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Lumps and Bumps. Anne Moore, MD Assistant Professor Radiology Children’s Mercy Hospital and University of Missouri, Kansas City. Imaging Modalities. Plain Xray imaging ULTRASOUND CT imaging MR imaging. Lumps and Bumps. Congenital Lesions Vascular Anomalies Acquired Lesions

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lumps and bumps

Lumps and Bumps

Anne Moore, MD

Assistant Professor Radiology

Children’s Mercy Hospital and

University of Missouri, Kansas City

imaging modalities
Imaging Modalities
  • Plain Xray imaging
  • ULTRASOUND
  • CT imaging
  • MR imaging
lumps and bumps3
Lumps and Bumps

Congenital Lesions

Vascular Anomalies

Acquired Lesions

Infectious Lesions

Traumatic Lesions

head and neck
Head and neck
  • Start with Ultrasound!
head and neck7
Head and Neck
  • Dermoid/Epidermoid
  • Branchial Cleft Cyst
  • Thyroglossal Duct Cyst
  • Accessory Parotid Tissue
  • Fibromatosis Coli
  • Vascular Anomalies
    • Hemangioma
    • Lymphatic/Venous Malformation
dermoid epidermoid
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
dermoid epidermoid10
Note Midline location

Near sutures

Often contains fat

Negative Hounsfield Units

Dermoid/Epidermoid
branchial cleft cyst second
Branchial Cleft Cyst:Second
  • Most common Branchial anomaly
  • Presents acutely with mass at the angle of the mandible
accessory parotid tissue
Accessory Parotid Tissue
  • Superficial and lateral to masseter muscle and anterior to superficial lobe
  • Rarely palpable
fibromatosis coli
Fibromatosis Coli
  • Idiopathic intramuscular hematoma
  • Focal mass or fusiform enlargement of sternocleidomastoid
  • Presents with torticollis < 8 weeks of age
fibromatosis coli14
Fibromatosis Coli

Fibromatosis Coli

Normal for comparison

in a 6 week old with torticollis which imaging study is initially suggested
In a 6 week old with torticollis, which imaging study is initially suggested?
  • MRI
  • CT
  • Ultrasound
  • Plain Radiographs
thyroglossal duct cyst
Thyroglossal duct cyst
  • Most common midline developmental lesion of the neck in childhood
  • Abuts hyoid bone
  • Presents acutely
    • Often after URI
hemangioma
Hemangioma
  • Most common tumor of infancy & childhood
  • Female > Male
  • Characteristic growth: proliferation, then regression
  • Presents 2weeks-2 months of age
  • Often skin changes
hemangioma19
Hemangioma
  • MRI
    • T2 bright
    • Enhancing
    • Lobular
    • Flow voids
  • Parotid is most common salivary gland
hemangioma20
Hemangioma

Proliferation

Involution

venous and lymphatic malformations
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
lymphatic malformation
Lymphatic Malformation

Note cystic and solid components

in a 1 month old child with a hemangioma on the arm what is the suggested imaging study
In a 1-month-old child with a hemangioma on the arm, what is the suggested imaging study?
  • No imaging needed
  • MRI
  • Bone scan
  • Plain radiographs
rhabdomyosarcoma
Rhabdomyosarcoma

Most common soft tissue sarcoma of childhood

Aggressive looking

lymphoma
Lymphoma
  • Third most common childhood malignancy
  • Asymptomatic lymphadenopathy
cervical lymphadenopathy
Cervical Lymphadenopathy
  • Common in children
  • Imaging studies will show size, number and location of enlarged lymph nodes
suppurative lymphadenitis
Suppurative Lymphadenitis
  • Bacterial infection may result in abscess formation
cephalohematoma
Cephalohematoma
  • Subperiosteal accumulation of blood
  • Confined by sutures
  • Most commonly parietal
  • No imaging usually needed
    • ? ultrasound
in a newborn male with unilateral parietal swelling since birth which imaging study is indicated
In a newborn male with unilateral parietal swelling since birth, which imaging study is indicated?
  • MRI
  • CT
  • Plain radiographs
  • No imaging indicated
baker s popliteal cyst
Baker’s/Popliteal Cyst
  • Synovial cyst in posterior aspect of knee joint
  • Intact cyst
  • Dissected Cyst
  • Ruptured Cyst
ganglion cyst
Ganglion Cyst
  • Cystic lesion usually attached to a tendon sheath
  • Location: hand, wrist, dorsum of foot
langerhan cell histiocystosis
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
slide39
LCH

15 month old

slide40
LCH

15 month old

slide41
LCH

15 month old clavicle/chest wall mass

11 year old female left chest wall mass

inguinal hernia
Inguinal Hernia
  • Patent processus vaginalis
  • Imaging not usually needed
    • Ultrasound if unsure about etiology
osteochondroma
Osteochondroma
  • Most common benign growth of the skeleton
  • Usually painless mass
  • Painful=possible malignancy and need MRI
sacral dimple
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
sacral dimple46
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
sacral dimple47
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
sacral dimple48
Sacral Dimple

Tethered Cord

Normal

lumps and bumps51
Lumps and bumps
  • Ultrasound First
  • Use Ultrasound and Clinical Setting to Determine Next Best Step in Evaluation and Treatment
in a 4 mo old with skin lesion which imaging study is indicated
In a 4-mo-old with skin lesion. Which imaging study is indicated?
  • MRI
  • Ultrasound
  • No imaging needed
  • Plain radiographs