Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

The Mediastinum

A variety of congenital and developmental anomalies, inflammatory and infectious diseases, and benign and malignant neoplasms occur in the mediastinum in the pediatric population. Up-to-date knowledge and a practical diagnostic approach combined with a clear understanding of the characteristic imaging appearances of these conditions can facilitate prompt diagnosis and optimal patient management. This chapter reviews the underlying etiology, imaging findings, treatment, and follow-up of commonly encountered…

Pulmonary Manifestations of Systemic Disease

Many systemic diseases of childhood involve the pulmonary parenchyma. The pulmonary manifestations may in fact prompt the patient or parents to seek medical attention and frequently a chest radiograph is obtained early in the illness. Therefore the radiologist can play an important role in directing the diagnostic workup by recognizing that the pulmonary findings reflect an underlying condition. In some patients, such as those with pulmonary…

Diffuse Lung Disease

The pediatric diffuse lung disorders, also known as childhood interstitial lung diseases (chILDs), comprise a rare and heterogeneous spectrum of progressive and often lethal pulmonary pathology. They are characterized by otherwise unexplained respiratory signs and symptoms, hypoxemia, and widespread pulmonary opacities on imaging. The diseases are not limited to the interstitium and may affect the alveoli, airways, blood vessels, lymphatic channels, and pleural spaces. Although much…

Neoplasia

Pulmonary neoplasm is much less common in children than in adults. Affected children may present clinically with respiratory symptoms, or a pulmonary neoplasm may be detected incidentally on a chest radiograph in an asymptomatic child. In a recent series of 204 pediatric lung tumors, the ratio of primary benign to primary malignant to secondary malignant pulmonary neoplasms (i.e., metastases) is 1.4 : 1:11.6. Primary lung tumors represent only…

Pulmonary Infection

Pneumonia and other pulmonary infections involving the lower respiratory tract continue to be the most common cause of illness in children, affecting over 150 million children under 5 years of age each year worldwide, with 20 million related US hospitalizations annually. Despite the decrease in hospitalizations for pediatric pneumonia since the introduction of the pneumococcal conjugate vaccine in 2000, the rates of pneumonia presenting in the…

Congenital Lung Anomalies

Congenital lung anomalies represent a heterogeneous group of pulmonary developmental disorders that affect the lung parenchyma, its arterial supply, venous drainage, or a combination thereof. The reported incidence of congenital lung anomalies ranges from 30 to 42 cases per 100,000 population. Although prenatal sonography, fetal magnetic resonance imaging (MRI) and advances in postnatal imaging have enhanced our understanding of congenital lung anomalies, substantial controversy continues regarding…

Lower Large Airway Disease

Overview Disorders of the lower large airways occur frequently in the pediatric population and have the potential to be life threatening. Because these disorders are often associated with nonspecific clinical symptoms, the diagnosis frequently is missed or delayed, particularly in infants and young children. After careful investigation of the clinical history and physical examination, imaging evaluation is the next management step. Imaging plays an important role…

Upper Airway Disease

The upper airway, by definition, lies above the thoracic inlet. The anomalies and abnormalities involving the upper airway in children are common and varied. They include a combination of congenital and acquired morphologic, neuromuscular, bony, and cartilaginous abnormalities. The anatomic considerations that predispose children to acute respiratory distress, even with only partial obstruction, are as follows: (1) The nasopharynx is narrower than in adults, (2) the…

Prenatal Imaging and Intervention

With the advances in ultrasound (US) and magnetic resonance imaging (MRI), thoracic lesions are now commonly detected before birth. The most common congenital thoracic lesions include congenital diaphragmatic hernia (CDH); congenital bronchopulmonary malformations, which represent a group of lung anomalies, including congenital pulmonary airway malformation (CPAM), bronchopulmonary sequestration (BPS), and congenital lobar overinflation (CLO); and congenital hydrothorax. Additionally, congenital high airway obstruction (CHAOS), which is caused…

Imaging Techniques

Overview Various imaging modalities—conventional radiography, fluoroscopy, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine studies—are used to assess the pediatric respiratory system. Although having abundant air in the respiratory system is beneficial when performing conventional radiography, fluoroscopy, and CT, it complicates assessment of the respiratory system with ultrasound and MRI. When answers to specific clinical questions are sought, radiologists and clinicians ideally should…

Embryology, Anatomy, and Neonatal Lung Pathophysiology

Overview The respiratory system consists of conducting and gas exchange components, with the bifurcating airways and accompanying pulmonary arteries (PAs) bringing air and blood to peripheral capillary-lined airspaces for gas exchange. In understanding and evaluating pulmonary pathologic processes, it is useful to view the lung as consisting of multiple sets of branching trees including airways, arterial and venous pulmonary vasculature, systemic vasculature, and lymphatics. This chapter…

Trauma

The mortality rate of spine-related trauma in children is higher than in adults and is estimated at 25% to 32%. Fortunately, children with incomplete neurologic lesions fare better than adults, with up to 90% having partial recovery and 60% having full recovery. Etiology Motor vehicle accidents (MVAs), falls, and sports injuries are the most common causes of pediatric spinal trauma. Young athletes are at higher risk…

Vascular Lesions

Vascular lesions of the spine are uncommon in children. Vascular lesions are subdivided into fast-flow lesions, such as arteriovenous malformations (AVMs) and arteriovenous fistulas (AVFs), and slow-flow lesions, such as venous (formerly “cavernous”) malformations. Rarely, children suffer spinal cord infarcts. Several syndromes are associated with spinal cord AVMs and AVFs, including hereditary hemorrhagic telangiectasia (Osler–Weber–Rendu), neurofibromatosis, and Parkes–Weber, Cobb, and CLOVES (congenital, lipomatous, overgrowth, vascular malformations,…

Spinal Tumor and Tumor-like Conditions

Spinal Neoplasms Overview. Spinal tumors occur predominantly in young or middle-aged adults and are rare in children. The most common presentation is vague pain, gait disturbance, change in spinal curvature, motor weakness, and bowel and bladder dysfunction. In this chapter, general concepts regarding spinal neoplasms are discussed, followed by anatomic categories of lesions. Categories include neoplasms located in the intramedullary, intradural-extramedullary, or extradural compartments. Imaging. The…

Infections of the Spine and Spinal Cord

Spinal infections in children occur uncommonly. Etiologies include direct and indirect (hematogenous) inoculation by bacterial, viral, parasitic, and fungal agents. Direct bacterial infectious inoculation may be as a result of trauma, instrumentation, or via a preexisting congenital sinus tract or area of spinal dysraphism (i.e., meningocele). Lyme disease ( Fig. 44.1 ), caused by a Borrelia burgdorferi -infected tick bite, is also a cause of spinal…

Congenital Abnormalities of the Spine

Embryology and Developmental Anatomy Spine formation begins early in gestation, commencing at the end of the second gestational week with formation of the Hensen node and continuing into the beginning of the third week with the appearance of the neural plate during gastrulation. The notochordal process forms at day 16 or 17, with transient communication of the amnion through the notochordal canal to the yolk sac…

Prenatal Imaging

Vast improvements have been made in the diagnosis and therapy of fetal anomalies as a result of advances in imaging and surgical technology. Nowhere is this more applicable than in the fetal spine. Ultrasonography is the primary imaging modality for fetal evaluation and helps distinguish normal from abnormal spine development and provides valuable information about spinal anomalies. Magnetic resonance imaging (MRI) is complementary to ultrasonography, as…

Spinal Cord Imaging Techniques

Pediatric spinal cord imaging relies heavily on ultrasound (US) in infants under 6 months of age and magnetic resonance imaging (MRI) thereafter. Other imaging modalities, such as radiography, computed tomography (CT), and nuclear scintigraphy, have a limited role but may provide useful information in cases with specific questions. Plain Radiography Plain radiographic spine series include frontal and lateral radiographs of the cervical, thoracic, or lumbar region.…

Embryology, Anatomy, and Normal Findings

Embryology The spinal cord forms in three stages beginning in the third gestational week. The first stage, neurulation, involves progression from neural plate to neural tube. The notochord becomes the nucleus pulposus of the intervertebral disks. The second stage, canalization, involves formation of cysts within the caudal cell mass that coalesce and fuse to the distal neural tube forming the primitive spinal cord. The third stage,…

Trauma

Incidence and Etiology Head trauma and resulting traumatic brain injury (TBI) are among the most common causes of morbidity and mortality in children. Head trauma alone is responsible for 50% of deaths in children ages 1 to 14 years. Approximately 475,000 cases of TBI occur annually in children less than 14 years in the United States. Half of the cases occur in children under 5 years.…