• Benign extraaxial collections of infancy

• Primary/Congenital
  • Epitympanum
• Secondary/Acquired
  • Mesotympanum

• Branched-linear pattern of echogenicity in the region of the basal ganglia and thalami on echoencephalogram
• Follow the course of the lenticulostriate branches of the middle cerebral arteries
• Secondary to a cerebrovasculitic response to congenital infection (most often ascribed to rubella, CMV, and syphilis), anoxia, or rarely trisomy 13

• Cephalohematoma
• Caput succedaneum
• Leptomeningeal cyst
  • related to dural tear
• Subgaleal hematoma

• Aqueductal stenosis
• Tectal glioma

• Scaphocephaly - Early fusion of the sagittal suture
• Anterior plagiocephaly - Early fusion of 1 coronal suture
• Brachycephaly - Early bilateral coronal suture fusion
• Posterior plagiocephaly - Early closure of 1 lambdoid suture
• Trigonocephaly - Early fusion of the metopic suture (metopic suture fuses between 6-8 months and sometimes as early as 3 months)

• Proper location for umbilical artery catheter = T8 - T12; alternative at L3 - L4
• Umbilical vein catheter tip should be at the right atrium

• I classify Pulmonic Atresia w/ VSD as a severe form of tetralogy
• Right Arch common w/ TGV, Truncus, Tets, Tricuspid Atresia (basically the cyanotic, increased vascularity ddx plus tets and minus TAPVR)
• Increased pulmonary flow, a right arch and cardiomegaly (biventricular) is classic for truncus arteriosus
• Hypoplastic Left Heart Syndrome has cardiomegaly, pulmonary edema, a small aorta, and is cyanotic

• Rhabdomyoma (small, multiple)
• Fibroma
• Myxoma

• Connective tissue disorders
• Takayasu's
• Syphilitic aortitis
• Neurofibromatosis
• FMD
• Giant cell arteritis
• Williams Syndrome

1. Overriding Aorta
2. VSD
3. Pulmonary Stenosis
4. Right Ventricular Hypertrophy

• Type 1
  • cardiomegaly and increased pulmonary vascularity
  • widened mediastinum (“snowman heart”) due to vertical vein
• Type 2
  • cardiomegaly and increased pulmonary vascularity
  • simulates shunt physiology
  • blood returns via pulmonary veins → coronary sinus → RA
• Type 3
  • normal heart size, increased pulmonary vascularity
  • blood returns via infradiaphragmatic systemic venous connection (IVC, hepatic vein, portal vein, etc.)

• Aortic Anomalies
  • aortic stenosis
  • coarctation
• LV dysfxn
  • aberrant L coronary artery
  • myocarditis
  • hypoplastic L heart syndrome
• Glycogen Storage Disease (Pompe)
• High Flow States
  • vein of galen
  • hemangioendothelioma
  • anemia
  • polycythemia

• dysphagia lusoria
• low association w/ congenital heart disease
• not a true ring

• CCAM (Type 1)
• CLE
• CDH
• PIE

• CCAM (Type 3)
• sequestration
• bronchgenic cyst

• Recurrent Infections → Pseudomonas and Staph
• Lung Fibrosis
• Progressive Respiratory Failure
• Clubbing
• Pancreatic Insufficiency
• Liver Cirrhosis
• Rectal Prolapse
• Meconium Ileus, Meconium Peritonitis, Intussusception
• Sinusitis
• Infertility in Males

• foreign body
• PTX
• congenital lobar emphysema
  • most common LUL > RML > RUL
• pulmonary artery hypoplasia
• compensatory hyperinflation b/c of bad c/l lung

• early (2-6 hr) prominent vascular markings with patchy round alveolar opacities and pleural fluid
• normal to large lung volumes, mild CM, rapid clearance by 42-78hrs, starting by 10-12hrs

• Low lung volumes
• Ground-glass opacities

• patchy, bilateral, asymmetric coarse opacities, representing areas of SSA
• marked hyperaeration - 25% get PTX and pneumomediastinum
• CXR clearing takes several weeks & lags clinical improvement
• treatment is ECMO if severe

• GBS looks like RDS, with bilateral granular, symmetric opacities and low lung volumes
  • GBS usually has effusions and RDS rarely does
• other pneumonias resemble meconium aspiration, w/ patchy, asymmetric opacities and hyperaeration
• organisms - Group B Strep, CMV (viral pneumonitis), Chlamydia

• Pneumonia
• Hyaline Membrane Disease
• Neurogenic (Brain Damage)

• Neuroblastoma
• Sequestration
• Pneumonia
• Nerve Sheath Tumors

* Rosenberg, et.al. AJR 1991

• hepatoblastoma
  • most common primary malignant liver tumor of childhood, M > F, elevated AFP
  • inhomogeneous appearance
  • associated with Beckwith-Wiedemann syndrome
• hemangioendothelioma
  • same CT appearance as adult hemangiomas; 50% calcify
  • MR - low T1, very high T2, large flow voids, Gd enhancement like CT
  • often presents w/ CHF or Kasabach-Meritt
• mesenchymal hamartoma
  • large multilocular cystic mass with thin internal septations
  • septa and any solid portions will enhance
• neuroblastoma mets

• HCC
• mesenchymal sarcomas
• mets
• lymphoma
• adenoma

• Mesenteric Cyst
• Urachal Cyst
• Duplication Cyst
• Choledochal Cyst
• Abscess
• Hydronephrosis
• Multicystic Dysplastic Kidney
• Cystic Ovarian Mass

• Posterior Urethral Valves
• Prune-Belly Syndrome
• Bilateral Megaureter

Mnemonics:

• Neuroblastoma encases and calcifies (NEC)
• Wilms invades and lung mets (WILM)

* Drash syndrome - Wilms, pseudohermaphroditism, glomerulonephritis

• 1 - confined to the organ of origin
• 2 - extension beyond the organ but not crossing midline
• 3 - extension across midline
• 4 - distal mets
• 4S - age <1 year, mets confined to skin, liver, and bone marrow (SLiM)

• 1 - confined to kidney, completely excised
• 2 - local extension, completely resected
• 3 - incomplete resection, no distant mets
• 4 - distant mets to lung, liver, bone, or brain
• 5 - bilateral synchronous tumors

• decreased calibur of aorta and IVC
• intense enhancement of bowel wall, aorta, IVC, pancreas, and kidneys
• dilated, fluid-filled bowel
• suggests tenuous hemodynamic state

• abdominal wall muscle deficiency (“prune belly”)
• nonobstructed, but markedly dilated redundant ureters ± hydronephrosis ± renal dysplasia
• bilateral cryptorchidism

• Grade I: Urine backs up into the ureter only, and the renal pelvis appears healthy, with sharp calyces.
• Grade II: Urine backs up into the ureter, renal pelvis, and calyces. The renal pelvis appears healthy and has sharp calyces.
• Grade III: Urine backs up into the ureter and collecting system. The ureter and pelvis appear mildly dilated, and the calyces are mildly blunted.
• Grade IV: Urine backs up into the ureter and collecting system. The ureter and pelvis appear moderately dilated, and the calyces are moderately blunted.
• Grade V: Urine backs up into the ureter and collecting system. The pelvis severely dilates, the ureter appears tortuous, and the calyces are severely blunted.

• hemorrhagic cystitis
• rhabdomyosarcoma

• Kohler's disease, if asymptomatic, is normal variant called Karp Dysplasia
• Blount's Disease = Tibia Vara
• The tarda form of hypophosphatasia mimics rickets radiographically
• Toddler's Fx - nondisplaced spiral fx of distal tibia

• Ossification of the iliac apophysis starts at the anterior superior iliac spine and progresses posteromedially.
• The iliac crest is divided into quadrants, and the stage of maturity is designated as the number of ossified quadrants. For example, 50 percent ossified is a Risser grade 2. On the anatomic left (right side of the figure), all quadrants are ossified and the apophysis is fused to the iliac crest, for a Risser grade 5.

• Idiopathic (adolescent)
  • usually females
  • R thoracic ± L lumbar curve
• Juvenile (3-10 years)
  • idiopathic
  • 2:1 female predominance
• Infantile
  • convex to L
  • boys

• left hip is more often involved (? due to fetal positioning)
• females: 80% of cases
• breech birth (may account for 25-45% of DDH cases)
• first born
• fixed positions of extension and adduction
• Down's syndrome

• Hilgenreiner's line is drawn thru the triradiate cartilages
• Perkins line is perpendicular to that, drawn from the anterior inferior iliac spine
• Femoral head should be in the lower inner quadrant fromed by the lines

• Alpha Angle
  • measurement of acetabular concavity
  • angle between the baseline and the roofline
• Beta Angle
  • measured between the baseline and the inclination line
  • indicates the acetabular cartilaginous roof coverage
• Type I hips
  • alpha angle > 60°
  • normal
  • require no treatment and no follow-up
• Type II hips
  • alpha angle = 50-59 degrees
  • hip is normally located, but the bony acetabulum is immature
  • if < 3mos → physiologic immaturity
  • if > 3mos → mild dysplasia
  • no treatment but should be closely observed clinically and with US until they meet type I criteria
  • small risk of delayed displacement or acetabular dysplasia
• Type III hips (low displacement) and type IV hips (high displacement)
  • beta angle < 55 degrees
  • usually very apparent clinically
  • both require immediate treatment

• causes coxa magna & coxa plana

• Lead Poisoning
• Heavy Metals
• Healing Phase of Rickets

• Blue Cell Tumor (Ewings/Neuroblastoma)
• Leukemia/Lymphoma
• Ricketts
• Rubella
• Congenital Syphillis → Wimberger Sign

• hypothyroidism
  • delayed skeletal maturity (bone age more than 2 SD below the mean)
  • small stature
  • wormian bones
  • enlarged sella
  • fragmented epiphyses
  • delayed closure of cranial sutures
• AVN (few epiphyses involved)
• multiple epiphyseal dysaplsia
• spondyloepiphyseal dysplasia

• Congenital infections (Syphilis, CMV, Rubella)
• Hypophosphatasia
• Achondroplasia
• Ricketts
• Metaphyseal dysostosis
• Scurvy

• Thalassemia (or other severe anemias)
• Osteopetrosis
• Pyle's disease (metaphyseal dysplasia)
• Diaphyseal aclasis (multiple osteochondromas)
• Ollier disease (multiple enchondromas)
• Gaucher disease

• J-shaped Sella
• Dense Skull/Dense Bones
• Vertebral Body Beaking
• Canoe Paddle Ribs
• Basilar Invagination
• Dural Ectasia
• Proximal Metacarpal Tapering

• Rhizomelic → proximal shortening (humerus or femur)
• Mesomelic → middle shortening (tibia/fibula or radius/ulna)
• Acromelic → distal shortening (hand)
• Micromelic → entire limb shortened

• Rhizomelic
• Increased craniofacial ratio
• Small skull base/foramen magnum
• Short vertebral bodies and large disc space
• Interpediculate distance decreases at more inferior levels in the L spine
• Pedicles are short and there is posterior vertebral body scalloping
• Metaphyses of long bones are flared
• Trident hand due to increased space between the middle fingers
• Iliac bones are short and rounded
• Decreased acetabular angles
• Champagne glass shaped true pelvis
• Lower extremities are short and thick
• Growth plates are “V” shaped

• Rhizomelic
• Severe platyspondyly, but with enlarged disc space, such that the overall thorax is nl in length
• Bowing and widening of femurs which look like telephone recievers
• Metaphyses are flared
• Small iliac wings and decreased acetabular angles
• May be a trident acetabulum
• Ribs are very short
• Tubular bones of the hands are feet and short and broad
• Interpediculate distance may be narrowed
• Cloverleaf skull

• Both are acromelic
• Very short ribs (especially Jeune) resulting in a very narrow chest, with a large appearing heart
• Trident acetabulum and decreased acetabular angle
• Premature ossification of the prox femoral epiphysis
• Skull and spine are normal, which helps distinguish from other dwarfisms
• Carpal bone fusions
• Polydactyly and an extra carpal bone are found much more commonly in ellis van creveld
• Could ask if the pt is Amish (ellis van creveld)

• Main feature is bowing of the long bones of the lower extremity, with the apex pointing toward a skin dimple
• Also hypoplastic scapulae, small face vs skull, and dysplastic pelvic bones

• Metaphyseal
• Rib
• Scapula
• Sternum
• Spinous process

• osteogenesis imperfecta (look for osteopenia and wormian bones)
• neuromuscular disorders
• Menkes syndrome (also causes osteopenia and wormian bones plus WM hypomyelination, cerebral atrophy and subdural collections due to decreased copper absorption in GI tract)
• congenital insensitivity to pain

• physiologic/nl variant - should be only diaphyseal, smooth, symmetric, mostly along medial prox femur
• prostaglnadin txt
• Caffey’s
• neuroblastoma mets
• TORCH infections
• syphilis

• Goes from Umbilicus to Right Atrium

• Goes from Umbilicus to T6-10 or below L3

• Keeps PDA Open
• Causes Mucosal Pyloric Hypertrophy
• Causes Periostitis

• Jeune Syndrome (asphyxiating thoracic dysplasia)
• Homozygous Achondroplasia

• Cleidocranial Dysostosis
• Hypothyroidism/Hypophosphatasia
• Osteogenesis Imperfecta
• Pyknodysostosis/Progeria
• Down Syndrome
• Idiopathic
• Kinky Hair Syndrome