Enchondromatosis, also known as Ollier disease (see Terminology section), is a non-hereditary, sporadic, skeletal disorder characterized by multiple enchondromas principally located in the metaphyseal regions.
Some authors make a distinction between Ollier disease and enchondromato...
Endocardial fibroelastosis (EFE) is a rare cardiac condition which is classically described in the pediatric population (typically first two years). It is one of the causes for infants to present with unexplained heart failure.
The condition results from increasing amounts of fibrou...
Endochondral ossification describes the process of ossification from mesenchymal cells (stem cells) with a cartilaginous template and is involved in the healing process of fractures.
Bone formation occurs at centers of ossification (or ossification centers) which are either primary or secondary...
Enterovirus 71 is one of the viruses that causes hand-foot-and-mouth disease in children. It is an enterovirus, one of the picornaviruses.
Infection with enterovirus 71 predominantly results in a vesicular rash of the hands and feet that follows a prodrome of symptoms including fever, vomiting ...
Enterovirus rhomboencephalitis is the most common neurological complication of enterovirus infection 1.
Enterovirus rhomboencephalitis causes acute and severe neurologic disorders such as ataxia, nystagmus, oculomotor palsies, or bulbar palsy. In some cases, neurologic af...
Ependymoma RELA fusion-positive is a recently accepted molecular variant of ependymoma, only recognised in the 2016 update to the WHO classification of CNS tumors. They are the most common type of supratentorial ependymoma in children, and not found in the posterior fossa or spinal cord.
Epicondyle fractures are common injuries in children. They represent 10% of all elbow fractures in children and usually occur in boys after a fall on an outstretched arm.
Medial epicondyle fractures comprise most of these injuries. They can usually be treated with splinting and early physiother...
Epiglottitis is a life-threatening condition caused by inflammation of the epiglottis and aryepiglottic folds 1, which can lead to acute airway obstruction. Treatment should be urgent and performed by appropriately trained individuals, e.g. instrumentation of the trachea should be performed by ...
Epispadias is a rare congenital anomaly that is almost always associated with bladder exstrophy.
It occurs in 1 in 30,000 births, with a male: female ratio of 3:1.
The roof of the urethra is absent and the urethra opens anywhere between the base and the gl...
Erb palsy, also known as brachial plexus birth palsy, is a form of obstetric brachial plexus injury as a result of complications during delivery.
The most common cause is due to excessive lateral traction or stretching of the fetal head and neck in opposite directions du...
Endotracheal tubes (ETT) are wide-bore plastic tubes that are inserted into the trachea to allow artificial ventilation. Tubes come in a variety of sizes and have a balloon at the tip to ensure that gastric contents are not aspirated into the lungs. Adult tubes are usually approximately 1 cm in ...
Ewing sarcomas are the second most common malignant primary bone tumors of childhood after osteosarcoma, typically arising from medullary cavity with invasion of the Haversian system. They usually present as moth-eaten destructive permeative lucent lesions in the shaft of long bones with large s...
Ewing sarcoma family of tumors (ESFT) are a group of small round blue cell tumors that are closely histogenetically related, all demonstrating non-random t(11;22)(q24;q12) chromosome rearrangement resulting in the formation of the EWS-ETS fusion gene 1-3. They include:
Ewing sarcoma of bone
Extracorporeal membrane oxygenation (ECMO) is used as a modified pulmonary or cardiopulmonary bypass technique in those with severe cardiac and/or respiratory failure refractory to conventional ventilatory support and medical intervention 1,3. There are two access paths for extracorporeal life s...
The extrusion index is a radiographic measurement of femoral head bony coverage by the acetabulum. It is useful in assessing for developmental dysplasia as well as femoroacetabular impingement.
It is calculated by dividing the horizontal distance of the lateral femoral head that is uncovered by...
Exudative retinitis, also known as retinal telangiectasis or Coats disease, is a rare congenital disease affecting the eyes and is a cause of leukocoria.
It occurs predominantly in young males, with the onset of symptoms generally appearing in the first decade of life with a peak ...
Facioscapulohumeral muscular dystrophy (FSHD) is a form of muscular dystrophy characterized by extremely variable degrees of facial, scapular and lower limb muscle involvement.
It is considered one of the more common hereditary muscular disorders with a prevalence of ~1 in 8,000.
Familial adenomatous polyposis syndrome (FAPS) is characterized by the presence of hundreds of adenomatous polyps in the colon. It is the most common of the polyposis syndromes.
Familial polyposis coli, attenuated familial adenomatous polyposis and Gardner syndrome are all variants...
Fatco syndrome is a syndrome consisting of
tibial campomelia and
It is a syndrome of unknown genetic basis and inheritance with variable expressivity and penetrance.
Fuhrmann syndrome and Al-Awadi syndrome are said to be similar to FA...
Faulty fetal packing, also known as congenital vault depression, is a congenital concave depression of the skull in a newborn.
Occurs in 1 in 10,000 births 1.
This appearance is due to external compression on the skull from 1,2:
fetal limb or twin
Febrile infection-related epilepsy syndrome (FIRES) is a severe postinfectious neurological disorder that presents with status epilepticus in a previously normal child (or less commonly adult) after a febrile illness.
FIRES has received several names in the literature:
Feingold syndrome is characterized by the combination of:
alimentary tract atresias especially esophageal atresia
Femoral facial syndrome, also known as femoral hypoplasia-unusual facies syndrome, is a rare congenital syndrome characterized by varying degrees of femoral hypoplasia and facial dysmorphism 1.
Femoral facial syndrome can cause varying degrees of femoral malformation rang...
Femur sparing intrauterine growth restriction is considered by some authors as a particular type of intrauterine growth restriction (IUGR) 1. In this type, the femoral length is the only standard fetal biometric parameter unaffected while all others are reduced.
Fetal circulation differs from the adult circulation due to the presence of certain vessels and shunts.
These shunts will close after birth, and most of these fetal vessels will be seen as remnants in the adult circulation. The function of these shunts is to direct oxygen-rich venous blood to ...
Fetal lung interstitial tumor (FLIT) is a recently proposed designation for a rare primary lung mass detected prenatally or when the patient is up to 3 months old.
Fetal lung interstitial tumors have a slight predominance in boys 1.
Fetal lung interstitial tumors were ...
A fetal orbital mass is a rare occurrence but can arise from many patholologies
The list includes
Tumourous orbital masses
fetal orbital teratoma
Non tumourous orbital masses
orbital encephalocoele 2
orbital heterotopic brain tissue 1
congenital cystic eyeball 4
Although rare, a number to tumors may be diagnosed antenatally. These fetal tumors are a diverse and a unique group of conditions, and include:
neuroblastoma: most common tumor overall
head and neck teratoma/epignathus
Fibrodysplasia ossificans progressiva (FOP), previously known as myositis ossificans progressiva (MOP), is a rare, inherited disorder characterized by progressive fibrosis and ossification of muscles, tendons, fasciae, aponeuroses, and ligaments of multiple sites. It is disabling and ultimately ...
Fibromatosis colli is a rare form of infantile fibromatosis that occurs within the sternocleidomastoid muscle.
There may be a slight male predilection. It typically presents a few weeks after birth.
Presentation is usually with torticollis and is most frequ...
Fibrosing colonopathy a condition characterized by progressive submucosal fibrosis, particularly of the proximal colon. It is associated with high dose lipase supplementation used to treat exocrine insufficiency of the pancreas, such as in treatment for cystic fibrosis.
It is more...
Fibrous cortical defects (FCD) are benign bony lesions and are a type of fibroxanthoma, histologically identical to the larger non-ossifying fibroma (NOF).
Fibrous cortical defects typically occur in children (usually 2-15 years), and indeed are one of the most common benign bony ...
Fibrous dysplasia (FD) is a non-neoplastic tumor-like congenital process, manifested as a localised defect in osteoblastic differentiation and maturation, with the replacement of normal bone with large fibrous stroma and islands of immature woven bone. Fibrous dysplasia has a varied radiographic...
Fibrous hamartoma of infancy is a rare benign tumor of the subcutaneous tissues seen in children. More than 90% of cases present in the first year of life with up to 25% being congenital 1.
There is a reported male:female ratio of 2:1 but the exact incidence is unknown 2.
Fibroxanthoma of bone is a confusing term that is sometimes used to encompass non-ossifying fibroma and fibrous cortical defect, and at other times synonymously with just non-ossifying fibromas. As non-ossifying fibroma and fibrous cortical defect are histologically the same, and differ only in ...
Fibular hemimelia is a congenital lower limb anomaly characterized by partial or complete absence of the fibula and includes a spectrum ranging from mild fibular hypoplasia to complete fibular aplasia 1.
Although rare in occurrence, it is the most common congenital absence of long...
A filar cyst is an incidental finding on neonatal lumbar sonography located in the filum terminale of the spinal cord. It is considered a normal variant and is often confused for a ventriculus terminalis, a smooth dilated cavity of the central canal, located within the conus medullaris.
The flat floor of fourth ventricle sign is useful in detecting a pontine mass and is a sign of mass effect. The normal floor of the fourth ventricle (remember that the floor is anterior) normally slopes upwards towards the midline, with the facial colliculi visible on either side.
It is a non-...
Focal periphyseal edema zones, also known as FOPE zones, are regions of bone marrow edema seen on MRI that are principally located at the physes about the knee. They are thought to represent potentially painful manifestations of physiologic physeal fusion 1.
FOPE zones are seen in...
The weightbearing lateral foot radiograph is important in the assessment of foot alignment and the diagnosis of abnormalities that cause malalignment and foot pain. Nonweightbearing views (e.g. oblique foot radiograph) are inadequate for the assessment of alignment because the bones of the feet ...
The foramen ovale (or ovalis) is the opening in the interatrial septum in the fetal heart that allows blood to bypass the right ventricle and non-ventilated lungs, shunted from the right atrium to the left atrium. Specifically it represents the opening between the upper and lower portions of the...
The fossa ovale (or ovalis) is the small oval depression in the interatrial septum at the site of the closed foramen ovale, which closes once fetal circulation ceases in the first few minutes of postnatal life. It represents the overlapping primary and secondary septa of the interatrial septum. ...
The fountain sign is sonographic sign described in acute idiopathic scrotal edema (AISE).
It refers to the appearance of the pattern of vascularity seen during transverse color Doppler sonography of the scrotum with both testes together1. In these transverse views in patients with AISE, marked ...
A fourth ventriculocoele is large posterior fossa cyst which remodels, thins and eventually erodes through the occipital bone to form an occipital encephalocoele.
It may be classified as part of the Dandy-Walker continuum, but this is controversial.
Fracture translation (also called translocation) describes the movement of fractured bones away from each other. In some cases, people will just use the term displacement to describe translation. However, displacement should really be used as a broad term that refers to angulation, translation a...
Fraser syndrome is an extremely rare congenital syndromic anomaly.
The estimated incidence is at around 0.04:10,000 live-born infants and 1:10,000 stillbirths.
The syndromic spectrum can comprises of:
syndactyly: often cutaneous
Freiberg disease, also known as Freiberg infraction, is osteochondrosis of metatarsal heads. It typically affects the 2nd metatarsal head, although the 3rd and 4th may also be affected. It can be bilateral in up to 10% of cases.
It is most common in females aged 10-18 years (male...
Frontal bossing is a calvarial radiographic feature where the front of the skull appears protruding anteriorly. It is best appreciated on a sagittal or lateral image.
This feature can be seen in many conditions (in alphabetical order):
Frontonasal dysplasia, also known as median cleft face syndrome, is a rare disorder characterized by midline defects involving the face, head, and central nervous system.
Frontonasal dysplasia is considered to be a very rare condition, with approximately 100 cases having been repo...
The Frykman classification of distal radial fractures is based on the AP appearance and encompasses the eponymous entities of Colles fracture, Smith fracture, Barton fracture, chauffeur fracture. It assesses the pattern of fractures, involvement of the radioulnar joint and presence of a distal u...
Fukuyama congenital muscular dystrophy (FCMD) is a form of congenital muscular dystrophy.
FCMD is almost exclusively found in Japan where it has an incidence of 2-4 per 100,000 infants and is the second most common muscular dystrophy after Duchenne muscular dystrophy 1,2. However,...
Gage sign is a V-shaped lucent defect at the lateral portion of the epiphysis and/or adjacent metaphysis. It is pathognomonic for Legg-Calve-Perthes disease.
It may occur early in the disease and is one of the five indicators of a worse prognosis, which are:
calcification lateral t...
Galeazzi fracture-dislocations consist of fracture of the distal part of the radius with dislocation of distal radioulnar joint and an intact ulna. A Galeazzi-equivalent fracture is a distal radial fracture with a distal ulnar physeal fracture 2.
Galeazzi fractures are primarily e...
Gallbladder ghost triad is a term used on ultrasound studies when there is a combination of three gallbladder features on biliary atresia:
atretic gallbladder, length less than 19 mm
irregular or lobular contour
lack of smooth/complete echogenic mucosal lining with an indistinct wall
Gangliogliomas are uncommon, usually low-grade, CNS tumors. Epilepsy is a common clinical presentation and this tumor has a typical occurrence in the temporal lobes, although they have been described in all parts of the central nervous system.
Their appearance on imaging is very variable: from ...
Ganglioneuromas are fully differentiated neuronal tumors that do not contain immature elements and potentially occur anywhere along the peripheral autonomic ganglion sites.
On imaging, usually, they present as well-defined solid masses and can be quite large at presentation. Generally, they ar...
Gastric duplication cysts are rare congenital foregut duplication cysts affecting the stomach. Gastrointestinal tract duplication cysts (GTDCs) most commonly affect the ileum, followed by the esophagus, large bowel, and jejunum; gastric location accounts for less than 10% of all gastrointestinal...
Gastro-esophageal reflux disease (GORD) is a spectrum of disease that occurs when gastric acid refluxes from the stomach into the lower end of the esophagus across the lower esophageal sphincter (LOS).
Common clinical features in adults include epigastric and retrosternal...
Gastroschisis refers to extra-abdominal herniation (evisceration) of fetal or neonatal bowel loops (and occasionally portions or the stomach and or liver) into the amniotic cavity through a para-umbilical abdominal wall defect.
The estimated incidence is at around 1-6 per 10,000...
Gaucher disease (GD) is the most common lysosomal storage disease in humans. It is an autosomal recessive, multisystem disease arising from a deficiency of glucocerebrosidase or beta-glucosidase activity, resulting in accumulation of a glycolipid (glucocerebroside) within the lysosomes of macrop...
The causes of generalised increased bone density in pediatric patients can be divided accodring to broad categories of cause :
dense metaphyseal bands
cortex and flat bones may also be slight...
The Gerbode defect describes a rare abnormal left-to-right shunt between the left ventricle and right atrium through a defect in the atrioventricular septum, usually congenital in etiology.
Gerbode defects are rare congenital cardiac anomalies, and are thought to account for less ...
Germinal matrix hemorrhages, also know as periventricular-intraventricular hemorrhages (PVIH), are the commonest type of intracranial hemorrhage in neonates and are related to a perinatal stress affecting the highly vascularized subependymal germinal matrix. The majority of cases occur in premat...
Grading of germinal matrix hemorrhage has taken several forms over the years. The most commonly used system is the sonographic grading system proposed by Burstein, Papile et al.
restricted to subependymal region/germinal matrix which is seen in the caudothalamic groove...
Ghost vertebra is a sign, that is generally used synonymously with bone-within-a-bone vertebra, and as such, the causes form a subset of those causing bone within a bone appearance 2:
Thorotrast administration: bone within a bone appearance due to temporary growth arrest 1
Gillespie syndrome is a rare genetic condition presenting as a mydriasis, secondary to an omnipresent partial aniridia. The abnormal iris is bilateral, with a highly-specific scalloped inner margin, due to hypoplasia of the central constrictor pupillae fibers. Associated features include an unch...
Glutaric aciduria type 1 is a leukodystrophy that can be subclassified as an organic acidopathy. It has a highly variable clinical presentation, and laboratory investigations are not always diagnostic. Imaging, therefore, has an important role to play as the MRI features can be characteristic.
Glycogen storage disease (GSD) refers to a number of syndromes which are characterized by a defect in synthesis, metabolism or storage of glycogen.
There are many types of GSD:
type I: von Gierke disease
type II: Pompe disease
type III: Cori or Forbes disease
type IV: Andersen di...
Glycogen storage disease type I (GSD-I), also known as von Gierke disease, is a type of glycogen storage disease where there is excess deposition of glycogen primarily in the liver, but also in the kidney and small bowel.
It occurs approximately one in every 100,000 live births 2,...
Glycogen storage disease type II, also known as Pompe disease or acid maltase deficiency disease, is an inherited lysosomal disorder characterized by abnormal glycogen accumulation within lysosomes. It is a multi-system disorder involving the heart, skeletal muscle and liver. It is caused by the...
Goldenhar syndrome (also known as oculo-auriculo-vertebral spectrum (OAVS), Goldenhar-Gorlin syndrome or facio-auriculo-vertebral dysplasia) is a complex congenital anomaly characterized by abnormalities of the ears, eyes and vertebrae.
The estimated incidence is at 1 in 3000-500...
Gomez-Lopez-Hernandez syndrome, also known as cerebellotrigeminal-dermal dysplasia, is a rare phakomatosis characterized by rhombencephalosynapsis, parietal-occipital scalp alopecia, brachycephaly, facial malformations and trigeminal anesthesia.
History and etymology
It is named after Manuel ...
Gonadal dysgenesis refers to a spectrum of anomalies with abnormal development of the gonads. It falls under the even broader group of disorders of gender development.
In many cases the gonads are replaced by fibrous tissue.
complete gonadal dysgenesis (CGD) / Swyer syndro...
Gonadoblastomas are uncommon sex cord / stromal tumors. They are associated with disorders of sexual development (previously known as "intersex disorders").
The vast majority are found <30 years of age. Most are discovered in the perinatal period. May occur in phenotypic males or ...
The causes of gracile bones can be recalled with the following mnemonic:
M: muscular dystrophy, e.g. Duchenne muscular dystrophy
R: rheumatoid arthritis (juvenile RA)
O: osteogenesis imperfecta
D: dysplasia, e.g. Marfan syn...
The Graf method for ultrasound classification system for developmental dysplasia of the hip (DDH) in infants, combines both alpha and beta angles. There are a number of additional subdivisions, which are often not used clinically.
As a general rule, the alpha angle determines the type and in s...
Greenstick fractures are incomplete fractures of long bones and are usually seen in young children, more commonly less than 10 years of age. They are commonly mid-diaphyseal, affecting the forearm and lower leg. They are distinct from torus fractures.
Greenstick fractures ...
The Greig cephalopolysyndactyly syndrome (GCPS) is a rare pleiotropic, multiple congenital anomaly syndrome.
It is primarily characterized by:
preaxial polydactyly (most common 2) or
mixed pre- and postaxial polydactyly
true ocular hypertelorism
The grey matter heterotopias are a relatively common group of conditions characterized by interruption of normal neuronal migration from near the ventricle to the cortex, thus resulting in "normal neurons in abnormal locations" 2. They are a subset of disorders of cortical formation 3-4.
Growth arrest lines, also known as growth resumption lines, Harris lines or Park lines, are alternating transverse rings of sclerosis at the metaphysis of a long bone.
The radiographic finding occurs from alternating cycles of osseous growth arrest and growth resumption. This appears...
Gymnast wrist is a term that used to describe variety of chronic overuse injuries of the wrist in gymnasts with immature skeleton. Gymnast wrist is a combined of osseous and ligamentous injury and usually manifests as a chronic Salter-Harris type I fracture of the distal radial physis on radiogr...
Hematuria in a child is evaluated differently than in an adult in two main respects:
there is a lower likelihood of a malignancy (renal or bladder) causing the hematuria
preference is given to nonionizing radiation
Hematuria can be considered in three main forms:
Hemolytic uremic syndrome (HUS) is a multisystem thrombotic microangiopathic disease characterized by the triad of renal failure, hemolytic anemia and thrombocytopenia. It is the most common cause of renal failure in infancy and childhood requiring dialysis.
There are two forms of this syndrom...
Haemophagocytic lymphohistiocytosis (HLH), also known as macrophage activation syndrome when occurring in the setting of a rheumatologic disorder, is a non-malignant but often-fatal disorder of immune dysregulation affecting multiple organs.
It typically affects infants and young ...
Hand-foot-and-mouth disease is a viral illness that manifests as vesicular eruptions on the hands and feet as well as painful ulcers of the oral mucosa. Symptoms usually resolve spontaneously in 7-10 days.
In most cases, there is a prodrome of fever, vomiting, diarrhea, anorexia, and malaise.
Hand-foot syndrome, also known as palmar-plantar erythrodysaesthesia or Burgdorf reaction, is a benign, aseptic, self-limiting complication of many chemotherapeutic agents characterized by a widespread erythema, edema and ulceration of the hands and feet.
Hand-foot syndrome, also simply referred to as dactylitis, is a self-limiting manifestation of a vaso-occlusive crisis in individuals with sickle cell anemia.
Dactylitis is not a specific finding in sickle cell disease, therefore cautious usage is advised if one chooses to employ i...
The harlequin eye deformity may be seen in unilateral (plagiocephaly) or bilateral (brachycephaly) coronal suture synostosis, and refers to the elevation of the superolateral corner of the orbit.
The term harlequin eye derives from the appearance of the eyes on a harlequin mask with their exagg...
Harrison's sulcus or Harrison's groove refers to a groove at the lower end of the rib cage seen in young children / infants with abnormally weak bones (e.g. rickets) or chronic respiratory disease (e.g. severe asthma). The lower chest is drawn in with flaring of the rib margin. The exact cause i...
The haystack sign on chest x-rays in pediatric patients is indicative of pneumomediastinum. The pediatric heart is surrounded above and below with gas, giving it an appearance of a haystack from Monet's paintings.
The Heiner syndrome is a rare form of primary pulmonary hemosiderosis associated with an allergy to cow's milk. The syndrome includes:
rectal blood loss with hypochromic microcytic anemia
pulmonary infiltrates (often recurrent)
Hemiconvulsion-hemiplegia epilepsy syndrome (HHE) is a clinical syndrome of infancy or early childhood that is associated with seizures, cerebral hemiatrophy and transient or permanent epilepsy.
It refers to the characteristic holohemispheric global atrophy of one hemisphere, that is independen...
Hemihyperplasia, also known as hemihypertrophy, is asymmetry in size between the right and left of the body, more than can be attributed to normal variation.
Hemihyperplasia is more scientifically correct than hemihypertrophy as the cells are hyperplastic rather than hypertrophied ...