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Developmental Dysplasia of the Hip

Etiology Developmental dysplasia of the hip (DDH), formerly referred to as congenital dislocation of the hip , was first described thousands of years ago. DDH is a spectrum that may vary from a normal congruent hip with normal appearing acetabula with ligamentous laxity, to a structurally abnormal hip with joint incongruity related to primary acetabular dysplasia. Usually, DDH is a result of a combination of both…

Scoliosis

Scoliosis is defined as a lateral spinal curvature greater than 10 degrees, as measured by the Cobb method. Curves less than 10 degrees are termed spinal asymmetry . The lateral curvature is often accompanied by abnormalities in the axial and sagittal planes rendering it a three-dimensional abnormality. Scoliosis is classified into various categories, according to etiology, curve location, age at onset, and curve type. The Scoliosis…

Alignment Disorders

Overview Malalignment of extremity bones may be congenital or acquired. Primary bone or secondary soft tissue or neuromuscular disorders can result in abnormal alignment. Malalignment is often seen with congenital deformities characterized by embryologic failure of development, discussed in Chapter 131 . One of the most common alignment disorders is developmental dysplasia of the hip, discussed in Chapter 135 . Upper Extremities Neonatal Brachial Plexus Palsy/Glenohumeral…

Skeletal Dysplasias and Selected Chromosomal Disorders

As opposed to just a decade ago, the study of congenital syndromes is no longer an exercise in the rote memorization of seemingly disconnected syndromes. Instead, the unveiling of the intricacies of the genetic code has made apparent relationships among many inborn syndromes that had been previously unsuspected. What has emerged is that a relatively few genes are the cause of a multitude of syndromes, and…

Congenital Anomalies of Bone

Regardless of origin, abnormal limb development tends to fall into patterns that can be recognized clinically and radiographically ( Fig. 131.1 ). Most classification systems of congenital malformations are based on osseous structures, but it is well recognized that anomalous conditions of surrounding soft tissues are certain to be present. Congenital malformations of the extremity can be generally classified as dysplastic or absent (amelia). Open full…

Prenatal Musculoskeletal Imaging

Overview Evaluation of the fetal skeleton is one of the more challenging aspects of prenatal imaging for a variety of reasons. It is such a rapidly changing system in gestation that ossification varies in extent and distribution from week to week; ultrasonography, the primary fetal imaging modality, does not clearly demonstrate the full morphology of a bone because of lack of sound penetration; and many skeletal…

Imaging Techniques

Pediatric musculoskeletal radiology is a broad field that requires an understanding of normal growth and developmental variations, fracture patterns unique to the immature skeleton, skeletal dysplasias, and knowledge of unique tumor and tumor-like conditions. Advanced imaging has improved our ability to arrive at a precise diagnosis. However, it also has created the need for additional expertise within the field of pediatric imaging to determine how and…

Embryology, Anatomy, and Normal Findings

Embryology Both striated muscle and bone are derived from the mesodermal germ layer. The limb buds form at the end of the fourth week of fetal life. Near the end of the second month of fetal life, the embryonic cartilaginous skeleton is already subdivided into its principal segments, which are the forerunners of bones of the limbs. Primary ossification centers are formed by deposition of calcium…

Amenorrhea and Abnormalities of Puberty

Indications for evaluation of the adolescent pelvis usually are based on complaints of abdominal pain, pelvic pain, or a mass. Other clinical symptoms resulting in imaging evaluation in female patients relate to abnormalities of development of secondary sexual characteristics of puberty. These changes may be seen earlier than normal (i.e., precocious puberty), may be delayed (i.e., delayed puberty), or may fail to develop (e.g., hypogonadism and…

Abnormalities of the Female Genital Tract

Imaging Techniques Ultrasound is the primary imaging modality to assess the pediatric gynecologic tract, its diseases, and the simulators of those diseases. Ultrasound provides quick evaluation of the uterus, ovaries, and cul-de-sac. Computed tomography (CT) and magnetic resonance imaging (MRI) provide a more global view of the pelvis and abdomen than does ultrasound, and they are preferred for the evaluation of tumor extent and metastases. The…

Abnormalities of the Male Genital Tract

Overview Ultrasound (US), including Doppler imaging in all its forms, is the main diagnostic imaging tool for evaluating the scrotum. Computed tomography (CT) is used predominantly to evaluate metastatic spread of testicular or other intrascrotal tumors. Magnetic resonance imaging (MRI) has been used in the search for undescended testes that remain in an intraabdominal position. MRI, like CT, also can be used to analyze metastatic spread…

Disorders of Sex Development

Embryology, Sex Differentiation, and Gonad Differentiation Overview. The three important precursor components needed for genital system development are the genital ridge and the two sets of internal sex ducts, the Müllerian-paramesonephric and the Wolffian-mesonephric. Around 7 weeks' gestation, the embryologic genital ridge becomes either an ovary or a testis. The development of the male genital system is an “active” process requiring testes and Müllerian inhibiting substance…

Genitourinary Trauma

Renal Injury Overview. The kidney is the third most frequently injured abdominal viscus in children and accounts for 1.3% to 15% of injuries in children who suffer blunt abdominal trauma. Children are more susceptible to renal injury during blunt trauma compared with adults because of the relatively increased mobility of the pediatric kidney, less perinephric fat, and reduced protection by a more compliant chest wall. Preexisting…

Acquired Conditions

Neuroblastoma Overview. Neuroblastoma is the most common extracranial solid neoplasm in children and accounts for almost 10% of all childhood neoplasms. Neuroblastoma arises in the abdomen in two-thirds of cases; of these, about two-thirds of lesions occur in the adrenal gland, whereas the remainder may arise anywhere along the sympathetic nerve chains. Neuroblastoma, ganglioneuroblastoma, and ganglioneuroma belong to a group of related neurogenic neoplasms arising from…

Congenital and Neonatal Conditions

Normal Adrenal The adrenal glands in the neonate are easily visualized on ultrasonography; they are relatively large because of the presence of the fetal adrenal cortex, which accounts for about 80% of the gland ( Fig. 121.1 ). On ultrasonography, the normal adrenal gland has a central hyperechoic stripe surrounded by a hypoechoic rim. The peripheral hypoechoic rim represents fetal as well as definitive cortex (see…

Bladder and Urethra

Urachal Anomalies Overview. The urachus is the fetal channel connecting the bladder and the allantosis. Fibrotic regression of the urachus typically extends from the umbilicus toward the bladder and results in the median umbilical ligament. Usually, this process is completed by 4 to 5 months of gestational age. Failure of urachal regression may result in: (1) patent urachus, (2) urachal sinus, (3) urachal diverticulum, and (4)…

Vesicoureteral Reflux

Definition and Imaging Objectives Overview. Vesicoureteral reflux (VUR) refers to the retrograde passage of urine from the urinary bladder into the ureter and often to the renal collecting system. VUR mainly affects infants and young children with a prevalence of 25% to 40% ( Box 119.1 ). VUR is a risk factor for the development of pyelonephritis, with consequent renal scarring. Box 119.1 Common Features in…

The Ureter

Embryology During the fifth week of gestation, the urinary collecting system begins development as an outpouching from the mesonephric duct known as the ureteral bud. Contact between the bulbous portion of the ureteral bud and the metanephric blastema induces this portion of the bud to branch and develop into the renal pelvis, calyces, and collecting tubules. Meanwhile, the stalk of the ureteral bud develops into the…

Renal Failure and Transplantation

Acute Renal Injury Overview. Acute renal failure is defined as a sudden loss of renal function that may be due to inadequate renal perfusion, renal cell injury, or obstruction to urine flow. The term acute kidney injury (AKI) has been proposed to replace the term acute renal failure and is gaining wide acceptance. AKI usually develops in hospitalized children as a result of systemic illness or…

Vascular Conditions

Renovascular Hypertension Overview. Approximately 5% to 10% of children and adolescents with severe hypertension have an underlying renal vascular lesion. In children younger than 5 years, up to 80% of clinically significant hypertension is due to renovascular disease. There are myriad developmental and acquired causes of renovascular hypertension ( Box 116.1 ). A complication related to umbilical artery catheterization is the most common cause of renovascular…