Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/222

Click to flip

222 Cards in this Set

  • Front
  • Back
stridor, wheezing
upper airway obstruction
tracheal lesions
rings and slings
foreign bodies
asthma
upper airway obstruction
inflammation
epiglottitis (h.inf)
croup (rsv)
retropharyngeal abscess
exogenous
caustic ingestion
foreign body
extrinsic upper airway compression
thyroglossal duct cysts
branchial cleft cysts
other masses
bubbly lungs in neonates
bronchopulmonary dysplasia (most common)
pulmonary interstitial emphysema
cystic fibrosis
wilson-mikity syndrome
mass lesions in airways
lymphangioma and hemangioma may occur in any 3 locations

nasal cavity, nasopharynx
antrochoanal polyp
meningoencephalocele
angiofibroma
lymphadenopathy
neuroblastoma
rhabdomyosarcoma
oropharynx
lymphadenopathy
ectopic thyroid tissue
hypopharynx, larynx, or trachea
retention cysts
papillomas
neonatal lung masses
lung bases; cp angle obliterated
sequestration
cdh
ccam
hypoplastic lung (scimitar syndrome)
phrenic nerve paralysis
other lung zones
pulmonary tumor
neuroblastoma
pulmonary blastoma
pnet (askin tumor)
congenital lobar emphysema (only early in disease)
hyperlucent lung
large anterior pneumothorax (common)
congenital lobar emphysema
congenital lung cyst
bronchiolitis obliterans (swyer-james syndrome, not until > 7 yo)
obstructive emphysema
obstruction at the bronchiolar level-cf, ashtma, pneumonia, foreign body
extrinsic compression-rings and sligns, adenopathy, bronchogenic cyst
ccam
neonatal pnumothorax
pressure ventilation
interstitial pulmonary emphysema
pulmonary hypoplasia (fetal anurai syndrome, potter sequences, oligohydramnios)
solitary pulmonary nodule
congenital
bronchogenic cyst (common)-65% in long, 35% from tracheobronchial tree

sequestration
avm, varix
bronchial atresia
infection
round pneumonia, most common
granuloma
abscess cavity

tumor
primary-pnet, pulmonary blastoma
neuroblastoma, wilms' tumor mets
multiple pulmonary nodules
tumor
mets-wilms, teratoma, rhabdomyosarcoma, osteosarcoma
laryngeal papillomatosis (pulmonary lesions are rare)

infection
septic emboli
tb, fungus

inflammatory
wegeners disease (sinuses also involved)
pediatric interstitial pattern
congenital
storage disease-gauchers, neimann pick
lymphangiectasia

other common causes
viral pneumonia
bronchopulmonary dysplasia
hyaline membrane disease
histiocytosis x
pediatric chest wall tumors
common signs-pleural effusions, rib destruction, soft tissue density
eosinophilic granuloma
askin tumor (PNET)
neuroblastoma
met's
Ewing's sarcoma
Dilated stomach
hypertrophic pyloric stenosis
pylorospasm
antral web
antral gastritis
rare
duplication cysts
ectopic pancreatic tissue
polyps, neoplasm
double bubble sign of stomach
little or no gas distally

duodenal atresia-associated with downs-or stenosis, most common

annular pancreas, 2nd most common

duodenal diaphragm, bands
midgut volvulus
vascular
preduodenal vein
sma syndrome
rare
duplication cysts
adhesions
proximal bowel obstruction
neonates (congenital causes)
atresia/stenosis of small bowel
midgut volvulus
Ladd's bands
children (>1 year)
intussusception (most common)
incarcerated inguinal hernia (6-24 months)
perforated appendicitis
distal bowel obstruction
hirschsprung's disease
meconium plug syndrome
colonic atresia/stenosis
imperforate anus
meconium ileus
rare causes
volvulus
presarcral tumors
post-nec strictures
microcolon
diabetic mothers
maternal mgso4 use
unused colon
ileal atresia
mecononium ileus
total colonic hirschsprung's disease
pediatric pneumatosis intestinalis
necrotizing enterocolitis
less common causes (benign)
cystic fibrosis
collagen vascular disease
leukemia
milk intolerance
immunodeficiency
obstruction
steroid use
gasless abdomen
severe vomiting (most common)
gastroenteritis
appendicitis
impaired swallowing
esophageal atresia
neurologic impairment
mechanical ventilization (paralyzed bowel)
displaced bowel loops
bowel not in abdomen (hernia, omphalocele)
masses
ascites
abdominal calcifications
intraabdominal-meconium peritonitis (most common)
renal
neuroblastoma, wilm's tumor
nephrocalcinosis
renal cysts
urinary tract calculus
bowel-fecallith of appendix, meckel's
bladder-hemorrhagic cystitis (cytotoxan therapy)
adrena-hemorrhage, wolman's disease
cholelithiasis (ss)
liver-hepatoblastoma, granuloma
abdominal mass lesions in neonate (<1month)
renal 55%
hydronephrosis
mcdk

gastrointestinal 15%
duplication
meconium pseudocyst
pseudocyst proximal to atresia

retroperitoneal 10%
adrenal hemorrhage

genital 15%
ovarian cyst
hydrometrocolpos

hepatobiliary 5%
hemnagioendothelioma
choledochal cyst
abdominal mass lesions in older infants, children
renal 55%
wilms tumor
hydronephrosis

gastrointestinal 15%
appendiceal abcess
intussusception
neoplasm

retroperitoneal 25%
neuroblastoma

genital 5%
ovarian cyst
hydrometrocolpos

hepatobiliary 5%
hepatoblastoma
gastric filling defect
foreign bodies
lactobezoar, phytobezoars, trichobezoars

congenital anomalies
duplications
ectopic pancreatic tissue

inflammation, rare
crohns disease
chronic granulomatous disease

tumors, rare
hamartoma
peutz, jeghers disease
thick folds
submucosal edema
enteritis
submucosal tumor
lymphoma, leukemia
submucosal hemorrhage
henoch-schonlein purpura
HUS
coagulopathies
gi hemorrhage
meckel diverticulum
juvenile polyps
ibd
portal hypertension
pediatric liver lesions
benign
cysts
hemangioendothelioma
mesenchymal hamartoma
malignant
hepatoblastoma
hemangioendothelioma (neonate)
hepatocellular carcinoma if underlying liver disease (glycogen storage disorders, phtn)
mets from wilms tumor or neuroblastoma
fatty liver
chronic protein malnutrition (most common)
congenital
cystic fibrosis
glycogen storage disease
wilsons disease
galactosemia
fructose intolerance
reye's syndrome
hepatitis
drugs-chemotherapy, steroids, hyperalimentation
pediatric cholelithiasis
hemolysis
sickle cell anemia
thalassemia
splenocystosis
other
cystic fibrosis
drugs-furosemide
metabolic disorders-hyperparathyroidism
premature infants with hyaline membrane disease
hydrops of gallbladder
sepsis
burns
leptospirosis
kawasaki's disease
cholecystitis
sickle cell
hemolytic anemia
biliary strictures
pancreatitis
gallstones
ascending cholangitis
post-kasai procedure
liver transplant
fatty replacement of pancreas
cystic fibrosis
schwachman-diamond syndrome
metaphyseal dysplasia
cyclic neutropenia
pancreatic fatty replacement
flaring of ribs
pediatric pancreatitis
trauma
viral infection
sepsis
idiopathic
anomaly
drugs (steroids, etc)
metabolic
cystic fibrosis
hyperlipidemia
cystic renal masses
cystic disease
arpckd
mcdk
multilocular nephroma
cysts associated with phakomatoses
vh
ts
other cystic disease

tumors
cystic wilms tumor
cystic adenocarcinoma
hydronephrosis
most common abdominal mass in neonates
reflux
upj obstruction
uvj obstruction
ectopic ureterocele
posterior urethral valves
prune belly
solid renal masses
wilms tumor-most common solid tumor in children, rare in newborn

mesoblastic nephroma-only solid renal mass in newborns

nephroblastomatosis-subcortical masses associated with wilms

angiomyolipoma, assoc with ts

secondary tumors
lymphoma
neuroblastoma
leukemia, diffuse bilateral enlargement

rare renal tumors
clear cell sarcoma
malignant rhabdoid
renal cell carcinoma
diffusely hyperechoic renal kidney in newborn
increased size
arpckd (bladder usually empty)
cmv glomerulonephritis (bladder may have some urine)
glomerular cystic disease
diffuse cystic dysplasi

decreased size
renal dysplasia from obstructive uropathy or necrosis
echogenic kidney (cortex similar to the spleen or liver with preserved corticomedullary differentiation)
ATN
glomerulonephritis
renal infiltration
glycogen storage disease
diabetes
renal vein thrombosis
leukemia
hiv
kawasaki disease
loss of normal corticomedullary differentiation
pyelonephritis, focal nephronia
infantile polycystic kidney
adult polycystic kidney
medullary cystic kidney
late renal vein thrombosis
medullary nephrocalcinosis
furosemide therapy
hyperparathyroidism
RTA
hypercalcemia or hypercalcuria
milk aklali
idiopathic hypercalcuria
sarcoidosis
hypervitaminosis D
oxalosis
medullary sponge kidney
congenital ureteric obstruction
primary megaureter
ureterocele (ectopic or orthotopic)
distal ureteral stenosis
ureteral atresia
circumcaval ureter
bladder diverticulum
adrenal masses
neonatal hemorrhage
neuroblastoma
rare
teratoma
adenoma
carcinoma
pheochromocytoma
other retroperitoneal masses
wilms tumor
hydronephrotic upper pole
retroperitoneal adenopathy
hepatoblastoma
splenic mass
cystic structure in or near bladder (us)
bladder
hutch diverticulum
urachal remnant (dome of the bladder)
normal "bladder ears" (incompletely filled bladder extends to femoral/inguinal canal)

ureter
ectopic insertion of ureter
ureterocele
megaureter

other
ovarian cyst
mesenteric, omental cyst
large abdominal cystic mass
lymphangioma (multiseptated noncalcified)

enteric duplication cyst (unilocular noncalcified with bowel signature)

meconium pseudocyst (unilocular containing echoes and debris)

choledochal cyst
adrenal hemorrhage
ovarian cyst
presarcral mass
rectal duplication
anterior meningocele
teratoma
neuroblastoma
interlabial mass
ectopic ureterocele
periurethral cysts
rhabdomyosarcoma of the vagina
prolapsed urethra
imperforate hymen
enlarged head (macrocephaly)
hydrocephalus (most common cause before closure of sutures)
communicating
noncommunicating

rate
subdural hematoma
calvarial abnormalities
benign macrocrania
chrondrodystrophies
brain abnormalities
beckwith-wiedemann syndr
hemiatrophy
cerebral gigantism
small head (microcephaly)
absent or atrophic brain (congenital infection, fetal alcohol syndrome)
craniosynostosis
shunt placement
thick skull
metabolic/systemic
healing stage of renal osteodystrophy
hyperparathyroidism (salt and pepper skull)
anemias

tumor
leukemia, lymphoma

other
chronic decreased intracranial pressure (shunts)
dilantin
dysplasia
fibrous dysplasia
engelmann's disease
lytic skull lesions
eg
leukemia, lymphoma
fibrous dysplasia
dermoid, epidermoid
hyperparathyroidism
normal intracranial calcifciation
choroid plexus calcification
habenula calcification
pineal gland calficiation
falx-dura, pacchionian bodies
hemangioblastoma calcifcation
abnormal intracranial calcifications

TIC MTV
Tumor
children-craniopharyngioma>oligodendroglioma>gliomas>other tumors
adults-meningioma>oligodendroglioma>ependymoma

infection
children-TORCH
adults-cysticercosis, TB

congenital, degenerative atrophic lesions
congenital atrophy or hypoplasia
tuberous sclerosis
sturge weber syndrome

metabolic
idiopathic hypercalcemia
lead poisoning
hypoparathyroidism
fahr's disease

trauma

vascular lesions
avm (vein of galen)
hematoma
aneurysms
enlarged sella turcica
tumor (most common)
craniopharyngioma
optic chiasm-hypothalamic glioma
less common-germ cell tumors, meningioma, pituitary adenoma

increased intracranial pressure
empty sella
nelson's disease
common pediatric bone tumors
primary
EG
ewing's sarcoma
osa
bone cysts
UBC (fallen fragment sign)
ABC (eccentric)
secondary
neuroblastoma mets
lymphoma
leukemia
tumors with fluid fluid level
ABC
telangiectatic OSA
giant cell tumor
single cysts with path fracture
widened joint space
joint effusion
septic arthritis
hemarthrosis (intraarticular fracture, hemophiliac)
transient toxic synovitis
JRA

synovial thickening without articular cartilage destruction
JRA
hemophiliac arthopathy
bowed bones

anterior and posterior bowing (fetal malposition) is always abnormal. anterior bowing maybe associated with medial and lateral bowing. isolated medial bowing is usually idiopathic
common causes of anterior bowing

metabolic
rickets
dysplasia
neurofibromatosis
osteogenesis imperfecta
fibrous dysplasia
diffuse pediatric osteopenia
rickets
hyperparathyroidism
immobilization
JRA
uncommon causes
infiltrative disease-gangliosidosis, mucolipidosis
same causes as in adults
diffuse dense bones in children
congenital
osteopetrosis
pyknodysostosis
melorheostosis
progressive diaphyseal dysplasia (engelmanns disease)
infantile cortical hyperostosis
idiopathic hypercalcemia of infancy (williams syndrome)
generalized cortical hyperostosis (van buchems disease)
pachydermoperiostosis

other
hypothyroidism
congenital syphillis
hypervitaminosis D
symmetrical periosteal reaction in children

can be physiological in first 6 months of life

TIC MTV
tumor
neuroblastoma
leukemia, lymphoma
infection
congenital infection-syphillis, rubella

congenital
caffeys disease (infantile cortical hyperostosis)
osteogenesis imperfecta

metabolic
hypervitaminosis A,D
prostaglandin E therapy
scurvy

trauma
battered child syndrome (subperiosteal hematoma)

vascular
bone infarctions (sickle cell)
periosteal reaction

SCALP
scurvy
caffey's disease
accident, hypervitaminosis A
leukemia, lues
physiological, prostaglandin inhibitors
deformed epiphysis
acquired (single epiphysis)
avn
lcp disease
steroids
trauma (ocd)
infection
hypothyroidism

congenital dysplasia (multiple epiphyses)
multiple epiphyseal dysplasia
myer's dysplasia
morquio's syndrome
enlarged epiphysis
most commonly caused by hyperemia associated with chronic arthritis

hemophiliac joints
JRA
chronic infectious arthritis
healed LCP disease
epiphyseal dysplasia hemimelia (Trevor's)
transverse metaphyseal lines

result of abnormal enchondral bone growth; undermineralization leadis to lucent lines and repair leads to dense lines, some diseases, dense and lucent lines coexist
lucent lines
neonates-stress lines (hypoperfusion of rapidly growing metaphyses of long bones) due to fever, congenital heart disease, any severe disease
>2 years consider tumors
neuroblastoma, mets
lymphoma, leukemia

dense lines
neonates-growth recovery lines
>2 yo
heavy metal poisoning (lead bands)
healing rickets
widened growth plate
>1mm

rickets (most common)
salter-harris type 1 fx
tumor-lymphoma, leukemia, neuroblastoma
infection-osteomyelitis
metaphyseal fragments
battered child-corner fx
trauma
blount's disease
osteomyelitis
vetebral plana
mets (neuroblastoma most common)

eg
leukemia, lymphoma
infection
trauma
generalized platyspondyly
osteogenesis imperfecta
dwarfism (thanatophoric, metatropic)
morquios syndrome
cushing syndrome
fused vertebrae
isolated fusions
klippel-feil syndrome (c2-c3 fusion, torticollis, short neck)
post-traumatic
large vertebral body or other abnormal shape
blood dyscrasia (expansion of red marrow)-sickle cell, thallasemia
atlantoaxial subluxation
down syndrome
morqios syndrome
JRA
trauma
disc space narrowing
common
infection-pyogenic, tb, brucella, typhoid)
block vertebra-congenital or acquired
scheuermanns disease
severe kyphosis or scoliosis

uncommon
congenital
cockayne
kniest dysplasia
morquio's
spondyloepiphyseal dysplasia

acquired
inflammatory arthritis
herniated disc
neuropathic arthropathy (syrinx)
trauma
enlarged disc space
osteoporosis
binconcave vertebra
gauchers disease
platyspondyly
sickle cell anemia
trauma
intravertebral disc space calcification
common
idiopathic (transient in children)
posttraumatic
uncommon
spinal fusion
ochronosis
aarskog syndrome
ankylosing spondylitis
cockaynes syndrome
homocystinuria
hpercalcemia
hyperparathyroidsm
hypervitaminosis D
infection
paraplegia
juvenile chronic arthritis
pediatric sacral abnormalities
meningocele
neurofibromatosis
presacral teratoma
agenesis
radial ray deficiency
absence of 1st and/or 2nd digits of hand; often involves radius

holt-orams syndrome (cardiac, chest wall anomalies)
polands syndrome
fanconis anemia
thrombocytopenia-absent radius syndrome
polydactyly
familial polydactyly
chondroectodermal dysplasia (ellis-van creveld syndrome)
trisomies 13-15
laurence-moon-bardet-biedel syndrome
abnormal 4th metacarpal
short metacarpal
normal variant
turners syndrome
pseudo, pseudopseudohypoparathyroidism
acrodysostosis
MED
growth arrest-sickle cell, infections
acquired
trauma, chronic arthritis

long metacarpal
macrodystrophia lipomatosa
neurofibromatosis
delayed bone age
systemic disease (most common)
hypothyroidism (cretinism, typical hypoplastic T12 and L1)
cyanotic congenital heart failure
chronic pulmonary disease

HGH deficiency (pituitary dwarfism)
isolated HGH deficiency
craniopharyngyoma, infections

peripheral tissue nonresponsive to HGH
african pygmies
turners syndrome
constitutional short stature
hemihypertrophy
enlargement of an extremity (rare)
intraabdominal tumors (frequently Wilms)
arteriovenous fistula
lymphangioma
isolated anomaly (idiopathic)
down syndrome
duodenal atresia
tracheoesophageal fistula, esophageal atresia
endocardial cushion defect
hirschsprungs disease
multiple sternal ossification centers
11 ribs
williams syndrome (idiopathic hypercalcemia)
aortic stenosis (supravalvular)
peripheral pulmonic stenosis
diffuse coarctation of abdominal aorta and stenosis of visceral branches
multisystem abnormalities
retardation
dentation abnormalities
elfin facies
beckwith wiedmann syndrome
macroglossia
visceromegally
gigantism
omphalocele
wilms tumor
premature infants
hyaline membrane disease
necrotizing enterocolitis
germinal matrix hemorrhage
periventricular leukoencephalopathy
PDA
urachal remnants
patent urachus (50%)
urachal cyst (30%)
urachal sinus (15%)
vesicourachal diverticulum (5%)

late complication mucinous adenoca-> resected
mullerian duct abnormalities in males
prostatic utricle
infants
hypospadias, incomplete testicular desent

mullian duct cysts not associated with other pelvic structures
can be associated with seminal vesicle cyst
cystic pelvic masses in children
dilated fluid filled vagina
transverse vaginal septum
dermoid (girls)
duplication cyst
mullerian duct cyst
hydronephrosis with megaureter in children
reflux megaureter
primary
primary reflux
prune-belly
secondary
neuropathic bladder
posterior urethral valve

obstructed megaureter
primary
stenosis (UVJ)
ureterocele
secondary
intrinsic obstruction (stone, clot)
extrinsic obstruction (tumor)

nonreflux, nonobstructed megaureter
primary
congenital
adynamic segment
secondary
infection
persistent after surgery
weigert-meyer rule
in duplicated collecting systems and ureters, the upper pole ureter is ectopic and often associated with an ureterocele and orifice inserts inferomedially in the bladder in relationship to the lower pole normal ureter which is prone to reflux
urolithiasis in children
chronic infection
metabolic disorders
hypercalcemia
hyperoxaluria
hyperuricosuria
congenital anomalies that cause obstruction
pediatric renal cystic disease
simple renal cyst
intrarenal
parapelvic

cystic medullary disease
nephronophthisis
medullary sponge kidney

polycystic renal disease
ADPCKD
ARPCKD-see striated nephrograms early on and then small multiple cysts as get older, pulmonary hypoplasia, inversely proportional to liver fibrosis and liver failure, if survive infancy

renal dysplasia
MCDK

cystic tumors
multilocular cystic nephroma
cystic wilms tumor

acquired renal cysts
infectious cysts
pyogenic cysts
chronic dialysis
simple renal cyst in children
very rare, so if you see it think of TS, VHL, caroli disease, and NF
striated nephrograms in children
infection
arpckd
medullary sponge kidney
Von Hippel Lindau Disease
AD
hemangioblastomas (brain, retina, spinal cord)
renal cysts + RCCs
type 1- no pheos
type II- pheos
pancreatic cysts, islet cell serous cystadenomas
tuberous sclerosis
adenoma sebaceum, seizures, mental retardation
renal cysts, AML
rhabdomyomas of the heart
cortical hamartomas and subependymal nodules, giant cell tumors
liver and pancreatic adenomas
multilocular cystic nephroma
bengin cystic part. diff. nephroma-baby boys (3m-4y)

thin septa, herniates into renal pelvis, septa enhance, bosniac 3

cystic nephroma-yong women

well-circumscribed multicystic renal mass, single multiloculated thickwalled cyst with enhancing septa

may have small foci of soft tissue, rim enhancement

microscopic foci of wilms or sarcoma

no mets

ddx
cystic wilms
cystic rcc
mcdk (segmental)-septation dont enhance
Wilms tumor
mean age 3 years
WT1 (11p13), WT2 (11p15.5)
5% bilateral
claw sign, pseudocapsule
calcifications, inhomogenous
enhances
tumor thromus in IVC
negative urine catecholamines
neuroblastoma
mean age 2 years
from adrenal gland/sympathetic chain
encases abdominal vessels, grows behind aorta
invades spinal canal
inhomogenous, ca++ in 40-60%
T1 hypo, T2 hyper
postivie MIBG
>90% +urine catecholamines
meosblastic nephroma
benign tumor, fetal renal hamartoma
spectrum from benign to malignant spindle cell sarcoma
most common renal tumor in neonates
complex abdominal mass, looks like wilms in baby <10 mo
nephroblastomatosis
mean age 3 years
WT1, WT2
often bilateral
specific appearance, 4 types
homogenous, well defined
does not enhance
no extension into renal vein or IVC

most regress, follow, however, can turn into wilms
solid renal or perirenal tumors of kids
wilms
neuroblastoma
mesoblastic nephroma
nephroblastomatosis
RCC
renal medullary carcinoma
renal medullary carcinoma
sickle cell disease
pediatric nose obstruction
anterior inlet stenosis-assoc with single central incisor, midline brain defects

choanal atresia

polyps

tumor

trauma

encephalocele

dacrocystocele
pediatric nasopharynx obstruction
adenoids-ie mononucleosis

lymphoma

abcess

juvenile angiofibroma-desnse enhancement, bone erosion, vascular, needs preembolization

teratoma

rhabdomyosarcoma
pediatric oropharynx obstruction
palatine tonsils-inf mono

peritonsillar abscess

macroglosssia

micrognathia

termatoma

lingual tonsil

thyroglossal duct cyst

ranula
pediatric supraglottic obstruction
epiglottitis

aryepiglottic fold cyst

hemangioma

lymphangioma
pediatric subglottic obstruction
croup

hemangioma
pediatric trachea obstruction
tracheomalacia/innominate artery impression

stenosis, congenital (complete cartilaginous rings)

stenosis, post-traumatic-granuloma, web

vascular ring/anomalous vessels

trachael foreign body

esophageal foreign body

lymphoma

granulomatuous disease

papilloma
double arch (right arch usually dominant)

right arch with anomalous left subclavian artery and ligamentum arteriosum
posterior tracheal narrowing

esophageal impression posteriorly
pulmonary sling
anomalous left PA from RPA

anterior esophageal impression/between trachea and esophagus

tracheal narrowing variable-associated with congenital tracheal stenosis/complete cartilaginous rings
innominate artery impression
not anomalous

anterior impression on trachea

occasionally causes sx along with tracheomalacia
agenesis-hypoplasia complex ie hypogenetic lung ie congenital pulmonary venolobar (scimitar) syndrome
agenesis, aplasia, hypoplasia

bronchial anomalies

anomalous pulmonary venous return "scimitar" appearance

associated anomalies-sequestration, cardiac, skeletal, diaphragm

horseshoe lung-part of spectrum, right lung crosses midline posteriorly, usually pleura separates r and l lung
congenital lobar emphysema
fluid-filled in utero, and initially at birth, but clears over time

inflated with air-mass effect

pulmonary vessels markedly attenuated

LUL, RML most common>rUL, 5% two lobes

CT hyperaeration with vascular structures

assoc with cv anomalies in 14-50%-pda, vsd, tof

ddx
bronchial atresia-hyperaeration plus bronchial impaction on CT
sequestration
intralobar
systemic arterial supply
pulmonary venous drainage
solid, cystic, air trapping

extralobar
systemic arterial supply
systemic venous drainage (occ. pulm., porta)
lower lobe L>R
above, at, or below diaphragm
associcated with other congenital malformations-hypoplasia/venolobar

occassionally systemic arteries are recruited to lung in chronic lung/pleural inflammation
bronchopulmonary foregut malformations
esophageal duplication

bronchogenic cyst
mediastinal>parenchymal
fluid filled>air filled

neuroenteric cysts-rare, vertebral anomalies

CCAM
type 1-large cysts, most common
type 2-small cysts
type 3-rare, solid
overlap with sequestration-systemic arteries
associated with pleuropulmonary blastoma

sequestration
brochiolitis obliterans
radiograph-hyperaeration or normal

unexplained respiratory symptoms

? prior infection (adenovirus not RSV) s/p bone marrow or organ transplantation

CT-mosaic pattern, small airway disease, asthma on CT has similar appearance

expiratory phase-air trapping

swyer james-unilateral lung, decreased pulmonary vascularity
pneumoperitoneum in a newborn
NEC

gastric perforation

isolated small bowel perf from intraurterine ischemic event

perf secondary to obstruction (hirschsprung, atresia, meconeum ileus)

iatrogenic colon perforation (thermometer, enema tip)

decompression of pneumothorax or pneumomediastinum
associations with malforation/midgut volvulus
congenital diaphragmatic hernia

omphalocele

gastroschisis

prune-belly syndrome

heterotaxy
hypertrophic pyloric stenosis
muscle thickness > 3mm

length of pyloric channel > 15 mm

absence of fluid through pyloric channel
intussuception
6 month to 4 years, if older think underlying cause

most common lead point if not idiopathic is meckel's diverticulum
salter harris classification
type 1-through growth plate

type 2-through metaphysis and growth plate (75%)

type 3-through epiphysis and growth plate

type 4-through metaphysis, growth plate, and epiphysis

type 5-compression fracture of growth plate
bowing fracture
may remodel without manipulation if <20 degree angulation
bunk bed fracture
buckle fracture of the proximal 1st metatarsal

3-6 yo

history of fall or jump from height onto hardwood floor
ossification centers in elbow

CRITOE
capitellum 1-2 yr
radial head 3-4 yr
Internal epi 5-6 yr
trochlea 7-8 yr
olecranon 9-10 yr
external 11-12 yr
juvenile tillaux fracture
salter harris 3
triplane fracture
salter harris 4

evaluate congruence of the articular component and displacement of fracture fragment
abdominal wall defects
cephalic fold defect-pentaology of cantrell (CHD, ventral hernia, sternal defect, absent anterior diaphragm, percardial defect)

lateral fold defect-omphalocele, gastroschisis

caudal fold defect-cloacal extrophy (omphalocele, epispadias, and bladder extrophy)
omphalocele
2/3 have-cardiovascular, chromosomal (13,18,21), malrotation abnormalities
esophageal atresia/tracheoesophageal fistula
maternal polyhydramnios

drooling, coughing, choking, cyanosis

can't pass ngt

50% have associated anomalies

most common type-proximal atresia, distal TE fistula
VACTERL
vertebral segmentation anomalies

anal atresia

cardiac

te fisula and ea

renal

limp
esophageal atresia w/o te fistula
no distal bowel gas

associated with down's patients
proximal bowel obstruction in neonate
gastric atresia or web

pyloric stenosis

duodenal atresia, stenosis or web-80% of atresias occur just distal to ampulla of vater

duodenal duplication cyst

malrotation and midgut volvulus

jejunal atresia and stenosis
duodenal atresia associated abnormalities
double bubble sign

bile duct or pancreas ie. annular pancreas and preduodenal portal vein

other insestinal atresia

CHD

down syndrome 30%

VATER
duodenal web associated abnormalities
wind sock deformity

downs syndrome
distal bowel obstruction
ileal atresia/stenosis-almost all have CF, but 5-10% CF present with this, complications ie volvulus of distal intestinal loop, perf, peritonitis

meconium ileus

colonic atersia

functional immaturity of the colon-small left colon, meconium plug, associated with diabetic mothers, mothers who receive MgSO4

hirschsprung disease

imperforate anus
hirschsprung's disease
failure of bowel to relax

continuous from region of neuronal arrest to the anus

M>F

assoc with downs 5%, congenital neuroblastoma
imperforate anus
high-ends above puborectalis sling

low-ends below sling, air below line between coccyx and pubic bone on prone xtable lateral

more frequently associated with high lesions than low-spine and urinary tract anomalies, rectourethral fistula
right upper quadrant cystic masses in children
gallbladder hydrops
choledochal cyst
cystic mesenchymal hamartoma
pancreatic pseudocyst
cystic pancreatic tumor
duplication cyst
mesenteric cyst
cystic adrenal tumor, adrenal hemorrhage
upper pole r hydronephrosis/renal cyst
ovarian cyst
lymphangioma
dermoid/teratoma
csf pseudocyst
cystic hemangioendothelioma
large radiolucent hemithorax
obstructive emphysema-inspir/exp views
asp foreign body
extrinsic compression of bronchus

compensatory emphysema

pneumothorax

cystic disease of the lung

large pneumatocele
aerated chest mass
ccam/cystic airway pulmonary malformation

CDH

congenital lobar emphysema
mediastinal neuroblastoma
posterior mediastinal mass

<2 yo

10-15% neuroblastomas in thorax

neurogenic tumors, most common mediastinal masses of childhood

ddx-ganlioneuroblastoma, ganglioneuroma
double bubble sign
ddx
duodenal atresia
ladd's bands/malrotation
annular pancreas
duodenal stenosis/web
achondroplasia
interpediculate distances decrease from uppter to lower lumbar spine

flattening of acetabular angles

iliac bone with decreased height and square shape

rhizomelic shortening of the long bones (slowed endochondral ossification)

craniofacial dysproportion with large calvaria and decreased size of skull base

small jugular foramen, foramen magnum, and spinal canal

short ribs, decreased AP diameter of chest
spondyloepiphyseal dysplasia
x-linked recessive

5-10 yo presentation

generalized platyspondyly

abnormal epiphyses, irregular flattened, premature OA

irregular acetabulum

short trunk
platyspondyly
odontoid hypoplasia

ddx
dysostosis multiplex
mucopollysaccharidoses
stippled epiphyses
ddx
chondrodysplasia punctata (conradi's dz)
avascular necrosis
cretinism
morquio's syndrome
multiple epiphyseal dysplasia
trisomy 18 and 21
prenatal infections
warfarin embryopathy
cleidocranial dysplasia
ddx
womian bones

abent clavicles
wormian bones

PORKCHOPS
ddx
pyknodysostosis
osteogenesis imperfecta
rickets
kinky hair syndrome
cleidocranial dysostosis
hypothyroidism / hypophosphatasia
otopalatodigital syndrome
primary acroosteolysis (hajdu-Cheney)/ pachydermoperiostosis / progeria
syndrome of Downs
hydrometrocolpos
dilation of vagina and uterus proximal to obstructiong
imperforate hymen
vaginal or cervical atresia or septum

neonatal or perimenarchal period of presentation

exclude GI and GU tract anomalies
posterior urethral valves
most common cause of bilateral hydronephrosis in boys

vur in 50% with valves

kidneys exposed to reflux at high pressures don't develop normally

if no vur, kidneys develop normally to detriment of bladder
calculi in nonfunctioning kidney
ddx
xanthogranulomatous pyelonephritis

renal tb

fungal infection
renal tb
initially>focal caseating lesion in upper pole

enlarging nidus, papillary necrosis

enlarged kidney which will atrophy over time

hydrocalyces with infundibular strictures, without pelviectasis

putty kidney

dystrophic ca++
pott's puffy tumor
abscess and osteomyelitis of the frontal bone associated with frontal sinusitis
optic globe calcification
ddx
retinoblastoma!
retinal astrocytic hamartomas of TS
pediatric optic lesions
ddx
retinoblastoma

persistent hyperplastic primary vitreous

retinopathy of prematurity

congenital cataract

coats disease
retinoblastoma
95% ca++

30% bilateral

2-8% b/l dz will develop intracranial midline tumor (trilateral retinoblastoma)
neurofibromatosis type 1
skull
macrocranium
dysplasia
orbits
lambdoidal suture
sphenoid wing
enlarged foramina, IAC
sellar abnormalities
orbital enlargement

CNS
optic gliomas
cerebral gliomas
hydrocephalus
plexiform neurofibroma
vascular dysplasia
CNS hamartoma
pediatric toxoplasmosis
ca++ typically basal ganglia, periventricular, and cortex

periventricular ca++ and chorioretinitis ddx
toxoplasmosis
cmv
pediatric CMV
more commonly associated with malformations of cortical development, microcephaly
anhydramnios
ddx
PUV-big bilatera, hydroureteronephrosis

bilateral MCDK-bilateral cystic masses

bilateral renal agenesis-look for lying down adrenal
amniotic band syndrome
thanatophoric dysplasia
osteogenesis imperfecta type 2
gastroschisis
fetal sequestration
pediatric brain ca++
ddx
toxoplasmosis
ca++ in bg and t/o cortex

cmv
more commonly periventricular and assoc with malformations of cortical development and microcephaly

herpes

hiv

metabolic

tuberous sclerosis

neoplasm

cysticercosis
pediatric ca++ only of the basal ganglia
ddx
metabolic
hiv
carbon monoxide
fibromatosis coli
benign mass of neonatal scm

neck mass and torticollis

etiology
birth trauma
in utero torticollis
venous occlusion leading to fibrosis

usually resolves with PT
CHF in newborn period
ddx
lv inflow obstruction (normal heart size)

lv outflow obstruction (enlarged heart)

muscle disease

noncardiogenic
hypervolemia, asphyxia, metabolic, arrythmias, hydrops, peripheral av fistula
vein of galen malformation
intracranial arteriovenous malformation from thalamoperforator, choroidal, ant cerebral arteries to a persistent midline prosencephalic vein

>90% present as neonate with CHF and intracranial bruit
pineal region tumors
germ cell tumors
germinoma
pineal parenchymal tumors
pineoblastoma (pnet)
glioma
malformative tumor
dermoid/epidermoid
grading of neonatal intracranial hemorrhage
grade 1-confined to subependymal germinal matrix

grade 2-blood in nondilated ventricles

grade 3-hemorrhage dilating the ventricles

grade 4-intraparenchymal hemorrhage
germinoma of the brain
65% intracranial germ cell tumors

35% occur in the pituitary region
pineal region most common

sx's include DI, emaciation, precocious puberty
craniosynostosis
primary (idiopathic)
secondary
syndromic
crouzon, apert, carpenter, treacher collincs, etc.
associations
metabolic disease ie rickets
bone dysplasia ie hypophophatasia, achondroplasia, etc
postshunt hydrocephalus
sagittal synostosis
most common form

scaphocephaly, dolicocephaly
coronal synostosis
second most common suture involved

brachycephaly

harlequin eye deformity
metopic synostosis
trigonocephaly

quizzical eye appearance with hypotelorism
neuroblastoma
most common extracranial solid tumor of childhood, third most common malignancy in childhood

stage 1-confined to structure of origin

stage 2-tumor extension in continuity not across midline

stage 3-tumor extension in continuity across midline

stage 4-disseminated disease

stage 4s
primary stage 1 or 2
mets to liver, skin, or bone marrow
primary ciliary dyskinesian/kartageners syndrome
autosomall recessive

chronic sinusitis
bronchiectasis
situs inversus 50%
male sterility
middle ear disease
base of pediatric tongue lesions
lymphadenopathy
lingual thyroid
lymphangioma/hemangioma
rhabdomyosarcoma
anomalies of the thyroid
agenesis, unilateral or complete

ectopic thyroid
most common at foramen cecum
maybe only functioning tissue

thyroglossal duct cyst
common midline developmental anomaly of the neck
occurs base of tongue to suprasternal region
pediatric cystic neck/upper chest mass lesions
cystic hygroma

vascular malformation

branchial cleft cyst

paramedian thyroglossal duct cyst

suppurative adenopathy

thymic cyst

duplication cyst
medical lung disease in the newborn

CHIMP + TTN
cardiac
hyaline membrane disease
immature lung
meconium aspiration
pneumonia
transient tachypnea of the newborn
cystic left upper quadrant pediatric lesions
cystic neuroblastoma
mcdk
upper pole hydronephrosis
cystic extralobar seq.
abdominal masses in neonates
usuall benign and of renal origin

renal 55%
hydronephrosis
mcdk
mesoblastic nephroma
renal vein thrombosis
polycystic kidney disease

genital masses 15%
hydrometrocolplos
ovarian mass

gastrointestinal 15%
duplication
mesenteric/omental cyst
complicated meconium ileus

nonrenal/retroperitoneal 10%
adrenal hemorrhage-f/u!
neuroblastoma

hepatobiliary 5%
mets
hemangioendothelioma
hepatoblastoma
mesenchymal hamartoma
choledochal cyst
hemangioendothelioma of liver
hypercellular tumor with hypervascularity
av shunting

proliferative phase during first 18 month then slow involution

present with hepatomegaly, chf, anemia, jaundice, kasabach-merritt syndrome

ddx
hepatoblastoma (elev afp)
abdominal masses in older children
renal 55%
wilms
hydronephrosis
cystic disease
hematoma
multilocular cystic nephroma
nephroblastomatosis
other tumors

nonrenal retroperitoneal 23%
neuroblastoma
rhabdomyosarcoma
other tumors

gi and biliary 18%
appendiceal abscess
intussusception
wilms tumor associations
sporadic aniridia

hemihypertrophy

beckwith-wiedemann

sotos syndrome (cerebral gigantism)

perlman syndrome (fetal gigantism)

drash syndrome
wilms tumor, glomerulopathy, and pseudohermaphroditism

WAGR
wilms tumor, aniridia, genitourinary malformations, retardation
nephroblastomatosis
persistent foci of metanephric blastema present >36 week gestation

potential for malignant degen into WT

3 developmental phases
dormant
regressing/sclerosisng
dar on t2, oblong, lenticular
hyperplastic-risk of transf.
lesions homogenous
t1 hypointense to cortex
t2 hyperintense
enhance less than normal tiss
renal lymphoma
appearances, hypoechoic, hypodense

single renal mass

multiple renal masses

diffuse infiltration of kidney

extrinsic renal mass that may cause obstruction
rhabdoid tumor
highly malignant
80% mortality
rare over 5 yo
mets to lung, liver, and brain
splenic abnormalities
congenital
asplenia and polysplenia
accessory splenic tissue
ectopic spleen
vascular malformation
acquired
splenomegaly
chronic liver disease
leukemia or lymphoma
metabolic disorders
hematologic disorders
splenic cyst
infection
trauma
hemolytic uremic syndrome
arf, microangiopathic hemolytic anemia, and thrombocytopenia

colitis, cns manifestations 25-50%, rhabdomyolysis, diabetes

children 1-5 yo
disciitis
6mo to 4yo

tend to refer pain to hip or knee

narrow disc space, adjacent vertebral marrow edema, maybe contrast enhancement of disc and vb
focal/diffuse periosteal reaction in infants
ddx
primary or secondary to malignancy
ewings
leukemia
neuroblastoma

histiocytosis
physiological
scurvy
hypervitaminosis a
stress fracture
osteomyelitis
post-traumatic
infantile cortical hyperostosis
prostaglandin induced periostitis
met bone disease
caffey disease
osteopetrosis
autosoma recessive lethal type
short stature
hepatosplenomegaly
hydrocephalus
cranial nerve dysfxn
blindness, deafness
marrow enchroachment->anemia and thrombocytopenia and recurrent infection
bone within bone app
frequent fracture

intmdte recessive type
autosomal dominant type
most mild form
recessive type with tubular acidosis
turners syndrome
45 xo
1/5000
short stature
webbed neck, low hairline, cystic hygroma

shield shaped chest/wide spaced nipples

high palate

coarctation of aorta, aortic stenosis

horseshoe kidney

primary amenorrhea
ewing sarcoma
second most common primary bone malignancy of children

60% arise in extremities
femur>pelvis>tibia>humerus

metaphyseal (eccentric) or diaphyseal (central)

most common ddx is osteosarc

highly variable appearance
varies from lytic 62% to sclerotic 15%
poorly marginate bone destruction
periosteal reaction (onion skin)
tarsal coalition
fibrous, cartilaginous or osseous fusion of two or more tarsal bones

asx to painful spastic/rigid pes planus

types
calcaneonavicular 50%
talocalcaneal 50%
talonavicular
calcaneocuboid
macrodactyly
ddx
macrodystrophia lipomatosa
neurofibromatosis
vascular malf
hemangioma
ktw
filling defects renal pelvis
calculus
neoplasm
clot
fungus ball
sloughed papilla
pyeoureteritis cystica
leukoplakia
malakoplakia
prune belly syndrome
distended bladder, urachal cyst or diverticulum

hypoplastic prostate, scaphoid megalourethra

urine ascites

oligohydramnios, pulmonary hypoplasia

group 1 potters
group 2 less severe lung abn
group 3 mild

ddx
posterior urethral valve
urethral stricture
bladder neck obstruction
anterior urethral diverticulum
bladder exstrophy
1/30000 persistent cloacal membrane separates mesoblast

rectus muscles separate

lower abdominal wall and anterior wall of bladder absent

ilia rotated outward, widened pubic symphysis

complications
ureteral reflux
cystitis glandularis
bladder ca
200x more common
90% adenoca
posterior urethral valves complications
vesicourethral reflux 30-70%
renal dysplasia 15-20%
oligohydramnios
lung hypoplasia

ddx
severe reflux
prune belly syndrome
posterior urethral polyp
anterior urethral diverticulum
mullerian duct cyst
midline cyst arising behind verumontanum extending above base of prostate

prostatic secretions arising from sinoutricular plate are blocked

cystic dilatation of utricle

develops after puberty (prostatic utricle is there in newborn)

no sperm or fructose

no anomalies of external genitalia

complications
stones
increased incidence of adenoca or scca

ddx
prostatic utricle-usually assoc wiht ambig genitalia or hypospadias, in infancy

prune belly

seminal vesicle cyst-not in midline, renal agenesis
primary megaureter
fusiform dilatation of ureter proximal to adynamic distal segment

juxta vesical segment aperistaltic causing function obstruction

insufficient musculature near uvj

20% of neonatal hydronephrosis

bilateral 8-50%

associated anomalies in 40%
contralateral agenesis
ipsilateral upj

ddx
refluxing megaureter-vur, prune belly, bph, urethral valves

obstructed megaureter-ureteral stenosis, valve, ureterocele, urethral valve

nonrefluxing nonobstructed megaureter-primary megaureter, post-obstruction, diabetes insipidus
angiomyolimpoma
20% have ts
80% of ts pt have aml, often bilateral

in pat w/o ts 90% unilateral, in females > 40

hypervascular + pseudoaneurysms + fat on ct/us/mri
rta type 1
most common cause of medullary nephrocalcinosis in kids

maybe associated with rickets and osteomalacia
developmental dysplasia of the hip
f>m
breech position
swaddling
+family hx

alpha angle greater than 60

delayed femoral head ossification

normal femoral head ossification by 2-6 months in girls and 3-7 monhts in boys

ddx delayed ossification
endocrine d/o ie hypothyroidism-bilateral
legg calve perthes
groin pain or limp

idiopathic avascular necrosis of the immature femoral head

age 5-8 yo

m/f 4/1

caucasian boys

usually unilateral, when bilateral (15%) asymmetric

ddx
meyer dysplasia-osteochondroses, irregular ossification <5 yo, asx, incidental

secondary femoral head avn
ss
steroids
infection
trauma
gauchers
septic arthritis
most common cause of arthritis in children, usually monoarticular

organisms-staph, strep, coliform bacteria in neonates

ddx
toxic synovitis
tonic synovitis
nonspecific inflammatory response to antecedent infection (viral or bacterial)

b>g, 3-10 yo

limp over 1-2 days

complete recover within 5-14 days
child with limp
ddx
legg calves perthes
septic hip
toxic hip
slipped capital femoral epiphysis
salter type 1
12-15 yo
m/f 2.5/1

african american, obese, tall

unilateral, 20-30% bilateral, almost always asymmetric

stable vs unstable/acute vs chronic

slip is usually posterior and medial
osteochondritis dissecans
secondary to repetitive compressive microtrauma

adolescent athletes

distal femur, talar dome, capitellum of humerus

males

mr to assess stability and guide management
osgood sclatters disease
osteochondroses of tibial apophysis

10-15 yo

local pain, swelling, tendnerness

clinical dx

irregularity of tibial tubercle in an asx patient a normal variant
blounts disease
secondary to stress induced injury of proximal tibial physis

infantile form
1-3 yo
early walkers, aa, obese
80% bilateral
may respond to conservative mgt otherwise surgery

adolescent form
8-14 yo
aa children
usually unilateral, present with knee pain
needs surgical correction
genu vara/tibia vara
ddx
physiological up to 2yo
blounts
rickets
renal osteodystrophy
osteogenesis imperfecta
fibrous dysplasia
nonaccidental trauma
common fx
mult fx
classical metaphyseal lesions
diaphyseal fractures
skull fractures

less common
spine
small bones of hands and feet
clavicular fx

uncommon
scapular
pelvic
sternal
facial and mandibular
enchondromatosis syndromes
olliers syndrome-multiple enchondromas, maybe segmental

mafuccis syndrome-assoc with multiple hemangiomas, malignant transformation
expansile lytic bone lesion in childrens
ddx
giant cell tumor
aneurysmal bone cyst
unicameral bone cyst
fibrous dysplasia
osteoblastoma
telangiectatic osteosarcoma
focal lytic calvarial lesion in children
histiocytosis
osteomyelitis
mets-neuroblastoma
intradiploic dermoid, epidermoid
hemangioma
prominent parietal foramina
vertebra plana
ddx
posttraumatic
infective spondylilitis
histiocytosis
lymphoma
pediatric aggressive appearing bone lesions
ewings
histiocytosis
osteomyelitis
lymphoma