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 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