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ExpertDDX: Pediatrics

SECOND EDITION

A. Carlson Merrow, MD, FAAP

Corning Benton Chair for Radiology Education, Cincinnati

Children’s Hospital Medical Center

Associate Professor of Clinical Radiology, University of Cincinnati

College of Medicine, Cincinnati, Ohio

Table of Contents

Cover image

Title page

Copyright Dedication

Contributing Authors

Preface

Acknowledgments

Sections

SECTION 1: CARDIAC

Chapter 1: High-Output Heart Failure

Chapter 2: Massive Cardiomegaly

Chapter 3: Cardiac or Pericardial Mass

Chapter 4: Acyanotic Heart Disease With Increased Vascularity

Chapter 5: Cyanotic Heart Disease With Decreased Vascularity

Chapter 6: Cyanotic Heart Disease With Variable or Increased Vascularity

Chapter 7: Right Atrial Enlargement

Chapter 8: Right Ventricular Enlargement

Chapter 9: Small Pulmonary Artery

Chapter 10: Prominent Pulmonary Artery

Chapter 11: Left Atrial Enlargement

Chapter 12: Left Heart Obstructive Lesion

Chapter 13: Congenital Aortic Arch Anomalies

Chapter 14: Obstructive Aortic Arch Lesions

Chapter 15: Dilated Thoracic Aorta

Chapter 16: Situs Anomalies

SECTION 2: CHEST

Chapter 17: Reticulonodular Infiltrate

Chapter 18: Neonatal Irregular Lung Opacities

Chapter 19: Bubbly Lungs

Chapter 20: Unilateral Hyperlucent Lung

Chapter 21: Bilateral Hyperlucent Lungs

Chapter 22: Lung Cavity

Chapter 23: Lucent Lung Mass

Chapter 24: Round Lung Mass

Chapter 25: Multiple Pulmonary Nodules

Chapter 26: Consolidation

Chapter 27: Neonatal Chest Mass

Chapter 28: Chest Wall Mass

Chapter 29: Rib Lesion

Chapter 30: Pneumothorax

Chapter 31: Pneumomediastinum

Chapter 32: Mediastinal Widening

Chapter 33: Anterior Mediastinal Mass

Chapter 34: Middle Mediastinal Mass

Chapter 35: Posterior Mediastinal Mass

Chapter 36: Esophageal Stricture

Chapter 37: Esophageal Extrinsic Impressions

SECTION 3: GASTROINTESTINAL

Chapter 38: Neonatal Proximal Bowel Obstruction

Chapter 39: Neonatal Distal Bowel Obstruction

Chapter 40: Microcolon

Chapter 41: Dilated Stomach

Chapter 42: Duodenal Obstruction

Chapter 43: Small Bowel Obstructions Beyond Neonates

Chapter 44: Diffusely Abnormal Small Bowel

Chapter 45: Acute Abdomen in Infants and Children

Chapter 46: Right Lower Quadrant Pain

Chapter 47: Abnormal Appendix

Chapter 48: Intussusception

Chapter 49: Colitis

Chapter 50: Pneumatosis

Chapter 51: Pneumoperitoneum

Chapter 52: Mesenteric Lesions

Chapter 53: Cystic Abdominal Mass

Chapter 54: Abdominal Mass in Neonate

Chapter 55: Solid Abdominal Mass in Child

Chapter 56: Abdominal Aortic Anomalies

Chapter 57: Hepatic Mass in Neonate

Chapter 58: Hepatic Mass in Child

Chapter 59: Multiple Liver Lesions

Chapter 60: Pancreatic Mass

Chapter 61: Splenic Lesions

Chapter 62: Abdominal Calcifications in Child

Chapter 63: Metallic Foreign Bodies

SECTION 4: GENITOURINARY

Chapter 64: Retroperitoneal Mass

Chapter 65: Suprarenal Mass

Chapter 66: Solid Renal Mass, Solitary

Chapter 67: Solid Renal Mass, Multifocal

Chapter 68: Renal Cysts

Chapter 69: Bilateral Hydronephrosis

Chapter 70: Unilateral Hydronephrosis

Chapter 71: Pelvic Mass

Chapter 72: Ovarian Mass

Chapter 73: Scrotal Mass

Chapter 74: Scrotal Pain

Chapter 75: Bladder Mass

Chapter 76: Urethral Variations and Abnormalities

SECTION 5: MUSCULOSKELETAL

Chapter 77: Epiphyseal Irregularity or Stippling

Chapter 78: Epiphyseal Overgrowth

Chapter 79: Dense Metaphyseal Bands and Lines

Chapter 80: Lucent Metaphyseal Bands and Lines

Chapter 81: Metaphyseal Fraying/Irregularity

Chapter 82: Metaphyseal Cupping

Chapter 83: Physeal Widening

Chapter 84: Physeal Bridge/Growth Arrest

Chapter 85: Bubbly Bone Lesion

Chapter 86: Multifocal Nonaggressive Bone Lesions

Chapter 87: Multifocal Aggressive Bone Lesions

Chapter 88: Extensive Marrow Abnormalities

Chapter 89: Diaphyseal Lesion

Chapter 90: Sclerotic Bone Lesions

Chapter 91: Painful Hip

Chapter 92: Abnormal Femoral Head

Chapter 93: Coxa Magna Deformity

Chapter 94: Joint Effusion or Synovitis

Chapter 95: Arthritis in Child

Chapter 96: Elbow Fractures

Chapter 97: Radial Dysplasia/Aplasia

Chapter 98: Lower Extremity Bowing

Chapter 99: Congenital Foot Deformity

Chapter 100: Skeletal Dysplasia With Short Extremities

Chapter 101: Skeletal Dysplasia With Short Ribs

Chapter 102: Skeletal Dysplasia With Major Spine Involvement

Chapter 103: Focal Gigantism/Macrodactyly

Chapter 104: Soft Tissue Mass

Chapter 105: Soft Tissue Calcifications

Chapter 106: Multifocal Periosteal Reaction

Chapter 107: Child Abuse

SECTION 6: BRAIN

Chapter 108: Microcephaly

Chapter 109: Macrocrania/Macrocephaly

Chapter 110: Subarachnoid Space Normal Variants

Chapter 111: Ventriculomegaly

Chapter 112: Intracranial Hemorrhage

Chapter 113: Suprasellar Mass

Chapter 114: Pineal Mass

Chapter 115: Cerebral Hemisphere Mass

Chapter 116: Lateral Ventricular Mass

Chapter 117: Posterior Fossa Neoplasm

Chapter 118: Cystic-Appearing Posterior Fossa Lesion

Chapter 119: Extraaxial Mass

Chapter 120: Brain Tumor in Newborn or Infant

Chapter 121: Thick Cerebral Cortex

Chapter 122: Abnormal Shape/Configuration of Corpus Callosum

Chapter 123: Signal/Attenuation Abnormalities of Corpus Callosum

Chapter 124: Abnormal Brainstem Morphology

Chapter 125: Congenital Cerebellar Malformation

Chapter 126: Intracranial Calcifications

Chapter 127: Multifocal White Matter Abnormalities

Chapter 128: Metabolic Disorders Affecting Primarily White Matter

Chapter 129: Diffuse Abnormalities of Myelination

Chapter 130: Deep Gray Nuclei Abnormalities

Chapter 131: Ring-Enhancing Lesions

Chapter 132: Craniocervical Arterial Stenosis

Chapter 133: Sulcal or Cisternal Enhancement

Chapter 134: Skull Base Lesion

SECTION 7: HEAD AND NECK

Chapter 135: Stridor

Chapter 136: Epiglottitis

Chapter 137: Thickened Retropharyngeal Tissues

Chapter 138: Enlarged Lymph Nodes in Neck

Chapter 139: Solid Neck Mass in Neonate

Chapter 140: Solid Neck Mass in Child

Chapter 141: Cystic Neck Mass in Child

Chapter 142: Transspatial Mass

Chapter 143: Extraluminal Gas in Neck

Chapter 144: Leukocoria

Chapter 145: Ocular Lesion

Chapter 146: Microphthalmos

Chapter 147: Macrophthalmos

Chapter 148: Optic Nerve or Nerve Sheath Lesion

Chapter 149: Rapidly Developing Proptosis

Chapter 150: Sinonasal Mass

Chapter 151: Congenital Midline Nasal Lesion

Chapter 152: Nasal Obstruction in Newborn

Chapter 153: Congenital Anomalies of Skull Base

Chapter 154: Sensorineural Hearing Loss in Child

Chapter 155: Inner Ear Lesion in Child

Chapter 156: Middle Ear Lesion in Child

SECTION 8: SPINE

Chapter 157: Scoliosis

Chapter 158: Kyphosis

Chapter 159: Bullet-Shaped Vertebra/Anterior Vertebral

Body Beaking

Chapter 160: Scalloped Vertebral Bodies

Chapter 161: Vertebra Plana or Platyspondyly

Chapter 162: Back Pain

Chapter 163: Spinal Dysraphic Lesion

Chapter 164: Presacral or Sacrococcygeal Mass

Chapter 165: Intramedullary Spinal Cord Lesion

INDEX

1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899

EXPERTDDX: PEDIATRICS, SECOND EDITION

ISBN: 978-0-323-68177-3

Copyright © 2020 by Elsevier. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).

Notices

Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds or experiments described herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.

Previous edition copyrighted 2010.

Library of Congress Control Number: 2019941281

Printed in Canada by TC Transcontinental, Beauceville, Quebec, Canada

Last digit is the print number: 9 8 7 6 5 4 3 2 1

Dedication

To Nan,

There is an intimacy of you and I where no interruption dare tread, where no calamity can take hold, where life is abundant and purposeful, and joy begets sustenance and wholeness, fight and adventure. I carry that with me every day … there are traces of it scattered throughout all of my work, and surely those are the best parts.

Thank you for sharing this life with me.

ACM

Contributing Authors

Michael R. Aquino, MD, MHSc, Pediatric Radiologist, Imaging Institute, Sections of Pediatric and Regional Radiology, Cleveland Clinic, Cleveland, Ohio

Bernadette L. Koch, MD

Associate Director of Radiology, Cincinnati Children’s Hospital Medical Center

Professor of Clinical Radiology and Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio

Christopher Z. Lam, MD

Staff Body and Cardiac Radiologist, Department of Diagnostic Imaging, Hospital for Sick Children

Lecturer, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada

Luke L. Linscott, MD

Pediatric Neuroradiologist, Primary Children’s Hospital, Intermountain Pediatric Imaging

Adjunct Assistant Professor of Radiology, University of Utah School of Medicine, Salt Lake City, Utah

Arthur B. Meyers, MD

Cincinnati Children’s Hospital Medical Center

Associate Professor of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio

Staff

Assistant Professor of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio

Additional Contributors

H. Christian Davidson, MD

H. Ric Harnsberger, MD

Steven J. Kraus, MD

Luke N. Ledbetter, MD

Kristine M. Mosier, DMD, PhD

Michael Nasser, MD

Sara M. O’Hara, MD, FAAP

Daniel Podberesky, MD

Karen L. Salzman, MD

Blair A. Winegar, MD

Preface

Welcome to the 2nd edition of ExpertDDx: Pediatrics. It is my honor and privilege to have led such an excellent team of pediatric radiologists in constructing a book that I believe will prove invaluable in your daily practice.

The capacity to craft a meaningful differential diagnosis remains, at least at this time, the skill of a human artisan, developed over many years, if not decades. To exquisitely articulate a narrow list of candidate pathologies provides critical direction for the clinician and patient, carrying great importance in the chain of care. But the valuable interpreter of images also knows to consider a broader spectrum of diseases intellectually before committing to a selective list of contenders in the radiologic report. This book generally embraces more extensive lists of entities that can produce characteristic radiologic findings, working through images and text to help you select the considerations most relevant to your patient’s clinical and imaging scenario.

I hope that you find this thoroughly updated volume a useful guide in the realm of pediatric radiology, where the background of normal anatomy is rapidly changing, and the pathology can be uniquely sinister. Use it to expedite care and improve outcomes.

A thank you to all who contributed to this book, including authors and Elsevier staff (especially Nina!), but also spouses, families, teachers, and patients. The best care comes

with deep passion, intense labor, and time that requires sacrifice. May there be great benefit for the children and families we serve.

Corning Benton Chair for Radiology, Cincinnati Children’s Hospital Medical Center

Associate Professor of Clinical Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio

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