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Physeal Fractures

KEY FACTS Terminology Fracture of immature skeleton involving cartilaginous primary growth plate (physis) Imaging Most fractures detected & managed by radiographs alone Widening or interruption of normally uniform undulating lucent physis Translation &/or angulation of bony fragment adjacent to physis with overlying soft tissue swelling Persistent physeal widening > 3 mm post reduction suggests tissue entrapment requiring open reduction CT: Helps evaluate comminution, displacement, articular surface…

VACTERL Association

KEY FACTS Terminology Nonrandom association of anomalies involving multiple organ systems V ertebral/vascular A nal atresia/auricular C ardiac T racheoesophageal fistula E sophageal atresia R enal/radial ray/rib L imb VACTERL association diagnosed when ≥ 3 of above malformations present; causative gene unknown Imaging Actively seek other features of VACTERL association when 1-2 components present Initial imaging in suspected cases: Radiographs & US Radiographs: Spine & limbs…

Approach to Pediatric Musculoskeletal System

Imaging Modalities Radiography Although there have been great advances in imaging technology, radiographs (i.e., x-rays or plain films) remain the most important imaging test in most circumstances of suspected musculoskeletal pathology. Most studies will require 2-3 views to adequately image the site of interest. Each of these views is typically obtained with different patient positioning &/or projection of the x-ray beam to analyze different components of…

Torsion of Testicular Appendage

KEY FACTS Terminology Definition Spontaneous twisting of pedunculated vestigial remnant along testicle or epididymis causing ischemia & pain Synonyms Twisted appendage, torsed appendix testis, torsion of appendix epididymis, appendiceal torsion Imaging US with Doppler best imaging modality Appendage size best indicator of torsion (> 5-6 mm acutely) Spherical shape suggests swelling (normally vermiform) Duration of symptoms determines echogenicity < 24 hours: Hypoechoic with salt & pepper…

Testicular Torsion

KEY FACTS Terminology Spontaneous or traumatic twisting of testis & spermatic cord within scrotum → vascular occlusion/infarction Imaging ↓ or absent blood flow in testicle on Doppler US Transverse side-by-side comparison image of asymptomatic & symptomatic testicles very helpful Spiral twist of spermatic cord just above testis ± abnormal lie of testicle within scrotal sac Enlarged testis ± altered echotexture May see hyperemia after detorsion Top…

Epididymoorchitis

KEY FACTS Terminology Infectious inflammation of epididymis, testicle, or both Orchitis much less common than epididymoorchitis Imaging Enlargement of affected tissues (i.e., testicle, epididymis, or both) with accompanying ↑ blood flow ↑ blood flow best demonstrated on transverse side-by-side comparison view Arterial waveforms typically remain low resistance Echotexture may be ↑ or ↓, often heterogeneous Reactive hydrocele Scrotal wall also thickened Top Differential Diagnoses Torsion of…

Ovarian Torsion

KEY FACTS Terminology Definition: Twisting of vascular pedicle of ovary, fallopian tube, or both → venous obstruction → edema → arterial compromise → ischemia → hemorrhagic infarction Imaging Unilaterally enlarged ovary Ovarian volume > 100 mL highly suggestive of torsion Ovarian volume < 20 mL in postpubertal patient never torsed in 1 series Ratio of abnormal to normal ovarian volumes ≥ 5:1 strongly correlated with torsion…

Ovarian Cyst

KEY FACTS Terminology Follicle: Normal physiologic cyst < 1 cm in diameter Dominant follicle may measure up to 3 cm Functional cysts: Can measure up to 3-10 cm Corpus luteal cyst: Dominant follicle after ovulation Follicular cyst: Normal mature follicle fails to involute Hemorrhagic cyst: Hemorrhage into functional cyst Imaging US mainstay of ovarian imaging; MR in limited circumstances Well-marginated round or ovoid structure within borders…

Ovarian Teratoma

KEY FACTS Terminology Synonyms Dermoid tumor, dermoid cyst, mature cystic teratoma Definition Teratomas made up of variety of parenchymal cell types from > 1 germ cell layer, usually all 3 Imaging Best clue: Heterogeneous pelvic mass containing Ca²⁺, hair, fat, & cystic components Bilateral in up to 15% Typically well-defined margins without surrounding inflammatory changes US 1st-line modality for female pelvic pain &/or mass Multiple classic…

Neuroblastoma

KEY FACTS Terminology Malignant tumor of sympathetic chain primitive neural crest cells Increasing degrees of cellular differentiation/benignity along spectrum: Neuroblastoma (malignant) → ganglioneuroblastoma → ganglioneuroma (benign) Imaging Location Adrenal (35-48%) Extraadrenal retroperitoneum (25-35%) Posterior mediastinum (16-20%) Small round solitary mass vs. large multilobulated lesion Aggressive tumor with tendency to invade adjacent tissues Frequently engulfs & displaces adjacent vascular structures (rather than just displacing) Ca²⁺ in up…