Purpose or Case Report: Over the past decades, pediatric nutritional disorders have undergone profound shifts in prevalence and clinical presentation. Whereas in some places of the globe malnutrition rates have increased significantly due to poverty expansion, in other places childhood obesity has surged, now affecting a substantial portion of school-aged children. In developed nations, obesity rates are even higher, whereas in developing regions, malnutrition remains a pressing concern. Chronic illnesses, prolonged hospitalizations, and neuropsychiatric conditions are contributors to nutritional deficits. Although radiologic findings have been well documented for some hypovitaminosis, other conditions such as anorexia nervosa and autism have been described in isolated imaging reports. On the other hand, pediatric obesity presents with musculoskeletal (MSK) manifestations and nonspecific pain syndromes that require further scrutiny.
In this case presentation we provide an overview of the spectrum of imaging findings associated with pediatric nutritional disorders, whether caused by deficiency or excess.
CONTENT ORGANIZATION:
1) Overview and epidemiology of pediatric nutritional disorders that lead to (a) MSK tissue deficiency including different hypovitaminosis, congenital, metabolic and neuromuscular disorders, bone deficiencies, conditions that manifest with gelatinous bone marrow transformation or soft tissue paucity, or (b) MSK tissue excess including genetic and metabolic disorders that manifest with fat overgrowth and hypertrophy syndromes. 2) Imaging findings of MSK bone and soft tissue deficiency or excess by different modalities (conventional radiology, ultrasound, CT, MRI). 3) Pearls, pitfalls and associated clinical findings specific for the described conditions. 4) Review of follow-up imaging considerations.
5) Discussion of the radiologist’s role in managing a child/adolescent with nutritional disorders.
SUMMARY: Major teaching points of this case presentation include: 1) Understanding different clinical presentations and key imaging findings that lead to the diagnosis of disorders that manifest with MSK deficiency or excess. 2) Differentiating disorders of either part of the spectrum (deficiency or excess) as an essential component for patients to receive appropriate care in a timely manner. 3) Providing recommendations for imaging follow-up as part of the integrated clinical-laboratory-imaging care of patients with nutritional disorders.
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