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Lumps and Bumps Anne Moore, MD Assistant Professor Radiology Children’s Mercy Hospital and University of Missouri, Kansas City.

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Presentation on theme: "Lumps and Bumps Anne Moore, MD Assistant Professor Radiology Children’s Mercy Hospital and University of Missouri, Kansas City."— Presentation transcript:

1 Lumps and Bumps Anne Moore, MD Assistant Professor Radiology Children’s Mercy Hospital and University of Missouri, Kansas City

2 Imaging Modalities Plain Xray imaging ULTRASOUND CT imaging MR imaging

3 Lumps and Bumps Congenital Lesions Vascular Anomalies Acquired Lesions Infectious Lesions Traumatic Lesions

4 Head, Shoulders, Knees and Toes

5 Eyes and ears and mouth and nose

6 Head and neck »Start with Ultrasound!

7 Head and Neck Dermoid/Epidermoid Branchial Cleft Cyst Thyroglossal Duct Cyst Accessory Parotid Tissue Fibromatosis Coli Vascular Anomalies –Hemangioma –Lymphatic/Venous Malformation

8 Dermoid/Epidermoid Found in a variety of locations around the skull, midface and neck Commonly in midline and frontotemporal location, followed by parietal location Midline or near midline lesion in neck

9 Dermoid Cystic or solid Hypovascular

10 Dermoid/Epidermoid Note Midline location Near sutures Often contains fat –Negative Hounsfield Units

11 Branchial Cleft Cyst: Second Most common Branchial anomaly Presents acutely with mass at the angle of the mandible

12 Accessory Parotid Tissue Superficial and lateral to masseter muscle and anterior to superficial lobe Rarely palpable

13 Fibromatosis Coli Idiopathic intramuscular hematoma Focal mass or fusiform enlargement of sternocleidomastoid Presents with torticollis < 8 weeks of age

14 Fibromatosis Coli Normal for comparison

15 In a 6 week old with torticollis, which imaging study is initially suggested? A.MRI B.CT C.Ultrasound D.Plain Radiographs

16 Thyroglossal duct cyst Most common midline developmental lesion of the neck in childhood Abuts hyoid bone Presents acutely –Often after URI

17 Thyroglossal Duct Cyst

18 Hemangioma Most common tumor of infancy & childhood Female > Male Characteristic growth: proliferation, then regression Presents 2weeks-2 months of age Often skin changes

19 Hemangioma MRI –T2 bright –Enhancing –Lobular –Flow voids Parotid is most common salivary gland

20 Hemangioma ProliferationInvolution

21 Venous and Lymphatic Malformations Present any age, but usually beyond infancy Venous Malformation: –Dysplastic venous channels; Solid with phleboliths and venous Doppler wave forms Lymphatic Malformation: –Dysplastic lymphatic structures; Cystic with fluid levels

22 Venous Malformation Venous wave forms Solid

23 Lymphatic Malformation Note cystic and solid components

24 In a 1-month-old child with a hemangioma on the arm, what is the suggested imaging study? A.No imaging needed B.MRI C.Bone scan D.Plain radiographs

25 Rhabdomyosarcoma Most common soft tissue sarcoma of childhood Aggressive looking

26 Lymphoma Third most common childhood malignancy Asymptomatic lymphadenopathy

27 Cervical Lymphadenopathy Common in children Imaging studies will show size, number and location of enlarged lymph nodes

28 Cervical Lymphadenopathy

29 Suppurative Lymphadenitis Bacterial infection may result in abscess formation

30 Suppurative Lymphadenitis Nodes with central necrosis/fluid May take weeks to resolve

31 Cephalohematoma Subperiosteal accumulation of blood Confined by sutures Most commonly parietal No imaging usually needed –? ultrasound

32 Cephalohematoma

33 In a newborn male with unilateral parietal swelling since birth, which imaging study is indicated? A.MRI B.CT C.Plain radiographs D.No imaging indicated

34 Shoulder, Knees and Toes aka Below the Neck

35 Baker’s/Popliteal Cyst Synovial cyst in posterior aspect of knee joint Intact cyst Dissected Cyst Ruptured Cyst

36 Baker’s/popliteal cyst

37 Ganglion Cyst Cystic lesion usually attached to a tendon sheath Location: hand, wrist, dorsum of foot

38 Langerhan Cell Histiocystosis Idiopathic disorder that can manifest as focal or systemic disease Initial lesion often identified with radiography Radiographic appearance is extremely variable May presents with palpable lumps –Especially on skull or ribs

39 LCH 15 month old

40 LCH 15 month old

41 LCH 15 month old clavicle/chest wall mass 11 year old female left chest wall mass

42 Inguinal Hernia Patent processus vaginalis Imaging not usually needed –Ultrasound if unsure about etiology

43 Inguinal Hernia

44 Osteochondroma Most common benign growth of the skeleton Usually painless mass Painful=possible malignancy and need MRI

45 Sacral Dimple Classified as low or high risk Low risk does not require imaging High risk require imaging –Ultrasound if < 6 months –MR imaging thereafter

46 Sacral dimple Low risk –Midline –Less than 5mm in diameter –Located with the gluteal crease –No cutaneous abnormalities or drainage –Can see bottom of dimple

47 Sacral dimple High risk –Greater than 5mm in diameter –Located above the gluteal crease –Cutaneous abnormalities –Draining cerebrospinal fluid –Bottom of dimple cannot be seen

48 Sacral Dimple Tethered CordNormal

49 Sacral Dimple Dermal sinus tract

50 Sacral Dimple

51 Lumps and bumps Ultrasound First Use Ultrasound and Clinical Setting to Determine Next Best Step in Evaluation and Treatment

52 In a 4-mo-old with skin lesion. Which imaging study is indicated? A.MRI B.Ultrasound C.No imaging needed D.Plain radiographs

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