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Peds > Peds Chest and Abdomen > Flashcards

Peds Chest and Abdomen Flashcards

1
Q

Meconium Aspiration

A

Term babies

Hyperinflation (ball-valve –> air trapping)

Coarse, Reticular, Ropy asymmetric perihilar opacities

NO AIR BRONCHOGRAMS

Risk of PTX

Mortality from severe CLD and Pulm HTN

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2
Q

RDS/Hyaline Membrane Disease

A

Premature

Surfactant Deficiency –> lung collapse

HYPOinflation

Bilateral GRANULAR opacities

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3
Q

TTN

A

Coarse Interstitial markings

Fluid in fissure

+/- Small Pleural Effusions

Normal to HYPERexpanded lungs

Starts at 6h, peaks at 1 day, resolved by 3 days

Seen in:

C-sections, sedated moms, & with DM

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4
Q

PIE

A

Pulmonary Interstitial Emphysema

Patient on Vent- air dissects out of alveoli into interstitium

Risk of PTX

Can progress to large cystic masses/bullae –> amss effect on mediastinum

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5
Q

PIE Treatment

A

Place Affected side Down

Change Vent settings- oscillating/high frequency

  • lower TV
  • higher RR
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6
Q

Bronchopulmonary Dysplasia

A

Chronic Lung disease (BPD)

Premature, tiny babies

Too long on Vent

2 weeks of Vent –> hazy lungs –> coarse opacities after a few months –> *bubble-like lucencies* or *Band-like opacities*

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7
Q

Sequestration

A

NO CONNECTION TO BRONCHIAL TREE or PAs

Blood supply from branch off aorta

Intra or Extra Lobar

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8
Q

INTRA-lobar Sequestration

A

Recurrent Pna’s in adolescents/young adults

Usually LLL (2/3) or RLL (1/3)

Does NOT have own Pleura

Drains via Pulm Vein into Left Atrium

No associated Devo Abn’s

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9
Q

EXTRA-lobar Sequestration

A

Presents in infancy

90% in LLL

10% Subdiaphragmatic

Drains via SYSTEMIC veins into Rt Atrium (via IVC or azygos)

Feeding artery can come from outside (i.e. below diaphragm)

Has EXTRA stuff

  • Pleura
  • Associated Developmental Abns
    • Cardiac Abns
    • CCAM aka CPAM
    • CDH and/or Pulm Hypoplasia
    • Vertebral Anomalies
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10
Q

CCAM aka CPAM

A

Congenital Pulmonary Airway Malformation

OR

Congenital Cystic Adenomatoid Malformation

  • Affects ONE lobe (any lobe)
  • Communicates with Airway (unlike Sequestration)
    • Air trapping 2/2 ball valve because adenomatoid tissue is in airways
  • NOT supplied by systemic artery (that is a Sequestration)
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11
Q

CPAM Types

A

Type 1

  • Most common
  • large cysts, 1 or more (1-10 mm)
  • malignancy risk

Type 2

  • Small cysts, multiple (0.5-1.5 mm)

Type 3

  • Microcysts, numerous (appears solid)
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12
Q

Congenital Lobar Emphysema (CLE)

A

Progressive Overinflation 2/2 Air trapping (more and more lucent lung over time)

Affects LUL (40%)

Also RML and RUL can be affected

Associated with Aberrant Left PA (pulm sling)

Assoc with Congenital Heart Defects (VSD, PDA, TOF)

Tx - Lobectomy

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13
Q

Swyer James Syndrome

A

Unilateral Lucent Hemithorax

2/2 Post infectious obliterative bronchiolitis (adenovirus or Mycoplasma) in infancy/young child

Looks like CLE but with Hx of infection

Affected lung tends to be smaller than the other

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14
Q

Neuroblastoma Locations

A

Adrenal Gland most common

Extra-adrenal RP

Posterior mediastinum/paravertebral symp chain (most common posterior mediastinal mass in kids under 2 yo)

Neck and Pelvis are least common

Likes to grow into neural foramina

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15
Q

Neuroblastoma Mets

A

Liver and Bone

Posterior mediastinal mass can involve ribs and vertebral bodies

Stage 4S = NB with mets confined to liver, skin, and bone marrow in a patient under 1 yo- better prognosis

If over 1 yo - just stage 4

If mets anywhere else in a child under 1 yo –> stage 4

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16
Q

Neuroblastoma Characteristic Feature

A

Calcifications!

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17
Q

Pepper Syndrome

A

Neuroblastoma with hepatomegaly 2/2 innumerable liver mets

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18
Q

Hutchinson Syndrome

A

Neuroblastoma with skeletal mets - particularly skull resulting in PROPTOSIS

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19
Q

Blueberry Muffin Syndrome

A

Neuroblastoma wth multiple skin mets (blue subQ nodules)

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20
Q

Opsoclonus Myoclonus Syndrome

A

Dancing eyes and feet related to inflammatpry/autoimmune Neuro d/o

Often paraneoplastic - strong assoc with Neuroblastoma

Dancing eyes, myoclonic jerks, cerebellar ataxia

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21
Q

Askin Tumor

A

PNET of the Chest Wall

Part of Ewing Sarcoma Spectrum

Heterogeneous with enhancing solid portions

Displaces structures then when it gets big – eats up rib

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22
Q

Pediatric Large Posterior Mediastinal Mass DDx

A
  • Over age 10
    • PNET/Ewing’s (with eaten up rib) - malignant
    • Ganglioneuroma (round)- benign
    • NFs - benign
    • Neurenteric cyst- benign
    • Extramedullary hematopoiesis- benign
  • Under age 10 - Neuroblastoma
  • Under age 2 - Pleuropulmonary blastoma
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23
Q

Neurenteric Cyst

A

Posterior mediastinum

No commonucation with CSF

Fluid attenuation

Assoc. with Vertebral Anomalies

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24
Q

VACTERL

A

Vertebral Anomalies

Anus (imperforate)

Cardiac

Tracheo - Esophageal fistula

Renal

Limb

Heart and kidneys most affected

If both limbs –> usually BOTH kidneys too

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25
Q

CHARGE

A

Coloboma (eye abnormality failure of choroidal fissure)

Heart Defects

Atresia (Choanal)

Retardation

Genital Hypoplasia

Ear Abnormalities

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26
Q

Vascular Rings and Slings (list)

A

Double Aortic Arch

R Aortic Arch w/ aberrant L Subclavian

L Arch with Aberrant R Subclavian

Anomalous L PA arising from the R PA (pulm sling)

Innominate Artery Syndrome (controversial)

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27
Q

Double Aortic Arch Findings

A

Posterior Impression on esophagus

Right arch is bigger than Left

Presents early with Stridor

Most common vascular ring- compresses trachea anteriorly, esophagus posteriorly

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28
Q

Branchial Arch defect causing Double Aortic Arch

A

Both left and right arches arise from LEVEL 4 Branchial arches

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29
Q

Findings of R Arch with Aberrant L Subclavian

A

Posterior impression on esophagus by Aberrant L Subclavian which courses R to L behind esophagus

R arch indents trachea anteriorly/right

Ring completed by Ligamentum Arteriosum

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30
Q

L arch and Aberrant R Subclavian Findings

A

NOT A RING OR A SLING

Posterior impresson on ESOPHAGUS

Dysphagia Lusoria

NO STRIDOR

Assoc with Diverticulum of Kommerell

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31
Q

Pulmonary Sling findings

A

ANTERIOR impression on ESOPHAGUS

L PA is abberrant and arises from R PA

L PA courses R –> L BETWEEN Trachea and Esophagus

Ligamentum arteriosum completes the ring

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32
Q

Innominate Artery Syndrome

A

Large thymus –> Innominate artery presses anteriorly against trachea

Controversial if actually causes breathing problems

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33
Q

Low Bowel Obstruction DDx

(neonates)

A

Long Microcolon

  1. Meconium Ileus
  2. Distal Ilial Atresia

Caliber Change

  1. Colonic atresia
  2. Imperforate Anus
  3. Meconium Plug Syndrome
  4. Hirschsprung disease
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34
Q

High Bowel Obstruction DDx

(neonate)

A

Midgut volvulus/malrotation

Duodenal atresia

Duodenal web

Jejunal atresia

Annular pancreas

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35
Q

Duodenal Atresia

A

Double Bubble Sign

No distal gas

Cannulation error

Associated with:

Down syndrome

Polyhydramnios

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36
Q

Double Bubble DDx

A

Congenital

  1. Duodenal Atresia
  2. Duodenal web
  3. Annular pancreas
  4. Midgut volvulus

External

  1. Choledochal or mesenteric cyst
  2. Intramural duodenal hematoma
  3. RP tumor
  4. SMA syndrome
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37
Q

Triple Bubble Sign

A

Jejunal atresia

2/2 vascular insult in utero

Multiple atresia = vascular error

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38
Q

Double bubble with distal gas

A

Duodenal Web/stenosis

Annular pancreas

Midgut volvulus

39
Q

Meconium Ileus

A

Mostly CF patients

Meconium obstructs at distal ileum

Filling defects/obstruction on Fluoro

Tx = enema

40
Q

Meconium Plug Syndrome

A

aka “Small Left Colon”

Transient functional obstruction

Filling defects in transverse colon

Tx = contrast enema

NOT ASSOC with CF

Seen if Mom had DM OR if Mom got MgSO4

41
Q

Distal Ileal Atresia

A

Vascular insult in utero

Contrast won’t reflux into ileal loops.

Tx = surgery

42
Q

Currarino Triad

A

Anorectal malformation (imperforate anus)

Sacrococcygeal agenesis/defect

Presacral Mass (anterior meningocele or teratoma)

43
Q

Imperforate Anus Associations

A

Tethered cord

VACTERL

Fistulas to GU tract

44
Q

Imperforate Anus Fistulas

A

High IAs in boys fistulize to bladder or posterior urethra

LOW in boys — perineum

High IA in girls - vagina or vestibule

Low in girls = perineum

45
Q

Hirschsprung Disease

A

Affected portion of colon = Small caliber

Innervated portion = dilated

Dx by Rectal Bx

Contrast Enema shows Rectosigmoid ratio < 1 or Sawtooth pattern of rectum (2/2 spasms)

46
Q

Total Colonic Aganglionosis

A

Rare variant of Hirschsprung

Looks like Microcolon BUT ALSO AFFECTS THE TERMINAL ILEUM

47
Q

Obstruction DDx in Older Children

A

AIM (AA-II-MM)

Appendicitis

Adhesions

Inguinal Hernia (1 month to 1 yo boys)

Intussusception (3 months –> 3 years)

Meckel’s Diverticulum

Midgut Volvulus

48
Q

Small Bowel-Small Bowel Intussusception

A

<2-2.5 cm in diameter

If length >3.5 cm –> Surgery consult bc less likely to resolve spontaneously

49
Q

Meckel’s Diverticulum

A

Persistent Vitelline duct

2% of population

2 types of mucosa = gastric and pancreatic

2 feet from ileum

2 inches long and wide

Under 2 yo

Dx - Tc-pertechnicate scan (after Pentagastrin, Ranitidine, Glucagon)

50
Q

Complications of Meckel’s Diverticulum

A

GI bleed (gastric mucosa)

Diverticulitis (mimics appendicitis)

Intussusception

Obstruction

51
Q

Midgut volvulus - 3 appearances on Upper GI

A
  1. Duodenum to R of midline (malrotation)
  2. Corskscrew duodenum
  3. Complete duodenal obstruction (looks like double bubble)
52
Q

Pyloric stenosis

A

Projectile, bilious vomiting

Age 2 weeks - 3 mos

>3 mm thick (hypoechoic part of one wall only)

>14 mm long

(or 4 mm and 16 mm)

XR = caterpillar sign (gastric contractions)

Paradoxical aciduria

Ddx = Pylorospasm

53
Q

Gastric Volvulus Types

A

Organoaxial - greater curvature flips over lesser along long axis (OLD ladies with paraesophageal hernias)

Mesenteroaxial - Stomach twists over mesentery (short axis), antrum flips near GE junction–> can cause ischemia and obstruction (KIDS)

54
Q

Duodenal Web

A

Bilious vomiting

Double Bubble in neonate

Windsock Deformity on Fluoro

Assoc with Downs Syndrome

55
Q

Cause of Annular Pancreas

A

failure of ventral bud to make full rotation with duodenum –> encasement of duodenum

Circumferential narrowing of duodenum on Fluoro

56
Q

Meconium Peritonitis

A

Sterile peritoneal reaction to bowel perf in utero

Results from atresia or meconium ileus

CALCIFIED MASS IN MID ABDOMEN on AXR

Can reult in adhesions or psuedocysts –> obstructions

57
Q

Enteric Duplication Cyst

  • locations
  • Rads findings
  • Associations
  • DDx
A

Ileial region, esophagus, and duodenum

50+% contain gastric or panc tissue

US - cyst in abdomen with alternating bands of hyper and hypoechoic signal –> diff layers of bowel (gut signature)

Without gut signature –> Omental Cyst (DDx)

Assoc with vertebral anomalies

58
Q

Cause of distal ileal obstruction in older kids

A

CF kids not taking pancreatic meds –> thick stools

AKA “grown up meconium ileus”

59
Q

Necrotizing Enterocolitis Risk Factors

A

Occurs in preemies and kids with heart problems

First 10 days of life

low birth weight

perinatal asphyxia

Hirschsprung

Hyperosmolar feeds

UACs (thrombosis risk)

Breast milk - decreases risk

60
Q

NEC imaging findings

A

Pneumatosis, PV gas

Focal, fixed dilated (tubular) loops of bowel (esp RLQ because TI and cecum most affected)

Featureless bowel with separation (edema)

Unchanging BG pattern over several days (TESTED)

61
Q

Gastroschisis

A

RIGHT Paraumbilical defect

NO surrounding membrane

NO assoc. anomalies

Elevated maternal AFP (more than omphalocele)

Reflux after repair

62
Q

Omphalocele

A

THROUGH umbilicus, midline

Has on membrane Over it

Assoc with Other abnormalities

63
Q

Omphalocele Associations

A

Trisomy 18, Turner’s, Klinefelter, Beckwith-Wiedemann

Cardiac (50%)

Other GI

CNS

GU

Umbilical cord cyst

Allantoic cysts

64
Q

Physiologic Gut Herniation

A

Normal

Occurs at 6-8 weeks in utero during organogensis

bowel herniates out through umbilicus to grow outside abd cavity (grows faster than abd cavity)

270 degree COUNTERclockwise rotation when going back in

Can only dx as abn in 2nd/3rd Tri

If contains LIVER– always abnormal, even in 1st Tri

65
Q

Small Left Colon

A

aka Meconium Plug Syndrome

Narrowed distal colon with more proximally dilated loops

Preemies

Mothers got MagSulfate

Mothers with DM

Tx - contrast enema

66
Q

Amyand hernia

A

appendix through inguinal canal

67
Q

Richter hernia

A

One wall of Sm. Bowel protrudes

68
Q

Spigelian Hernia

A

Lateral wall hernia along semilunar line

lateral to Rectus Abdominis

69
Q

Mesenteric Adenitis

A

Viral, inflammatory

self limiting

Cluster of large RLQ LNs on US

Mimics appendicitis

70
Q

Pediatric Liver Tumor DDx

A

Age 0-3 yo

  1. Infantile Hemangioendothelioma
  2. Hepatoblastoma
  3. Mesenchymal Hamartoma

Age > 5 yo

  1. HCC (kids with biliary atresia, Fanconi, Glycogen storage), elevated AFP
    1. Fibrolamellar HCC - patients under 25, no cirrhosis
      1. Central scar is T2 dark unlike FNH
  2. Undifferentiated Ebryonal Sarcoma

Any age

  1. Mets from Wilm’s or Neuroblastoma
  2. Normal things- hepatic adenoma, hemagiomas, FNH, Angiosarcoma
71
Q

Infantile Hemangioendothelioma

A

Under 1 yo

Assoc. High output cardiac failure

CXR- large heart + liver mass

  • Single large mass OR Multifocal OR diffuse
  • Peripheral enhancement on arterial, progressive fill in (technically hemangiomas)
  • Celiac artery dilated more than infraceliac aorta

Tx- propanolol (like any hemangioma)

Most involute spontaneously as they calcify

72
Q

Infantile hemangioendothelioma Associations

A

Kasabach Merritt Syndtome (hemangioendothelioma eats up platelets –> bleeding and bruising)

50% have skin hemangiomas

VEGF may be elevated

73
Q

Hepatoblastoma

A

Under 5 yo

Painless RUQ mass + Distension (+/- jaundice)

Well circumscribed solitary mass - often Right hepatic lobe

  • US - hypo/isoechoic mass with SPOKE WHEEL appearance (fibrous septa +/- chunky calcs)

May extend into PVs, HVs and IVC

50% have calcifications

  • Mets to lung (doesn’t r/o surgery)
  • Sensitive to chemo
74
Q

Hepatoblastoma associations

A
  • Beckwith-Weidemann
    • (hemihypertrophy, big tongue, enl. liver/spleen, cardiac abn’s, omphalocele, otic dysplasia, neonatal hypoglycemia, facial nevus flammeus)
  • Wilm’s tumor
75
Q

Mesenchymal Hamartoma Features

A

Predominantly cystic (can be multiple cysts)

Developmental anomaly

AFP normal

Calc’s are rare

Large PV feeding branch

Small risk of malignant degen so surgically remove

76
Q

Types of Choledocal cysts (Todani)

A
  • Type 1
    • focal CBD dilatiaton
  • Type 2
    • Saccular outpouching off CBD
  • Type 3
    • Choledococele (at ampulla)
  • Type 4
    • Intra and extrahepatic
  • Type 5 (Caroli)
    • Intrahepatic only
77
Q

Presentation of Choledocal cyst

A

Young

Recurrent abdominal pain

+/- weight loss

+/- fever

78
Q

Caroli Disease

A

Intrahepatic ductal dilation - large and saccular

Central Dot Sign = PV surrounded by dilated ducts

Cysts connect with biliary system

79
Q

Associations of Caroli Disease

A

PCKD

Medullary Sponge kidney

80
Q

Osler-Weber-Rendu

A

HHT

Hereditary Hemorrhagic Telangiectasia

Multiple AVMs in liver and lung

leads to cirrhosis and dilated hepatic artery

Lung AVMs–> brain abscesses

Lung AVM treated when afferent vessel >3mm

81
Q

Biliary Atresia

A

Prolonged jaundice >2 weeks

Abnormal or absent GB, can get gallstones

Cirrhosis if not treated

Kasai procedures before 3 months old

Absence of extrahepatic biliary system

82
Q

Biliary Atresia on Imaging

A

Triangle.Echogenic cord sign - triangular or linear echogenic structure in front of PV = hepatic duct remnant

**Do cholangiogram and bx to confirm (r/o Alagille Syndrtome)

HIDA scan – give phenobarb for 5 days before

99m-Tc-IDA

83
Q

Biliary Atresia associations

A

Polysplenia

Trisomy 18

84
Q

Alagille Syndrome

A

hereditary cholestasis from no intrahepatic ducts

Peripheral Pulm Artery stenosis

Absence of intra AND extra hepatic ducts

85
Q

ARPKD

A

Cysts in kidney

Fibrosis in liver - usually worse if kidneys are less cystic (and vice versa)

Initial XR- wide abdomn

86
Q

Schwachman-Diamons Syndrome (SDS)

A

Pancreatic insufficiency (2nd most common cause after CF)

Short stature (S)

Diarrhea (D)

Eczema (S = skin)

Lipomatous pseudohypertrophy of pancreas

87
Q

Dorsal Pancreatic Agenesis

A

Dorsal bud of pancreas doesn’t form –> no tail

Ventral bud only –> head

Increased risk of DM because most beta cells are in tail

Assoc with POLYSPLENIA

88
Q

Pediatric Pancreatic Masses

A

Age 1 - Pancreatoblastoma

Age 6 = Adenocarcinoma

Age 15 -Solid pseudopapillary tumor of Panc

89
Q

Pancreatoblastoma

A

Primary DDx in patient under 10

Beckwith Wiedemann increases risk

Large + calcifications + vessel encasement

Liver mets

90
Q

Situs Inversus Organ locations

A

Liver on L

Stomach on R

Minor fissure on L

Inverted bronchial pattern - airways run ABOVE the PAs (eparterial) except RUL bronchus where it is below (hyparterial)

Assoc with Primary Ciliary Dyskinesia

91
Q

Situs Ambiguus with Right Isomerism

A

Bilateral minor fissures

Absent spleen

Strong assoc with Cyanotic heart disease

92
Q

Situs Ambiguus with Left Isomerism

A

Absent minor fissues

Interrupted IVC

Polysplenia

Assoc with Biliary Atresia in 10%

93
Q

Turner’s Syndrome Features/Associations

A

Cystic Hygroma

Aortic Coarctation

Bicuspid Ao valve

Horseshoe kidney

Short 4th metacarpals

IUGR

Hydrops fetalis

Short fetal limbs

Peds (3 decks)

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