Lumps and Bumps

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. Cystic or solid Hypovascular Dermoid

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

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 Fibromatosis Coli Normal for comparison

15. In a 6 week old with torticollis, which imaging study is initially suggested? • MRI • CT • Ultrasound • 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 Proliferation Involution

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 wave forms Solid Venous Malformation

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? • No imaging needed • MRI • Bone scan • 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. Nodes with central necrosis/fluid May take weeks to resolve Suppurative Lymphadenitis

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? • MRI • CT • Plain radiographs • No imaging indicated

34. Shoulder, Knees and Toesaka 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 Cord Normal

49. Dermal sinus tract Sacral Dimple

50. Sacral Dimple