Guide Pediatric Imaging (RadCases)

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Please try again later. Format: Kindle Edition Verified Purchase. I like the radcases series, they seem to have more relevant cases than some other review series. There are a lot of typos in the book but they don't seem to distract from the learning too much. They explain the imaging findings after each case and give nice pertinent info. I would recommend these books. Easy to read. You can review cases n one hour or less. Certainly a time saver. Recommend it for sure.

This text provides several good pediatric radiology cases, many with classic imaging findings. Some of the images were subpar for visualizing or diagnosing the abnormality. Review for kindle version. See all 4 reviews. Amazon Giveaway allows you to run promotional giveaways in order to create buzz, reward your audience, and attract new followers and customers. Learn more about Amazon Giveaway. This item: Pediatric Imaging RadCases.

Set up a giveaway. There's a problem loading this menu right now. About this Item: Thieme, Condition: New. Seller Inventory More information about this seller Contact this seller 1. About this Item: Condition: New. This is Brand New. More information about this seller Contact this seller 2. Condition: Good. Satisfaction Guaranteed! Book is in Used-Good condition. Pages and cover are clean and intact. Used items may not include supplementary materials such as CDs or access codes. May show signs of minor shelf wear and contain limited notes and highlighting. More information about this seller Contact this seller 3.

More information about this seller Contact this seller 4. Condition: UsedAcceptable. More information about this seller Contact this seller 5. Language: English. Brand new Book. Pediatric Imaging will enable you to diagnose the full range of conditions affecting pediatric patients. Bronchogenic cyst: This is rarely multilocular and rarely contains air unless infected.

The most common location is mediastinal rather than intrapulmonary, and it does not have a systemic blood supply. Essential Facts A pulmonary sequestration is a congenital area of abnormal lung that does not communicate with the bronchial tree and has a systemic arterial supply. It most commonly presents as recurrent pneumonia. Treatment is resection in symptomatic cases; in asymptomatic cases, treatment is controversial. Two types that are very difficult to distinguish by imaging are the following: Intralobar: This is located within a normal lobe, has no separate visceral pleura, and usually drains via pulmonary veins.

Persistent lung opacity is seen over multiple presentations. The condition is most common in the left lower lobe, then the right lower lobe. Systemic arterial supply most commonly arises from the descending aorta but may arise from below the hemidiaphragm; venous drainage varies. The sequestration typically does not contain air unless infected. Note the systemic blood supply arising from the descending aorta arrow. Any modality that can identify the systemic artery feeding the sequestration can be used for diagnosis.

Diagnostic clincher: a systemic artery is feeding the mass. Extralobar sequestration may appear as a paraspinal mass and can be confused with neuroblastoma. Clinical Presentation A year-old boy with chest pain. A follow-up study was obtained after the acute episode. A Frontal chest radiograph demonstrates cardiomegaly and left lower lobe air space disease. There is irregularity of the humeral head epiphyses arrows. B Lateral chest radiograph: there are multiple vertebral body end plate irregularities arrows. Acute chest syndrome ACS , sickle cell disease: The constellation of findings including cardiomegaly, humeral head and vertebral end plate changes, and air space disease points to ACS.

Community-acquired pneumonia: Community-acquired pneumonia could have these chest radiograph findings, but it does not account for the bony and heart findings. Aspiration pneumonia: Aspiration pneumonia would have these chest radiograph findings, but it does not account for the bony and heart findings. Musculoskeletal plain films: findings include avascular necrosis of the humeral heads, H-shaped vertebral bodies, bony sclerosis because of infarcts. Essential Facts ACS is defined as the appearance of a new air space opacity accompanied by chest pain, leukocytosis, and fever in a patient with sickle cell disease.

It is often recurrent and can lead to pulmonary hypertension and chronic lung disease. It is a significant cause of mortality in patients with sickle cell disease. Chest radiograph: Opacities may rapidly resolve; lower lobes predominate; cardiomegaly, pulmonary edema, and effusions are common; enlarged ribs arise from marrow expansion. Look for small, possibly calcified spleen and right upper quadrant cholecystectomy clips. Because the exact etiology of ACS is multifactorial, it can have many radiographic appearances.

Frontal radiograph of the chest demonstrates coarse interstitial opacities with increased lung volumes. There is no pleural effusion.

Notice that the humeral epiphyses are ossified arrows , indicating that this is probably a full-term infant. Meconium aspiration: Linear densities emanating from the hila and increased lung volumes are consistent with meconium aspiration. Transient tachypnea of the newborn: Although this also occurs in term infants, the course is benign, and intubation is not required. The diagnosis of transient tachypnea of the newborn may have pleural effusion. Neonatal pneumonia: This can also appear as asymmetric, patchy, perihilar densities with hyperinflated lungs. The diagnosis of neonatal pneumonia may have pleural effusion.

Meconium aspiration occurs in term infants. Pleural effusion is uncommon. It can appear identical to neonatal pneumonialook for. Essential Facts Meconium aspiration most often occurs in term infants with in utero or intrapartum stress; it rarely occurs in infants born before 34 weeks gestation. There is often a clinical history of meconium-stained amniotic fluid. Only meconium aspirated to below the vocal cords is clinically significant. Treatment includes immediate suction, then ventilation, antibiotics, surfactant, and inhaled nitrous oxide.

The severity of persistent pulmonary hypertension is a major prognostic determinant. Radiographic findings include increased lung volumes, heterogeneous opacities in the central two-thirds of lung, and frequent manifestations of air leak. The radiographic severity of disease does not correlate with clinical findings. The plain radiographic findings almost always return to normal by 1 year of age. A,B Frontal and lateral chest radiographs demonstrate a smooth, well-defined soft-tissue mass in the apex of the left hemithorax arrows.

C Axial post-contrast computed tomography CT image demonstrates that the smooth, homogeneous left apical mass has an attenuation value approximately equal to that of the subcutaneous adipose tissue arrow. Lipoma: The smooth, homogeneous character of the mass and its fat density are highly suggestive of a lipoma, a benign tumor.

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Angiomyolipoma: These fat-containing masses associated with tuberous sclerosis can arise outside the kidney in such locations as the liver, spleen, and lymph nodes, but they usually contain nonadipose tissue and are rarely found in children who do not have tuberous sclerosis. Ultrasound can generally distinguish lipomas from cysts and more heterogeneous tumors.

Lipomas are the most common soft-tissue tumors, and more than half are located in the subcutaneous tissues, where they demonstrate the so-called slippage sign because they are not attached to the subcutaneous fascia. Lipomas appear lucent on radiographic imaging. A Frontal chest radiograph demonstrates a large, predominately left-sided posterior mediastinal mass. The posterior location of the mass is apparent from several features: It obscures the margin of the descending aorta, and it is associated with increased distances between the posterior aspects of the lower ribs on the left in comparison with those on the right.

Moreover, these ribs are eroded and narrowed medially arrows. B Axial post-contrast computed tomography image demonstrates a large posterior mediastinal mass displacing the mediastinal structures anteriorly. It contains multiple calcifications and expands the left neural foramen as it invades the vertebral canal arrow. Neuroblastoma: This is by far the most common posterior mediastinal malignancy in infants and children; the calcification and widening of the neural foramen are classic.

Other neural tumors: These include ganglioneuroblastoma, ganglioneuroma, and neurofibroma, which are generally smaller and do not demonstrate such aggressive behavior. Adenopathy: Infection, such as tuberculosis, can produce a posterior mediastinal mass, although such masses generally do not grow so large or displace adjacent structures to this degree.

Bone scan: this is useful to detect cortical skeletal metastases. Cranial imaging is important to detect central nervous system and skull involvement. Neuroblastoma is the most common extracranial solid neoplasm and the most common abdominal malignancy in pediatric patients, as well as the third most common pediatric malignancy. The prognosis is best when the tumor is diagnosed in children younger than 1 year of age. It tends to insinuate between adjacent structures, rather than simply displace them.

The most common sites of metastasis are bone and liver. Frontal radiograph demonstrates cystic lucencies at the base of the right hemithorax, which appear continuous with abdominal bowel gas arrow. The mediastinum is shifted to the left, and the gas-filled stomach is clearly located in the abdomen. Congenital diaphragmatic hernia: The bowel gas extending up from the abdomen, ipsilateral atelectasis, and contralateral mediastinal shift are all typical of congenital diaphragmatic hernia.

Congenital pulmonary adenomatoid malformation: This may present as a multicystic mass in the base of the hemithorax but should not be continuous with bowel gas; the rate of change in appearance is considerably slower because the cysts do not represent bowel. Cavitary pneumonia: Although necrotizing pneumonia can produce multiple cavities in the lung base, this does not occur in the first few hours of life, when congenital diaphragmatic hernia typically presents.

Essential Facts Nearly 9 in 10 congenital diaphragmatic hernias are leftsided. The presence of bowel in the thorax from this early stage results in pulmonary hypoplasia. Pulmonary hypertension is an important sequela of pulmonary hypoplasia and is often combined with hypoxemia and acidosis. Congenital diaphragmatic hernias are often detected at prenatal sonography. The incidence is approximately 1 in births. The lesion may be radiopaque initially because of the absence of gas in the bowel. If this persists with a rightsided lesion, it may indicate a hernia that contains only liver.

There is a strong association with malrotation. Extracorporeal membrane oxygenation is often used to sustain the patient during the first week of life, when pulmonary hypertension tends to be the worst, before surgical repair. A lateral radiograph of the soft tissue of the neck demonstrates marked thickening of the epiglottis thumb sign, arrow and aryepiglottic folds. Epiglottitis: The finding of marked thickening of the epiglottis and aryepiglottic folds is typical, particularly in a clinical setting that includes stridor, dysphagia, fever, and a toxic appearance.

Normal variant: Sometimes called an omega epiglottis, this imaging artifact occurs when patients are positioned slightly obliquely so that both sides of the esophagus are seen adjacent to each other, but there is no thickening of the aryepiglottic folds. Croup: There may be narrowing of the subglottic airway steeple sign on the frontal view, but the epiglottis and aryepiglottic folds themselves should be normal. Essential Facts Epiglottitis usually has an infectious etiology, although other causes include thermal injury, trauma, chemical ingestion, and angioneurotic edema. Routine immunization against Haemophilus influenzae type b infection has raised the median age of patients, so that teenagers are affected more often than small children.

The danger of acute airway occlusion makes this an emergent condition, requiring care by a medical professional skilled in airway management. The age distribution is very different from that of croup, which usually occurs in the first 2 years of life. Clinical Presentation An infant with persistent respiratory distress and poor breath sounds despite intubation.

Frontal chest radiograph demonstrates underinflated lungs and the endotracheal tube paralleling the course of the esophageal tube, with the tracheal air column clearly positioned separately and to the right arrow. Esophageal intubation: An endotracheal tube positioned in the esophagus can be very difficult to detect on frontal radiographs, but in this case seeing the endotracheal tube positioned lateral to the trachea establishes the diagnosis.

Bronchial intubation: An endotracheal tube positioned too far caudally in one of the main bronchi usually the right can be associated with contralateral atelectasis and lack of breath sounds. High position of the endotracheal tube: An endotracheal tube positioned above the glottis can result in hypoventilation of the lungs, and in some cases the tip of the endotracheal tube may be above the top edge of the radiograph and thus not visualized.

Essential Facts Many esophageal intubations are detected clinically and corrected before radiography. Chest radiography is always indicated following endotracheal intubation to verify tube position. By the time the radiograph is seen by a radiologist, the problem has typically been corrected, but it is important to verify immediately that the physician, nurse, or respiratory therapist is aware of it. Look to make sure that the endotracheal tube follows the expected location of the trachea.

Hypoinflated lungs and gaseous distention of the esophagus and stomach are typical findings in esophageal intubation. Do not fail to notify the clinical service immediately, as this condition can result in rapid deterioration. Frontal chest radiograph demonstrates a masslike opacity in the right upper lobe arrow with otherwise clear lungs. Round pneumonia: In the clinical setting of acute infection and because primary pulmonary malignancies are so rare in children, a round opacity in a child is most likely to represent a round pneumonia, a diagnosis supported in this case by the presence of air bronchograms in the medial portion of the lesion.

Bronchogenic cysts: These lesions often appear as round masses, although they are typically located closer to the main airways and should not contain gas unless they have become infected. Pulmonary metastasis: Hematogenous metastases from lesions such as Wilms tumor and rhabdomyosarcoma often appear as round masses, although such lesions are typically multiple and do not contain air bronchograms.

In patients with typical clinical features of pneumonia, computed tomography is not indicated to rule out a neoplasm, although a follow-up chest radiograph may be obtained in 2 to 3 weeks to ensure resolution. Essential Facts As with community-acquired pneumonias in general, the most common agent is Streptococcus pneumoniae. In children between the ages of 1 month and 5 years, most community-acquired pneumonias are viral. Many bacterial pneumonias probably result from viral respiratory infection, which impairs the host defenses and is followed by bacterial superinfection.

Chest radiography is the mainstay of diagnosis and is performed not only to look for pneumonia but also to rule out other processes e. A,B Frontal and lateral chest radiographs demonstrate innumerable small pulmonary nodules bilaterally and hilar enlargement bilaterally arrows , presumably reflecting adenopathy. C A high-resolution axial computed tomography image at the level of the tracheal bifurcation demonstrates innumerable pulmonary nodules bilaterally in a miliary pattern.

RadCases Plus Q&A Pediatric Imaging

Tuberculosis: The miliary pattern of pulmonary nodules with hilar adenopathy is highly suggestive of tuberculosis, particularly in the setting of cough and night sweats. Other granulomatous disease: In the appropriate geographic regions, histoplasmosis midwestern United States and coccidioidomycosis southwestern United States can exhibit a similar imaging pattern and clinical presentation. Hypersensitivity pneumonitis: This can manifest with centrilobular nodular opacities, caused by the inhalation of organic particulate matter including fungi, avian proteins, and dusts.

Essential Facts Tuberculosis is the most important infectious cause of death worldwide, infecting one-third of the human population. It is transmitted by respiratory droplets. Mycobacteria may lie dormant in granulomas and reactivate the infection many years later. Risk factors include exposure to an infected adult and contact with people from or travel to Asia, the Pacific Islands, Latin America, the Middle East, and Africa. Children in whom tuberculosis is suspected should undergo a tuberculin skin test. Chest radiographs should be obtained in all patients with a newly positive tuberculin skin test result; a positive chest radiograph establishes the diagnosis of tuberculosis.

Treatment for tuberculosis typically involves at least three drugs, with a fourth drug added for multidrug-resistant disease. Other relatively common manifestations include menin gitis, osteomyelitis, and arthritis. A,B Frontal and lateral chest radiographs demonstrate a large, thick-walled cystic mass in the right lower lobe containing a prominent air-fluid level arrows. Congenital pulmonary adenomatous malformation CPAM : This commonly presents as a mass lesion containing several large cysts or multiple small cysts, although it may rarely appear solid.

In this case, the thickness of the wall and presence of fever suggest bacterial superinfection. Necrotizing pneumonia: A bacterial or fungal pneumonia may cavitate and appear as a thick-walled cyst with an air-fluid level, indistinguishable radiologically from an infected CPAM. Hiatal hernia: A large hiatal hernia can present as an airfluid level containing a mass in the lower mediastinum, although this lesion appears to be centered in the right lower lobe.

Essential Facts A hamartoma consisting of abnormal terminal bronchiolar proliferation with a relative paucity of alveoli Bronchial communication present congenitally No lobar predilection Often detected on prenatal sonography At least three types: Type 1: one or more large cysts measuring more than 2 cm in diameter Type 2: numerous smaller macroscopic cysts Type 3: appears solid on radiologic imaging Presentation arising from mass effect or infection recurrent pneumonias in older children.

Because of this risk, combined with the risk for infection, many centers routinely resect asymptomatic lesions after the neonatal period. A On an anteroposterior view of the chest, the right lung is smaller than the left, and the heart and mediastinum are shifted to the right asterisk. Additionally, the right hilar shadow is diminutive. B On an axial contrasted computed tomography CT image, the right hemithorax is smaller than the left, and the right pulmonary artery is not seen.

Additionally, multiple small, enhancing vessels surround the right main bronchus arrows. Differential Diagnosis Congenital absence of the right pulmonary artery: The absent pulmonary artery is usually on the side opposite the aortic arch, and the ipsilateral lung is hypoplastic or absent. The small, enhancing vessels are collaterals that supply blood to the right lung. Swyer-James syndrome: In this syndrome, there is a hyperlucent and underperfused lung with a normal or decreased volume.

The ipsilateral hilum is small but present. There is also air trapping on expiration, which is not seen in congenital absence of the right pulmonary artery. Hypogenetic lung syndrome: This is associated with right lung hypoplasia and anomalous pulmonary venous drainage. The pulmonary artery is usually present but small, although it can be absent or normal.

A small, hyperlucent lung on the side opposite the aortic arch has an absent or small hilum and decreased pulmonary vascular markings. The mediastinum is shifted to the side of the absent artery. Ventilation-perfusion scanning demonstrates complete absence of perfusion to the affected lung with normal ventilation. There are no perfusion or ventilation defects in the contralateral lung.

CT may demonstrate an aortopulmonary collateral network feeding the intrapulmonary vessels in the ipsilateral lung. The bronchial arteries, internal mammary arteries, and lateral thoracic artery may be enlarged. CT should demonstrate a normal bronchial branching pattern and may show bronchiectasis as a result of recurrent infections. Congenital absence of the right pulmonary artery usually occurs on the side opposite the aortic arch, and the ipsilateral lung is absent or hypoplastic.

Absence of the left pulmonary artery is associated with a right arch without congenital heart disease. Absence of the right pulmonary artery is associated with a left arch and congenital heart disease usually tetralogy of Fallot. Frontal chest radiograph demonstrates hyperinflation with patchy air space opacities bilaterally, most prominent in the right upper lobe arrow. Viral bronchiolitis: Classic findings include hyperinflation, areas of atelectasis and hyperinflation, and predominately perihilar air space and interstitial opacities. Pneumonia: Viral bronchiolitis and pneumonia exist along a continuum, but bacterial pneumonias typically demonstrate more focal air space disease and are more likely to be accompanied by pleural effusion.

Asthma: In infants and small children, viral bronchiolitis and asthma are radiographically indistinguishable. Essential Facts The most common causes are rhinovirus, respiratory syncytial virus, and parainfluenza virus. Infection results in airway inflammation, increased mucous production, and the formation of intraluminal cellular debris, resulting in airway occlusion. Airway narrowing is a more serious problem in smaller children because tiny decreases in luminal diameter produce disproportionately large reductions in cross-sectional area.

Seasonal increases in incidence are noted, with a peak in winter. Once the diagnosis is established, radiography is used to assess support apparatus and rule out complications such as pneumothorax.

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A Frontal chest radiograph demonstrates a small, hyperlucent left lung with diminished pulmonary vascularity. Left hilar vessels are present arrow. B Axial computed tomography CT image confirms small left lung with decreased vascularity. C A nuclear medicine perfusion scan demonstrates markedly diminished perfusion of the left lung arrow. D,E Nuclear medicine ventilation scans demonstrate decreased aeration of the left lung with air trapping arrow.

Differential Diagnosis Swyer-James syndrome: A small, hyperlucent lung that has a small hilum and exhibits decreased perfusion and ventilation with air trapping is consistent with SwyerJames syndrome. Essential Facts Swyer-James syndrome is likely due to adenoviral or other infection causing bronchiolitis obliterans before the age of 8 years, when the full complement of alveoli has formed.

This leads to obliteration of the distal bronchioles, fewer alveoli, and hypoplasia of the vasculature. It can lead to chronic lung disease. Lung hyperlucency, underperfusion, and air trapping with a normal to decreased lung volume are characteristic. Imaging findings appear a few months to a few years after the inciting infection.

Serial radiographs show little growth in the affected lung. CT: Expiratory imaging should be obtained to demonstrate air trapping. Treatment involves maximizing the function of the normal lung with such measures as avoiding smoking and inhalational injury. Other Imaging Findings Fluoroscopy: During rapid expiration, the mediastinum swings sharply toward the normal lung and the hemidiaphragm rises sharply on the normal side.

The hemidiaphragm on the abnormal side will have much less movement because of air trapping. When Swyer-James syndrome involves just a lobe, it may be mistaken for congenital lobar emphysema. A Frontal chest radiograph demonstrates clear lungs and a normal cardiac silhouette. However, there is a right-sided impression on the tracheal air column at the level of the aortic arch arrow. B,C Lateral image from a barium esophagogram demonstrates a prominent, smooth posterior impression on the upper esophagus arrow , whereas the frontal view shows bilateral impressions, the one on the right located cranial to the one on the left arrows.

D,E Post-contrast axial computed tomography images of the chest demonstrate right- and left-sided aortas arrows , which impinge on the anterior aspect of the trachea and posterior aspect of the esophagus, a so-called vascular ring. Double aortic arch: The finding of right and left aortic arches connected to both the ascending and descending aorta is diagnostic.

Right aortic arch with aberrant left subclavian artery: May appear identical on plain radiographs and esophagography but shows no left aortic arch on cross-sectional imaging. Esophageal duplication: May impinge on the trachea and esophagus on radiography and barium studies but does not enhance with intravenous administration of contrast. The condition often presents with stridor. Cross-sectional images above the arch show four arteries. Essential Facts Persistence of both embryonic aortic arches Most common symptomatic vascular ring Each arch with its own carotid and subclavian arteries Right arch crossing behind esophagus to join left-sided arch, descending aorta Increased incidence of congenital heart disease.

Frontal chest radiograph demonstrates extensive linear and bubble-like lucencies throughout both lungs that radiate from the hila to the periphery. Pulmonary interstitial emphysema PIE : Bubble-like or linear lucencies that radiate from the hila in a premature infant on a ventilator are consistent with PIE. When SDD is treated with surfactant, there may be re-expansion of some alveoli, but not others, in a pattern that mimics PIE.

It is helpful to know when surfactant was administered. Computed tomography: Not needed to evaluate typical PIE; however, it can be obtained to differentiate PIE from other lucent lung lesions. In PIE, air engulfs the pulmonary vessels, which appear as a round soft-tissue density surrounded by abnormal lucency.

Essential Facts Abnormal collections of air in the peribronchial and perivascular spaces are secondary to increased alveolar pressure and rupture barotrauma. Air may further dissect through the interstitium, causing pneumomediastinum or pneumothorax.

[abepivurev.tk] Pediatric Imaging (RadCases), 1e | Lung | Pneumonia

PIE occurs in ventilated infants, usually during the first several days of life but almost always during the first week of life. It may be asymptomatic but can cause difficulty in ventilation. It is often treated by adjusting the ventilator settings or switching from conventional ventilation to high-frequency ventilation. Plain films: Lucencies may be focal or diffuse. On consecutive radiographs, the lucencies are typically transient. The lucencies and volume of the involved lung may not change with respiration.

If PIE affects just one lobe, or if it persists and forms an air-filled mass, it can appear similar to congenital cystic adenomatoid malformation or congenital lobar emphysema. A A frontal chest radiograph demonstrates leftward shift of the mediastinum, suggesting hyperinflation of the right lung. B A lateral barium esophagogram reveals a focal mass effect on the posterior aspect of the trachea and the anterior aspect of the esophagus arrow. C Axial post-contrast computed tomography CT scan of the chest at the level of right pulmonary artery reveals an anomalous origin of the left pulmonary artery, which is arising from the right pulmonary artery arrow and then coursing leftward between the trachea and esophagus.

Pulmonary sling: This is the only relatively common vascular anomaly that lies between the trachea and esophagus, thus creating an impression on the anterior aspect of the esophagus. The CT appearance is pathognomonic. Foregut malformation: Other nonvascular congenital malformations, such as bronchogenic cyst and esophageal duplication cyst, can present as a mass between the trachea and esophagus, although neither would exhibit vascular enhancement.

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Lymphadenopathy: Enlarged lymph nodes could present as a mediastinal mass in this location. Essential Facts Pulmonary sling typically presents with respiratory symptoms such as stridor. It is associated with other anomalies, such as tracheomalacia, complete tracheal rings, and congenital heart disease.

In some cases, the anomalous pulmonary artery may supply only a portion of the left lung. On diagnosis, echocardiography is indicated to rule out associated congenital heart disease. Clinical Presentation A hypertensive teenager with lower blood pressures in the lower extremities than in the upper extremities. Frontal chest radiograph demonstrates ectasia of the ascending aorta and an enlarged aortic knob with a notch between the aortic knob and the proximal descending thoracic aorta arrow.

There is also mild rib notching, best seen in the posterior aspect of the left sixth rib arrowhead. Coarctation of the aorta: The findings of a prominent ascending aorta, enlarged aortic knob, notch between the aortic knob and proximal descending thoracic aorta, and rib notching are highly suggestive of coarctation of the aorta. Aortic stenosis: This lesion is associated with post-stenotic dilatation of the ascending aorta, but isolated aortic stenosis should not demonstrate the other clinical and radiographic findings seen in this case.

Pseudocoarctation: A condition associated with elongation and kinking of the aorta, pseudocoarctation causes a radiographically prominent aortic knob but no true stenosis or blood pressure gradient. Computed tomography is excellent for detection but provides little hemodynamic assessment. Magnetic resonance imaging permits a more accurate assessment of the hemodynamic effects, such as pressure gradients, and is useful for postoperative follow-up.

Echocardiography is good for hemodynamic assessment. Angiography is increasingly reserved for intervention balloon angioplasty. Coarctation of the aorta is likely associated with the contraction of smooth muscle at the time of closure of the ductus arteriosus. It is three times more common in males. Coarctation is also associated with ventricular septal defect, patent ductus arteriosus, and mitral stenosis. An increased incidence of cerebral aneurysms is noted in these patients. Rib notching is caused by the development of intercostal collaterals.

Decreased renal perfusion may exacerbate hypertension through the renin-angiotensin system. Frontal chest radiograph demonstrates massive boxlike cardiomegaly with marked convexity of the right border of the heart arrow. Pulmonary vascularity appears to be diminished. Ebstein anomaly EA : Massive cardiomegaly with marked convexity of the right border of the heart, as well as diminished pulmonary vascularity, is typical of EA.

Pulmonary atresia with intact ventricular septum: This lesion can have an identical appearance, with massive right atriomegaly arising from tricuspid insufficiency. Pericardial effusion: Large pericardial effusions can mimic severe cardiomegaly, although they should not be associated with cyanosis or diminished pulmonary vascularity.

Echocardiography is diagnostic. Magnetic resonance imaging is useful in evaluating chamber volumes and ejection fractions. Essential Facts Displacement of the tricuspid valve into the right ventricle, with atrialization of the ventricle and tricuspid insufficiency, causes right atriomegaly and volume overload of the right side of the heart. EA is associated with maternal lithium use.

EA is associated with numerous other cardiac problems, such as atrial septal defect and reentrant dysrhythmias. The severity varies widely, with some patients not presenting until adolescence or adulthood. A large pericardial effusion can mimic Ebstein anomaly.

Clinical Presentation A child with severe sore throat, fever, swollen neck, and respiratory distress. A Axial lung window computed tomography CT image of the chest demonstrates bilateral nodular air space opacities arrows and pleural effusions. On subsequent imaging, cavitation was noted in some of the nodular air space opacities. B Axial post-contrast CT image of the neck demonstrates inflammation and early abscess formation in the left lateral pharyngeal tissues and a filling defect in a branch of the left internal jugular vein arrow.

Lemierre syndrome: This disorder is defined as infection of the lateral pharyngeal space and septic thrombosis of the jugular vein, which may be complicated by septic pulmonary emboli. Wegener granulomatosis: This is a necrotizing vasculitis that can cause cavitary pulmonary nodules and is also associated with necrotizing granulomas in the upper respiratory tract and focal glomerulonephritis. Laryngotracheal papillomatosis: This condition also may present with cavitary lung nodules but is not associated with pharyngitis, thrombophlebitis, or pleural effusions.

Chest radiograph demonstrates typical findings of septic emboli. Neck sonography shows jugular thrombosis and adjacent inflammation. CT is generally best for the assessment of neck and chest disease. Essential Facts Lemierre syndrome is most common in children and young adults, who may present with high fever, respiratory distress, and septic shock.

Suppurative infection spreads from the lateral pharyngeal space into the carotid sheath, causing thrombophlebitis of the jugular vein. It is most often associated with Fusobacterium necrophorum, an anaerobe normally present in the oral cavity. Remember that pulmonary nodules in children are much less likely to reflect mallignancy than in adults.

A,B Frontal chest radiograph demonstrates right paratracheal opacity. The left lung is hyperlucent. Lateral chest radiograph demonstrates a large mass posterior to the trachea arrow , associated with tracheal narrowing. C Esophagogram demonstrates that the esophagus is displaced to the right by an extramural mass arrow. D Axial post-contrast computed tomography CT image shows a large, low-density mass at the level of the carina. It narrows the left main bronchus arrow. The right lung is now hyper-expanded. Bronchogenic cyst: All of the preceding findings are typical of a bronchogenic cyst.

On an esophagogram, esophageal cysts are typically intramural. Necrotic lymphadenopathy: Lymphadenopathy is usually multilobular, not typically with fluid density, and would show some contrast enhancement. T2 and short inversion recovery magnetic resonance images show high signal intensity, almost always equal to or greater than that of cerebrospinal fluid. Essential Facts Bronchogenic cysts result from abnormal ventral budding of the tracheobronchial tree very early in gestation.

Infants may present with respiratory distress. Older children may have chest pain or dysphagia. The lesions may also be found incidentally. Bronchogenic cysts may become infected. Surgical resection is recommended. They can be detected on prenatal ultrasound. Plain radiographs: These show a well-defined, soft-tissuedensity mass with smooth borders. CT: The lesion can be aqueous to proteinaceous in density.

The thin wall should be nonenhancing or minimally enhancing. If the cyst is infected, the wall will be thicker and enhance. Esophageal duplication cysts are typically intramural le sions. A,B Axial computed tomography CT images demonstrate multiple soft-tissue masses throughout both lungs arrows.

Notice the mural soft-tissue mass in the trachea arrowhead. Papillomatosis: Soft-tissue masses within the airway as well as nodules in the lungs indicate papillomatosis. Metastatic disease: Wilms tumor frequently metastasizes to the lung, but the airway is not usually involved. Invasive fungal disease: These soft-tissue masses may have a ground-glass halo and occur in immunocompromised individuals. Also, they do not involve the trachea. Plain film: nodularity can often be seen in the trachea and bronchi. Fluoroscopy: this may be used to determine if soft-tissue masses in the trachea are due to secretions.

Essential Facts Perinatal transmission of the human papillomavirus from mother to child leads to benign tumors of the respiratory system and less commonly the digestive system.

The mean age at diagnosis is 4 years.