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(BQ) Part 2 book Diagnostic imaging of infants and children presents the following contents: Congenital abnormalities of the brain, intracranial infections, autoimmune disorders of the brain, intracranial neoplasms and masses, neoplasms and masses of the spine, trauma and surgery of the spine,...
Diagnostic Imaging of Infants and Children VOLUME I Notice Medicine is an ever-changing science As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required The author and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and gener ally in accord with the standards accepted at the time of publication However, in view of the possibility of human error or changes in medical sciences, nei ther the author nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work Readers are encouraged to confirm the information contained herein with other sources For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for adminis tration This recommendation is of particular importance in connection with new or infrequently used drugs Diagnostic Imaging of Infants and Children Robert G Wells, MD Pediatric Diagnostic Imaging, SC PDI Pediatric Teleradiology Milwaukee, Wisconsin Director, Pediatric Imaging Northwestern Lake Forest Hospital Lake Forest, Illinois Associate Clinical Professor of Radiology and Pediatrics Medical College of Wisconsin Milwaukee, Wisconsin VOLUME I edical New York Chicago Milan San Francisco New Delhi Lisbon San Juan Seoul London Madrid Singapore Mexico City Sydney Toronto � McGrow·H/1/ CompanieS Copyright© 2013 by The McGraw-Hill Companies, Inc AU rights reserved Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any fonn or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher ISBN: 978-0-07-180839-2 MHJD: 0-07-180839-6 The material in this eBook also appears in the print version of this title: ISBN: MHJD: 0-07-176966-8 978-0-07-176966-2, All trademarks are trademarks of their respective owners Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark Where such designations appear in this book, they have been printed with initial caps McGraw-Hill eBooks are available at special quantity discounts to use as premiums and sales promotions, or for use in corporate training programs To contact a representative please e-mail us at bulksales@mcgraw-biU.com TERMS OF USE This is a copyrighted work and The McGraw-Hill Companies, Inc ("McGraw-Hill") and its licensors reserve all rights in and to the work Use of this work is subject to these tenns Except as pennitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile, disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the work or any part of it without McGraw-Hill's prior consent You may use the work for your own noncommercial and personal use; any otber use of the work is strictly prohibited Your right to use the work may be terminated if you fail to comply with these tenns THE W ORK JS PROVIDED "AS JS." McGRAW-HILL AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE W ORK VIA HYPERLJNK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NO T LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE McGraw-Hill and its licensors not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be uninterrupted or error free Neither McGraw-Hill nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom McGraw-Hill has no responsibility for the content of any information accessed through the work Under no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages This limitation of liability shall apply to any claim or cause whatsoever whetber such claim or cause arises in contract, tort or otherwise To Annie, my loving wife and best friend To my sons, Jack, Sam, and Joe, who have taught me much more than I will ever teach them And to Jack Sty, who one day said to me, "Bob, let's write another book " This page intentionally left blank Contents Foreword Preface Acknowledgments ix xi xiii VOLUME I PART Developmental Abnormalities of the Lungs and Diaphragm Neonatal Lung Disease Pulmonary Infection Abnormalities, and Systemic Disease Pulmonary Neoplasms and Masses PART 179 219 17 Autoimmune Disorders of the Brain THE CARDIOVASCULAR Heart and Pericardium 11 Congenital Heart Disease 13 The Vascular System 277 279 14 Congenital Abnormalities of the Brain 315 403 THE BRAIN 15 Hydrocephalus 267 12 Anomalies of the Great Vessels 251 433 485 625 18 Metabolic and Destructive Disorders of the Brain 21 Head Trauma PART 641 20 Intracranial Vascular Abnormalities 683 797 THE SPINE of the Spine 847 887 22 Developmental Abnormalities 889 23 Infection, Inflammation, and Degenerative Disorders of the Spine 24 Neoplasms and Masses of the Spine 25 Trauma and Surgery of the Spine 977 957 1007 VOLUME II PART THE HEAD AND NECK 26 The Skull and Face 10 Acquired Diseases of the PART 191 SYSTEM 75 The Chest Wall 139 Pulmonary Trauma, Surgery, The Mediastinum 45 Chronic Lung Disease, Genetic The Breast 597 ································· 19 Intracranial Neoplasms and Masses THE THORAX and Toxins 16 Intracranial Infections 27 The Orbit 1043 28 The Paranasal Sinuses 1045 1091 1137 29 The Nose, Nasal Cavity, and Nasopharynx 30 The Neck, Pharynx, and Trachea 31 The Salivary Glands 32 The Thyroid and Parathyroid Glands 33 The Temporal Bone and Ear 1153 1173 1249 1261 1293 487 575 vii viii Contents PART THE GASTROINTESTINAL SYSTEM 34 The Esophagus 35 The Stomach 323 1325 1357 50 Urinary Tract Calcifications and Stones 51 Urinary System Trauma, Surgery, and Therapy 36 The Smalllntestine 1379 52 Renal Vascular Abnormalities 37 The Colon 1447 53 The Female Genital System 38 The Omentum, Mesentery, and Peritoneal Cavity 39 The Anterior Abdominal Wall 1495 1503 40 Abdominal Trauma and Otherlntraabdominal Emergencies PART THE HEPATOBILIARY SYSTEM 41 The Hepatobiliary System PART THE PANCREAS 42 The Pancreas PART THE SPLEEN 43 The Spleen 1629 1631 653 1655 47 Urinary System lnfection 48 Vesicoureteral Reflux 49 Neoplasms and Masses of the Urinary System 1715 1741 1759 1777 1785 PART 11 THE ADRENAL CiLANDS 56 The Adrenal Glands SYSTEM 58 Dysostoses and Developmental Deformities 59 Metabolic Bone Diseases Go Systemic Arthritis 931 1933 57 Skeletal Dysplasias 1925 PART 12 THE M USCULOSKELETAL 1965 1967 202 2073 2113 61 Hematological and of the Extremity Soft Tissues 65 Musculoskeletal Trauma 2141 64 Nonneoplastic Abnormalities Index 2123 62 Musculoskeletal Infections 1855 1887 63 Musculoskeletal Tumors 46 Diseases of the Renal Parenchyma Affect Both Genders 1827 1841 55 Genital Abnormalities that Ischemic Bone Disease 44 Developmental Abnormalities 45 Renal Cysts 1523 1609 PART 10 THE GENITOURINARY of the Urinary System 1521 1607 SYSTEM 1511 54 The Male Genital System 1813 2161 2237 225 /-1 Fo rewo rd Diagnostic Imaging of Infants and Children by Robert Wells is a must-have text that I am sure you will keep as a con stant friend It is a one-of-a-kind book, written in a style pathophysiology For clinicians, this text is a resource for reviewing the advantages and disadvantages of various imaging approaches and for understanding the signifi that is concise and informative Kudos to Dr Wells for the cance of imaging findings The easy-to-read style and the superlative work clear correlation of radiologic findings with disease patho This richly illustrated reference covers the gamut of pediatric diseases and injuries Extensive integration of physiology and clinical features make it an excellent choice for medical students, residents, and fellows clinical considerations and review of disease pathogenesis This text is a terrific source of information across the help to make sense of imaging patterns and provide the entire spectrum of pediatric radiology, and I strongly rec radiologist with tools to establish a confident diagnosis ommend this book to anyone interested in the subject Readers of various backgrounds will find this text use ful Radiologists can pull it off the shelf for a quick review Richard Towbin, MD of the imaging findings and differential diagnosis of a con Radiologist-in-Chief dition, with additional material available for those desiring Phoenix Children's Hospital a more in-depth review of the clinical presentation and Phoenix, Arizona ix 588 Part The B i n A Figure 5-18 Ex vacuo ventriculomegaly A T2-weighted MR image a 2-year-old child with a history of perinatal asphyxia shows prominence of the lateral ventricles in conjunction with expansion of the subarachnoid spaces and parenchymal brain thinning B c Figure 5-17 Benign enlargement of the subarachnoid spaces This s-month-old infant presented with macrocephaly A, B Coronal and midline sagittal color Doppler sonographic images show vessels coursing through prominent subarachnoid spaces C Bridging cortical veins in the convexity subarachnoid spaces are also visible on this unenhanced CT image Complications and malfunctions of CNS shunts are common The risk for mechanical shunt failure is great est during the first several months after placement Infants are also at greater risk for shunt failure than are older chil dren and adults The overall failure rate (including infec tions) for CNS shunt catheters is approximately 40% per year Mechanical failure occurs in approximately 30% of patients per year The most frequent form of shunt malfunction is luminal obstruction, without mechanical shunt disrup tion A radionudide shunt study is the mainstay imaging technique for assessing shunt patency and the adequacy of fluid absorption Injection of iodinated contrast under fluoroscopic observation is useful for selected patients With both techniques , the shunt reservoir is punctured, the C S F pressure measured, a specimen collected, and the ease of fluid aspiration assessed During injection of radiopharmaceutical, the distal limb of the shunt should be compressed (or the on-off valve depressed into the off position) Anterior and lateral images are then obtained of the head The valve, if present, is returned to the "on" Chapter Hyd roce p h a l u s 589 ' • • I 1· � I ' • • I A radiopharmaceutical in the lateral ventricles, shunt reservoir, and distal limb B A posterior image of the abdomen at 25 minutes • t • • o •' : ' - : '-.' • : •' ,• J � · I · I • · �· · • Figure 5-19 Normal ventriculoperitoneal shunt A A lateral image of the head and thorax shows • I '-o t �� � '-' ' ' : /)f '· :· • ' • ' ,• :, t ' , � 1• • ;o � I ' !.,.· , • • •, ! I,J ' r ·� ::· · '· , I ,' I : '• • : �= \ t _ l e t- :;:.)�.�·:: >��: �· � • I ; · : o : � · ·: o · • · ,' I ' � ' ·, ' c demonstrates dispersion of tracer in the peritoneal cavity There is faint activity in the bladder C At o minutes, most remaining activity is in the kidneys and bladder position, and images are obtained of the neck, thorax, and abdomen to follow the distal passage of tracer If spontane ous distal passage does not occur, the patient should sit up or ambulate for a few minutes before additional imag ing With persistent stasis, pumping of the reservoir may force the labeled C S F distally With ventriculoperitoneal shunts, delayed images of the abdomen allow assessment of intraperitoneal dispersion, absorption, and renal excre tion (Figure 5-1 9) 8-33 Ventriculoperitoneal Shunt Complications Potential mechanical malfunctions of ventriculoperito neal shunt catheters include malposition, disconnec tion, occlusion, and migration (Figures 5-20 and 5-21 } (Table 5-3) Ideally, CSF bathes the drainage holes of the ventriculostomy catheter Poor drainage can occur if the catheter is buried in the brain parenchyma or in contact with the choroid plexus or ependyma Iatrogenic or pre existing intraventricular hemorrhage can impede shunt function Ventricular system loculations and foramen of Monro obstruction are relatively common complicating factors Obstruction can also occur at the distal open ing of a ventriculoperitoneal shunt, due to peritoneal adhesions or other mechanical factors ( Figure 5-22) Intraperitoneal pseudocyst formation at the tip can pre vent adequate C S F absorption Less common complications include migration of the tip of the shunt into the subphrenic space, intrathoracic region, or scrotum Perforation of a viscus by a ventricu loperitoneal shunt is a rare serious complication Rarely, there is malposition of the catheter at the time of insertion into the preperitoneal space or the anterior abdominal wall (Figu re 5-23) ·32 · 33 Figure 5-20 Ventriculoperitoneal shunt disconnection An oblique radiograph shows separation of the distal limb from the valve device (arrows) 590 Part The Brain Table 5-3 Ventriculoperitoneal S h u nt Complications Malposition Occl usion by choroid plexus Catheter fractu re M igration Discon nection Kinking Tract calcification Over-sh u nting I nfection CSF pseudocyst Periton itis Bowel perforation A B Figure 5-21 Ventriculoperitoneal shunt catheter disconnection A The distal limb of the shunt catheter is absent on this lateral skull radiograph The arrow marks the level of the valvef reservoir device B The disconnected catheter has migrated into the peritoneal cavity A peritoneal pseudocyst is a potential complication of ventriculoperitoneal shunts The cyst adjacent to the shunt tip can develop over a broad time range, from within a few weeks of catheter placement to many years later The cyst has a thin wall that is composed of fibrous tissue without an epithelial lining The cyst contains C S F and a variable amount of debris The pseudocyst can either move freely within the peritoneal cavity or become adherent to adjacent structures The pathophysiology of pseudocyst formation is unclear in most patients, although subclinical infection is hypothesized to be a common cause The clinical manifestations of a C S F peritoneal pseudocyst relate to shunt dysfunction (e.g., intracranial pressure elevation) , bowel obstruction, or torsion of the pseudocyst Children most often exhibit manifestations of elevated intracranial pressure and abdominal pain, whereas adults more often suffer abdominal complaints Abdominal radiographs may show soft tissue-density fullness and displacement of bowel loops in the region of the distal portion of the shunt catheter ( Figu re 5-2.4 ) Sonography and CT show a clear fluid collection through which the catheter passes ( Figu re 5-25) Septations are sometimes present ( Figure 5-26) A scintigraphic shunt study usually demonstrates slow distal passage of radio pharmaceutical through the shunt catheter, eventual accu· mulation within the peritoneal loculation, and delayed or absent renal excretion The treatment of an uninfected pseudocyst consists of drainage of the cyst and reposition ing of the shunt tip If infection is present, the intraperi· toneal portion of the shunt tube is typically removed and the pseudocyst is drained; percutaneous techniques can be utilized for drainage of an infected pseudocyst once the shunt has been removed Overdrainage of C S F is an important potential com plication of CNS shunts Excessive drainage of fluid in a patient with substantial ventriculomegaly can lead to subdural hemorrhage or a subdural hygroma Overdrainage in an infant can cause cranial collapse and overlapping of sutures, with the potential for subsequent Chapter Hyd roce p h a l u s 591 · 16 �