#pedsrad

A posterior fossa tumor arising from the fourth ventricle in a child is likely an ependymoma (image 1, Case courtesy of Jini P Abraham, Radiopaedia.org, rID: 98653).

Today's case is an intracranial ultrasound of a 2-week-old neonate born at 24 weeks. A single coronal image depicts the ventricles which should be hypoechoic but are instead nearly completely filled with echogenic material, compatible with intraventricular hemorrhage (IVH). There is likely extension into periventricular white matter on the right.

IVH is a common complication seen in preterm neonates and is often described in four grades, as outlined below. This case is a grade 4 IVH.

Grade 1. Bleeding occurs just in a small area of the ventricles.

Grade 2. Bleeding also occurs inside the ventricles.

Grade 3. Ventricles are enlarged by the blood.

Grade 4. Bleeding into the brain tissues around the ventricles.

(Credit Children's Hospital of Philadelphia, https://www.chop.edu/conditio.../intraventricular-hemorrhage)

Here's a companion case to yesterday's. This is a neonate with respiratory distress.

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The right mid to lower lung is hyperinflated. There is leftward medisastinal shift, including prominent medisatinal fat (that's not a mass in the left lung). CT shows cystic expansion of the right lung (2nd image). This is a congenital pulmonary airway malformation (CPAM) formerly known as congenital cystic airway malformation (CCAM). CPAM is a multicystic mass with abnormal bronchial proliferation. Differential diagnosis includes pulmonary sequestration, congenital lobar overinflation, and bronchogenic cyst (usually not aerated).

This is an 11-year-old girl with several months of right chest pain.

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This case is your reminder that not all important chest x-ray findings are in the heart and lungs. There is a mixed lytic/sclerotic lesion in the right lateral 10th rib. At CT this was shown to be an expansile mass with a large soft tissue component. In a patient of this age, you should be thinking sarcoma, and this was indeed Ewing sarcoma.

Today's case is a 25-year-old woman with bilateral echogenic, shadowing renal medullas, compatible with medullary nephrocalcinosis. Radiograph also shows the bilateral calcium deposits. In this condition, calcium salts deposit in the renal medulla and predispose the patient to infection and obstructing renal stones. Differential diagnosis includes hypercalcemia (esp in hyperparathyroidism), hypervitaminosis D, renal tubular acidosis type I, papillary necrosis, medullary sponge kidney, and other rarer entities. This patient renal tubular acidosis.

This is a case of a 7 year-old boy who presented with vomiting, diarrhea, and shortness of breath.

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There is a right lung mass or consolidation with irregular margins, and an adjacent airspace opacity. History and location of the finding are strongly suggestive of round pneumonia. Imaging follow-up is not required but this can be done 30 days after treatment if needed. In this patient, follow-up chest radiograph after 6 weeks was clear.

This week we will focus on congenital malformations of the genitourinary system. Such defects are common and can lead to recurrent infection, incontinence and other complications.

This is a case of duplicated collecting system, shown on intravenous pyelogram. Note complete duplication of the right collecting system and partial duplication on the left, with ureters joining at the level of L3. In complete duplication, the upper pole moiety tends to obstruct, while the lower pole moiety tends to reflux, placing patient at risk for infection. In this case, the left side shows eveidence of obstruction and/or reflux (VCUG or nuclear cystogram can be performed to demonstrate reflux). Case courtesy of Dr Aditya Shetty, Radiopaedia.org, rID: 27218

This is an image from a voiding cystourethrogram of a neonate showing bilateral reflux caused by posterior urethral valves (PUVs). PUVs are caused by failure of regression of the Wolffian duct leading to a valve-like membrane that obstructs the urethra. Treatment involves transurethral ablation of the membrane. How would you grade the reflux on each side?

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