Pediatric calvarial lesions are uncommon and range in significance from incidental developmental variants to life-threatening disorders. Lesions often come to attention as nonspecific palpable abnormalities and initial imaging work-up may vary. A structured approach is therefore critical to differentiate between non-aggressive and aggressive lesions, between lesions germane to bone and those with secondary calvarial involvement, as well as between truly localized lesions and focal manifestations of multifocal or systemic disease. Lesions with a characteristic imaging appearance include atretic cephalocele, occipital encephalocele, parietal foramina, calcified cephalohematoma, dermoid cyst and fibrous dysplasia. Other lesions may require further imaging of other body regions in conjunction with clinical features and laboratory tests including pathology, laboratory markers and genetic testing. These include chronic non-bacterial osteomyelitis, Langerhans cell histiocytosis, sarcoidosis and neoplastic lesions such as Ewing sarcoma, osteosarcoma, lymphoma and metastasis. The aim of this pictorial essay is to illustrate the multi-modality imaging appearance of the most common focal pediatric calvarial lesions to aid in narrowing the differential diagnosis and to direct subspecialty referral where appropriate. Read More

Meeting name: SPR 2023 Annual Meeting & Postgraduate Course , 2023

Authors: Gerrie Samantha, Rosenbaum Daniel, Hughes Emily

Keywords: Calvarial, focal, mass

Underlying causes for loss of knee flexion in a child are myriad. Once an intrinsic cause has been excluded and a physical block to flexion has been confirmed, pathology within the extensor component must be sought. Idiopathic contractures, congenital contractures, and fibrosis of multiple components of the quadriceps muscle as causes of limitation to flexion of the knee have been reported in the orthopedic literature. More recently, additional structures within the quadriceps muscle have been described, leading to the new designation of a ‘quinticeps femoris’ muscle. This has been termed both an accessory quadriceps femoris and a tensor vastus intermedius (TVI). The latter has been described as a previously unrecognised common variant of anatomy, whereas the former presents as a pathological entity, resulting in progressive fixed flexion of the knee. Two such cases of 'quinticeps femoris' have presented to our institution. Both patients were reviewed by multiple health professionals and had a significant delay in diagnosis (of two and five years respectively), with marked progression of fixed knee flexion during this period. Both diagnoses were ultimately made on MRI, with the causative abnormality appearing as a fusiform structure of low signal intensity arising from the anterolateral proximal femur and blending with the common quadriceps tendon distally. This highlights the importance of radiologists being aware of this anatomical entity as they will often be first to suggest the diagnosis. Both patients underwent surgical release of the anomalous quadriceps band with significant functional improvement. Here we discuss the presentation, underlying pathology, and treatment of this uncommon cause of restricted knee flexion, to our knowledge unreported in the pediatric imaging literature, as well as the need for its recognition and inclusion in the differential diagnosis of progressive loss of knee flexion. Read More

Meeting name: SPR 2020 Annual Meeting & Postgraduate Course , 2020

Authors: Mendes Da Costa Thomas, Leveille Lise, Rosenbaum Daniel

Keywords: Quinticeps, knee flexion

Caudal duplication syndrome is a rare entity that involves duplication of various structures arising from the embryonic cloaca and notochord. This presentation outlines the case of a 38-year-old G2P1 woman referred to our institution at 21 weeks gestation for anomalies detected on antenatal ultrasound. Antenatal ultrasound demonstrated sagittal duplication of the bladder, duplex phallus, a bifid scrotum and a horseshoe kidney. A subsequent fetal MRI confirmed those findings and also demonstrated apparent duplication of the colon and dysmorphic lumbosacral spine. Following delivery, the baby passed urine via both urethras and meconium via a right-sided anus; there was a left-sided anal dimple with an imperforate anus. VCUG showed no communication between the two bladders. A colovesical fistula was demonstrated between the left bladder and colon, which is likely the redundant duplicated colon with the imperforate anus. MRI of the abdomen and pelvis showed a lipomeningocele with attempted sacral duplication, redemonstrated duplication of the pelvic organs, and confirmed absence of a left-sided rectum and sphincteric complex. Caudal duplication syndrome is a complex malformation, the management of which often requires a multidisciplinary approach involving radiology, general surgery, urology, and neurosurgery. This case illustrates the findings of this rare entity with good correlation between fetal and postnatal imaging. It also highlights respective contributions of the various imaging modalities in guiding management, which usually entails staged surgical correction. Read More

Meeting name: SPR 2019 Annual Meeting & Postgraduate Course , 2019

Authors: Smyth Anna, Nowik Christina, Pugash Denise, Rosenbaum Daniel

Keywords: Caudal duplication