Imaging in Neonates

Description:

This book provides a concise overview of neonatal imaging. After a short clinical introduction on the crucial role of imaging in diagnosing and treating neonatal conditions, it discusses the various methods (ultrasound, digital radiography, fluoroscopy, CT, and MRI) available and explains in detail how they have to be adapted for neonatal applications. Chapters feature imaging findings and differential diagnoses for the most common neonatal conditions. Additionally, some relevant aspects of foetal imaging are presented.

Written by an interdisciplinary team, Imaging in Neonates is a practical resource for daily use in the ward for all medical professionals involved in treating neonates.

Preface

Neonates are something special—everybody realises as soon as one can hold a baby in his/her arms. They deserve special care and our attention for their well-being as they cannot articulate their feelings and needs and rely on us— which also applies to health care and medical imaging. We also depend on them, as they are the base of mankind’s future. All this should be strong motivation to engage in enabling dedicated care and imaging of this special, very vulnerable patient group with quite different conditions, needs and restrictions than older children or adults—which I learned already when specialising in paediatrics in the early years of my professional career. Before becoming a (paediatric) radiologist I was a paediatrician, very much involved with neonatology and neonatal intensive care; I also was a member of the paediatric ECMO team. As such I have been searching for information on how to properly image neonates, particularly those who were critically ill, and learn about imaging options as well as restrictions.

After becoming a paediatric radiologist, I have often been asked by my clinical colleagues about imaging in neonates and where they can find information. I could suggest various book chapters or booklets on one or another subtopic but could not find a book that would give a comprehensive overview on this subspecialised topic in paediatric imaging. So, I approached various publishing companies, and eventually Springer agreed to enable this project, for which I am very grateful. This effort may provide extra value, as increasingly neonatologists are performing and reading studies themselves—similar to the situation 30–40 years ago when I as the neonatologist had to read the films, perform fluoroscopy and do the ultrasound, as no specialised (paediatric) radiologist was available; this at that time additionally motivated me to eventually become a paediatric radiologist. Today, there is also a decreased interest of young radiologists in doing these basic studies—they often prefer to read the fancy MRIs or CTs but are more reluctant to perform basic ultrasound (US) studies or fluoroscopy particularly in these tiny babies, where these studies can be time consuming and cumbersome. They also claim that there is no proper textbook where one could learn about these conditions, and in fact, there are few who have focused on imaging of neonates with all the respective implications—another additional motivation to take on this task and write/edit such a book.

Times are changing, not only has insight into some of the typical neonatal conditions grown, but also terminology and management have changed, such as new and different respiratory therapies, ECMO has decreased, and new drugs are on the market (although many are not registered for paediatric or neonatal use, but indispensable for treating some of those very ill babies, for example, with pulmonary hypertension or oncologic and cardiac conditions, or infections with resistant bacteria or fungus). New laboratory tests and markers have been introduced and developed, but the restrictions in taking blood samples in these increasingly small and vulnerable preterm infants for repeated laboratory testing for diagnosis and follow-up (that can lead to iatrogenic anaemia) makes imaging even more important for these patients’ care.

Finally, having seven grandchildren, I personally experienced the need for good imaging in certain neonatal situations and queries, particularly the need for imaging suggestions and algorithms—to avoid diagnostic overkill (which may also lead to overtreatment) but without missing important conditions with short-term and long-term sequalae. Thus, I want to dedicate this book to my grandchildren and children. I want to thank Springer for enabling this book, and my wife Barbara for her patience while preparing the book. And of course, I need to thank also all my authors and co-authors. I also want to acknowledge the support from many colleagues both in my institution and abroad by providing images, giving hints and comments on how to improve, or by editing several sections for language and content. Finally, I would like to thank everybody for their special efforts making this book possible in these crazy times with COVID and all the respective workload and illness implications—all this and all their input eventually made the book possible.

I hope you will enjoy reading this book, find the information you need, and will find the book useful to optimise imaging in these little patients entrusted to you.

Table of contents :

Preface
Acknowledgement
Contents
1: Introduction
2: Clinical Basics and Remarks: Why and When Do Neonatologists Need Imaging
2.1 Introduction
2.2 Respiratory Tract
2.2.1 The Developing Lung
2.2.2 Surfactant Replacement Therapy
2.2.3 Pulmonary Function and Mechanisms of Lung Injury
2.2.4 Bronchopulmonary Dysplasia
2.3 Special Considerations According to the Vulnerable Term and Preterm Infant
2.3.1 Physiologic Changes During Adaption to Extra-Uterine Environment–Asphyxia
2.3.2 Importance of Water and Heat Exchange to the Skin and the Environment
2.3.3 The Open Ductus Arteriosus and Its Mechanism of Closure
2.3.4 Foetal and Umbilico-Placental Circulation
2.3.5 Gastrointestinal Tract and Motility
2.3.6 Inflammatory Response in the Preterm Neonate
2.3.7 Miscellaneous Other Aspects
2.4 Point-of-Care Ultrasound (POCUS)
2.4.1 POCUS of the Neonatal Brain
2.4.2 Basic Echocardiography
2.4.3 Other Applications
2.5 What Are the Main Indications for Radiologic Examinations at the NICU?
2.6 Screening
2.6.1 Screening in Neonates
2.6.2 Screening by US
2.7 Summary
References
Further Reading
3: General Remarks, Rules, and Considerations
3.1 General Remarks and Considerations
3.2 Which Are the Methods That Can Be Applied and Are Used for Imaging Neonates?
3.2.1 Ultrasound
3.2.2 Radiographs
3.2.3 Fluoroscopy
3.2.4 What About CT and MRI in Neonates?
3.3 Indications for Imaging Neonates
3.4 Contrast Agent Applications in Neonates
3.4.1 Ultrasound Contrast Agents (UCA)
3.4.2 Radiopaque Contrast Agents
3.4.3 Gadolinium-Based Contrast Agents
3.5 Miscellaneous Other Aspects to Consider When Imaging Neonates
3.6 Summary and Conclusion
Reference
Further Reading
4: Prenatal Imaging: What a Paediatric Radiologist or Neonatologist Should Know?
4.1 Introduction
4.2 Techniques/Requisites
4.2.1 Ultrasound (US)
4.2.1.1 First Trimester US
4.2.1.2 Second Trimester US
4.2.1.3 Third Trimester US
4.2.2 Foetal Magnetic Resonance Imaging (MRI)
4.2.3 Foetal Computed Tomography (CT)
4.3 Anomalies Implying Significant Modification of Perinatal Management
4.3.1 Cervicofacial Anomalies with Possible Airway/Respiratory Challenge and Soft-Tissue Masses
4.3.1.1 Micro and Retrognathia
4.3.1.2 Soft-Tissue and Cervicofacial Masses
4.3.2 Thoracic Malformations at Risk for Respiratory Distress
4.3.2.1 Congenital Diaphragmatic Hernia (DH)
4.3.2.2 Congenital Lung Malformation
4.3.3 Congenital Heart Defects (CHDs)
4.3.4 Abdominal Wall Defects
4.3.4.1 Omphalocele
4.3.4.2 Gastroschisis
4.3.5 Abnormal Appearance of the Digestive Tract
4.3.5.1 Absence of Visualisation of the Stomach
4.3.5.2 Oesophageal Atresia
4.3.5.3 Proximal (Gastric/Duodenal) Digestive Obstruction
4.3.5.4 Small and Large Bowels Obstruction
4.3.5.5 Echogenic Dilated Bowel Loops (EDBL)
4.3.5.6 Meconium Peritonitis
4.3.6 Anomalies with Possible Renal Insufficiency
4.3.6.1 Bladder Anomalies
4.3.6.2 Foetal Pelvicalyceal Dilatation
4.3.6.3 Foetal Nephropathies
4.3.7 Spinal Cord Anomalies
4.3.7.1 Open Spinal Dysraphisms
4.3.7.2 Closed Spinal Dysraphism
4.3.8 Musculoskeletal Anomalies with Perinatal Implications
4.3.8.1 Segmental Vertebral Anomalies
4.3.8.2 Skeletal Dysplasias
4.3.9 Brain Anomalies: Limitations of Prenatal Imaging
4.3.9.1 Midline Anomalies
4.3.9.2 Posterior Fossa Malformations
4.3.9.3 Ventricular Dilatation
4.3.9.4 Malformations of Cortical Development
4.3.9.5 White Matter Anomalies
4.4 Conclusion
References
Further Reading
5: Postnatal Imaging in Babies with Prenatal Diagnosed Malformations or Conditions
5.1 Introduction
5.2 Imaging Approach in Foetally Diagnosed Malformations and Conditions: What to Do When, and Who and Why?
5.2.1 When to Do
5.2.2 What to Do: Which Kind of Imaging Is Needed?
5.2.3 Who Should Perform the Examinations?
5.3 Imaging in Foetally Diagnosed Malformations and Conditions: Examples
5.3.1 Hydrocephalus and Brain Malformations
5.3.2 Spinal (Cord) Malformations and Associated Finings
5.3.3 Congenital Pulmonary Airway Malformation (CPAM) and Sequestration or Other Congenital Lung Conditions (e.g. Congenital Lobar Emphysema, Bronchogenic Cyst…)
5.3.4 Diaphragmatic Hernia and Oesophageal Atresia
5.3.5 Congenital Heart Disease and Malformations
5.3.6 Urinary Tract Dilatation and Malformations
5.3.7 Atresia/Obstruction/Stenosis of the Gastrointestinal (GI) Tract
5.3.8 Limb Deformity and Malformation or Fracture, Skeletal Dysplasias, Small Parts and Miscellaneous Other Queries
5.3.9 Congenital Tumourous Conditions
5.4 Summary and Conclusion
Further Reading
6: Pre-, Peri-, and Post-Operative Imaging in Neonates
6.1 Introduction
6.2 Pre-operative Imaging
6.2.1 Brain
6.2.2 Chest
6.2.3 Upper Gastrointestinal Obstruction
6.2.4 Lower Gastrointestinal obstruction
6.2.5 Anorectal and or Cloacal Malformations
6.2.6 Hirschsprung Disease
6.2.7 Secondary Bowel Obstruction
6.2.8 Biliary Atresia
6.2.9 Urogenital Tract
6.2.10 Musculoskeletal Conditions
6.2.11 (Pseudo)tumours
6.3 Peri-operative Imaging
6.4 Post-operative Imaging
6.5 Summary and Take Away
Further Reading
7: Image-Guided Interventions in Newborns
7.1 Introduction
7.2 Requisites
7.2.1 The Team
7.2.2 Image Guidance Methods
7.2.3 Equipment
7.2.4 Patient Preparation
7.2.5 Sedation and Analgesia
7.2.6 Post-procedural Care
7.3 Clinical Applications
7.3.1 Vascular Access
7.3.2 Enteric Access
7.3.3 Aspiration and Drainage
7.3.3.1 Peritoneal Cavity
7.3.3.2 Thorax
7.3.3.3 Liver and Biliary Tract
7.3.3.4 Genitourinary Tract
7.3.4 Lumbar Puncture
7.3.5 Biopsy
7.3.5.1 Liver
7.3.5.2 Kidney
7.3.6 Vascular Intervention
7.3.6.1 Vascular Tumours
7.3.6.2 Vascular Malformations
7.4 Summary
Further Reading
Untitled
8: Neonatal Neuroimaging: Ultrasound of the Neonatal Brain and Spine, with Some Remarks on Plain Film and CT
8.1 Introduction
8.2 Requisites
8.3 Brain Haemorrhage
8.3.1 US Appearance of Haemorrhages
8.3.2 Classification of Intracranial Haemorrhages
8.4 Brain Hypoxia
8.4.1 Asphyxia
8.4.2 Periventricular Leukomalacia
8.4.3 Infarction/Neonatal Stroke
8.5 Brain Malformations
8.6 Hydrocephalus and Cysts
8.6.1 Hydrocephalus
8.6.2 Brain and Intracranial Cysts
8.7 Infectious Conditions
8.7.1 Congenital/Foetal Infections
8.7.2 Postnatal Infections
8.8 Miscellaneous Other Conditions
8.9 Spinal and Spinal Canal/Cord US
8.9.1 How to do Spinal Cord US
8.9.2 Spinal Canal and Cord Malformations, Dysraphism
8.9.3 Other Pathology of the Spinal Canal
8.9.4 Spine US
8.10 Other Peripheral Neurosonographic Applications in Neonates
8.11 Is There a Role for Radiographs, Fluoroscopy, or CT in Neonatal Neuroimaging?
8.11.1 Radiographs
8.11.2 Computed Tomography (CT)
8.11.3 Catheter Angiography and Fluoroscopy
8.12 Summary and Conclusions: Take Away
Further Reading
9: Neonatal Neuroimaging: Neuro MRI in Neonates
9.1 Introduction
9.2 Requisites/Imaging Strategy
9.2.1 Investigation Strategy and Preparation
9.2.2 Performing the MRI
9.2.3 Basic MR Sequences
9.2.3.1 Diffusion-Weighted (DWI) MRI Sequence
9.2.3.2 T2-Weighted Sequences
9.2.3.3 Susceptibility-Weighted Imaging (SWI)
9.2.3.4 T1-Weighted Imaging
9.2.3.5 BTFE/CISS Sequences
9.2.4 Advanced MR Techniques
9.2.4.1 MR Spectroscopy
9.2.4.2 Diffusion Tensor Imaging (DTI)
9.2.4.3 Arterial Spin Labelling
9.2.4.4 Blood Oxygen Level Dependent (BOLD) fMRI Imaging
9.2.4.5 Synthetic MRI©, MR Fingerprinting
9.3 Hypoxic-Ischaemic Injury
9.3.1 MRI Within the First 24–96 h After HI Event
9.3.2 MRI More Than 3 Days After HI Event
9.4 Neonatal Brain Haemorrhage
9.4.1 MR Scoring of IVH
9.4.2 MR Characteristics of Neonatal Intracranial Haemorrhages
9.4.3 Cerebral Haemorrhages Other Than Intraventricular Haemorrhages
9.5 MRI of the Brain Injury Spectrum in Premature Neonates
9.5.1 Aetiology of Prematurity-Associated Neonatal Brain Changes
9.5.2 MRI Features of Prematurity-Associated Neonatal Brain Changes
9.5.2.1 Periventricular Leukomalacia (PVL)
9.5.2.2 Cortical and Subcortical Grey Matter Injury of Prematurity
9.6 Neonatal Brain Infection
9.6.1 Bacterial Meningitis
9.7 MRI of Malformations of the Brain
9.7.1 Polymicrogyria
9.7.2 Lissencephaly/Pachygyria
9.7.3 Schizencephaly
9.7.4 Focal Cortical Dysplasia (FCD)
9.7.5 Cystic Posterior Fossa Malformations
9.8 Metabolic Disorders
9.8.1 Bilateral Basal Ganglia Signal Abnormalities/Diffusion Restriction
9.8.1.1 White Matter Signal Abnormalities
9.8.1.2 Dysmyelinating Disorders
9.9 Summary and Overall Conclusion
References
Untitled
10: Chest and Lung Imaging in Preterms and Neonates
10.1 Introduction
10.2 Imaging Modalities for Chest and Lung Imaging in Neonates
10.2.1 Chest Radiography
10.2.2 Chest Ultrasound (US)
10.2.3 Chest CT, MRI, and Fluoroscopy
10.3 Embryology of the Respiratory System
10.4 Normal Imaging Findings in Neonates
10.4.1 Chest Radiographs
10.4.2 Chest and Lung Ultrasound (US)
10.4.3 Chest CT/MRI
10.4.4 Chest Fluoroscopy
10.5 Pulmonary Abnormalities
10.5.1 Respiratory Distress Syndrome (RDS)
10.5.2 Bronchopulmonary Dysplasia (BPD)
10.5.3 Transient Tachypnea of the Newborn (TTN): Old Term “Wet Lung”
10.5.4 Meconium Aspiration Syndrome and Other Particle Aspiration in Neonates
10.5.5 Neonatal Pneumonia
10.5.6 Congenital Pulmonary Lymphangiectasia (CPL)
10.5.7 Air Space Diseases
10.5.7.1 Congenital Lobar Hyperinflation (CLH)
10.5.7.2 Bronchial Atresia
10.5.7.3 Other Causes of Pulmonary Hyperinflation in One Lung
10.5.8 Cystic Pulmonary Lesions
10.5.8.1 Pulmonary Bronchogenic Cyst
10.5.8.2 Localised Pulmonary Interstitial Emphysema (PIE)
10.5.8.3 Congenital Pulmonary Airway Malformation (CPAM) and Hybrid Lesion
10.5.9 Developmental Pulmonary Solid Lesions
10.5.9.1 Pulmonary Sequestration
10.5.9.2 Fluid-Filled Congenital Cystic Pulmonary Lesions
10.5.9.3 Lung Tumours and other Solid Appearing Masses
10.5.10 Pulmonary Agenesis/Aplasia Hypoplasia and Related/Similar Conditions
10.5.10.1 Pulmonary Agenesis/Aplasia
10.5.10.2 Pulmonary Hypoplasia
10.5.10.3 Scimitar Syndrome or Pulmonary Venolobar Syndrome
10.5.10.4 Atelectasis
10.6 Pleural Abnormalities
10.6.1 Neonatal Pleural Effusion
10.6.2 Other Pleural Pathologies
10.7 Air Leaks
10.7.1 Pulmonary Interstitial Emphysema (PIE)
10.7.2 Pneumothorax
10.7.3 Pneumomediastinum
10.7.4 Pneumopericardium
10.8 Tracheal Abnormalities
10.8.1 Abnormal Tracheobronchial Branching
10.8.2 Tracheal Lesions with Luminal Compromise
10.9 Oesophageal Abnormalities
10.9.1 Oesophageal Atresia (OEA) and/or Trachea-Oesophageal Fistula (TOEF)
10.9.1.1 Diagnosis of OEA and/or TOEF and Preoperative Imaging
10.9.1.2 Postoperative Imaging
10.9.2 Congenital Broncho-Oesophageal Fistula
10.9.3 Congenital Short Oesophagus
10.10 Mediastinal Abnormalities
10.10.1 Normal Thymus Mimicking Pathologies
10.10.2 Mediastinal Masses
10.10.3 The Aortic Arch and Other Mediastinal Vessels
10.11 Diaphragmatic Abnormalities
10.11.1 Congenital Diaphragmatic Hernia (CDH)
10.11.1.1 Bochdalek Hernia
10.11.1.2 Anteromedial Diaphragmatic Hernia
10.11.1.3 Central Tendon Hernia
10.11.2 Congenital Hiatal Hernia
10.11.3 Elevation of the Diaphragm
10.12 Chest Wall Abnormalities
10.12.1 Birth-Related Injury of the Chest Wall
10.12.2 Skeletal Dysplasias
10.12.3 Chest Wall Deformities
10.12.4 Chest Wall Masses
10.13 Summary and Conclusions: Take Away
References
Further Reading
11: Imaging the Neonatal Heart and Large Vessels
11.1 Introduction
11.2 Embryology and Development
11.2.1 Basics of Foetal Development of the Heart
11.2.2 Foetal Circulation
11.2.3 Important and Common Cardiac and Vascular Malformations
11.3 Clinical Indications for Imaging the Neonatal Heart
11.4 Imaging Modalities
11.4.1 Echocardiography
11.4.1.1 Basics, Transducers, How to Do
Transducers
Standard Techniques
Patient Position
11.4.1.2 Standard Planes and Standardised Course of Examination
11.4.1.3 Standardised Views
Parasternal Long-Axis View (Fig. 11.3)
Parasternal Short-Axis Views (Fig. 11.4)
Apical Views
Apical Four-Chamber View (Fig. 11.5)
Subcostal Sagittal and Four-Chamber View (Fig. 11.6)
Suprasternal View (Fig. 11.7)
11.4.1.4 POCUS of the Neonatal Heart
11.4.1.5 Echocardiographic Methods
M (Motion)-Mode Echocardiography
Transesophageal Echocardiography (TEE)
Tissue Doppler Imaging (TDI)
11.4.1.6 Doppler Sonography in the NICU
Colour Doppler Sonography
PW- and CW-Doppler
11.4.1.7 Assessment of LV and RV Function
11.4.1.8 Normal Neonatal and Paediatric Values
11.4.2 Chest Radiography
11.4.2.1 Hardware
11.4.2.2 Image Acquisition
11.4.2.3 Image Post-processing
11.4.2.4 Image Optimisation
11.4.2.5 Image Evaluation/Analysis
11.4.3 Cardiac CT
11.4.4 Cardiac MRI (cMRI)
11.4.5 Cardiac Catheterisation and Catheter Angiography
11.5 Pathologic Findings
11.5.1 Congenital Heart Defects with Left-to-Right Shunt
11.5.1.1 Atrial Septal Defect (ASD)
11.5.1.2 Ventricular Septal Defects (VSD)
11.5.1.3 Atrioventricular Septal Defects (AVSD)
11.5.1.4 Patent Ductus Arteriosus of Botalli (PDA)
11.5.2 Obstructions of Left Ventricular Outflow
11.5.2.1 Aortic Valve Stenosis (AS)
11.5.2.2 Aortic Coarctation (CoA)
11.5.3 Obstructions of the Right Ventricular Outflow
11.5.3.1 Pulmonary Valve Stenosis (PS)
11.5.3.2 Tetralogy of Fallot (TOF)
11.5.4 Miscellaneous Other Congenital Heart Defects
11.5.4.1 Transposition of Great Arteries (TGA)
11.5.4.2 Total Anomalous Pulmonary Venous Return (TAPVR)
11.5.5 Cardiomyopathies (CMP)
11.5.5.1 Hypertrophic CMP
11.5.5.2 Dilated (Congestive) CMP
11.5.5.3 Diabetic Foetopathy
11.5.6 Pericardial Effusion (PE)
11.5.7 Intracardiac Thrombi and Cardiac Tumours
11.6 Typical Clinical Conditions in Newborns with Cardiologic Presentation
11.6.1 Persistent Pulmonary Hypertension of the Newborn (PPHN)
11.6.2 Congenital Diaphragmatic Hernia (CDH)
11.7 Summary
References
12: Imaging the Neonatal Urogenital Tract
12.1 Introduction
12.2 Imaging Modalities Used in the Neonatal UGT
12.2.1 Urogenital Sonography in Neonates
12.2.2 Radiography and IVU
12.2.3 Fluoroscopy
12.2.4 CT
12.2.5 MRI
12.2.6 Scintigraphy
12.3 Imaging in Emergencies of the Neonatal Urogenital Tract
12.3.1 Acute Renal Failure/Kidney Injury
12.3.2 Renal Vein Thrombosis/Acute Haematuria and Hypertension
12.3.3 Miscellaneous Other Conditions
12.3.4 Potter Syndrome/Bilateral Renal Agenesis
12.4 Obstructive Uropathy
12.4.1 Postnatal Imaging in the Dilated Urinary Tract: General Considerations
12.4.2 Imaging in Neonates with Suspected Posterior Urethral Valve (PUV)
12.4.3 Imaging in Newborns with Suspected Pelvi-Ureteric Junction Obstruction (PUJO) (and Cystic Dysplastic Kidney/Multicystic Dysplastic Kidneys)
12.4.4 Imaging in Neonates with Megaureter, Ureterovesical Junction Obstruction (UVJO) and its Differential Diagnosis (i.e. VUR)
12.5 Duplication and Other or Associated Malformations of the Urinary Tract
12.5.1 Renal Duplication
12.5.2 Other Common Renal Migration, Position, and Fusion Anomalies
12.5.3 Miscellaneous Other Conditions
12.6 Cystic Kidney Disease
12.6.1 Differential Diagnosis in CKD
12.7 Urinary Tract Infection in the Newborn
12.8 The Neonatal Female Genitalia
12.8.1 Neonatal Ovarian Cysts
12.8.2 Malformations/Congenital Anomalies of the Female Genital Tract
12.8.3 Ovarian Torsion in the Neonate
12.8.4 Tumours of the Neonatal Female Genital Tract
12.9 Problems in the Male Neonatal Genitalia
12.9.1 Penis and Urethra Pathology
12.9.2 Scrotal and Testicular Pathology
12.9.3 Anomalies of the Inner Male Genitalia
12.10 Neonatal Urogenital Tumours
12.11 The Neonatal Adrenal Gland
12.11.1 Variations in Size and Shape of the Adrenal Gland
12.11.2 Adrenal Gland Haemorrhage
12.11.3 Neuroblastoma and Related Issues
12.12 Summary
References
Further reading
13: Imaging the Neonatal GI Tract, Also Including Liver, Spleen, Pancreas, Retroperitoneum and Mesentery
13.1 Introduction
13.2 Imaging Methods, Needs and Restrictions as Applicable to the Neonatal GI Tract
13.2.1 Ultrasonography (US)
13.2.2 Radiography
13.2.3 Fluoroscopy
13.2.4 MRI (CT)
13.2.5 Contrast Agent Aspects
13.2.6 Specific Appearances of Neonatal Abdominal Organs
13.3 Congenital Malformations of the Stomach and the Bowel
13.3.1 Atresia and Associated Findings
13.3.1.1 Oesophageal Atresia
13.3.1.2 Gastric Outlet and Duodenal (Small Bowel) Stenosis/Atresia
13.3.1.3 Atresia of the Colon and Differential Diagnosis (e.g. Hirschsprung’s Disease)
13.3.1.4 Anorectal and Cloacal Malformations
13.3.2 Malrotation and Volvulus
13.3.3 Duplication (Cyst), Meckel’s Diverticulum and Persisting Omphaloenteric Duct
13.3.4 Hernias: Hiatal and Diaphragmatic Hernia, Inguinal/Umbilical/and Internal Hernia
13.4 Congenital Malformations of Abdominal Parenchymal Organs, the Retroperitoneum and the Mesentery
13.4.1 Biliary Atresia and Its Differential Diagnosis (Neonatal Hepatitis Syndrome)
13.4.2 Choledochal Cysts and Their Differential Diagnosis
13.4.3 Splenic and Pancreatic Conditions Important in the Neonatal Period
13.4.4 Vascular Variations/Pathology, Retroperitoneal Anomalies and Miscellaneous Other Conditions
13.5 Acquired Conditions in the Neonatal Abdomen
13.5.1 Hypertrophic Pyloric Stenosis and Pylorospasm with Respective Differential Diagnosis
13.5.2 Necrotizing Enterocolitis (Including Pneumatosis and Perforation), Neonatal Colitis and Respective Differential Diagnosis
13.5.3 Meconium Plug and Neonatal Meconium Ileus
13.5.4 Miscellaneous Other (Rare) Conditions (Neonatal Appendicitis, Intussusception, Bile Stone …)
13.6 Abdominal Tumourous Conditions in Neonates (Except in the Urogenital Tract)
13.6.1 Abdominal Cysts and How to Approach Them
13.6.2 Hamartoma and Other Benign Tumours
13.6.3 Congenital and Infantile Abdominal Haemangioma
13.6.4 Mesenteric and Intestinal Lymphatic/Vascular/Arteriovenous Malformation and Respective Differential Diagnosis
13.6.5 Malignant Abdominal Tumours
13.7 Summary
References
Literature
14: Imaging of the Neonatal Musculoskeletal Tract
14.1 Normal Prenatal Development of the Skeleton
14.2 Normal Skeletal Imaging Features of Term and Preterm Neonates
14.3 Abnormal Shape and Ossification Defects of the Skull
14.3.1 Craniosynostosis
14.3.2 Abnormal Mineralisation/Ossification of the Skull
14.4 Visible or Palpable Lesions of the Paediatric Head and Neck
14.4.1 (Epi)-Dermoid Cysts
14.4.2 Haemangioma
14.4.3 Fibromatosis Colli
14.4.4 Lymphatic Malformations
14.4.5 Cervical (Lymph)-Adenitis
14.4.6 Malignant Neck Masses in Neonates (Please See Also Chap. 16)
14.5 Neonatal Osteomyelitis
14.6 The Floppy Infant, Suspected Myopathy/Muscle Disease
14.7 Medical Devices and the Neonatal Skeleton: Intraosseous Needles
14.8 Insufficiency Fractures in Hospitalised Neonates and Preterm Babies
14.9 Congenital Anomalies of the Musculoskeletal Tract: A First Aid Kit
14.9.1 Lower Extremity: Congenital Femoral Deficiency (CFD)
14.9.2 Lower Extremity: Tibial Hemimelia
14.9.3 Lower Extremity: Fibular Hemimelia
14.9.4 Lower Extremity: Anterolateral Bowing of the tibia (= Congenital (Pre)-Pseudoarthrosis of the Tibia; CPT)
14.9.5 Lower Extremity: Posteromedial Bowing (Crus Valgum Recurvatum)
14.9.6 Lower Extremity: Selected Congenital Abnormalities of Feet
14.9.7 Upper Extremity: Selected Congenital Abnormalities of Hands
14.9.8 Congenital Joint Dislocations and Contractures
14.9.9 Congenital Malformations of Vertebrae
14.10 The Neonate with Suspected Skeletal Dysplasia: A Radiologic Approach
14.10.1 Which Views/Planes Should Be Included in a Neonatal Skeletal Survey?
Further Reading
15: Imaging the Neonatal (and Paediatric) Hip
15.1 Introduction and General Remark
15.1.1 Technical Requisites
15.1.2 Other Requisites
15.1.3 What About Imaging Techniques Other than US?
15.2 Developmental Dysplasia of the Hip (DDH)
15.3 Hip US According to Graf
15.3.1 Standard Plane
15.3.2 Device Presets
15.3.3 Examination Technique
15.3.3.1 Positioning the Infant for Sonographic DDH Assessment
15.3.3.2 Access from Lateral in Coronal Section
15.3.3.3 Dynamic Assessment in the Graf Technique
15.3.4 Documentation
15.3.5 (Normal) US Anatomy of the Newborn and Infant Hip (Fig. 15.5)
15.3.6 US Criteria in Graf’s Technique (Landmarks) (Fig. 15.2)
15.3.7 Findings in DDH
15.3.8 Angle Measurement: Measured Between the Three Lines
15.3.9 Classification of the Hip According to Graf
15.3.9.1 Type I: Normal or Mature Hip (Figs. 15.2, 15.4, and 15.5)
15.3.9.2 Type II: Immaturity
15.3.9.3 Type IIb: Ossification Deficit
15.3.9.4 Type IIc
15.3.9.5 Decentred Hips
Type D (Formerly IId)
Type III: Decentred Hip
Type IV: Luxated Hip (Fig. 15.10)
15.4 Modified Graf Classification (Rosendahl)
15.5 Hip US According to Harcke
15.5.1 Technique
15.5.2 Normal Findings During Harcke Investigation
15.5.3 DDH According to Harcke
15.6 Femoral Head Coverage According to Morin (and Modified Morin = Terjesen, Also Called the French approach)
15.6.1 Modified Morin (Terjesen)
15.6.2 Hip Assessment Based on Femoral Head Coverage
15.6.3 Pubo-Femoral Distance
15.7 Three-Dimensional US (3DUS) for DDH Assessment
15.8 Ultrasound and Imaging of Other Hip Conditions
15.8.1 Indications and Technique
15.8.2 The Normal Hip Joint
15.8.3 Arthritis and Inflammation of Hip Joint
15.8.4 (Femoral Head) Epiphysiolysis/Slipped (Capital Femoral) Epiphysis
15.8.5 Perthes Disease
15.9 Summary and Take Away Message
Further Reading
16: Neonatal Imaging in Thyroid Disease, Inherited Disease, Syndromes, and Oncology
16.1 The Normal Neonatal Thyroid Gland: Imaging Appearance and Reference Values
16.1.1 Neonatal Thyroid Disease
16.2 Selected Chromosomal Disorders, Syndromes, and Multi-system Associations
16.2.1 Chromosomal Disorders
16.2.2 Trisomy 21
16.2.3 Trisomy 18 and 13
16.2.4 Turner’s Syndrome (45 XO)
16.2.5 VACTERL
16.2.6 CHARGE Syndrome
16.2.7 Beckwith-Wiedemann Syndrome
16.2.8 Metabolic Disease Presenting in the Neonatal Period: Implications for Imaging
16.3 Skeletal Dysplasias
16.3.1 Introduction and Basic Concepts
16.3.2 Structured Assessment of a (Neonatal) Skeletal Survey (Adapted from Hall’s Atlas)
16.3.3 Selected Normative Values for Assessment of Bone Size and Proportions
16.4 Neonatal Oncology
16.4.1 Clinical Key Concepts: Made Easy for Radiologists
16.4.2 Normal and Abnormal Neonatal Bone Marrow: Imaging Appearance
Further Reading
17: Imaging After Birth Trauma and in Suspected Non-accidental or Inflicted Injury
17.1 Introduction
17.2 Clinical Indications for Imaging Birth Trauma, Accidents, and Suspected Inflicted Trauma
17.2.1 Injury Patterns
17.2.1.1 Bruises
17.2.1.2 Fractures
Fracture Healing
17.2.1.3 Shaken Baby Syndrome
17.2.1.4 Intracranial Injuries
17.3 Imaging Methods
17.3.1 Ultrasound (US)
17.3.2 Radiography
17.3.3 Computed Tomography (CT)
17.3.4 Magnetic Resonance Imaging (MRI)
17.3.5 Nuclear Medicine
17.4 Cranial Injuries
17.4.1 Superficial Bruising, Grazes, and Lacerations
17.4.2 Skull Fractures
17.4.3 Extracranial Haemorrhage
17.4.3.1 Caput Succedaneum
17.4.3.2 Subgaleal Haematoma
17.4.3.3 Cephalohaematoma
17.4.4 Intracranial Haemorrhage
17.4.4.1 Epidural Haemorrhage
17.4.4.2 Subdural Haemorrhage
17.4.4.3 Subarachnoid Haemorrhage
17.4.4.4 Subpial Haemorrhage
17.4.4.5 Intracerebral Haemorrhage, Contusions, and Diffuse Axonal Injury
17.4.4.6 Hypoxic Ischaemic Brain Injuries
17.4.4.7 Cortical Laminar Necrosis
17.5 Spinal Cord and Spine Injuries
17.5.1 Spinal Cord Injuries
17.5.2 Vertebral Fractures
17.5.3 Brachial Plexus Injuries
17.5.4 Fibromatosis Colli
17.6 Thoracic Injuries
17.6.1 Pneumothorax
17.6.2 Rib Fractures
17.7 Abdominal Injuries
17.8 Musculoskeletal
17.8.1 Clavicle Fractures
17.8.1.1 Humerus Fractures
17.8.2 Femur Fractures
17.8.3 Tibia Fractures
17.8.4 Congenital Pseudoarthroses
17.8.5 Differential Diagnosis
17.9 Summary
Bibliography
Further Reading