-
Germinal matrix hemorrhage
Periventricular leukomalacia
-
Dorsal induction
Chiari
Type I
Tonsillar herniation >5 mm.
Spinal nerve roots point superiorly.
Type II
Cerebellar tonsils, vermis, fourth ventricle and brain stem are herniated through the foramen magnum
Hydrocephalus
Associated with (CT MiFC)
Colpocephaly
Tectal beaking
Large massa intermedia
Fenestrated falx
Cervicomedullary kink
Corpus callosum abnormalities
Tethered cord
Lumbosacral myelocele or meningomyelocele
Type III
Chiari II with herniation through occipital or high cervical encephalocele
Ventral induction
-
Lobar
Formation of the interhemispheric fissure is incomplete
White matter fibers can be seen anterior to corpus callosum
Failure of clevage of cerebral hemispheres frontally
Semilobar
Partial development of the interhemispheric fissure
Partial fusion of the thalami
Temporal horns may be formed
Single ventricle anteriorly
Falx may present posteriorly
Alobar
Monoventricle
Fused thalami
No falx
No corpus callosum
DiffDx of alobar holoprosencaphaly
Hydranencephaly => no cortical mantle is discernible around the dilated CSF space
Maximal hydrocephalus => midline structures are present
Septooptic dysplasia
Septum pellucidum is partially or completely absent
Small optic nerves and chiasm
-
Proposed etiology => obstruction of foramen of Magendie and Lushka
Vermian hypoplasia or aplasia
Large cystic structure in the posterior fossa, which communicated with 4th vetricle
Hydrocephalus is common
Associated with
Holoprosencephaly
Agenesis of corpus callosum
Polymicrogyria
Heterotopias
Torcular-Lambdoid inversion
Elevation of torcular above the lambdoid suture
Dandy-Walker complex
Posterior fossa enlarged
Dandy-Walker variant
Posterior fossa is normal
Hypoplasia of cerebellar vermis
Presence of falx cerebelli rules Dandy-Walker malformation
Differential dx
Giant cisterna magna (no mass effect)
Arachnoid cyst (mass effect)
Dysgenesis of corpus callosum
Colpocephaly
Squared lateral ventricles
Probst bundles
High-riding third ventricle
Associated with lipomas and arachnoid cysts
-
Migration anomalies
Gray matter heterotopias
Nodular
Band heterotopia
Schizencephaly
Cleft with grey matter lining coursing from ventricular ependyma to pia
Closed-lipped
Open-lipped
Lissencephaly
Incomplete => pachygyria
Complete => agyria
Types
Type 1
Type 2
Type 3
Type 4 => congenital
Lissencephaly is a migrational disorder – cortex is thick (in normal premature brain – cortex is thin)
Walker-Warburg syndrome
Lissencephaly with dysmorphic heterotopic gray matter
Optic disk anomalies
Hydrocephalus
Posterior fossa malformations
Polymicrogyria
Injury of formed structures
Hydranencephaly
Falx present
Bilateral ICA occlusion
DiffDx
Maximal hydrocephalus
Porencephaly
CSF cyst
Cysts
Aracnoid cysts
Follow CSF signal
Maybe slightly higher on PD, FLAIR, and DWI due to stasis of fluid and pulsation effects. Mass effect on adjacent brain tissue is present. Bone remodelling may be present.
Differential diagnosis:
Subdral hygroma – crescentric in shape, mass effect on adjacent brain tissue, T1W and FLAIR signal is different from CSF due to usual presence of blood products from leptomeningeal tears
Normal subarachnoid space due to adjacent encephalomalacia – no mass effect present, cerebral veins can be seen crossing the enlarged subarachnoid space.
Epidermoid – bright on FLAIR and DWI
Rathke cleft cysts
Remnants of neuroectoderm that ascends from oral cavity to form anterior pituitary and pars intermedia
Classic location of Rathke cleft cyst is between anterior and posterior pituitary.
Meningoceles and meningoencephaloceles
Neuroepithelial cysts
Arise within the ependyma
Leptomeningeal cyst (growing fracture)
Leakage of CSF from pia-arachnoid
Protrusion of leptomeninges through dural tear
Formation of encapsulated cyst
Cortical dysplasia
Joubert syndrome
Parallel enlarged horizontally oriented superior cerebellar peduncles => molar tooth sign
Klippel-Feil syndrome
C2-C3 fusion
Short clivus
Odontoid or C1 abnormalities
Neurocutaneous syndromes
NF1
NF2
TS
Sturge-Weber
Low flow vascular malformation along distribution of trigeminal nerve extracraniallu and intracranially
Altered flow results in chronic ischemic injury
Masses
Pediatric supratentorial neoplasms
Pediatric infratentorial neoplasms (AMEC)
Astrocytomas
Juvenile pilocytic astrocytomas
Cystic, some have mural nodule (similar to adult hemagioblastoma)
Brainstem astrocytomas
Medulloblastoma (PNET of the posterior fossa)
Arises from roof of 4th ventricle
Ependymomas
Arises from floor of 4th ventricle
Children => 4th ventricle, Adults => hemispheres
Choroid plexus papillomas
-
Gliomas (optic glioma and hypothallamic glioma)
Craniopharyngioma
Germ cell tumors (present with diabetes insipidus)
EG (presents with diabetes insipidus)
Lytic skull lesion with no sclerosis at the margins
Thickening of pituitary infundibulum
Vertebrae plana
Floating tooth sign
Tuber cinereum hamartoma
Skull
Dolichocephaly
Sagittal suture synostosis
Trigonocephaly
Metopic suture synostosis
Cloverleaf skull
Synostosis of all sutures
Lacunar (luckenschnadel) skull
Associated with myelomengocele
C-spine
Normal variants Radiographics 2003
Anterior dental interval =/< 5mm
Pseudo Jefferson Fx =/< 6mm
Pseudosubluxation C2-C3, C3-C4
Posterior cervical line should be maintained
Anterior vertebral body wedging
-
Nasal cavity
Neoplasms
Juvenile angiofibroma => occurs in adolescent boys
-
Inflammatory
Adenoids become pathologic when they encroach on the nasopharyngeal airway
Retropharyngeal abcess
The width of prevertebral soft tissues should not exceed 1/2 of the vertebral bodywidth in the upper neck from C1 to C4-C5 in children less than 3 years of age
Acute epiglottitis
AIDS
Cervical nodal enlargement with cystic parotid lesions
Masses
Cystic
Thyroglossal duct cyst
Branchial cleft cyst => usually in the anterior cervical traingle, at the angle of the jaw
Lymphangiomas / Cystic hygromas (posterior cervical triangle)
Ranula => epithelial retention cyst
Cervical thymic cysts
Other
Fibromatosis colli
Hemangiomas
Dermoid/Teratoma
Lingual thyroid
Rhabdomyosarcoma => most common malignant neoplasm
Hodgkin’s lymphoma
Neuroblastoma
Airway
Choanal atresia
Acute epiglottitis
Viral croup
Membranous croup (Staph. aureus)
Subglottic hemangioma
Laryngeal papilloma
Tracheal granuloma (ETT)
Laryngomalacia
Hereditary angioneurotic edema (C1 esterase deficiency)
Thyroid
Parathyroid
-
-
Aortic arch anomalies
Left arch with aberrant right SC artery (most common)
Right arch
Right arch with aberrant left SC artery (complete ring around trachea and esophagus)
Complete ring
Impression on posterior wall of esophagus and on right lateral wall of esophagus
Right arch with mirror image branching
Associated with cardiac anomalies
Double aortic arch
Posterior compression of esophagus on lateral view (bilateral compression on the frontal view)
Pulmonary arteries anomalies
Left pulmonary artery sling
Arises from the right pulmonary artery
Venous
Persistent left SVC
Azygoud continuation of IVC
TAPVR/PAPVR
Aortic aneurysm
Marfans
Ehlers-Danlos
Takayasu
Kawasaki
Aortic dissection
Marfan
Cardiac
Increased pulmonary blood flow, acyanotic (Left-to Right Shunts)
LAE
VSD
PDA
No LAE
ASD – Right atrial enlargement
PAPVR
AV canal
Eisenmenger (large central pulmonary arteries and decreased size of peripheral vessels)
Decreased pulmonary blood flow, cyanotic, no cardiomegaly
ToF
Pulmonary stenosis
Tricuspid atresia
Pulmonic atresia
Decreased pulmonary blood flow, cyanotic, cardiomegaly
Ebstein anomaly
Pulmonary stenosis (critical)
Tricuspid atresia
Pulmonic atresia
Increased pulmonary blood flow, cyanosis
TGA
Egg on a string (D-transposition)
TAPVR
Snowman sign
Truncus arteriosus
Right sided aortic arch
Cardiomegaly
Increased pulmonary blood flow
Waterfall sign
Tricuspid atresia
Single ventricle
DORV
Normal pulmonary blood flow, acyanotic
Coarctation of aorta
Reverse "3" sign
AS
Valvular pulmonic stenosis
Pulmonary venous hypertension
Hypoplastic left heart syndrome
Interrupted aortic arch
Anomalous coronary arteries
Cardiomyopathy
Kawasaki disease
CHF
Vein of Galen malformation
Hemangioendothelioma
Other vascular malformations
Developmental lung anomalies
Primary lung anomalies
Lung agenesis
Lobar underdevelopment
Intrathoracic factors => diaphragmatic hernia, extralobar sequestration
Extrathoracic factors => oligohydramnios, arthrogryposis
Scimitar(venolobar) syndrome => unique form of lobar agenesis or aplasia associated with other anomalies
Secondary anomalies
Masses
-
Intralobar => most common
Contained within the visceral pleura of the lung
Presents as PNA
Single large artery from infradiaphragmatic aorta enters lung via pulmonary ligament
Venous drainage via pulmonary veins
Extralobar => associated with CCAM
Enclosed by its own visceral pleural envelope
Usually asymptomatic
Receives several branches from systemic and occasionally pulmonary arteries
Venous drainage via systemic veins
Pathology: cystic and bronchiectatic lung
Radiology: solid or multicystic air collection
Congenital cystic adenomatoid malformation
Type I => Single/multiple cysts > 2cm
Type II => Smaller cysts < 2cm mixed with solid components
Type III => Solitary solid masses
Congenital lobar emphysema
Initially dense due to fluid in the air spaces
Hyperinflated lucent lobe
Bronchogenic cysts
Neurenteric cysts
-
Pulmonary AVM
Neonatal
Hyaline membrane disease (RDS)
Premature infants born prior to 37 weeks
If CXR is normal at 6 hours, RDS is unlikely
Hypoaeration and symmetric reticulogranular opacities, no pleural effusions
Complications
Barotrauma => pulmonary interstitial emphysema
Left to right shunting across patent PDA => pulmonary edema
Bronchopulmonary dysplasia
Retained fetal lung liquid (transient tachypnea of newborn)
Usually seen after c-section
Peak symptoms are at 24-36 hours
Reticular opacities
DiffDx: pulmonary lymphangiectasia, TAPVR with obstruction, streptocococcal PNA, mild HMD (need serial radiographs for differentiation).
Meconium aspiration
Postmature neonates
Chemical pneumonitis
Hyperinflation and bilateral interstitial and airway opacities. Pneumothorax and pneumomediastinum may result from alveolar rupture.
Pulmonary lymphangiectasia
Overaeration, coarse nodular or reticular opacities, Kerley B lines, pleural effusions
Neonatal pneumonia (prolnged rupture of membranes is a risk factor)
GBS
Reticulogranular opacities
Pleural effusions
Chlamydia (2 weeks to 3 months of age)
Associated with conjunctivitis
Hyperinflation and asymmetric interstitial and alveolar opacities
Bronchiectasis
Cystic fibrosis => bronchiectatic cavities predominantly in upper lobes.
Kartagener syndrome => immotile cilia (sinusitis, OM, bronchiectasis, deafness and infertility), thoracic and cardiac situs inversus
Localized from post-infectious causes
Unilateral hyperlucency
-
Small hyperlucent lung
Foreign body
PTX
Congenital lobar emphysema
Compensatory hyperinflation
-
PNA
Round PNA usually related to strep. pneumoniae
Parenchymal cavitation => staph. aureus
TB
Histoplasmosis
Aspergillus
Aspergilloma
ABPA
Bronchiectasis with impacted mucus
Invasive aspergillosis
Nodular opacities which undergo cavitation
Diffuse lung disease
Central airways
Small airway disease
Bronchiolitis obliterans (tree-in-bud, mosaic pattern, centrilobular nodules)
Swyer-James (Macleod) syndrome
Interstitial disease
BPD (bronchiectasis usually absent)
IPF
Cysts
LCH (nodules then cysts)
TS
Air space attenuation
Alveolar proteinosis ("crazy paving")
Hemosiderosis
Pulmonary edema
Emphysema
Alpha-1-antitrypsin deficiency
-
Neuroblastoma
Ewing
LCH
Osteosarcoma
Leukemia
Osteomyelitis
Mesenchymal hamartoma
Osteochondroma
Fibrous dysplasia
-
Lymphangioma (fluid filled)
Hemangioma (phleboliths, flow)
Lipoma
Rhabdomyosarcoma
Ewing (PNET)
-
-
Esophageal atresia/TEF
VACTERL
Hypertrophic pyloric stenosis
3.14 => wall thickness – 3mm, length of pyloric channel – 14 mm
Obstruction in infancy
-
Malrotation/midgut volvulus
Duodenal-jejunal junction should be at the same height as duodenal bulb and at least over left vertebral pedicle
On US, SMA and SMV relationship may be reversed
Annular pancreas
Duodenal stenosis
Duodenal web
Duodenal atresia
-
Meconium plug (small left colon syndrome)
Infants born of diabetic mothers
Ileal atresia
Meconium ileus (CF)
Anal atresia
Hirschprung disease
-
Obstruction in children (AAIIMM)
Adhesions
Appendicitis
Intussusception
3 mos to 1 yr (3yrs)
Currant jelly stools
Crescentic fat within the intussesceptum => mesentery drawn into the intussesceptum
Rates of reduction with air or liquid contrast are not statistically different
Incarcerated inguinal hernia
Malrotation with volvulus
Meckel diverticulum
Tc-99m pertechnetate localizes to gastric tissue
May be false negative if Meckel’s diverticulum little or no gastric tissue
Obstruction results from inversion of diverticulum
Calcified stones or lamellated pattern in the lower right quadrant
Appendicitis
On US: hyperemic, non-compressible appendix, 6mm
NEC
Unchanging bowel gas pattern over several films
Pneumatosis
Duplication cysts
Round cysts with bowel wall signature on US, ususally do not communicate with lumen
Tubular duplications are less common, but may communicate with lumen
Mesentery
Mesenteric adenitis
CF
Meconeum ileus
Meconium ileus equivalent
Pseudomembranous colitis
Colonic thickening or stricture from pancreatic enzyme replacement
Gallstones
Pancreatic atrophy
Immunocompromised patient
Pseudomembrabous colitis
Neutropenic colitis (typhlitis)
Graft-Versus-Host disease
Mucositis
Lymphoprliferative disorders
Proliferation of EBV infected cells
Liver
Jaundice
Neonatal hepatitis
Biliary atresia
Hepatic masses – age < 5 years (HHMM)
Hepatic masses – age > 5 years (HHELM)
HCC
Fibrolamellar HCC
Hepatic adenoma
Embryonal sarcoma
Lymphoma
Metastatic disease
-
Adrenals
Neuroblastoma
Adrenal hemorrhage
Kidneys
UPJ obstruction
Intrinsic narrowing
Compression by anolmalous vessel
Cystic kidney disease
MCDK
Severe obstruction during fetal development
Cysts that do not communicate
Non-functioning kidney
ARPCKD
Large kidneys
Juvenile polycystic kidney disease
ADPCKD
Tumors
Wilms tumor (nephroblastoma)
Calcifications uncommon (calcifications are common in neuroblastoma)
Displaces blood vessels (neuroblastoma engulfs blood vessels)
Nephroblastomatosis
Persistent nephrogenic rests
Multilocular cystic nephroma
Mesoblastic nephroma
Usually encountered during the first few months of life
Ureter
Bladder
Prune-Belly syndrome
Hypoplasia of abdominal musculature
Cryptorchidism
GU tract abnormalities
Pelvic rhabdomyosarcoma
Urethra
PUV
Hydrometrocolpos
-
CRITOE => Sequence of appearance of ossification centers (1,3,5,7,9,11 years)
-
Hypoparathyroidism and pseudohypoparathyroidism => basal ganglia calcifications.
-
Umbilical vein =>
ductus venosus => IVC (T8-T9)
portal vein => hepatic sinusoids => hepatic veins => IVC
Umbilical artery => interal iliac artery => common iliac artery => aorta (T6-T9)