Pediatric Imaging Pearl of the Week

View the illustrated DDX of diffuse thyroid disease.

School ager with a lump in the right neck

US of papillary thyroid cancer — Sagittal US of the right neck (above) shows an enlarged lymph node that does not have a normal fatty echogenic hilum and that does have several microcalcifications within it. Transverse US of the thyroid gland (below) shows a mass in the right lobe of the thyroid gland that contains numerous microcalcifications.

The diagnosis was papillary thyroid cancer.

School ager with hypothyroidism

US of Hashimoto thyroiditis — Transverse grayscale (above) and color doppler (below) US of the thyroid show an enlarged, heterogenous thyroid gland that has increased vasacularity.

The diagnosis was Hashimoto thyroiditis.

Teenager with hyperthyroidism

US of Graves disease — Transverse grayscale (above), color doppler (middle), and power doppler (below) US of the thyroid show an enlarged, heterogenous and hypervascular thyroid gland.

The diagnosis was Graves disease.

Our DDX For This Week Is

View the illustrated DDX of diffuse thyroid disease.

Newborn with bilious vomiting

Surgical image of malrotation with midgut volvulus — Surgical image shows the entire midgut being twisted around a single narrow mesentery in the center of the image.

The diagnosis was malrotation with midgut volvulus.

Pediatric Imaging Pearl of the Week

View the illustrated DDX of cervical spine instability.

Preschooler with cervical pain

Radiograph of pseudosubluxation of the cervical spine — Lateral radiographs of the cervical spine in flexion (left) show anterior subluxation of the C2 vertebral body on the C3 vertebral body which reduces on extension (right) and is now in normal alignment.

The diagnosis was pseudosubluxation of the cervical spine.

School ager with Trisomy 21

Radiograph of atlanto occipital instability — Lateral radiograph of the cervical spine in flexion (left) shows a normal atlanto dens interval and normal relationship of the occipital condyles to the lateral masses of C1 while on extension (right) there is posterior translation of the occipital condyles in relation to the lateral masses of C1.

The diagnosis was atlanto occipital instability in a patient with Trisomy 21.

Preschooler with Trisomy 21

Radiograph of atlanto axial instability — Lateral radiographs of the cervical spine show a mildly enlarged atlanto dens interval in neutral position (left), that increases significantly on flexion (center) and reduces on extension (right).

The diagnosis was atlanto axial instability in a patient with Trisomy 21.

Our DDX For This Week Is

View the illustrated DDX of cervical spine instability.

Newborn with bilious vomiting

Surgical image of malrotation with midgut volvulus — Surgical image shows the midgut is dusky but not necrotic.

The diagnosis was malrotation with midgut volvulus.

Pediatric Imaging Pearl of the Week

View the illustrated DDX of cervical vertebral junction anomalies.

Teenager with progressive spasticity

CT of os odontoideum — Sagittal CT without contrast of the cervical spine (left) shows a large well-corticated ossicle posterior and superior to the anterior arch of C1 and superior to the dens, hypertrophy of the anterior arch of C1, and a large atlanto-dens interval due to atlanto-axial dislocation. Sagittal T2 MRI without contrast of the cervical spine (right) shows a narrow spinal canal secondary to the atlanto axial dislocation with spinal cord compression and abnormal bright signal in the spinal cord at C1-C2.

The diagnosis was dystopic os odontoideum.

School ager with headaches

CT of basilar invagination — Sagittal CT without contrast of the cervical spine shows the tip of the dens is 6 mm above Chamberlain’s line.

The diagnosis was basilar invagination.

Our DDX For This Week Is

View the illustrated DDX of cervical vertebral junction anomalies.

Newborn with abdominal distension and failure to pass meconium

Surgical image of Hirschsprung disease — Surgical image shows a visible transition zone in the mid sigmoid colon with the forceps at the actual site of transition. The sigmoid colon (to the right) is dilated and had ganglion cells on biopsy. The rectum (to the left), descending into the pelvis, is not dilated and had no ganglion cells on biopsy.

The diagnosis was Hirschsprung disease.

Pediatric Imaging Pearl of the Week

View the illustrated DDX of Chiari malformations.

Newborn with polyhydramnios on prenatal ultrasound and bilious vomiting after birth

Surgical image of jejunal stenosis due to jejunal web — Surgical image after the bowel has been incised shows a jejunal web within the bowel lumen.

The diagnosis was jejunal stenosis due to a jejunal web.

Newborn with vomiting

Surgical image of jejunal atresia — Surgical image shows a dilated stomach and duodenum (above) due to an atresia in the proximal jejunum. The remainder of the jejunum is spiraled around the ileocolic artery (apple peel atresia).

The diagnosis was jejunal atresia.

Newborn with vomiting

Surgical image of jejunal atresia — Surgical image obtained after resection and anastomosis of an atresia in the proximal jejunum (upper left) shows the jejunum spiraled around the ileocolic artery (apple peel atresia).

The diagnosis was jejunal atresia.

School ager with crampy abdominal pain and a fixed small bowel-small bowel intussusception

Surgical image of Non-Hodgkin lymphoma in the mesentery — Surgical image obtained after intussusception reduction and resection of the intussusception’s pathological lead point shows multiple large mesenteric lymph nodes.

The diagnosis was diffuse B-cell lymphoma (Non-Hodgkin lymphoma).

School ager with crampy abdominal pain and a non-transient small bowel-small bowel intussusception

Surgical image of small bowel - small bowel intussusception due to Non-Hodgkin lymphoma — Laparoscopic surgical image (above) shows the small bowel-small bowel intussusception. Surgical image of the small bowel after reduction of the intussusception (below) shows the serosa is pink-tan and intact with a 1.5 x 0.6 cm puckered, red, firm area that when opened in pathology revealed a 2.6 x 2.0 cm red-pink mass.

The diagnosis was diffuse B-cell lymphoma (Non-Hodgkin lymphoma) causing small bowel-small bowel intussusception.

School ager with abdominal pain and a non-transient small bowel-small bowel intussusception

Gross pathological image of small bowel - small bowel intussusception due to Burkitt lymphoma — Gross pathological images of the resected segment of intussuscepted small bowel shows on its serosal surface (above) a 2.0 x 1.2 cm irregular, tan-white centrally ulcerated and umbilicated firm area. The opened image of small bowel (below) reveals a 3.4 x 2.9 x 1.2 cm irregular, tan-white, smooth, firm mass which was sectioned to reveal smooth, tan-white, glistening, homogenous cut surfaces.

The diagnosis was Burkitt lymphoma causing small bowel-small bowel intussusception.

Newborn with emesis and bloody stools with an ileocolic intussusception which spontaneously perforated during reduction

Surgical image of ileocolic intussusception — Surgical image shows forceps in a 1.5 cm perforation in the mid point of the transverse colon. The ascending colon (on the right) is distended and is full of necrotic intussuscepted ileum up to the level of the hepatic flexure.

The diagnosis was ileocolic intussusception.