Lumps and Bumps
Anne Moore, MD
Assistant Professor Radiology
Children’s Mercy Hospital and
University of Missouri, Kansas City
Imaging Modalities
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Plain Xray imaging
ULTRASOUND
CT imaging
MR imaging
Lumps and Bumps
Congenital Lesions
Vascular Anomalies
Acquired Lesions
Infectious Lesions
Traumatic Lesions
Head, Shoulders, Knees and
Toes
Eyes and ears
and mouth
and nose
Head and neck
»Start with
Ultrasound!
Head and Neck
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•
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Dermoid/Epidermoid
Branchial Cleft Cyst
Thyroglossal Duct Cyst
Accessory Parotid Tissue
Fibromatosis Coli
Vascular Anomalies
– Hemangioma
– Lymphatic/Venous Malformation
Dermoid/Epidermoid
• Found in a variety of locations around the
skull, midface and neck
• Commonly in midline and frontotemporal
location, followed by parietal location
• Midline or near midline lesion in neck
Dermoid
• Cystic or solid
• Hypovascular
Dermoid/Epidermoid
• Note Midline
location
• Near sutures
• Often contains fat
– Negative
Hounsfield Units
Branchial Cleft Cyst:
Second
• Most common
Branchial anomaly
• Presents acutely with
mass at the angle of
the mandible
Accessory Parotid Tissue
• Superficial and lateral to masseter muscle
and anterior to superficial lobe
• Rarely palpable
Fibromatosis Coli
• Idiopathic
intramuscular
hematoma
• Focal mass or fusiform
enlargement of
sternocleidomastoid
• Presents with torticollis
< 8 weeks of age
Fibromatosis Coli
Fibromatosis Coli
Normal for comparison
In a 6 week old with torticollis,
which imaging study is initially
suggested?
A.
B.
C.
D.
MRI
CT
Ultrasound
Plain
Radiographs
0%
A.
0%
0%
B.
C.
0%
D.
Thyroglossal duct cyst
• Most common midline
developmental lesion
of the neck in
childhood
• Abuts hyoid bone
• Presents acutely
– Often after URI
Thyroglossal Duct Cyst
Hemangioma
• Most common tumor
of infancy & childhood
• Female > Male
• Characteristic growth:
proliferation, then
regression
• Presents 2weeks-2
months of age
• Often skin changes
Hemangioma
• MRI
–
–
–
–
T2 bright
Enhancing
Lobular
Flow voids
• Parotid is most
common salivary
gland
Hemangioma
Proliferation
Involution
Venous and Lymphatic
Malformations
Present any age, but usually beyond infancy
• Venous Malformation:
– Dysplastic venous channels; Solid with
phleboliths and venous Doppler wave forms
• Lymphatic Malformation:
– Dysplastic lymphatic structures; Cystic with
fluid levels
Venous Malformation
• Venous wave forms
• Solid
Lymphatic Malformation
Note cystic and solid components
In a 1-month-old child with a
hemangioma on the arm, what is the
suggested imaging study?
A.
B.
C.
D.
No imaging needed
MRI
Bone scan
Plain radiographs
0%
A.
0%
0%
B.
C.
0%
D.
Rhabdomyosarcoma
Most common soft
tissue sarcoma of
childhood
Aggressive looking
Lymphoma
• Third most common
childhood malignancy
• Asymptomatic
lymphadenopathy
Cervical Lymphadenopathy
• Common in children
• Imaging studies will show size, number and
location of enlarged lymph nodes
Cervical Lymphadenopathy
Suppurative Lymphadenitis
• Bacterial infection
may result in
abscess formation
Suppurative Lymphadenitis
• Nodes with central
necrosis/fluid
• May take weeks to
resolve
Cephalohematoma
• Subperiosteal
accumulation of blood
• Confined by sutures
• Most commonly
parietal
• No imaging usually
needed
– ? ultrasound
Cephalohematoma
In a newborn male with unilateral
parietal swelling since birth, which
imaging study is indicated?
A.
B.
C.
D.
MRI
CT
Plain radiographs
No imaging
indicated
0%
A.
0%
0%
B.
C.
0%
D.
Shoulder, Knees and Toes
aka Below the Neck
Baker’s/Popliteal Cyst
• Synovial cyst in
posterior aspect of
knee joint
• Intact cyst
• Dissected Cyst
• Ruptured Cyst
Baker’s/popliteal cyst
Ganglion Cyst
• Cystic lesion usually
attached to a tendon
sheath
• Location: hand, wrist,
dorsum of foot
Langerhan Cell Histiocystosis
• Idiopathic disorder that can manifest as
focal or systemic disease
• Initial lesion often identified with
radiography
• Radiographic appearance is extremely
variable
• May presents with palpable lumps
– Especially on skull or ribs
LCH
15 month old
LCH
15 month old
LCH
15 month old clavicle/chest wall
mass
11 year old female left chest wall
mass
Inguinal Hernia
• Patent processus
vaginalis
• Imaging not usually
needed
– Ultrasound if unsure about
etiology
Inguinal Hernia
Osteochondroma
• Most common benign
growth of the skeleton
• Usually painless mass
• Painful=possible
malignancy and need
MRI
Sacral Dimple
• Classified as low or high risk
• Low risk does not require imaging
• High risk require imaging
– Ultrasound if < 6 months
– MR imaging thereafter
Sacral dimple
• Low risk
– Midline
– Less than 5mm in
diameter
– Located with the
gluteal crease
– No cutaneous
abnormalities or
drainage
– Can see bottom of
dimple
Sacral dimple
• High risk
–
–
–
–
–
Greater than 5mm in diameter
Located above the gluteal crease
Cutaneous abnormalities
Draining cerebrospinal fluid
Bottom of dimple cannot be seen
Sacral Dimple
Tethered Cord
Normal
Sacral Dimple
• Dermal sinus
tract
Sacral Dimple
Lumps and bumps
• Ultrasound First
• Use Ultrasound and Clinical Setting to
Determine Next Best Step in Evaluation and
Treatment
In a 4-mo-old with skin lesion. Which
imaging study is indicated?
A. MRI
B. Ultrasound
C. No imaging
needed
D. Plain
radiographs
0%
A.
0%
0%
B.
C.
0%
D.