Lumps and Bumps Anne Moore, MD Assistant Professor Radiology Children’s Mercy Hospital and...
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Transcript of Lumps and Bumps Anne Moore, MD Assistant Professor Radiology Children’s Mercy Hospital and...
Lumps and BumpsAnne Moore, MD
Assistant Professor Radiology
Children’s Mercy Hospital and
University of Missouri, Kansas City
Lumps and Bumps
Congenital Lesions
Vascular Anomalies
Acquired Lesions
Infectious Lesions
Traumatic Lesions
Head and Neck
• Dermoid/Epidermoid• Branchial Cleft Cyst• Thyroglossal Duct Cyst• Accessory Parotid Tissue• Fibromatosis Coli• Vascular Anomalies
– Hemangioma– Lymphatic/Venous Malformation
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/Epidermoid
• Note Midline location
• Near sutures• Often contains fat
– Negative Hounsfield Units
Branchial Cleft Cyst:Second
• Most common Branchial anomaly
• Presents acutely with mass at the angle of the mandible
Accessory Parotid Tissue
• Superficial and lateral to masseter muscle and anterior to superficial lobe
• Rarely palpable
Fibromatosis Coli
• Idiopathic intramuscular hematoma
• Focal mass or fusiform enlargement of sternocleidomastoid
• Presents with torticollis < 8 weeks of age
In a 6 week old with torticollis, which imaging study is
initially suggested?
A. B. C. D.
0% 0%0%0%
A. MRI
B. CT
C. Ultrasound
D. Plain Radiographs
Thyroglossal duct cyst
• Most common midline developmental lesion of the neck in childhood
• Abuts hyoid bone• Presents acutely
– Often after URI
Hemangioma
• Most common tumor of infancy & childhood
• Female > Male • Characteristic growth:
proliferation, then regression
• Presents 2weeks-2 months of age
• Often skin changes
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
In a 1-month-old child with a hemangioma on the arm,
what is the suggested imaging study?
A. B. C. D.
0% 0%0%0%
A. No imaging needed
B. MRI
C. Bone scan
D. Plain radiographs
Cervical Lymphadenopathy
• Common in children• Imaging studies will show size, number and
location of enlarged lymph nodes
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?
A. B. C. D.
0% 0%0%0%
A. MRI
B. CT
C. Plain radiographs
D. No imaging indicated
Baker’s/Popliteal Cyst
• Synovial cyst in posterior aspect of knee joint
• Intact cyst• Dissected Cyst• Ruptured Cyst
Ganglion Cyst
• Cystic lesion usually attached to a tendon sheath
• Location: hand, wrist, dorsum of foot
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
Inguinal Hernia
• Patent processus vaginalis
• Imaging not usually needed– Ultrasound if unsure about
etiology
Osteochondroma
• Most common benign growth of the skeleton
• Usually painless mass• Painful=possible
malignancy and need MRI
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 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 dimple
• High risk– Greater than 5mm in diameter– Located above the gluteal crease– Cutaneous abnormalities– Draining cerebrospinal fluid– Bottom of dimple cannot be seen
Lumps and bumps
• Ultrasound First• Use Ultrasound and Clinical Setting to
Determine Next Best Step in Evaluation and Treatment