1
Q
DDx for vertebra plana
A
- LCH
- Mets (neuroblastoma)
- Leukemia/Lymphoma
- Infection
- Trauma
2
Q
DDx for Erlenmeyer Flask deformity
A
“CHONG”
- Craniometaphyseal dysplasias
- Hemoglobinopathies (e.g. sickle cell, thalassemia)
- Osteopetrosis
- Niemann Pick
- Gaucher
3
Q
DDx for multifocal bone lesions in peds
A
- LCH
- Fibrous dysplasia
- Enchondromas (Ollier, Maffucci)
- Fibroxanthomas (NF1, Jaffe-Campanacci)
- Osteochondromas (MHE)
- Infection/CRMO
- Mets
- Lymphoma/Leukemia
4
Q
DDx bilateral lung opacities in the newborn
A
- RDS / Surfactant deficiency disease / HMD
- TTN
- Pneumonia
- Meconium aspiration
- Edema
5
Q
DDx lucent unilateral chest lesion in a newborn
A
- CPAM (type 1)
- PTX
- Congenital lobar emphysema
6
Q
DDx opaque thorax in a newborn
A
- Atelectasis (agenesis)
- Pleural effusion
- Congenital mass
- CLE (early)
7
Q
What are the types of CPAM?
A
- Type 1 (a few big cysts)
- Type 2 (lots of small cysts)
- Type 3 (solid)
8
Q
DDx for newborn intra-abdominal calcification
A
- Meconium peritonitis
- Calcified neoplasm (neuroblastoma, teratoma, hepatoblastoma)
- Intrahepatic infection (CMV, toxo, parvovirus)
- Gallstone
- Adrenal hemorrhage
- Calcified torsed ovary
9
Q
DDx for low intestinal obstruction in neonates
A
- Hirschsprung disease
- Meconium plug syndrome
- Ileal atresia
- Meconium ileus
- Anal atresia/anorectal malformations
10
Q
What triad is associated with Eagle-Barrett (Prune Belly) syndrome?
A
1) Hypoplasia of the abdominal muscles
2) Cryptorchidism
3) Urinary tract abnormalities
11
Q
What is the Currarino triad?
A
1) Presacral mass
2) Anorectal malformation
3) Sacral deformity
12
Q
What is the classic triad of Meckel-Gruber syndrome?
A
- renal cystic dysplasia (multiple renal cysts)
- occipital encephalocele/holoprosencephaly (70%)
- post-axial polydactyly (65%)
13
Q
DDx cystic posterior fossa lesion
A
- Dandy Walker malformation
- Blake pouch
- Retrocerebellar arachnoid cyst
- Mega cisterna magna
14
Q
What are key x-ray findings in Achondroplasia?
A
- Posterior scalloping of the vert. bodies
- Narrowing IP distances
- Tombstone iliac wing; short femoral necks
- Rhizomelia
- Trident hand with short stubby fingers
- frontal bossing
- short ribs
15
Q
What are key x-ray findings of Thanatophoric Dysplasia?
A
- Platyspondyly
- Curved femurs (telephone receiver)
- Cloverleaf skull
- Trident or flat acetabulum
- Short ribs
- U/H shaped vertebral bodies
- Diffuse narrowing of the interpedicular distance
16
Q
What are key features of Asphyxiating Thoracic Dystrophy (Jeune Syndrome)?
A
Normal spine
Small thorax- resp distress
Handlebar clavicles
Trident acetabulum
17
Q
What are key features of Cleidocranial Dysplasia?
A
- Delayed (abn) ossification of membranous bone
- Clavicles (total or partial aplasia)
- Wormian bones
- Widened pubic symphysis
18
Q
What are key features in mucopolysaccharidoses?
A
Vertebral body beaking (+/- Gibbus deformity)
Widened ribs
Madelung deformity
Bullet-shaped fingers (undertubulated bones)
19
Q
DDx for stippled epiphyses
A
Chondrodysplasia punctata
Multiple epiphyseal dysplasia
Fetal alcohol / warfarin exposure
20
Q
DDx fatty replacement of the pancreas
A
- Cystic fibrosis
- Schwachman Diamond syndrome
- Steroid therapy
- Cushing syndrome
21
Q
DDx for joint effusion in a child
A
Septic arthritis
Toxic synovitis
Hemarthrosis- trauma, hemophilia
Arthropathy
22
Q
What is the classic triad of radiological findings in Meckel Gruber Syndrome?
A
- Renal cystic dysplasia (multiple renal cysts)
- Occipital encephalocele/holoprosencephaly
- Post-axial polydactyly
23
Q
What are typical findings of Chiari II malformation?
A
- Posterior fossa: towering cerebellum; downward vermian displacement; slitlike 4th ventricle; tectal beaking; wrapping of cerebellum around brainstem; medullary kink
- Other: myelomeningocele, hydrocephalus; dysgenesis of the CC; syringomyelia; aqueductal stenosis
24
Q
What is the definition of a Chiari I malformation?
A
Cerebellar tonsils >5 mm below the foramen magnum
Syringomyelia seen in 50% of pts
25
What are typical findings of semilobar HPE?
- absence of septum pellucidum
- monoventricle with partially developed occipital and temporal horns
- rudimentary falx cerebri: absent anteriorly
- incompletely formed interhemispheric fissure
- partial or complete fusion of the thalami
- absent olfactory tracts and bulbs
- agenesis or hypoplasia of the corpus callosum
- incomplete hippocampal formation
26
What are findings of alobar HPE?
- "pancake" of parenchyma
- single midline monoventricle (or holosphere)
- absent midline structures (absent septum pellucidum; agenesis or hypoplasia of the CC; absent interhemispheric fissure and falx cerebri; absent olfactory tract
- dorsal cyst of HPE
- absent, fused or normal optic nerves
- middle and anterior cerebral arteries may be replaced by tangled branches of internal carotid and basilar vessels
27
How do you differentiate between lobar and semilobar HPE?
In lobar HPE, the falx is present, the interhemispheric fissure is fully formed and the thalami are not fused.
28
What are findings of lobar HPE?
- fusion of the frontal horns of the lateral ventricles (wide communication of this fused segment with the third ventricle)
- fusion of the fornices
- absence of septum pellucidum
- normal or hypoplasia of the CC
- anterior cerebral artery may be displaced anteriorly to lie directly underneath the frontal bones (snake under the skull sign)
29
Renal AML's are associated with which 3 phakomatoses?
Tuberous sclerosis
VHL
NF 1
30
DDx for lucent hemithorax on CXR
"CRAWLS"
C: contralateral lung increased density, e.g. supine pleural effusion
R: rotation
A: air, e.g. pneumothorax
W: wall, e.g. chest wall mass, mastectomy, polio, Poland syndrome
L: lungs, e.g. airway obstruction, emphysema, Swyer-James syndrome, unilateral large bullae, large pulmonary embolus
S: scoliosis
31
DDx multifocal renal masses
```
Nephroblastomatosis
Leukemia/lymphoma
Metastases
Pyelonephritis
Infarcts (a/w sickle cell disease)
```
32
DDx adrenal masses
```
Adrenal hemorrhage
Neuroblastoma
Pheochromocytoma
Adrenal cortical carcinoma
Teratoma
```
33
DDx hepatic masses
- Hepatoblastoma
- HCC
- Mesenchymal hamartoma (more cystic)
- Metastasis (most commonly Neuroblastoma)
- Hemangioendothelioma (avidly enhancing)
34
DDx cystic abdominal mass
```
Abscess
Pseudocyst
Duplication cyst
Urachal/Meckel/Omphalomesenteric
Lymphatic malformation
Blood
```
35
How can you differentiate osteosarcoma from Ewing sarcoma?
- ES is diaphyseal (OS is metaphyseal)
- ES more common in the flat bones and axial skeleton
- ES has no tumor matrix (OS has a cloudlike matrix)
- ES has onion skin periosteal rxn (OS has a sunburst appearance)
36
DDx for hemihypertrophy?
- Beckwith-Wiedeman syndrome
- Klippel-Trenauney Weber syndrome
- NF 1
- Proteus syndrome
37
DDx for SBO in a child
"AAIIMM"
- Adhesions
- Appendicitis
- Inguinal hernia
- Intussusception
- Malrotation
- Miscellaneous
38
DDx cystic mass in neck
- Lymphatic malformation
- Cystic teratoma
- Branchial cleft cyst
- Abscess
39
DDx for complete microcolon
- meconium ileus
- ileal atresia
- total colonic Hirschsprung disease
40
DDx for widened symphysis pubis (pubic diastasis)
"EPOCH"
- Exstrophy of the bladder
- Prune Belly Syndrome, Pregnancy/childbirth
- Osteogenesis imperfecta
- Cleidocranial dysostosis
- Hypothyroidism
- (Trauma)
41
What are the minimum sonographic distances for pyloric muscular thickness and channel length to be considered diagnostic for hypertrophic pyloric stenosis?
3 mm, 15 mm
42
What are normal measurements for pediatric prevertebral soft tissue?
- At C2, the distance from the anterior surface of the vertebrae to the posterior border of the airway should be 7 mm or less, regardless of the patient's age.
- At C6, this distance should be
43
What is the most common cause of upper GI obstruction in a neonate?
duodenal atresia
44
DDx for UGI obstruction in a neonate
- duodenal atresia
- jejunal atresia
- midgut volvulus
- duodenal web
- annular pancreas
45
DDx for distal GI obstruction in a neonate
| microcolon vs. non-microcolon
- Microcolon (e.g. meconium ileus, jejunoileal atresia, colonic atresia, meconium plug syndrome)
- Non-microcolon (e.g. Hirschsprung disease, functional immaturity of the colon, anorectal malformation, colonic atresia)
46
Name 3 syndromes associated with lissencephaly
- Walker-Warburg syndrome
- Fukuyama syndrome
- muscle-eye-brain disease (predominantly reported in Finnish populations)
47
DDx for posterior fossa mass in children
```
"BEAM"
-brainstem glioma
-ependymoma
-(pilocytic) astrocytoma
-medulloblastoma (most common)
Less typical: Atypical teratoid/rhabdoid tumor, hemangioblastoma (VHL), abscess, infarct, nerve sheath tumor, meningioma, epidermoid/dermoid
```
48
X-linked adrenoleukodystrophy typically affects which part of the brain?
occipital lobes typically, but can involve the brain diffusely. Think adrenal glands are located in the posterior part of the body so adrenoleukodystrophy affects the posterior brain.
49
Alexander disease typically affects which part of the brain?
the frontal lobes
50
Which 2 leukodystrophies are associated with macrocephaly?
Alexander disease
| Canavan disease
51
What is the most common location for bronchial atresia?
Apicoposterior LUL most common, but can occur anywhere.
| Look for round/tubular mass with surrounding decreased vascularity and hyperinflation distally
52
Where is the most common location for pulmonary sequestration?
LLL
53
What is the most common pulmonary malignancy of early childhood?
pleuropulmonary blastoma:
Types:
1) large, air-filled, multilocular cystic mass
2) large, air-filled, cystic and solid mass
3) solid pulmonary mass
54
What is the most common primary bone tumor in paediatrics?
osteosarcoma
- metaphyseal in 90%, but epiphyseal involvement possible
- most commonly around the knee
- skip lesions in 3%
55
What is the upper limit of the cartilage cap for an osteochondroma in children?
If cartilage cap measures >3 cm, then worry about malignant degeneration (>1.5 cm in adults)
56
What is congenital vertical talus associated with?
50% of the time it is associated with another abnormality, such as meningomyelocele, sacral genesis, trisomy 18
57
What is the most common renal tumor in a neonate?
mesoblastic nephroma
| DDx: Wilms tumor, rhabdoid tumor
58
What is the normal T1 signal of the spine compared to the disc in a child?
On T1: between 0-1 year, vertebra signal lower than the disc
| After 5 years, vertebra signal higher than the disc
59
What is the staging of neuroblastoma?
Stage 1: The cancer is still in the area where it started. It is on one side of the body (right or left).
Stage 2: The cancer is still in the area where it started and on one side of the body, but not all of the visible tumor could be removed by surgery. Lymph nodes outside the tumor are free of cancer.
Stage 3: Main tumor crosses the midline or regional LNs involve contralateral side.
Stage 4: distant metastases
Stage 4S ("special"): The child is younger than 1 year old. The cancer is on one side of the body. It might have spread to lymph nodes on the same side of the body but not to nodes on the other side. The neuroblastoma has spread to the liver, skin, and/or the bone marrow
60
How can you differentiate between Wilms tumor and neuroblastoma?
Neuroblastoma:
- calcification very common: 90%
- encases vascular structures but does not invade them
- younger age group (
61
What are x-ray findings of achondrogenesis?
Lethal
- Fractures may be present
- Severe micromelia
- Short trunk
- Disproportionately large cranium
62
DDx Vein of Galen malformation
- Parenchymal AVM
- Cavum velum interpositum
- Arachnoid cyst
- Dandy Walker variant possibly
63
How does the corpus callosum normally develop?
Genu, body, splenium and then rostrum is last.
One apparent exception to this rule is holoprosencephaly in which it is the anterior parts of the corpus callosum which are absent 7. This has been termed atypical callosal dysgenesis.
64
DDx cystic abdominal mass
- Abscess
- Pseudocyst
- Duplication cyst (gut signature +/- debris)
- Urachal cyst/diverticulum
- Meckel's
- Lymphatic malformation
- Consider bladder or ovarian cyst in pelvis
65
Findings in Rickets?
"RICKETS"
- Reaction of the periosteum (may occur)
- Indistinct cortex
- Coarse trabeculation
- Knees, wrists, and ankles affected predominantly
- Epiphyseal plates, widened and irregular
- Tremendous metaphysis (cupping, fraying, splaying)
- Spur (metaphyseal)
66
Caffey disease?
Infantile cortical hyperostosis.
- Typically spares the epiphysis and metaphysis. 80% involve the mandible. Ulna and clavicle are also common sites.
- Presents
67
Umbilical arterial catheter position
T6-T10 or L3-5
68
Umbilical venous catheter
Cavoatrial junction
Radiology
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