Pediatric Imaging Pearl of the Week

View the illustrated DDX of spinal canal lesions.

Toddler with back pain and decreased weight bearing

MRI of atypical teratoid rhabdoid tumor (ATRT) of the spine — Sagittal T1 without contrast (left), sagittal T2 (middle) and sagittal T1 with contrast (right) MRI of the lumbar spine shows an extramedullary intradural lesion that is inferior to the conus medullaris and fills the spinal canal from the level of the L1-L3 vertebral bodies. The lesion has heterogenous signal intensity on T2 and heterogenous enhancement with contrast.

The diagnosis was atypical teratoid rhabdoid tumor.

Our DDX For This Week Is

View the illustrated DDX of spinal canal lesions.

Newborn post op from repair of an anterior abdominal wall defect

Surgical image of gastroschisis — Surgical image shows a prosthetic silo over loops of bowel not encased by a membranous sac that was created by sewing the silo to the fascia on either side of the incision. The silo was then wrapped in cotton gauze and sterile drapes. The patient underwent serial mesh tightening and on day of life eight underwent removal of the silo and final closure of the gastroschisis.

The diagnosis was gastroschisis.

Pediatric Imaging Pearl of the Week

View the illustrated DDX of term infant brain cysts.

Newborn with intracranial cyst on prenatal US

CT of cavum vergae — Axial CT without contrast of the brain show a cystic structure that is a posterior extension of cavum septum pellucidum, posterior to anterior columns of the fornix, and anterior to the splenium of the corpus callosum.

The diagnosis was cavum vergae.

Teenager with headaches

MRI of cavum vellum interpositum — Sagittal (left) and axial (right) T1 MRI without contrast of the brain show a cystic structure between the atria/trigones of the lateral ventricles, behind the foramen of Monro, beneath the columns of the fornices and above the tela choroidea of the 3rd ventricle.

The diagnosis was cavum vellum interpositum.

Infant with macrocephaly

MRI of hemispheric arachnoid cyst — Axial T2 (left) and coronal T1 (right) MRI without contrast of the brain show a large extra-axial cystic structure in the right hemisphere causing significant mass effect to the left.

The diagnosis was arachnoid cyst.

Newborn with hydrocephalus on prenatal US

Head US of agenesis of the corpus callosum with a small interhemispheric cyst — Coronal US of the brain shows a Viking horn deformity of the anterior horns of the lateral ventricles (above left) and parallel bodies of the lateral ventricles (above right). There is mild hydrocephalus present and the third ventricle is high riding. Sagittal US of the brain (below) shows absence of the corpus callosum.

The diagnosis was agenesis of the corpus callosum with a small interhemispheric cyst.

Newborn with hydrocephalus on prenatal US

Head US of agenesis of the corpus callosum — Coronal US of the brain shows a Viking horn appearance of the anterior horns of the lateral ventricles (above left) and parallel bodies of the lateral ventricles (above right). Sagittal US of the brain (below) shows absence of the corpus callosum.

The diagnosis was agenesis of the corpus callosum.

Newborn with brain cyst on prenatal US

Head US of agenesis of the corpus collosum with large interhemispheric cyst — Coronal (left) and sagittal (right) US of the brain show a Viking horn appearance of the anterior horns of the lateral ventricles and absence of the corpus callosum and a large midline cyst.

The diagnosis was agenesis of the corpus callosum with a large interhemispheric cyst.

Our DDX For This Week Is

View the illustrated DDX of term infant brain cysts.

Newborn with anterior abdominal wall defect

Clinical image of gastroschisis — Clinical image shows an anterior abdominal wall defect with stomach and small bowel exposed through an opening on the right side of the umbilicus. Note the absence of a peritoneal sac enclosing the abdominal contents.

The diagnosis was gastroschisis.

Pediatric Imaging Pearl of the Week

View the illustrated DDX of posterior fossa cysts.

Premature newborn with a small cerebellum on prenatal US

MRI of Dandy Walker variant — Sagittal T1 MRI with contrast of the brain (upper left) shows an normal size posterior fossa containing a dilated fourth ventricle resulting in a small midline cyst. Axial (upper right) and coronal (below) T1 MRI with contrast of the brain show hypoplasia of the cerebellar vermis. No hydrocephalus is present.

The diagnosis was Dandy Walker variant.

Toddler with cervical adenopathy with an incidental finding on a neck CT exam

MRI of Dandy Walker malformation — Sagittal T1 MRI without contrast of the brain (upper left) shows an enlarged posterior fossa containing a dilated fourth ventricle resulting in a large midline cyst that is causing elevation of the superior cerebellum and torcular inversion. Axial (upper right) and coronal (below) T1 MRI without contrast of the brain show agenesis of the cerebellar vermis. A mild-moderate amount of hydrocephalus is present.

The diagnosis was Dandy Walker Malformation.

Preschooler with headaches

CT of arachnoid cyst of the posterior fossa — Axial CT without contrast of the brain shows a cystic structure on the left side of the posterior fossa that is shifting the cerebellum, which is structurally normal, to the right. The fourth ventricle is compressed leading to a moderate amount of hydrocephalus.

The diagnosis was arachnoid cyst of the posterior fossa.

Our DDX For This Week Is

View the illustrated DDX of posterior fossa cysts.

Newborn with anterior abdominal wall defect and dilated small bowel

Surgical image of gastroschisis — Surgical image shows an anterior abdominal wall defect with the small bowel protruding out of the abdomen, with no surrounding membranous sac. The small bowel loops are dilated. There was an atresia just distal to the cecum and the distal colon was small in caliber. A silo for the abdominal contents was constructed. A gastrostomy and cecostomy were also placed.

The diagnosis was gastroschisis and colonic atresia.

Pediatric Imaging Pearl of the Week

View the illustrated DDX of premature brain cysts.

Pediatric Imaging Pearl of the Week

View the illustrated DDX of premature brain periventricular increased echogenicity.

Pediatric Imaging Pearl of the Week

View the illustrated DDX of premature brain injury.

Premature newborn screening head US exam

Head US of connatal cysts — Coronal (above) and sagittal (below) US of the brain show bilaterally multiple small cysts just lateral to the superolateral angles of the anterior horns of the lateral ventricles.

The diagnosis was connatal cyst.

Premature newborn now 4 weeks old screening head US exam

Head US of periventricular leukomalacia — Coronal (above) and left sagittal (lower left) and right sagittal (lower right) US of the brain shows bilateral increased echogenicity in the periventricular white matter posterior to the lateral ventricles that has multiple cysts present within it bilaterally.

The diagnosis was periventricular leukomalacia.

Premature newborn with lethargy

Head US of neonatal intraventricular hemorrhage grade III and periventricular hemorrhage — Coronal US of the brain shows increased echogenicity within the anterior horn of the left lateral ventricle with ventricular dilation (upper) and increased echogenicity within the brain parenchyma in the left anterior periventricular region and right temporal region (lower left) and in the bilateral posterior periventricular regions (lower right).

The diagnosis was left grade III neonatal intraventricular hemorrhage and bilateral periventricular hemorrhage.