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Pediatric Radiologic Differences

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Ossification Centers

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Multiple ossification centers in children may appear as separate bones or fragments but are normal anatomical variations.

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Fontanelles and Sutures

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Open fontanelles and sutures in infants allow for brain growth and may be misinterpreted as skull fractures if not recognized.

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Medulloblastoma

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MRI findings of medulloblastoma in children differ in location and characteristics from adult posterior fossa tumors.

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Cystic Fibrosis

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Imaging findings in pediatric cystic fibrosis patients can include bronchiectasis and mucus plugging, which may progress differently from adults.

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Croup

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The classic 'steeple sign' on a pediatric neck x-ray indicates subglottic narrowing seen in croup, not typically observed in adults.

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Slipped Capital Femoral Epiphysis (SCFE)

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In pediatric patients, SCFE appears as a displacement of the femoral head and may be missed if not assessed on frog-leg lateral views.

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Perthes Disease

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In Perthes disease, x-rays can show fragmentation and collapse of the femoral head, affected by the vascular supply unique to pediatric patients.

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Appendicitis Presentation

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In pediatric patients, ultrasound is the preferred initial imaging modality for suspected appendicitis to avoid radiation exposure.

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Renal Ultrasound

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Pediatric kidneys can have increased echogenicity on ultrasound due to their relative immaturity compared to adult kidneys.

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Pediatric Fractures

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Buckle (torus) fractures are common in children due to softer bones and may not be as visible as adult fractures on imaging.

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Lymphadenopathy

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Reactive cervical lymphadenopathy is common in pediatric imaging due to frequent viral infections, usually benign compared to adults.

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Bone Density

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Pediatric bones have lower mineral density and show more pronounced periosteal reactions than adults.

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Cardiomegaly Evaluation

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Pediatric hearts can appear relatively larger on an x-ray compared to adults, affected by age and respiratory phase.

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Pulmonary Patterns

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Pediatric lung fields may show increased prominence of the pulmonary markings due to the relative size of blood vessels to the lung parenchyma.

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Thymus Size and Shape

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The thymus is larger in children and can be mistaken for pathology; it normally involutes with age.

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Intussusception

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Ultrasound is diagnostic for pediatric intussusception, whereas in adults, it is more often incidental or identified on computed tomography (CT).

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Bronchiolitis Imaging

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Chest x-rays in pediatric bronchiolitis often show hyperinflation and peribronchial thickening, often different from adults with similar symptoms.

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Organomegaly Assessment

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Pediatric abdominal organs can appear relatively enlarged due to body size, with normal variations that differ from adults.

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Brain Myelination

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MRI imaging of the pediatric brain shows different myelination patterns than in adults, affecting signal intensity.

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Hepatic Tumors

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Certain pediatric liver tumors, such as hepatoblastoma, are more prevalent in children and have different imaging characteristics than in adults.

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Vascular Rings

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Pediatric vascular rings can cause tracheoesophageal compression and are best evaluated with MRI or CT, different from imaging choices in adults.

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Hypoxic-Ischemic Encephalopathy (HIE)

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MRI patterns of injury in HIE in neonates differ significantly compared to adults with hypoxic or ischemic brain injury.

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Epiphyseal Plates

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Growth plates in pediatric imaging can be mistaken for fractures; however, they are normal findings in growing bones.

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Neuroblastoma

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Pediatric neuroblastoma presents with different imaging findings compared to adult cancers, often with calcifications and cross midline.

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Pneumomediastinum

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Spontaneous pneumomediastinum is more common in children and adolescents may show continuous diaphragm sign on imaging.

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