You are here: >home >outlines >outlinespeds    


  • Neuro

    • Germinal matrix hemorrhage

    • Periventricular leukomalacia

    • Congenital

      • 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

        • Holoprosencephaly

          • 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

        • Dandy-Walker

          • 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

        • Short list (GPEC)

          • Gliomas

          • PNET

          • Ependymoma

          • Choroid plexus tumors

        • Long list

          • Pleomorphic xanthoastrocytoma

          • Embryonal

            • PNET

            • Medulloepithelioma

            • Ependymoblastoma

          • Neuronal

            • Ganglioglioma

            • Gangiocytoma

            • Dysembyonic neuroepithelial tumor (DNET)

      • 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

      • Parasellar masses (GCG ET)

        • 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

    • Face

      • Nasal cavity

        • Neoplasms

          • Juvenile angiofibroma => occurs in adolescent boys

    • Neck

      • 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

  • Chest

    • Mediastinum

      • 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

        • Congenital diaphragamtic hernia

        • Bronchiolitis obliterans (Swyer-James or Macleod syndrome) can cause lung hypoplasia

          • Hyperlucent lung

          • Expiration films show air trapping in the hyperlucent region

          • Lung scintigraphy shows delayed wash-in and wash-out due to air trapping and decreased perfusion

      • Masses

        • Sequestration

          • 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

      • Swyer-James syndrome

        • 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

        • CF

        • Dyskenetic cilia syndrome

          • Kartegener syndrome

            • Situs inversus, bronchiectasis and sinusitis (SBS)

      • 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

    • Bones (NELOL OMOF)

      • Neuroblastoma

      • Ewing

      • LCH

      • Osteosarcoma

      • Leukemia

      • Osteomyelitis

      • Mesenchymal hamartoma

      • Osteochondroma

      • Fibrous dysplasia

    • Soft tissues (LHL REP)

      • Lymphangioma (fluid filled)

      • Hemangioma (phleboliths, flow)

      • Lipoma

      • Rhabdomyosarcoma

      • Ewing (PNET)

  • GI

    • Esophageal atresia/TEF

      • VACTERL

    • Hypertrophic pyloric stenosis

      • 3.14 => wall thickness - 3mm, length of pyloric channel - 14 mm

    • Obstruction in infancy

      • High (MAD3)

        • 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

      • Low (MIMAH)

        • 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)

      • Hepatoblastoma

        • Infants to 5 years old (most occurences prior to age 2 years)

        • Well defined lesions that displace rather than invade structures

      • Hemangioendothelioma

      • Mesenchymal hamartoma

      • Mestastatic disease (neuroblastoma and Wilms)

    • Hepatic masses - age > 5 years (HHELM)

      • HCC

        • Fibrolamellar HCC

      • Hepatic adenoma

      • Embryonal sarcoma

      • Lymphoma

      • Metastatic disease

  • GU

    • 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

      • Primary megaureter

        • Aperistaltic distal ureter

      • Ureterocele

      • VUR

        • Grade III - blunting of calyces

    • Bladder

      • Prune-Belly syndrome

        • Hypoplasia of abdominal musculature

        • Cryptorchidism

        • GU tract abnormalities

    • Pelvic rhabdomyosarcoma

    • Urethra

      • PUV

    • Hydrometrocolpos

  • MSK

    • CRITOE => Sequence of appearance of ossification centers (1,3,5,7,9,11 years)

  • Metabolic

    • Hypoparathyroidism and pseudohypoparathyroidism => basal ganglia calcifications.

  • Lines

    • 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)



Our website is supported by displaying online advertisements to our visitors.
We only place minimal non-intrusive ads.
Please consider supporting us by disabling your ad blocker.
You will be able to access this page after your ad blocker is paused or disabled on this website.
Thank you for your understanding!