The supine cross-table lateral view is an additional projection to demonstrate the pediatric abdomen. As radiation dose is an important consideration for pediatric imaging, the horizontal beam lateral view is not often performed; although this will vary based on the department.
The Pediatric Appendicitis Score (PAS) is a clinical decision rule and predictor of the likelihood of acute appendicitis in the pediatric population.
cough/percussion/hopping tenderness in right lower quadrant (+2)
nausea or emesis (+1)
tenderness in righ...
Pediatric benign liver tumors are a relatively rare, but important group of conditions. Importantly, the commonest cause of a benign liver tumor is specific to the pediatric population. The list in descending order of frequency is:
infantile hepatic hemangioma (previously hemangioendothelioma)
A number of pediatric cardiovascular procedures are encountered when reporting pediatric imaging. They include:
Blalock-Taussig (BT) shunt
classic: end to side subclavian to ipsilateral pulmonary arterial anastomosis
modified: graft anastomosis
Sano shunt: right ventricle to...
The differential diagnosis of pediatric cervical lesions is commonly encountered in practice, unfortunately, the list is long.
Most lesions tend to be inflammatory 3:
non-tuberculous mycobacterial lymphadenitis
The anteroposterior erect chest view is ideal in younger cooperative pediatric patients (approximately 3-7 years old; this age range is only a guide). This chest view examines the lungs, bony thoracic cavity, mediastinum and great vessels.
The AP erect view is often chosen over th...
The horizontal beam (cross-table) pediatric lateral chest view is a modified lateral projection often utilized in populations under the age of 6 months old due to the inability of that patient to independently hold up their head.
A lateral radiograph helps confirm the presence of a...
The pediatric lateral chest view may be performed as an adjunct to a frontal chest radiograph in cases where there is diagnostic uncertainty. T
The lateral chest view examines the lungs, bony thoracic cavity, mediastinum, and great vessels. Lateral radiographs can be particularly u...
In pediatric imaging, the anteroposterior supine chest x-ray is beneficial for imaging unconscious or uncooperative patients.
This view is preferred in infant and neonate imaging, whilst AP erect and PA erect views are ideal for children able to cooperate in sitting or standing 1.
The clavicle is a unique bone and as such it often displays unique pathology. The following is an attempt to summarize pediatric clavicle abnormalities.
Pediatric bone tumors and tumor-like lesions of the clavicle
majority of clavicular tumors are malignant
Ewing sarcoma (most common)
The pediatric curriculum is one of our curriculum articles and aims to be a collection of articles that represent the core pediatric knowledge.
Topics pertaining to pediatric radiology, including pediatric neuroradiology and fetal radiology, although there will be some cross coverag...
The pediatric cystic renal diseases are a heterogeneous group of conditions defined by the presence of kidney cysts due to hereditary or non-hereditary causes:
isolated simple cyst
cystic renal dysplasia
multicystic dysplastic kidney (MCDK)
obstructive cystic renal dysplasia
The anteroposterior elbow view for pediatrics is part of the two view elbow series, examining the distal humerus, proximal radius and ulna.
The projection demonstrates the elbow joint in its natural anatomical position allowing for adequate radiographic examination of the articula...
The horizontal beam anteroposterior elbow view for pediatrics is an alternative projection to the anteroposterior view in the elbow series, examining the distal humerus, proximal radius and ulna.
This view is ideal for patients who are unable to move their arm as per the standard ...
The horizontal beam lateral elbow view for pediatrics is an alternative projection to the lateral view in the elbow series, examining the distal humerus, proximal radius and ulna.
This view demonstrates an orthogonal view of the AP elbow and is ideal for patients who are unable to...
The lateral elbow view for pediatrics is part of a two view elbow series, examining the distal humerus, proximal radius and ulna.
The projection is the orthogonal view of the AP elbow allowing for examination of the ulna-trochlear joint, coronoid process, and the olecranon process....
Pediatric elbow radiographs are commonly encountered in the emergency department and, when approached in a systematic fashion, are not as difficult to interpret as most people think!
Check that the ossification centers are present and in the correct position. Th...
The posteroanterior finger view for pediatrics is part of a two view series examining the distal metacarpal, distal, middle and proximal phalanges of the finger of interest.
This projection demonstrates the metacarpal and interphalangeal joint spaces in their natural anatomic posi...
The anteroposterior forearm view for pediatrics is one of two standard projections in the forearm series to assess the radius and ulna.
This view demonstrates the elbow joint in its natural anatomical position allowing for assessment of suspected dislocations or fractures and local...
The horizontal beam lateral forearm view for pediatrics is one of two modified trauma projections in the forearm series, examining the radius and ulna.
This view is ideal for patients who are unable to move their arm as per the standard forearm positioning technique but require as...
The lateral forearm view for pediatrics is one of two standard projections in the forearm series to assess the radius and ulna.
This view allows for the assessment of suspected dislocations or fractures and localizing foreign bodies within the forearm.
However, this view should no...
The posteroanterior forearm view for pediatrics is one of two modified trauma projections in the forearm series, examining the radius and ulna.
This view is ideal for patients who are unable to move their arm as per the standard forearm positioning technique but require assessment...
The lateral hand view for pediatrics is an orthogonal view taken along with the PA view of the hand. The lateral view is used to primarily assess for foreign bodies and/or displacement of fractures/dislocations.
This view is useful in assessing suspected dislocations, fractures or ...
The oblique hand view for pediatrics is part of a two view series examining the phalanges, metacarpals, carpal bones and distal radioulnar joint.
This view is useful in assessing suspected dislocations or fractures, localizing foreign bodies or evaluating juvenile idiopathic/rheuma...
The posteroanterior hand view for pediatrics is part of a two view series examining the phalanges, metacarpals, carpal bones and distal radioulnar joint.
This view is useful in assessing suspected dislocations or fractures, localizing foreign bodies or evaluating juvenile idiopath...
The frog leg lateral view is a special radiograph of the pelvis to evaluate the hip. Some departments will perform this routinely instead of the AP pelvis view to reduce exposure and maintain high diagnostic accuracy 1.
Bilateral examination allows for better visualization of the ...
The anteroposterior humerus view for pediatrics is part of the humerus series and is usually taken in a standing position. However, it can also be obtained in a supine position.
The projection demonstrates the humerus in its natural anatomical position allowing for adequate radiographic examina...
The lateral humerus view for pediatrics is part of the humerus series and is usually taken in a standing position. However, it can also be obtained in a supine position.
The projection demonstrates the humerus orthogonal to the AP view, allowing for adequate radiographic examination of the enti...
Pediatric immobilization relates to techniques used to keep children still for medical imaging examinations. Since radiation dose can affect children up to ten times more than adults 1, it is important to keep the radiation dose to a minimum. One method of achieving this is by avoiding repeat im...
The pediatric kidneys follow a growth curve. The measurements below are of the longest maximal dimension. Measurements in parentheses are one standard deviation.
0 months 1: female: 4.15 cm (0.35); male: 4.22 cm (0.32)
2 months: 5.28 cm (0.66)
6 months: 6.15 cm (0.67)
10 months: 6.23 cm (0....
Pediatric knee radiographs are commonly encountered in the emergency department and vary from adult knee radiographs. Younger knees have open growth plates, ossification center development and display unique injury patterns. Growth plates are areas of weakness, susceptible to fracture and injuri...
The PRETEXT system proposed by the International Childhood Liver Tumors Strategy Group (previously called Société Internationale d’Oncologie Pédiatrique - Epithelial Liver Tumor Study Group - SIOPEL) aims for staging and risk stratification of liver tumors at diagnosis.
It is used to describe ...
Pulmonary lung lesions are a heterogeneous group of lung lesions:
lung agenesis-hypoplasia complex
hypogenetic lung syndrome (Scimitar syndrome)
Pediatric cystic lung lesions:
congenital lobar overinflation
congenital cystic adenoma...
Pediatric mediastinal masses are the most common chest masses in children, with the anterior mediastinum being the most common site 1.
As in adults, mediastinal masses are classified depending on anatomical sites:
anterior mediastinal masses
middle mediastinal masses
posterior mediastinal ma...
This classification system based on the embryology and anatomy of the nasal cavity, nasofrontal region, and nasolacrimal apparatus as well as anomalies associated with craniofacial syndromes.2
choanal atresia and stenosis
pyriform aperture stenosis
Pediatric nasal cavity masses can occur within the nose or the nasopharynx. These masses are often found incidentally on imaging but can be readily apparent clinically.
The clinical features of these lesions tend to mimic upper respiratory processes and may result in dela...
The AP pelvis view is a routine view for pediatric patients to examine the hip joints, proximal femora, iliac crests and pelvic ring. The complications of pelvic pathology in pediatrics can significantly affect the child's future, highlighting the importance of proper patient positioning 1.
Tumors of the posterior fossa in children can be remembered using the mnemonic:
The mnemonic is not in order of prevalence; pilocytic astrocytomas are most common.
B: brainstem glioma
A: astrocytoma (pilocytic) (85%)
Pediatric radiography is a subset within general radiography specializing in the radiographic imaging of the pediatric population.
The general principles of radiography remain the same. However, additional consideration needs to be taken into account when determining patient-specific exposure f...
This is a basic article for medical students and other non-radiologists
Pediatric radiology curriculum for medical students covers the fundamental imaging modalities, conditions and presentations on children that require imaging.
As expected and of more importance compared to adults, when cons...
Pediatric renal tumors and masses are another group of diseases (just like cystic renal diseases in both the adult and child) that are bewildering in their number, nomenclature and overlapping findings.
Wilms tumor: common in older children 1-8 years old
Pediatric shoulder radiographs are usually performed after trauma in older children. However, seat-belt injuries during motor vehicle accidents can cause shoulder trauma at any age. Birth trauma may also be factor.
Check the cortex and review alignment:
if there is...
There are a wide range of primary malignancies that result in pediatric skeletal metastases 1:
leukemia: although not truly metastases
clear cell sarcoma: Wilms’ variant
Ewing sarcoma: lung metastases much more common
The anteroposterior (AP) or posteroanterior (PA) view of the thumb in pediatrics is part of a two view series and is orthogonal to the lateral view. Often the decision to choose between the AP or PA thumb depends on what the child can manage and how agitated they are. An AP thumb is ideal as the...
The lateral thumb view for pediatrics is part of a two view series examining the distal metacarpal, distal and proximal phalanges.
This projection is useful for diagnosing fractures and localizing foreign bodies in pediatric patients. It also presents as an orthogonal view of the ...
The oblique thumb view in pediatrics is an additional projection for thumb imaging. Typically, this view is not performed unless specified by the referring doctor or radiologist.
For pediatrics, this oblique view is only indicated when specifically requested. This view may help to...
Pediatric urinary tract infections are common and are a source of significant imaging in young children.
Pediatric urinary tract infections affect up to 2.8% of all children every year, with approximately 2% of boys and 8% or more of girls developing a urinary tract infection at s...
The British National Institute for Health and Care Excellence (NICE) published the “Urinary tract infection in under 16s: diagnosis and management” in 2007 as a guideline for pediatric urinary tract infection (UTI) management, including imaging, prophylaxis and follow-up 1.
This article intend...
The lateral wrist view for pediatrics is one of three views in order to examine the carpal bones, distal radioulnar joint and metacarpals.
This projection is an orthogonal view of the PA wrist and is used to diagnose fractures and localize foreign bodies in pediatric patients. It a...
The oblique wrist view for pediatrics is one of three views in order to examine the carpal bones, distal radioulnar joint and metacarpals.
This projection is useful for diagnosing subtle wrist fractures and the location of the fracture; particularly in adults. However, the oblique...
The posteroanterior wrist view for pediatrics is one of three views in order to examine the carpal bones, distal radioulnar joint and metacarpals.
This projection demonstrates the wrist joint in its natural anatomical position allowing for evaluation of the distal radius, ulna and...
Page kidney, or Page phenomenon, refers to systemic hypertension secondary to extrinsic compression of the kidney by a subcapsular collection, e.g. hematoma, seroma, or urinoma.
Patients present with hypertension, which may be recognized acutely after an inciting event or...
Paget disease of the bone is a common, chronic bone disorder characterized by excessive abnormal bone remodeling. The classically described radiological appearances are expanded bone with a coarsened trabecular pattern. The pelvis, spine, skull, and proximal long bones are most frequently affect...
Paget disease of the breast, which is also known as Paget disease of the nipple, has traditionally been described as a form of breast malignancy characterized by infiltration of the nipple epidermis by malignant cells. Although most cases have underlying focus or foci of in situ or invasive carc...
Paget disease can refer to:
Paget disease of bone
Paget disease of breast
extramammary Paget disease
History and etymology
These conditions are named after Sir James Paget (1814-1899) 1,2, British surgeon and pathologist.
Paget-Schrötter syndrome, alternatively spelled Paget-Schroetter syndrome and also known as effort thrombosis, refers to primary thrombosis of the axillary and/or subclavian vein. It can be thought of as a venous equivalent of thoracic outlet syndrome - i.e venous thoracic outlet syndrome.
There are a number of pain rating scales used by clinicians and researchers to gauge the severity of patients' pain. Commonly used methods:
pain numeric rating scale (NRS/NPRS)
visual analog scale (VAS)
verbal rating scale (VRS)
faces pain scale-revised (FPS-R)
Pain numeric rating scale
A paintbrush appearance describes the streaky appearances of dilated contrast filled tubules within the renal medulla on IVP or CT-IVU. This appearance is characteristic for medullary sponge kidneys.
A similar appearance is also seen in the renal tubular ectasia; though less pronounced.
The paint brush borders sign may be seen on MRI of a giant cell tumor, at the margin between the lesion and the normal bone. The sign specifically refers to the jagged interface as the tumor penetrates into the bone which mimics the profile of the bristles of a paint brush.
It has recently been...
The paired t-test is the appropriate method when the researcher takes an experimental group, measures the baseline, subjects the members to an intervention, and then measures the results.
Testing in a before-and-after manner like this ("matched data" or "repeated measures") requires a different...
Pair production (PP), like the photoelectric effect, results in the complete attenuation of the incident photon. Pair production can only occur if the incident photon energy is at least 1.022 MeV. As the photon interacts with the strong electric field around the nucleus it undergoes a change of ...
The palate is the partition between the oral and nasal cavities, forming the roof of the oral cavity and the floor of the nasal cavity. It is composed of the osseous fixed hard palate comprising the anterior 2/3rds of the palate and a mobile soft palate devoid of bone and with multiple functions...
The palatine bones are paired L-shaped bones joined at the midline. They form the hard palate with the maxillary bones. They also form part of the floor of the nasal cavity (the hard palate separates the oral cavity from the nasal cavity).
The palatine bones are located at the b...
The palatine tonsils, (also known as the faucial tonsils or simply "the tonsils") are a bilateral collection of lymphoid tissue in the pharyngeal mucosa. They form part of Waldeyer's ring.
It is often described to have two borders, two poles and two surfaces:
anterior and poster...
The palatoglossus muscle is one of the four extrinsic muscles of the tongue. The paired muscles create ridges of mucous membrane in the lateral pharyngeal wall called the palatoglossal arches (also known as the anterior pillars of the fauces). These form the lateral boundary between the oral cav...
The palatopharyngeus muscle is a muscle of the head and neck, and one of the inner longitudinal muscles of the pharynx. It is also referred to as one of the five paired muscles of the soft palate. The paired muscles create ridges of mucous membrane in the lateral pharyngeal wall called the pala...
The palatovaginal canal, also known as the pharyngeal canal, is a small short canal located at the articulation of the sphenoidal process of palatine bone and the vaginal process of the body of the sphenoid bone. It is lateral to the variably present vomerovaginal canal.
It transmits the pharyn...
Palla sign is a sign seen on chest radiographs suggestive of pulmonary embolism, usually seen in the acute setting.
Although uncommon, it can be seen along with several other described signs of pulmonary embolus on chest radiography.
Palla sign describes an enlarged right descending...
Pallister-Hall syndrome displays a wide range of severity and is characterized by hypothalamic hamartomas seen as a mass at the floor of the third ventricle, posterior to the optic chiasm 3,4.
Pallister-Hall syndrome is rare and the exact prevalence is unknown. Patients with posta...
Pallister-Killian syndrome (PKS) is an extremely rare chromosomal anomaly.
It may be more prevalent in births from women of advanced age 4.
Phenotypic expression can significantly vary from multiple anomalies resulting in perinatal death to the more charact...
The palmar aponeurosis is the thickened strong part of the palmar fascia in the hand which is continuous with the flexor retinaculum and the tendon of palmaris longus tendon. It is superficial to the long flexor tendons and is an inverted triangle in shape, fanning over the palm and thinning med...
The two palmar carpal branches originate from the radial and ulnar arteries, respectively. They anastomose centrally, supporting the arterial supply of the anterior aspect of the wrist via their contribution to forming the palmar carpal arch 1.
The palmar carpal branch of the ulnar artery trave...
The interossei muscles, form part of the intrinsic muscles of the hand, and as a group consisting of four palmar (1st is often rudimentary) and four dorsal muscles. Collectively the interossei contribute to abduction and adduction of the fingers and also contribute to flexion of the metacarpopha...
The palmaris brevis muscle, a small intrinsic muscle of the hand, is a quadrangular-shaped subcutaneous muscle that overlies the hypothenar muscles, ulnar artery and superficial branch of the ulnar nerve at the medial side of the palm. Although it overlies the hypothenar group it is not part of ...
Palmaris longus (PL) muscle is a superficial, weak flexor of the wrist located in the anterior compartment of the forearm. It is one of the extrinsic muscles of the hand.
origin: medial epicondyle of the humerus
insertion: palmar aponeurosis
arterial supply: anterior ulnar recurrent ...
The palmar radial bursa (plural: palmar bursae) is one of the bursae in the palmar surface of the hand. It is the smaller bursa, surrounds and communicates with the flexor pollicis longus tendon sheath at the metacarpophalangeal joint and usually extends around 1-2 cm proximal to the proximal ed...
The palmar ulna bursa is one of the bursae in the palmar surface of the hand.
The palmar ulnar bursa is usually the larger bursa and encases the majority of the flexor tendons. It typically originates at the level of the pronator quadratus muscle and continues distally to approxi...
Palmer classification for triangular fibrocartilage complex (TFCC) abnormalities is based on the cause, location, and degree of injury 1:
Class 1 - traumatic injury
a: central perforation of the triangular fibrocartilage (TFC) disc proper
b: ulnar avulsion with or without distal ulnar fractur...
Palmer notation, also known as the Zsigmondy system or Zsigmondy-Palmer system, is a nomenclature for numbering and naming of teeth, primarily used in the United Kingdom.
Similar to the FDI World Dental Federation notation, individual teeth within each quadrant of the dental ar...
Palmini classification of focal cortical dysplasia published in 2004 was one of the leading classification systems used for focal cortical dysplasia, recently replaced by a newer classification; Blumcke classification of focal cortical dysplasia.
Unfortunately, as is the case with many classif...
The pampiniform plexus (plural: plexuses) is the venous network of approximately 10 veins draining the testis and epididymis. The network surrounds the testicular artery in the spermatic cord and lies anterior to the ductus deferens. Each network coalesces to form the testicular (internal sperma...
The term panbronchiolitis refers to a bronchiolitis affecting throughout the lungs. Most radiological publications describe this as diffuse panbronchiolitis.
Pancake brain is the classical sign of alobar holoprosencephaly. It is due to fusion of the cerebral hemispheres leaving a single ventricle in its center. It is the most severe form of holoprosencephaly. It is associated with multiple facial abnormalities.
Pancake kidney (also known as discoid kidney, disc kidney, lump kidney, fused pelvic kidney or cake kidney) is a rare renal fusion anomaly of the kidneys of the crossed fused variety.
Pancake kidney may be an incidental finding. However, they can present clinically becaus...
A variety of organ abnormalities have been described as having an appearance similar to a pancake.
Pancoast syndrome (historically known as Ciuffini-Pancoast-Tobías syndrome, Hare syndrome or variation thereof) results from involvement of the brachial plexus and sympathetic chain by a Pancoast tumor or, less commonly, from other tumors - or even non-malignant disease - involving the lung apex...
Pancoast tumor, also known as superior sulcus tumor, refers to a relatively uncommon situation where a primary lung cancer arises in the lung apex and invades the surrounding soft tissues. Classically a Pancoast syndrome results, but in actuality this is only seen in one quarter of cases.
The pancreas (plural: pancreata) is a retroperitoneal organ that has both endocrine and exocrine functions: it is involved in the production of hormones (insulin, glucagon, and somatostatin), and also involved in digestion by its production and secretion of pancreatic juice.
Pancreas divisum represents a variation in pancreatic ductal anatomy that can be associated with abdominal pain and idiopathic pancreatitis. It is characterized, in the majority of cases, by the dorsal pancreatic duct (i.e. main pancreatic and Santorini ducts) directly entering the minor papilla...
The CT pancreas protocol serves as an outline for a dedicated examination of the pancreas. As a separate examination, it is usually conducted as a biphasic contrast study and might be conducted as a part of other scans such as CT abdomen-pelvis, CT chest-abdomen-pelvis.
Note: This article aims...
A pancreas transplant is a procedure in which a donor pancreas is transplanted to a recipient. The donor pancreas is typically cadaveric, but may rarely be a segment from a living donor 1. The transplant is meant to establish normoglycemia in patients with diabetes mellitus, typically type 1, th...
Pancreatic atrophy is non-specific and is common in elderly patients, although in younger patients it can be a hallmark of pathology. Most commonly it is associated with aging, obesity and end-stage chronic pancreatitis.
It occurs principally with fatty replacement of the pancreas (pancreatic ...
Pancreatic calcifications can arise from many etiologies.
Punctate intraductal calcifications
alcoholic pancreatitis (20-40%) 2
intraductal, numerous, small, irregular
preponderant cause of diffuse pancreatic intraductal calcification
gallstone pancreatitis (2%) 2