CONTENTS SECTION 1 GENERAL 1. Technical Considerations in Pediatric Imaging... 1 Ashu Seith Bhalla, Arun Kumar Gupta, Amar Mukund Minimizing Heat Loss... 1 Immobilization... 1 Sedation... 1 Nil Per Orally (NPO) Status... 2 Reduction of Radiation Dosage... 2 Use of Contrast Media... 8 2. Recent Advances in Pediatric Radiology... 11 Akshay Kumar Saxena, Kushaljit Singh Sodhi Radiation Protection... 11 Neuroradiology... 11 Thoracic Imaging... 12 Gastrointestinal Imaging... 14 Uroradiology... 16 Musculoskeletal Imaging... 16 3. Interventions in Children... 19 Part A Vascular Interventions... 19 Gurpreet Singh Gulati, Sanjiv Sharma Introduction... 19 Techniques... 20 Procedures... 20 Embolization Materials and Substances... 21 Angioplasty... 27 Thrombolysis... 30 Foreign Body Removal... 30 Part B Nonvascular Interventions... 32 Amar Mukund, Ashu Seith Bhalla, Shivanand Gamanagatti Patient Evaluation... 32 Sedation and Anesthesia... 32 Basic Procedures... 32 Thoracic Interventions... 33 Gastrointestinal Interventions... 33 Genitourinary Interventions... 36
xii Diagnostic Radiology: Paediatric Imaging 4. Imaging of Pediatric Trauma... 39 Shivanand Gamanagatti, Atin Kumar Imaging Methods... 39 SECTION 2 CHEST 5. Neonatal Respiratory Distress... 57 Akshay Kumar Saxena, Kushaljit Singh Sodhi Medical Causes of Neonatal Respiratory Distress... 57 6. Childhood Pulmonary Infections... 68 Jyoti Kumar Introduction... 68 Pneumonia... 68 Tuberculosis (TB)... 78 Fungal Infections... 81 Parasitic Infestations... 84 Pulmonary Infections in HIV-positive Children... 84 7. Chest Masses... 87 Sanjay Thulkar, Arun Kumar Gupta Lung Masses... 87 Mediastinal Masses... 91 Chest Wall Masses... 96 8. Pediatric Airway... 99 Ashu Seith Bhalla Upper Airway Obstruction... 100 Acute Obstruction... 101 Chronic Obstruction... 101 Lower Airway Obstruction... 104 SECTION 3 GASTROINTESTINAL AND BILIARY TRACT, LIVER AND PANCREAS 9. Developmental Anomalies of Gastrointestinal Tract... 120 Alpana Manchanda, Sumedha Pawa Imaging Modalities... 120 Esophagus... 121 Stomach... 125 Developmental Obstructive Defects... 125
Contents xiii Duodenum... 128 Small Bowel... 130 Large Bowel... 138 10. Imaging of Anorectal Anomalies... 144 Arun Kumar Gupta ARA in Males... 147 ARA in Females... 149 11. Gastrointestinal Masses in Children... 154 Arun Kumar Gupta Plain Radiographs... 154 Contrast Studies... 154 Ultrasonography... 154 Computed Tomography... 154 Magnetic Resonance Imaging... 154 Esophageal Masses in Children... 154 Gastric Masses in Children... 155 Neoplastic Masses... 157 Bezoars... 159 Small Bowel Masses in Children... 159 Neoplastic Masses... 160 Mesenteric Masses in Children... 164 Colonic Masses in Children... 165 12. Hepatic and Pancreatic Masses in Children... 171 Akshay Kumar Saxena, Kushaljit Singh Sodhi, Naveen Kalra Imaging... 171 Hepatic Masses... 172 Hepatoblastoma... 172 Hepatocellular Carcinoma (HCC)... 173 Rhabdomyosarcoma... 174 Hepatic Metastases... 175 Infantile Hemangioendothelioma... 175 Hemangioma... 176 Mesenchymal Hamartoma... 178 Focal Nondular Hyperplasia (FNH) and Hepatic Adenoma... 179 Peliosis Hepatis... 179 Inflammatory Lesions... 179 Simple Hepatic Cyst... 181 Polycystic Liver Disease... 181
xiv Diagnostic Radiology: Paediatric Imaging Caroli s Disease... 182 Pancreatic Masses... 182 Islet Cell Tumors... 184 Solid and Papillary Epithelial Neoplasm (SPEN) (Frantz Tumor)... 185 Mesenchymal Tumors... 185 Pancreatic Adenocarcinoma... 186 Pseudocysts... 186 Pancreatic Tuberculosis... 186 13. Childhood Biliopathies... 189 Veena Chowdhury Definition and Pathophysiology of Cholestasis... 189 Physiological Neonatal Jaundice... 189 Etiology of Jaundice in the Neonate and Infant... 189 Diagnosis of Jaundice in Infancy and Childhood... 190 Neonatal Hepatitis... 190 Biliary Atresia (BA)... 191 Hepatobiliary Cystic Malformations... 196 Caroli s Disease... 199 Primary Sclerosing Cholangitis (PSC)... 205 Cystic Fibrosis... 206 Destructive Cholangitis Associated with Langerhans Cell Histiocytosis... 206 Bile Duct Paucity... 207 Spontaneous Perforation of CBD... 207 Inspissated Bile Syndrome (IBS)... 209 Jaundice in Older Children... 209 Hepatitis... 209 Chronic Active Hepatitis... 209 Metabolic... 210 Cirrhosis... 210 Biliary Tract Neoplasms... 211 Diseases of the Gallbladder... 212 SECTION 4 GENITOURINARY 14. Congenital Anomalies of the Urinary Tract... 216 Smriti Hari, Arun Kumar Gupta Introduction... 216 Abnormalities of Kidney... 219 Anomalies of the Ureter... 227 Anomalies of the Urinary Bladder... 230 Abnormalities of the Urethra... 233
Contents xv 15. Urinary Tract Infections (Including VUR and Neurogenic Bladder)... 237 Kushaljit Singh Sodhi, Akshay Kumar Saxena 16. Renal and Retroperitoneal Masses... 248 Anju Garg Imaging... 248 Renal Masses... 249 Wilms Tumor (Nephroblastoma)... 249 Nephroblastomatosis... 254 Mesoblastic Nephroma (Bolande s Tumor)... 254 Clear Cell Sarcoma... 256 Rhabdoid Tumor... 256 Renal Cell Carcinoma... 256 Multilocular Cystic Renal Tumor... 257 Angiomyolipoma... 257 Ossifying Renal Tumor of Infancy... 258 Metanephric Adenoma (Nephrogenic Adenofibroma, Embryonal Adenoma)... 259 Lymphoma... 259 Leukemia... 260 Primary Neurogenic Tumors of the Kidney... 260 Cystic Diseases of the Kidney... 261 Adrenal Masses... 261 Neuroblastoma... 261 Ganglioneuroblastoma... 265 Ganglioneuroma... 265 Pheochromocytoma... 265 Adrenal Cortical Tumors... 266 Adrenal Hemorrhage... 268 Adrenal Cysts... 268 Primary Retroperitoneal Tumors... 268 Neurogenic Tumors... 268 Germ Cell Tumors... 269 Mesenchymal Tumors... 269 Retroperitoneal Lymphangioma... 270 Lymph Node Masses... 270 Retroperitoneal Abscess and Hematoma... 270 17. Evaluation of Female Pelvis and Testicular Abnormalities... 274 Kushaljit Singh Sodhi, Akshay Kumar Saxena Anomalies of the Female Pelvis... 276 Pelvic Masses in Children... 277 Nongynecologic Pelvic Masses... 281
xvi Diagnostic Radiology: Paediatric Imaging Extratesticular Tumors... 290 Adrenal Rests... 291 18. Imaging of Intersex Disorders... 295 Sanjay Sharma, Arun Kumar Gupta Introduction... 295 Classification of Intersex... 297 Clues to the Diagnosis... 305 SECTION 5 MUSCULOSKELETAL 19. Skeletal Dysplasias... 307 Gaurav S Pradhan Introduction... 307 Terminology... 307 Osteochondrodysplasias... 308 Dysostoses... 323 Idiopathic Multicentric Osteolysis... 324 Primary Disturbance of Growth... 324 Constitutional Diseases of Bone with Known Pathogenesis... 324 20. Skeletal Maturity Assessment... 328 Arun Kumar Gupta Measurement of Maturity... 328 21. Spinal Dysraphism... 333 Raju Sharma, Ankur Gadodia Introduction... 333 Classification... 333 Embryology... 333 Imaging Modalities... 334 Open Spinal Dysraphism (OSD)... 337 Closed Spinal Dysraphism (CSD)... 339 Split Cord Malformation (SCM)... 346 Dorsal Dermal Sinus (DDS)... 346 Caudal Agenesis (Caudal Regression Syndrome, CRS)... 348 Segmental Spinal Dysgenesis (SSD)... 348 22. Imaging of Pediatric Hip... 351 Anjali Prakash Introduction... 351 Methods of Investigation... 351
Contents xvii Pediatric Hip Disorders... 355 Developmental Dysplasia of the Hip... 356 Natural History and Pathology... 356 Imaging in DDH... 356 Transient Synovitis of Hip... 366 Legg-Calve-Perthes Disease... 367 23. Benign Bone and Soft Tissue Tumors & Conditions... 381 Mahesh Prakash, Kushaljit Singh Sodhi Cartilaginous Tumors... 381 Osseous Tumors... 383 Fibrous Tumors... 385 Histiocytosis X (Langerhans Cell Histiocytosis)... 385 Giant Cell Tumor... 386 Tumor Like Lesions... 386 Soft Tissue Tumors... 387 Fibroblastic/Myofibroblastic Tumors... 390 24. Pediatric Malignant Bone and Soft Tissue Tumors... 395 Manisha Jana, Ashu Seith Bhalla, Deep N Srivastava Introduction... 395 Imaging Modalities... 395 Malignant Bone Tumors... 397 Soft Tissue Tumors... 401 SECTION 6 CENTRAL NERVOUS SYSTEM 25. Congenital Brain Anomalies... 404 N Khandelwal Introduction... 404 Disorders of Organization... 404 Disorders of Histogenesis... 414 26. Hypoxic-Ischemic Encephalopathy... 419 Atin Kumar, Arun Kumar Gupta Neuroimaging in Infants with HIE... 419 Below 34 Weeks Group The Premature Neonate... 419 Above 34 Weeks Group The Term Neonate... 428 Hypoxic Ischemic Injury in Postnatal Age Group... 431 Imaging Choice for Evaluation of Hypoxic-ischemic Injury... 432 Prediction of Clinical Outcome... 432
xviii Diagnostic Radiology: Paediatric Imaging 27. Cranial Sonography... 436 Rashmi Dixit, Veena Chowdhury Destructive Brain Lesions... 441 Hydrocephalus... 441 Intracranial Hemorrhage... 444 Hypoxic or Ischemic Encephalopathy... 446 Neonatal and Acquired Infections... 449 28. Inflammatory Diseases of the Brain... 454 V Gupta, N Khandelwal, P Singh Introduction... 454 Investigative Modalities... 454 Bacterial Infections... 454 Cranial Tuberculosis... 457 Neurocysticercosis... 461 Hydatid Disease... 464 Viral Encephalitis... 465 Congenital Infections... 468 Fungal Infections... 475 29. Pediatric Brain Tumors... 477 Shailesh B Gaikwad, Ajay Garg Introduction... 477 Classification of Childhood Tumors Based on Topography... 477 Posterior Fossa Tumors... 477 Supratentorial Tumors... 482 Sellar and Suprasellar Tumors... 485 Pineal Region Masses... 487 Extraparenchymal Tumors... 488 Tumors of the Orbit and Neck... 490 Ocular Tumors... 490 Retrobulbar Orbital Tumors... 490 MR Spectroscopy (MRS) in Brain... 491 Nanotechnology... 492 30. Metabolic Disorders of the Brain... 494 Sapna Singh, Veena Chowdhury Introduction... 494 Metabolic Disorders... 495 Lysosomal Storage Disorders... 498 Peroxisomal Disorders... 505
Contents xix Unclassified Leukodystrophies... 509 Mitochondrial Disorders/Defects of the Respiratory Chain... 516 Disorders of Amino Acid Metabolism/Aminoacidopathies... 520 Organic Acidemias... 524 Metabolic Disorders Primarily Affecting Gray Matter... 526 Disorders of Metal Metabolism... 527 Index... 533