcs, foci of T1 shortening that are not fat but proteinaceous fluid, and some enhancement
Craniopharyngioma
9% of peds intracranial neoplasm
peak 8-12yo, p/w sx of hydrocephalus or mass effect
adamantinomatous subtype seen in peds
–> germinoma is another suprasellar mass, but usu is more solid than cystic and p/w diabetes insipidus
–>hypothalamic-chiasmatic glioma usu a/w neurofibromatosis (lower grade)
areas of atalectasis, barotrauma, and ropelike opacities in a newborn term infant
Meconium Aspiration
–> neonatal pneumonia can also happen in term babies but is more focal and no barotrauma + pleural effusions
–> TTN also in term babies but w/Csx bc it’s retained fetal fluid
premature baby w/diffuse GGO, lack of pleural fluid and low lung volumes
RDS/Surfactant deficiency disease
TTN, neonatal PNA, and meconium aspiration tend to have hyperinflated lungs
Chiari II malformation
Sagittal T2WI MR shows an inferiorly herniated cerebellar vermis below the foramen magnum, an elongated and flattened 4th ventricle , a low-lying cervicomedullary junction with kinking , an upper cervical spinal cord syrinx , a towering cerebellum , and an enlarged massa intermedia, tectal beaking, stenogyrea (elongated and flattened gyri), dysgenesis fo the corpus callosum
result of myelomeningocele w/CSF loss and ‘sump’ type effect on posterior fossa
Chiari I Malformation
isolated low lying cerebellar tonsils
usu don’t need surgery
occasionally has a syrinx
Club Foot (talipes equinovarus)
M>F, 50% bilateral
4 components: hindfoot varus, calcaneus equinus *(en pointe), metatarsus adductus, and talonavicular subluxation
Rocker Bottom Foot
A/w TS18, TS13, 18 Deletion, spina bifida, arthrogriposis
components: fixed equinus (rigid flat foot)
vertical talus *they both look en pointe
forefoot valgus
Metatarsus adductus
hindfoot is fine in this one, they usually self resolve
MC than clubfoot
Caffey disease (infantile cortical hyperostosis)
self limited
flat bones MC mandile > clavicles > scapulae
in long bones only affects diaphysis –> bone becomes spindle shaped
^ uptake bone and Gallium scans in acute phases
Nephroblastomatosis
multifocal/diffuse nephrogenic rests–> persistence of metanephric blastema
precursor to wilms
Associated with: BW, WAGR, and hemihypertrophy
kiddo
NEHI
Neuroendocrine Cell hyperplasia of Infancy
one of the peds ILDs
Central GGO, lingular and RML MC
Canal of Nuck Hydrocele
On US can just look like a cyst in the labia
*analogous to patent processus vaginalis in male
ddx includes indirect inguinal hernia +/- bowel or ovary
vascular paratesticular mass in a kiddo
think of?
Rhabdomyosarcoma
comes from epididymis or cord
Klippel Feil syndrome
vertebral segmentation anomalies (more than two)
short neck, low hairline and restricted neck motion
A/w sprengel deformity (congenital elevation of the scapula)
Mesenchymal hamartoma
Classically large, cystic mass w/internal septations
2nd MC benign hepatic tumor after hemangioma
AFP ^
If more solid can confuse w/hepatoblastoma
infantile hemangioma
lesion composed of large endothelial-lined vascular channels seen in fetuses and neonates
can p/w kasabach merritt syndrome or p/w unexplained HOHF if not detected in utero
rapid proliferative growth first 6mo of life then involute
**Congenital and acquired (congenital more likely to be single, skin, acquired more likely to be multiple and check the liver)
rapidly growing vascular tumors in peds can cause what syndrome
kasabach merritt
thrombocytopenia, microangiopathic hemolytic anemia and consumptive coagulopathy.
well defined heterogenous mass, hypointense in a ped
Hepatoblastoma
MC primary malignant liver tumor in peds <4
^ AFP and painless abd mass
Most sporadic but can be a/w BW, hemihypertrophy
patient under 15 w/normal AFP levels
undifferentiated embryonal sarcoma
Rare
a kiddo
Subpleural cysts
A/W
Down’s syndrome
Truncated sacrum and inability to pass NGT
Caudal Regression Syndrome
results from hypogenesis of the embryologic caudal cell mass.
more severe type (type 1, seen here) = shortened vertebral column with high position of a truncated conus medullaris. Higher likelihood severe associated anomalies like VACTERL, omphalocele and currarino triad (anal atresia and presacral mass)
type 2= tethered cord with low conus position.
VACTERL sequence (vertebral anomalies, anal atresia, cardiac anomalies, tracheoesophageal fistula, esophageal atresia, renal anomalies, and limb malformations),
Pilomatricoma
peds -benign neoplasm of hair follicle cells
painless hard mobile mass in an area where there is hair
*often calcified, at junction of dermis and subcutaneous fat
granuloma anulare
usually over the anterior tibia
no specific imaging findings
bascially just inflammation of the subcutaneous tissues
–>on US-ill defined mass, hypoechoic to fat.
Neuroblastoma
primitive neural crest cell malignancy, comes from sympathetic chain usually adrenal
~2 years average
suprarenal mass, 50% have calcifications
*often invades neural foramina and spinal canal
+on MIBG (I-123)
Mets 75%– bone marrow (permeative, lytic)
Classic px: intracranial, subdural mass arising from marrow
mesoblastic nephroma
benign tumor arising from persistent metanephric blastema, removed bc cannot be diffx from Wilms on imaging
kiddos under 1 year (early for wilms)
**DO NOT confuse with multilocular cystic nephroma (cystic renal mass w bimodal age distribution, not related to metanephric blastema)
multilocular cystic nephroma
mixed epithelial and stromal cell tumor
Does NOT arise from mesonephric blastema and not related to mesoblastic nephroma
cystic renal neoplasm–young boys and middle aged women
Canal of Nuck Hydrocele
**may not be able to diffx from inguinal hernia on US
ganglioneuroma/ganglioneuroblastoma
benign neorgenic tumor –looks similar to neuroblastoma on imaging
slightly older children (6 years avg)
+ MIBG
don’t have restricted diffusion
Most common causes of diffuse cerebral swelling in kiddos
Hypoperfusion with anoxic-ischemic injury
trauma with vasodilation/hyperemia
and diffuse axonal injury
**make sure to look for herniation patterns
Medulloblastoma
classically arises from the roof of the 4th ventricle in the posterior fossa midline and is hyperdense on NECT (90%)
corresponding intermediate T2 signal (isointense to gray matter) due to hypercellularity (may also cause restricted diffusion).
>90% enhance.
Drop metastases may occur.
best clue in this case is the anterior displacement of the residual 4th ventricle, suggesting an origin of the tumor from the 4th ventricular roof.
Ependymoma
soft or “plastic” tumor (“toothpaste lesion”, classically arises from the floor of the 4th ventricle and extends out through the foramen of Magendie and Luschka.
more likely to contain foci of hemorrhage or calcification as compared to other pediatric 4th ventricular neoplasms.
does not usually show restricted diffusion.
Drop metastases may occur.
Peak age is 1-5 years.
Atypical Teratoid/Rhabdoid Tumor
follows a medulloblastoma in imaging features but classically seen in children less than 3 years
off-midline location is more typical, including the cerebellopontine angle.
Forty percent are supratentorial.
Unlike medulloblastoma, prognosis is dismal
JPA
variety of appearances
including a solid heterogeneously enhancing mass
classic appearance = off-midline posterior fossa mass that is largely composed of a cyst with an enhancing mural nodule
Peak age is 5-15 years.
T1 Fat Sat post con
Dysgenesis of the corpus callosum
with associated interhemispheric lipoma in this case (variable, can also have midline cyst)
Best clue on imaging is appearance of lateral vents:
widely spaced frontal horns of the lateral ventricles, parallel ventricular configuration and colpocephaly.
7yo with fever and pain
Ewing sarcoma
often presents with pain and swelling at the affected site with associated fever and fatigue.
permeative pattern of osseous destruction
Skeletal scintigraphy shows increased activity, which is typical as photopenic lesions are present only if the tumor is very aggressive.
Caffey disease should have more periosteal reaction
fever and wheezing
RSV bronchiolitis
Hyperinflation, geographic subsegmental areas of opacity and volume loss are classic (RUL in this case with mediastinal/thymic shift)
Bilateral enlarged hypoechoic
Double aortic arch
What are the findings and diagnosis in a 5 year old patient
Absent perfusion in the lateral left femoral head
Legg-Calve-Perthes disease
Usually dx radiographs with findings of AVN–on NM bone scan will see absent perfusion
and on MR we see absent enhancement in lateral FH with increased enhancement medically on the left, from adjacent edema.
present with limp over weeks-months
F 4-8 years, M 5-10
