Pediatric differentials
Terms
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- Stridor, wheezing
-
upper airway obstruction
tracheal lesions
rings and slings
FB
asthma - Upper airway obstruction in a child
-
epiglottitis
croup
retropharyngeal abscess
caustic ingestion
FB
tonsillar hypertrophy
adenopathy
thyroglossal duct cyst
branchial cleft cyst
choanal atresia (nasal obstruction) - Bubbly lungs in neonates
-
BPD
PIE
CF
CDH
CCAM
CLE - Child with mass lesions in airways
-
lymphangioma
hemangioma
antrochoanal polyp
angiofibroma
neuroblastoma
rhabdomyosarcoma
lymphadenopathy
retention cysts
papillomas - Neonatal lung masses
-
sequestration
CDH
CCAM
CLE
hypoplastic lung
phrenic nerve paralysis
neuroblastoma - Hyperlucent lung
-
PTX
CCAM
CLE
congenital lung cyst
BO
obstructive emphysema (CF, asthma, PNA, FB, rings, LAD, bronchogenic cyst) - Neonatal respiratory distress
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HMD - vol low
TTN
MAS - coarse, volume high
NP - Neonatal PTX
-
pressure ventilation
PIE
pulmonary hypoplasia - Child with small SPN
-
bronchogenic cyst
sequestration
AVM
bronchial atresia
round PNA (most common)
granuloma
abscess
plasma cell granuloma
neuroblastoma
Wilms met - Multiple pulmonary nodules
-
mets (Wilms, teratoma, rhabdomyosarc, OSA)
laryngeal papillomatosis
septic emboli
TB / fungus
Wegener’s - Interstitial lung disease in a child
-
storage disease
lymphangiectasia
EG
LAM
viral
BPD, HMD
TTN
MAS
NP - Chest wall mass in a child
-
EG / Ewing's
PNET
neuroblastoma
mets
empyema - Neonate with Dilated stomach
-
HPS
pylorospasm
antral web
antral gastritis - Double bubble
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duodenal atresia/stenosis/web
annular pancreas
Ladd’s bands
midgut volvulus
preportal vein
SMA syndrome - Proximal bowel obstruction
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NEONATES-
small bowel atresia/stenosis
midgut volvulus
Ladd’s bands
CHILDREN–
intussusception
incarcerated inguinal hernia
perforated appendicitis - Neonate with Distal bowel obstruction
-
Hirschsprung’s
meconium plug
ileal atresia/stenosis
meconium ileus
imperforate anus - Microcolon
-
ileal atresia
meconium ileus
total colonic Hirschsprung’s - Neonate with pneumatosis
-
NEC
CF
CVD
leukemia
obstruction
steroids - Gasless abdomen
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severe vomiting – gastroenteritis, appendicitis
poor swallowing – esoph atresia, neurologic impairment
displaced bowel – CDH, omphalocele, masses, ascites - Neonate with Abdominal calcifications
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intraabdominal– meconium peritonitis (most common)
renal– neuroblast, Wilms, nephrocalcin, renal cysts, stones
bowel – fecalith of appx, Meckel’s
bladder – hemorrhagic cystitis
adrenal – hemorrhage, Wolman’s disease
cholelithiasis – sickle cell
liver – hepatoblastoma, granuloma - Neonatal abdominal mass
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RENAL– hydronephrosis, MCDK, mesoblastic nephroma
GI – duplication, meconium pseudocyst
RP – adrenal hemorrhage
GENITAL– ovarian cyst, hydrometrocolpos
HEPATOBIL– hemangioendothelioma, choledochal cyst - Abdominal mass in older child
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RENAL– Wilms, hydronephrosis
GI – appendiceal abscess, intussusception, neoplasm
RP – neuroblastoma
GENITAL– ovarian cyst, teratoma, hydrometrocolpos
HEPATOBIL– hepatoblastoma, HCC, mesenchymal hamartoma
VP SHUNT– CSFoma - Gastric filling defect
-
FB (most common)
bezoar
duplication
ectopic pancreas - Thick bowel folds in a child
-
enteritis
lymphoma / leukemia, Henoch-Schonlein purpura
HUS
coagulopathies - Child with GI bleed
-
Meckel’s
juvenile polyps
IBD - Liver lesions in a child
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cysts
hemangioendothelioma
mesenchymal hamartoma
hepatoblastoma
HCC
mets from Wilms or neuroblastoma - Child with Fatty liver
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chronic protein malnutrition (most common)
CF
glycogen storage disease
hepatitis
chemotherapy
steroids
hyperalimentation - Child with Cholelithiasis
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sickle cell
thalassemia
CF
HPT
premature infants with HMD - Congenital GU anomalies
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*malrotation, ectopic kidney, horseshoe kidney, cross-fused ectopia, renal hypoplasia
*ureteral duplication, ureterocele, UPJ or UVJ obstruction, megaureter
*bladder extrophy, prune belly, PUV, hypospadias, caudal regression - Cystic renal masses in kids
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hydronephrosis
ARPKD
MCDK
multilocular cystic nephroma
VHL
TS
cystic Wilms -
Child w/ Hydronephrosis
(most common abdominal mass in neonates) -
UPJ obstruction
UVJ obstruction
ectopic ureterocele
PUV
prune belly - Child w/ Solid renal mass
-
Wilms (children)
mesoblastic nephroma (newborns)
nephroblastomatosis
AML
lymphoma / leukemia
neuroblastoma - Child w/ Adrenal mass
-
neonatal hemorrhage (common)
neuroblastoma
other RP masses (Wilms, hydro upper pole, RP LAD, hepatoblastoma, splenic mass) - Child with Cystic structure in or near bladder wall
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Hutch diverticulum
urachal remnant
ureterocele
megaureter
ovarian cyst
mesenteric cyst - Child with Interlabial mass
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ectopic ureterocele
periurethral cysts
rhabdomyosarcoma of vagina
prolapsed urethra
imperforate hymen - Child with Enlarged head
-
hydrocephalus (most common)
SDH
hemiatrophy
Beckwith-Wiedemann - Child with Small head
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absent or atrophic brain
craniosynostosis
shunt placement - Child with Thick skull
-
renal osteodystrophy
HPT
anemias
leukemia / lymphoma
chronic low ICP (shunts mc cause of calvarial thickening)
dilantin
FD - Child with Lytic skull lesions
-
EG
leukemia / lymphoma
FD
dermoid
epidermoid
HPT - Child with Multiple lacunae
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physiologic
increased ICP
meningocele
encephalocele - Wormian bones
- normal, cleidocranial dysostosis, hypothyroidism, OI, pyknodysostosis, Downs – CHOPS
- Harlequin eyes
- craniosynostosis, NF, craniometaphyseal dysplasia
- Congenital nasal masses
- nasal cephalocele, nasal glioma, dermoid/dermal sinus
- Neck mass in infant
- fibromatosis colli, branchial cleft cyst, lymphangioma/hemangioma, thyroglossal duct cyst, thymic cyst, dermoid, adenopathy, rhabdomyosarcoma, lymphoma, neuroblastoma
- Child with Intracranial calcification
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-physiologic (choroid plexus, pineal gland, falx)
-tumor (craniopharyngioma, oligodendroglioma, meningioma)
-infection (TORCH, TB, cysticercosis)
-congenital (congenital atrophy, TS, Sturge-Weber), metabolic (hypoparathyroid, Fahr’s)
-trauma, vascular (AVM, hematoma, aneurysm) - Enlarged sella turcica in kids
-
craniopharyngioma (most common)
optic chiasm/hypothalamic glioma
increased intracranial pressure
empty sella - Bone tumors in kids
-
chondroblastoma, ABC, NOF, EG, SBC, FD, osteoid osteoma, Ewing’s, OSA, neuroblastoma mets, lymphoma, leukemia
fluid-fluid level – ABC, telangiectatic OSA, GCT, single cysts w/ pathologic fx - Widened joint space in kids
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*joint effusion
– septic arthritis
- hemarthrosis
- transient toxic synovitis
- JRA
*synovial thickening w/o articular cartilage destruction
– JRA
- hemophilia - Bowed bones
-
rickets (most common)
NF
OI
FD - Diffuse osteopenia in kids
-
rickets
HPT
immobilization
JRA - Diffuse dense bones in kids
-
osteopetrosis, pyknodysostosis
melorheostosis
Caffey’s
idiopathic hypercalcemia
pachydermoperiostosis
hypothyroidism
syphilis
hypervitaminosis D - Symmetric periosteal reaction in kids
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physiologic
neuroblastoma
lymphoma, leukemia
infection
Caffey’s, hypervitaminosis A/D
prostaglandins
scurvy
child abuse, trauma
sickle cell – SCALP - Dwarfs
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achondroplasia
thanatophoric dysplasia
OI
hypophosphatasia, achondrogenesis
multiple epiphyseal dysplasia - Deformed epiphysis in kids
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single – AVN, trauma, infection, hypothyroidism
multiple – multiple epiphyseal dysplasia, Morquio’s - Stippled epiphysis
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chondrodysplasia punctata
multiple epiphyseal dysplasia
AVN
hypothyroid
coumadin/alcohol embryopathy
chromosomal anomalies - Enlarged epiphysis in kids
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JRA
hemophilia
chronic infection
healed Perthes - Frayed metaphysis in kids
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*rickets, hypophosphatasia, scurvy
*rubella, syphilis
*achondroplasia, metaphyseal dysostosis - Transverse metaphyseal lines
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--lucent--
stress lines from any severe dz
> 2 yrs consider neuroblast mets, lymphoma, leukemia
--dense--
neonatal growth recovery lines
>2 yrs lead bands or healing rickets -
Widened growth plate
>1mm
DDx -
rickets (most common)
Salter 1 fx
neuroblastoma
lymphoma, leukemia
infection - Metaphyseal fragments
-
child abuse / trauma
Blount’s
infection - Vertebral plana (localized platyspondyly)
-
neuroblastoma mets
EG
lymphoma, leukemia
infection
trauma - Generalized platyspondyly in kids
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OI
dwarfism
Morquio
Cushing - Fused vertebrae in kids
-
isolated fusion
Klippel-Feil syndrome (C2-3 fusion)
posttraumatic - Atlantoaxial subluxation
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Downs
Morquio
JRA
trauma - Sacral abnormalities
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meningocele
NF
presacral teratoma
agenesis - Pediatric Proximal femur abnormalities
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Perthes
SCFE
congenital coxa vara
femoral focal deficiency - Radial ray deficiency
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absence of 1st and/or 2nd digit, often involves radius
Holt-Oram
thrombocytopenia-absent radius syndrome - Polydactyly
-
familial
chondroectodermal dysplasia
trisomy 13
Meckel-Gruber - Short 4th metacarpal
-
normal variant
Turner
pseudohypoparathyroid
pseudopseudohypoparathyroid - Long 4th metacarpal
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NF
macrodystrophia lipomatosa - Causes of delayed bone age
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hypothyroidism
cyanotic CHD
chronic lung disease
HGH deficiency - Hemihypertrophy DDx
-
Wilms
Beckwith-Wiedemann’s
AV fistula
lymphangioma - Down’s syndrome common manifestations
-
duodenal atresia
TE fistula
EA
ECD
Hirschsprung’s
mult sternal ossification centers
11 ribs - Things that happen to premature infants
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HMD
NEC
germinal matrix hemorrhage
PVL
PDA - Child with Presacral mass
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rectal duplication
anterior meningocele
teratoma
neuroblastoma