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Imaging in
PEDIAT RI S
MERROW
ii
Imaging in
PEDIATRICS
A. Carlson Merrow, Jr., MD, FAAP
Corning Benton Chair for Radiology Education
Cincinnati Children's Hospital Medical Center
Associate Professor of Clinical Radiology
University of Cincinnati College of Medicine
Cincinnati, Ohio
Selena Hariharan, MD, MHSA, FAAP

Division of Emergency Medicine
Associate Professor of Pediatrics
Cincinnati, Ohio
iii
ELSEVIER
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
IMAGING IN PEDIATRICS ISBN: 978-0-323-47778-9
Copyright C 2018 by Elsevier. All lights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including
photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details
on how to seek permission, further information about the Publisher's permissions policies and our arrangements with organizations
such as the Copyiight Clearance Center and the Copyright licensing Agency, can be found at our website: www.elsevier.com/
permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be
noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and
experience broaden our understanding, changes in research methods, professional practices,
or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds, or experiments described
herein. In using such information or methods they should be mindful of their own safety
and the safety of others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check
the most current information provided (i) on procedures featured or (ii) by the manufacturer
of each product to be administered, to verify the recommended dose or formula, the
method and duration of administration, and contraindications. It is the responsibility of
practitioners, relying on their own experience and knowledge of their patients, to make
diagnoses, to determine dosages and the best treatment for each individual patient, and to
take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or
editors, assume any liability for any injury and/or damage to persons or property as a matter
of products liability, negligence or otherwise, or from any use or operation of any methods,
products, instructions, or ideas contained in the material herein.
Publisher Cataloging-in-Publication Data
Names: Names: Merrow, A. Carlson, Jr. (Arnold Carlson) I Hariharan, Selena.

Title: Imaging in pediatrics I [edited by] A. Carlson Merrow, Jr. and Selena Hariharan.
Description: First edition. I Salt Lake City, UT : Elsevier, Inc., [2017] I Includes
bibliographical references and index.
Identifiers: ISBN 978-0-323-47778-9
Subjects: LCSH: Pediatric diagnostic imaging--Handbooks, manuals, etc. I MESH: Diagnostic Imaging--methods--Atlases. I Child--
Atlases. I Infants--Atlases.
Classification: LCC RJ51.D5 I43 2017 I NLM WN 240 I DDC 618.9200754--dcZJ
International Standard Book Number: 978-0-323-47778-9

C<TVer Designer: Tom M. Olson, BA
Printed in Canada by Friesens, Altona, Manitoba, Canada
Working together
Last digit is the print number: 9 8 7 6 5 4 3 2 1 to grow libraries in
developing countries
www.d~c:vier.com • W\nv.hookaid.org
iv
Dedications
To my family: Thank you for your patience,
encouragement, and love.
To my colleagues: Thank you for your teaching, vision,
wisdom, and support.
To my patients and their families: Thank you for your
courage, trust, and endurance.
ACM
Thank you to my parents, P.R. and Brindha Hariharan, for

always nurturing my dreams; to my children, Nikhil and
Ami Hariharan, for reminding me that dreams can come
true, both at work and at home; and to my husband, James
Kalinowski, who supports my dreams so completely that
he moved to a new city without any questions and laughs
when people call him "Mr. Hariharan."
SH
v
Contributing Authors
Christopher G. Anton, MD Nicholas A. Koontz, MD
Division Chief of Radiography Director of Fellowship Programs
Cincinnati Children's Hospital Medical Center Assistant Professor of Radiology
Assistant Professor Department of Radiology and Imaging Sciences
Clinical Radiology and Pediatrics Indiana University School of Medicine
Associate Radiology Residency Indianapolis, Indiana
Program Director
University of Cincinnati College of Medicine Steven J. Kraus, MD
Cincinnati, Ohio Division Chief of Fluoroscopy
Michael R. Aquino, MD, MHSc Associate Professor
Staff Pediatric General Radiologist Clinical Radiology and Pediatrics
The Hospital for Sick Children University of Cincinnati College of Medicine
Assistant Professor of Medical Imaging Cincinnati, Ohio
University of Toronto
Toronto, Ontario, Canada Luke L. Linscott, MD
Pediatric Neuroradiologist
Hank Baskin, MD Primary Children's Hospital
Pediatric Imaging Section Chief lntermountain Healthcare
Primary Children's Hospital Adjunct Assistant Professor of Radiology
lntermountain Healthcare University of Utah School of Medicine
Adjunct Associate Professor of Radiology Salt Lake City, Utah
University of Utah School of Medicine
Salt Lake City, Utah B.J. Manaster, MD, PhD, FACR
Emeritus Professor
Lane F. Donnelly, MD Department of Radiology
Chief Quality Officer University of Utah School of Medicine
Associate Radiologist-in-Chief Salt Lake City, Utah
Texas Children's Hospital
Professor of Radiology Prakash M. Masand, MD
Baylor Co liege of Medicine Division Chief of cardiovascular Imaging
Houston, Texas Department of Radiology, Texas Children's Hospital
Assistant Professor of Clinical Radiology
Robert J. Fleck, Jr., MD Baylor College of Medicine
Section Chief of cardiovascular Imaging Houston, Texas
Associate Professor of Clinical Radiology Arthur B. Meyers, MD
University of Cincinnati College of Medicine Nemours Children's Health System
Cincinnati, Ohio Nemours Children's Hospital
Orlando, Florida
Blaise V. Jones, MD
Division Chief of Neuroradiology Ryan A. Moore, MD
Cincinnati Children's Hospital Medical Center Assistant Professor of Clinical Cardiology
Professor of Clinical Radiology and Pediatrics Cincinnati Children's Hospital Medical Center
University of Cincinnati College of Medicine University of Cincinnati College of Medicine
Cincinnati, Ohio Cincinnati, Ohio
Bernadette L. Koch, MD Usha D. Nagaraj, MD

Associate Chief of Radiology Academic Affairs Neuroradiologist
Cincinnati Children's Hospital Medical Center Cincinnati Children's Hospital Medical Center
Professor of Clinical Radiology and Pediatrics Assistant Professor
University of Cincinnati College of Medicine Clinical Radiology and Pediatrics
Cincinnati, Ohio University of Cincinnati College of Medicine
Cincinnati, Ohio
vi
Sara M. O'Hara, MD, FAAP
Division Chief of Ultrasound
Professor of Clinical Radiology and Pediatrics
Cincinnati, Ohio
Anne G. Osborn, MD, FACR

University Distinguished Professor
Professor of Radiology
William H. and Patricia W. Child Presidential Endowed Chair
in Radiology
University of Utah School of Medicine
Salt Lake City, Utah
Daniel J. Podberesky, MD
Radiologist-in-chief
Nemours Children's Health System
Chair, Department of Radiology, Nemours Children's Hospital
Associate Professor of Radiology
University of Central Florida and
Florida State University Colleges of Medicine
Orlando, Florida
Mantosh S. Rattan, MD
Division Chief of cardiac Imaging
Assistant Professor of Clinical Radiology
Cincinnati, Ohio
Randy R. Richardson, MD
Chairman of Radiology
St. Joseph's Hospital and Medical Center
Associate Dean
Professor of Radiology
Creighton University School of Medicine
Phoenix Regional Campus
Phoenix, Arizona
Ethan A. Smith, MD
Co-Director of Thoracoabdominal Imaging
Cincinnati, Ohio
Alexander J. Towbin, MD
Associate Chief of Radiology
Clinical Operations and Informatics
Neil D. Johnson Chair of Radiology Informatics
Associate Professor
Clinical Radiology and Pediatrics
Cincinnati, Ohio
vii
Foreword
In an era of rapid technological progress and virtually unlimited access to information, there are
increasingly high expectations on pediatricians to coordinate efficient and accurate care For their
patients. As a result, physicians may be anxious about choosing the best imaging modality to serve
their patient, a decision that must include an evaluation of the accuracy, availability, risks, and costs
of an ever-evolving array of diagnostic exams in relation to a specific diagnosis. Imaging in Pediatrics is
designed to help answer the questions that not only lead up to choosing a radiologic study but also
follow the exam, such as, "What does the radiologist mean by the wording in this report?" and ffWhat
can I as the pediatrician point out to the patient and family on these images?"
This work has been written and edited by a team of pediatric radiologists and pediatricians led by Drs. A.
Carlson Merrow and Selena Hariharan From Cincinnati Children's Hospital Medical Center. Dr. Merrow is
an associate professor of clinical radiology and holds the Corning Benton Chair for Radiology Education.
He has received numerous teaching awards and has recently published a pediatric radiology text with
on line content that is used by the majority of radiology training programs in the USA. Dr. Hariharan is
an associate professor of pediatrics and specializes in emergency medicine, which has provided her
with a clear understanding of the clinical dilemmas and imaging conundrums faced by physicians who
care For children. As a result, she is able to address the varied presentations of even common illnesses
and ensures that the text is well suited For clinicians who are not radiology experts but are asked to
incorporate imaging into their daily practice.
The text of Imaging in Pediatrics is an ideal marriage between practical information and visual examples.
There are incredible images and illustrations that are highlighted by factual and easy-to-understand
text. The chapters are grouped by physiologic systems with each chapter targeted to a suspected
diagnosis and written with a bullet-point "Key Facts" style, creating a text that is easy to reference.
This book is ideally suited for anyone who is interested in becoming more proficient at understanding
pediatric imaging in a primarily clinical setting. Physicians who use this volume will be able to
intelligently discuss recommendations and results of imaging with the radiologist, clinical colleagues,
and, most importantly, patients and Families.
Karen Remley, MD, MBA, MPH, FAAP

Professor of Pediatrics
Eastern Virginia Medical School
Norfolk, Virginia
ix
Preface
There is an ever-expanding world of resources available to the pediatrician for education and point-of-
care reference, particularly in this era of nearly instantaneous access to data. We thank you For selecting
this text that we believe offers a unique perspective on the clinical care of children by providing
guidance through the increasingly complex landscape of available imaging tests. This book includes not
only direction on when to employ imaging but also instruction on which studies to consider and how
they should be ordered. This text will also lead you through the Fundamentals of how these studies
work as well as their advantages and disadvantages (including potential health risks). Common language
employed by radiologists is explored, and numerous imaging examples are provided.
A quick glance through the book reveals that it is not a typical prose-filled reference. While you will find
a Few prose introductory chapters at the beginning of the book and leading each body section (which
will help explain relevant imaging exams), the majority of the book utilizes a bullet point style to enable
quick extraction of critical data From the text. Most of the chapters have only a "Key Facts" component
(plus images), though we have chosen a number of important topics to expand For a more thorough
discussion. Finally, please note that there is an abbreviation index to help guide you through the most
common radiologic and anatomic notations.
Our ultimate hope is that this book will increase your comfort in the effective and eFAcient utilization of
imaging in your practice, daily enhancing your care of children.

Corning Benton Chair For Radiology Education
Cincinnati, Ohio
Selena Hariharan, MD, MHSA, FAAP

Division of Emergency Medicine
Associate Professor of Pediatrics
Cincinnati, Ohio
xi
Acknowledgments
Text Editors
Arthur G. Gelsinger, MA
Terry W. Ferrell, MS
Lisa A. Gervais, BS
Karen E. Concannon, MA, PhD
Matt W. Hoecherl, BS
Megg Morin, BA
Image Editors
Jeffrey J. Marmorstone, BS
Lisa A. M. Steadman, BS
Medical Editors
Lauren C. Riney, DO
Caitlin Valentino, MD, MS
1llustrations
Laura C. Wissler, MA
Lane R. Bennion, MS
Richard Coombs, MS
Art Direction and Design

Tom M. Olson, BA
Laura C. Wissler, MA
Lead Editor
Nina I. Bennett, BA
Production Coordinators
Angela M. G. Terry, BA
Rebecca L. Bluth, BA
Emily C. Fassett, BA
ELSEVIER
xiii
Sections
Section 1:
Airway
Section 2:
Chest
Section 3:
Cardiac
Section 4:
Gastrointestinal
Section 5:
Genitourinary
Section 6:
Musculoskeletal
Section 7:
Brain
Section 8:
Spine
Section 9:
Head and Neck
xv
2 Basics of Imaging
EXTRINSIC VASCULAR COMPRESSION OF
6 Potential Health Risks of Pediatric Imaging AIRWAY
A. Carlson Merrow, Jr., MD, FAAP 27 Double Aortk Arch
II SECTION 1:AIRWAY 28 Pulmonary Sling
INTRODUCTION & NORMALS 29 Right Arch With Aberrant Left: Subdavian Artery
10 Approach to Pediatric Airway Prakash M. Masand, MD
A carlson Merrow, Jr., MD, FAAP
12 Expiratory Buckling of Trachea MISCELLANEOUS AIRWAY OBSTRUCTIONS
A. Carlson Merrow, Jr., MD, FAAP and Lane F. Donnelly, 30 Infantile Hemangloma, Airway
MD Bernadette L. Koch, MD
13 Pseudothlckening of Retropharyngeal Tissues 31 Tracheobronchomalada
A. Carlson Merrow, Jr., MD, FAAP and Lane F. Donnelly, Mantosh S. Rattan, MD
MD
NEWBORN AIRWAY OBSTRUCTION II SECTION 2: CHEST

14 Congenital Nasal Pyrifonn Aperture Stenosis
Bernadette L. Koch, MD
INTRODUCTION & NORMALS
34 Approach to Pediatric Chest
------
15 Nasolacrimal Duct Mucocele A. Carlson Merrow, Jr., MD, FAAP
Bernadette L. Koch, MD 38 Nonnal Thymus
16 Choanal Atresia Arthur 8. Meyets, MD
Bernadette L. Koch, MD 39 Palpable Normal Variants of Chest Wall
A carlson Merrow, Jr., MD, FAAP and Lane F. Donnelly,
INFECTIOUS CAUSES OF AIRWAY MD
COMPROMISE
Eplglottitis
CONGENITAL LUNG LESIONS
17
Michael R. Aquino, MD, MHSc and Lane F. Donnelly, MD 40 Congenital Pulmonary Airway Malformation
18 Retropharyngeal Abscess Hank Baskin, MD andA Carlson Merrow, Jr., MD, FAAP
Bernadette L. Koch, MD 41 Bronchopulmonary Sequestration
20 Croup A. Carlson Merrow, Jr., MD, FAAP
A. Carlson Merrow, Jr., MD, FAAP 42 Bronchogenlc Cyst
22 Exudative Tracheitis A. Carlson Merrow, Jr., MD, FAAP
A. Carlson Merrow, Jr., MD, FAAP 43 Congenital Lobar Overlnflation
Hank Baskin, MD and A Carlson Merrow, Jr., MD, FAAP
OBSTRUCTIVE SLEEP APNEA
NEONATAL CHEST ISSUES
23 Enlarged Adenoid Tonsils
A. Carlson Merrow, Jr., MD, FAAP 44 Esophageal Atresfa and Tracheoesophageal Fistula
24 Enlarged Palatine Tonsils Steven J. Krous, MD
A. Carlson Merrow, Jr., MD, FAAP and Lane F. Donnelly, 46 Congenital Diaphragmatic Hernia
MD A. Carlson Merrow, Jr., MD, FAAP
25 Enlarged Lingual Tonsils 48 Surfactant Deficiency Disease
Mantosh S. Rattan, MD and Lane F. Donnelly, MD Hank Baskin, MD
26 Glossoptosis 50 Neonatal Pneumonia
Mantosh S. Rattan, MD Michael R. Aquino, MD, MHSc
51 Meconium Aspiration Syndrome
52 Transient Tachypnea of Newborn
Hank Baskin, MD and Randy R. Richardson, MD
S3 Pulmonary Interstitial Emphysema
A. Carlson Merrovv, Jr., MD, FMP
CONGENITAL HEART DISEASE
S4 Neonatal Pneumothorax 86 Atrial Septal Defect
Michael R. Aquino, MD, MHSc A. Carlson Merrovv, Jr., MD, FMP and Randy R.
SS Chylothorax Richardson, MD
Randy R. Richardson, MD and A Carlson Merrow, Jr., MD, 87 Ventricular Septal Defed
FAAP Randy R. Richardson, MD
S6 Bronchopulmonary Dysplasia 88 Atrioventricular Septal Defect
A. Carlson Merrovv, Jr., MD, FMP and Randy R. Randy R. Richardson, MD
Richardson, MD 89 Patent Ductus Arteriosus
CHEST INFECTIONS 90 Tetralogy of Fallot
S8 Viral Chest Infection Ryan A. Moore, MD and Robert J. Reck, MD
Michael R. Aquino, MD, MHSc 91 Pulmonary Atresia
60 Round Pneumonia Randy R. Richardson, MD
Michael R. Aquino, MD, MHSc 92 Ebstein Anomaly
62 Parapneumonic Effusion and Empyema Randy R. Richardson, MD
Michael R. Aquino, MD, MHSc 93 D-Transposition of Great Arteries
64 Pneumonia With Cavitary Necrosis Randy R. Richardson, MD
Michael R. Aquino, MD, MHSc and Lane F. Donnelly, MD 94 L-Transposition of Great Arteries
65 Papillomatosis Randy R. Richardson, MD
AlexanderJ. Towbin, MD and A. Carlson Merrovv, Jr., MD, 9S Tricuspid Atresia
FAAP Randy R. Richardson, MD
96 Truncus Arteriosus
MEDIASTINAL MASSES Randy R. Richardson, MD
97 Total Anomalous Pulmonary Venous Return
66 Lymphoma Randy R. Richardson, MD
AlexanderJ. Towbin, MD 98 Hypoplastic Len Heart Syndrome
67 Germ Cell Tumors
Ryan A. Moore, MD and Robert J. Reck, MD
AlexanderJ. Towbin, MD
99 Left Coronary Artery Anomalous Origin
TRAUMA Ryan A. Moore, MD
100 Double Outlet Right Ventricle
68 Child Abuse, Rib Fractures Randy R. Richardson, MD
Michael R. Aquino, MD, MHSc 101 Aortic Coardation
70 Lung Contusion and Laceration Randy R. Richardson, MD
Michael R. Aquino, MD, MHSc 102 Aortic Stenosis
71 Pneumomediastinum Randy R. Richardson, MD
Michael R. Aquino, MD, MHSc 103 Pulmonary Artery Stenosis
MISCELLANEOUS
72 Asthma CARDIOMYOPATHIES
Hank Baskin, MD 104 Myocarditis
74 Bronchial Foreign Body Ryan A. Moore, MD
Hank Baskin, MD 1OS Hypertrophic Cardiomyopathy
76 Cystic Fibrosis, Pulmonary Ryan A. Moore, MD
78 Sickle Cell Disease, Acute Chest Syndrome MISCELLANEOUS
AlexanderJ. Towbin, MD 106 Heterotaxy Syndromes
80 Pectus Excavatum Ryan A. Moore, MD and Daniel Podberesky, MD
108 Kawasaki Disease
81 Askin Tumor/Ewing Sarcoma of Chest Wall
Ryan A. Moore, MD and Robert J. Fleck, MD
Arthur B. Meyers, MD
110 Rheumatic Heart Disease
II SECTION 3: CARDIAC
111
Marfan Syndrome
INTRODUCTION & NORMALS Randy R. Richardson, MD
84 Approach to Pediatric Heart
Randy R. Richardson, MD and A Carlson Merrow, Jr., MD,
FAAP
II SECTION 4: GASTROINTESTINAL OTHER ABNORMALITIES ASSOCIATED WITH
BOWEL OBSTRUCTION
144 Appendicitis
114 Approach to Pediatric Gastrointestinal Tract A. Carlson Merrow, Jr., MD, FMP
A. Carlson Merrow, Jr., MD, FMP 146 lleocolic lntussusception
Steven J. Kraus, MD
NEONATAL UPPER INTESTINAL 148 Meckel Diverticulum
OBSTRUCTION Sara M. O'Hara, MD, FMP
118 Malrotation
Steven J. Kraus, MD LIVER ABNORMALITIES
1ZO Midgut Volvulus 150 Hepatoblastoma
Steven J. Kraus, MD AlexanderJ. Towbin, MD
1zz Duodenal Atresia or Stenosis 151 Hepatic Hemangiomas, Infantile and Congenital
Steven J. Kraus, MD A. Carlson Merrow, Jr., MD, FMP
123 Duodenal Web 152 Focal Nodular Hyperplasia
Steven J. Kraus, MD and A Carlson Merrow, Jr., MD, FMP Ethan A Smith, MD
153 Hepatic Aclenoma
NEONATAL LOWER INTESTINAL Ethan A Smith, MD
OBSTRUCTION 154 Biliary Atresia
124 Jejunoileal Atresia Sara M. O'Hara, MD, FMP
Steven J. Kraus, MD 155 Choledochal Cyst
1ZS Meconium lleus Sara M. O'Hara, MD, FMP
Steven J. Kraus, MD 156 Steatosis/Steatohepatitis
126 Hirschsprung Disease AlexanderJ. Towbin, MD
Steven J. Kraus, MD 157 Hepatic Fibrosis/Cirrhosis
128 Neonatal Small Left Colon Syndrome AlexanderJ. Towbin, MD
A. Carlson Merrovv, Jr., MD, FMP
1zg Anorectal Malfonnation PANCREATIC ABNORMALITIES
Steven J. Kraus, MD 158 Pancreatitis
OTHER NEONATAL GASTROINTESTINAL
DISORDERS MESENTERIC ABNORMALITIES
130 Necrotizing Enterocolitis 160 Mesenteric Adenitis
Hank Baskin, MD and A Carlson Merrow, Jr., MD, FMP Michael R. Aquino, MD, MHSc
161 Omental Infarction
UPPER GASTROINTESTINAL ABNORMALITIES Michael R. Aquino, MD, MHSc
TYPICALLY SEEN IN INFANTS AND YOUNCi
CHILDREN TRAUMA
132 Hypertrophic Pyloric Stenosis 162 Hepatic Trauma
Sara M. O'Hara, MD, FMP Michael R. Aquino, MD, MHSc
134 Gastroesophageal ReRux 163 Splenic Trauma
Steven J. Kraus, MD Michael R. Aquino, MD, MHSc
135 Gastric Volvulus 164 Duodenal Trauma
Michael R. Aquino, MD, MHSc Michael R. Aquino, MD, MHSc
136 Ingested Coins 165 Bowel Injury
138 Ingested Button Batteries 166 Pancreatic Trauma
140 Ingested Multiple Magnets
Michael R. Aquino, MD, MHSc ABNORMALITIES IN IMMUNOCOMPROMISED
CHILDREN
ABNORMALITIES OF ABDOMINAL WALL
167 Pseudomembranous Colitis
142 Hernias Michael R. Aquino, MD, MHSc
INFLAMMATORY BOWEL DISEASE
168 Crohn Disease
169 Ulcerative Colitis
MISCELLANEOUS RENAL CONDITIONS
198 Pyelonephritis
MISCELLANEOUS Sara M. O'Hara, MD, FMP
170 Esophageal Strictures 200 Renal Stones
AlexanderJ. Towbin, MD AlexanderJ. Towbin, MD
171 Bezoar 202 Renal Injury
Michael R. Aquino, MD, MHSc Michael R. Aquino, MD, MHSc and A. Carlson Merrow, Jr.,
172 Gastrointestinal Duplication Cysts MD,FMP
A. Carlson Merrow, Jr., MD, FMP and Sara M. O'Hara, 203 Renal Vein Thrombosis
MD,FMP Ethan A Smith, MD
173 Small Bowel lntussusception
Michael R. Aquino, MD, MHSc
BLADDER ABNORMALITIES
174 Henoch-Schonlein Purpura 204 Neurogenic Bladder
Michael R. Aquino, MD, MHSc Steven J. Kraus, MD
175 Cystic Fibrosis, Gastrointestinal Tract 205 Bladder Diverticula
AlexanderJ. Towbin, MD Steven J. Kraus, MD
206 Rhabdomyosarcoma, Genitourinary
II SECTION 5: GENITOURINARY Sara M. O'Hara, MD, FMP
INTRODUCTION & NORMALS ADRENAL ABNORMALITIES

178 Approach to Pediatric Genitourinary Tract 207 Neonatal Adrenal Hemorrhage
A. Carlson Merrow, Jr., MD, FMP Sara M. O'Hara, MD, FMP
208 Neuroblastoma
CONGENITAL URINARY TRACT A. Carlson Merrow, Jr., MD, FMP
ABNORMALITIES
182 UreteropelvicJunction Obstruction UTERINE/OVARIAN ABNORMALITIES
Sara M. O'Hara, MD, FMP 21 O Hydrometrocolpos
184 Vesicoureteral Reftux Sara M. O'Hara, MD, FMP
Sara M. O'Hara, MD, FMP 211 Mlillerian Duct Anomalies
186 Ureteropelvic Duplications Sara M. O'Hara, MD, FMP
Sara M. O'Hara, MD, FMP 212 Ovarian Teratoma
187 Ureterocele Sara M. O'Hara, MD, FMP
Sara M. O'Hara, MD, FMP 214 Ovarian Cyst
188 Primary Megaureter Sara M. O'Hara, MD, FMP
Steven J. Kraus, MD 216 Ovarian Torsion
189 Posterior Urethral Valves Sara M. O'Hara, MD, FMP
Sara M. O'Hara, MD, FMP
190 UrachalAbnormalities SCROTAL/TESTICULAR ABNORMALITIES
Sara M. O'Hara, MD, FMP 218 Epididymoorchitis
191 Renal Ectopla and Fusion Sara M. O'Hara, MD, FMP
Sara M. O'Hara, MD, FMP 220 Testicular Torsion
Sara M. O'Hara, MD, FMP
MULTICYSTIC RENAL DISEASE 222 Torsion of Testicular Appendage
192 Multicystic Dysplastic Kidney Sara M. O'Hara, MD, FMP and A. Carlson Merrow, Jr.,
Sara M. O'Hara, MD, FMP MD,FMP
193 Polycystic Kidney Disease, Autosomal Recessive 224 Testicular Tumors
Sara M. O'Hara, MD, FMP Hank Baskin, MD
194 Polycystic Kidney Disease, Autosomal Dominant 225 Testicular Trauma
Sara M. O'Hara, MD, FMP Hank Baskin, MD
RENAL MASSES
195 Mesoblastic Nephroma
II SECTION 6: MUSCULOSKELETAL
A. Carlson Merrow, Jr., MD, FMP
196 Wilms Tumor 228 Approach to Pediatric Musculoskeletal System
Hank Baskin, MD A. Carlson Merrow, Jr., MD, FMP
232 Normal Primary and Secondary Growth Centers
Arthur B. Meyers, MD
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... tragically old.
Dianne dried her eyes and looked beautiful, which wasn't hard. "I'm a
cry baby," she said bitterly.
"How long has it been since you've been with another person?"
Dianne sniffled. "About four years. I can't remember exactly."
"You're no cry baby kid, you've got a right to cry, and cry a helluva
lot." He put a finger under her chin, raised her face, and kissed her
lightly. "Hell! I haven't seen a girl in three years." She laughed.
"What about you, Romeo," she said. "How did the war affect your
life?" He sort of grinned, and leaned back against the tree, pulling
her with him.
"You know, I think it affected my life for the better. If it weren't for the
war, I night not have met you. It seems that I'm falling in love with
you already."
Dianne frowned. "Don't say that.... Don't say that you wanted the
war, think of the people that died ... your folks ... mine."
"It was coming, I didn't realize then, but it had to come. Man was too
far apart from Nature and Nature wanted him back...."
"That's silly."
"No, Dianne, no, it's not silly. Man lived in his concrete skyscraper,
above the earth ... complex, not simple. He lost his sense of good
and decency; he depended upon someone else for his food and well
being. He became soft. It had to come."
"Maybe you're right Clark, maybe," Dianne whispered, nestling close
to him warmly.
"I know I am," he said. He was aware of her in the crook of his arm,
and, he added, almost too softly to be heard, "I know."
"How about when you were little?" she softly enquired.
"Oh, nothing really. The only thing I remember clearly was the
Huntington Park Bomb that dropped on my tenth birthday."
"Birthday?"
"Yeah. Had a party going full blast when it hit. I remember it as a sort
of a thunder-clap and a bright flash in the sky. Then, amid the
screams of my playmates, came a wave of heat that prickled my skin
while flying glass cut everybody around me. I don't remember
anything very clear after that; guess I was in a state of shock or
something. After that, I wandered around, living and growing up with
Nature. It's been very pleasant ... though I haven't met many people
until I saw you, lucky day." She grinned.
"You've been through a lot," she said simply.
"We've all been through a lot. Maybe a lot more. Who knows?
There's always a few lunatics and degenerates wandering around
after the war ... ever been bothered by them?" Suddenly, she
cringed, wrinkling her face with revulsion, then swallowed hard.
"When I was about twelve...." She was nearly ready to cry again.
She pressed closer to Clark....
"Never mind," said Clark, "It's over now, don't think about it." Again
she was pouring out the sadness of many years of loneliness.
"I love you," said Clark. It was later in the day and they were still in
the same position. "I think I love you too," she said leaning back on
him. "It's strange," he breathed.
"A few years ago they'd call it puppy love. I'm sure this isn't. It can't
be, Dianne. The war has changed things. Before I met you, I used to
lay on the grass, staring up at stars thinking. Maybe that civilization
was finished, but man wasn't. He's a tough animal to kill off. The
future may lie in us, Dianne."
"You're being dramatic, Clark, we're not the only ones left; there are
plenty more people. In fact," she said suspiciously, "I am beginning
to doubt your intentions. My name is Dianne, not Eve."
"And mine's Clark, glad to know you." They laughed and settled
down to watch the sunset. "Where are you living?" asked Clark a
little later.
"It's a cave over near the Santa Monica mountains."
"There? That's infested with a lot of renegades?" Dianne smiled.
"They're too stupid to look under their own noses." She sat up and
stretched. "Come up, I'll show you." She sprang up and began
running, her long hair streaming out behind her. Clark bounded after,
at a pace only youth and vigor could maintain. He soon caught her
and they both rested, laughingly. When the shadows were deep,
they continued, silently. Within an hour, they were at the cave.
"Well, I'll be damned!"
"It's cozy."
"No doubt. Now I begin to doubt your intentions, young lady." She
smiled and squelched him.
"I hope you're used to the hard cold ground, because that's where
you're sleeping. There is only one bed. Or you can go outside."
"Never mind, I've got a tough back. But allow me this; this cave's
pretty well concealed." The last was true. The cave was situated so
that it was invisible and nearly impregnable. A dense growth foliage
covered the entrance while the passage-way into the main chamber
twisted and turned so that light and smoke were diffused perfectly.
"Where ... how did you find it?" Dianne sat down on a makeshift bed
and began to braid her hair. She raised her eyes and said:
"When I was a little girl, my family came up here on Sundays to visit
my uncle. I used to play around in the hills while they were so
engrossed in their deep adult conversation. One day I just found it. I
didn't tell anybody about it, and used it for a secret hideaway ...
when the war came, I remembered it. Once in a while I go to my
uncle's house just over the rise for things I need, but most of the time
I've been here." She finished braiding her hair and leaned back on
the bed.
"I lived in the open," Clark said moodily. "With the grass for a
mattress and the sky for cover." He glanced around, "I think I'll like it
here, better." Dianne raised an eyebrow.
"Keep the gleam out of your eyes or else you'll be roughing it again,"
she said jokingly. He laughed and sat down beside her.
"Where did you get the candles?" Clark motioned to several wax
lumps scattered about.
"Uncle liked them, so...."
"Yeah," she yawned. "Tired?" he asked.
"Very." There was a silence.
"Ever read the Bible?"
"Some."
"I remember a verse that I read a long time ago ... it sort of stuck in
my mind."
"Tell it to me, Clark, please."
"Sure." Clark licked his lips and recited his favorite verse into the
murky stillness of the room:
"To everything there is a season; and a time to every purpose under
the heavens;
"A time to be born and a time to die; a time to plant and a time to
pluck up that which is planted;
"A time to love and a time to hate; a time of war and a time of
peace...."
"Hmmm," she said lazily, "Where did you get that from?"
"Ecclesiastes."
"Nice." There was a long silence.
"Dianne?" There was no answer. He stood over the bed and saw
that she slept. He stood there a long time, just watching her, drinking
in her beauty. She was something he couldn't tear his eyes from. He
scratched his youthful stubble, and was aware that the candles were
low, casting a ruddy glow, deepening the shadows on her face,
creasing her ankles and thighs, accenting everything that needed to
be accented, and perfectly. Her breasts rose and fell to the even
tempo of her breathing. He walked over and blew out the candles,
thoughtfully.
Clark stretched out full length on the rough floor of the cave using his
hands for pillows, staring straight into the blackness of the ceiling.
The ground felt good against his back. He grinned. Something ran
through his mind over and over again.
A time to love.... A time to love.... A time to love....
Soon, he slept.
The End
ASSAY REPORT
For the July-September
issue:
PLACE AUTHOR STORY POINTS
1 Don Howard Donnell I LOVE YOU, ROBERTA 1.57
2 Tom Covington A BIT PREMATURE 2.36
3 J. S. Semens I 2.79
4 Terry Carr SUPER BOMB 3.29
... and the Nov.-Jan.:

1 Larry Saundors A PHONE IS RINGING 1.33
2 Al Leverentz TARRY THOU HERE 2.33
COLIN AND THE
3 Toby Duane 2.83
LEPRECHAUN
4 Ken J. Krueger SOLUTION T-400 3.50
For once, the ratings flowed in in a manner reminiscent of old times
—thanks to my consistent bewailing. There is no rating sheet
provided for your use in this issue, so I am not too hopeful about the
results. I hope, though, that you will fool me and send in your story-
preferences in volume. In the latter issue, the poem most liked was
VIGIL, by Isabelle E. Dinwiddie, and second was Toby Duane's THE
MAN-HEART.
In the next issue, you may definitely expect DeWeese's long story,
which was promised for this issue. Circumstances intervened,
however.
—THE EDITOR
NOVA
A yellow star
Burned wanly in the spreading dawn,
Then died.
"Hello, Joe, how's the missus?"

"Fine, Bill.
Did you see the news?"
"No, what's up?"
"Something about a new bomb, K
factor Of two hundred, whatever
that means."
"Probably Nothing, they're always

talking about new bombs, And
anyway, we're not at war."
"Well, I don't know, I hear this
one's something new."
"That's what they say about any

new stuff. Remember the first
Atom bomb?"
"Yeah, well there's nothing we can
do, and like you said, we're not at
war."
A red star
Burned fiercely in the black void,
Then died.
—Keran O'Brien
THE SEA AT EVENING
It was in the purple evening, as the moon rose on the sand,

When I heard the restless waters calling me across the land;
And I left the moors and meadows and the forests stretching
free,
Left the wind-swept fields behind me, and went down to meet
the sea.
How the surges roared to greet me, soared to meet me as I

came!
And it seemed that they were calling clearer, chorusing my
name.
When the moonlight on them glowing like the luster in a pearl
And the sapphire dwelling in their depths, I saw the waves
uncurl
As they spread their crystal fingers, carving figures in the
sand—
That the sea had known and bounded, tales from every
distant shore;
And I knew that the enchantment would be with me evermore,
That the restless roll and refluence would shackle me apart,
For the sea was in my spirit, and its song was in my heart.
—Andrew Duane
TAVERN MOOD
The melancholy
faces drift in gloom like pale
headlights through the fog.
—Walt Klein
WHAT THE CAT DRAGGED IN
All letters for this column should be sent to Robert E.
Briney, 561 W. Western Avenue, Muskegon, Michigan.
No letter should exceed 250 words in length.
Dear Bob: Maybe you're wondering what my reaction was toward
Saunders' story, A PHONE IS RINGING. Well, I'm still wondering,
too. I don't know whether I liked it or whether I didn't. I'm perplexed.
Before I go any further, however, I must admit that the story held my
interest. The suspense was superbly executed. But when I read the
ending, I was disappointed. It seemed as if Saunders had a good
idea in the beginning ... but as the tale progressed, he forgot about it.
He seemed to be in too much of a rush to get it finished. And the
ending struck me——huh? I'm still saying "huh?" Perhaps I skipped
a vital paragraph in the story—I'll have to reread it one of these days
and possibly my "huh?" will change to an "Oh!" I don't know, though.
The short-shorts, I didn't care for, and as for Leverentz' column.... I
cannot see how he considers "The Crimson Pirate" as science-
fiction. He creates an argument that really isn't an argument. CP was
a comedy, anyway, and it was supposed to create a laugh, which it
did.... This is the first time I have heard it classed as science fiction.
[If memory serves, it was not Leverentz but the movie reviewer he
quoted who classed "Crimson Pirate" as science fiction, thus
reflecting the public opinion of sf.—Ed.] Not that science fiction is
"respectable"—but Leverentz should have chosen a better example
to illustrate his point.——Joe Semenovich, 155-07 71st Avenue,
Flushing 67, New York. P.S.: In SOLUTION T-400 there are 399
words! You're wrong, Ken, I took time to count them.
[Judging from the following letter from Larry Saunders, we doubt that
you missed a vital point in A PHONE IS RINGING. In fact, you
probably noticed something that no one else has bothered to
comment upon, and which Larry mentions in his letter.—Ed.]
Dear Bob: An explanation for the confusion that probably resulted
from the appearance of A PHONE IS RINGING seems to be in order.
I wrote the story some years ago while I was under the influence of
Leiber, Bradbury, and Benet. When I submitted it to Paul, he
accepted it with reservations. In other words, he was confused. He
suggested that I might rewrite it and clear up a few points. This
seemed like a good idea. The fact remains that I am a lazy SOB, in
other words a typical fan, and I never did rewrite it for him. Its
appearance in the Nov.-Jan. issue of F-F thus came as a complete
and utter surprise to me. I was both pleased and embarrassed.
Embarrassed because the story is a confused mess. As it stands, I
know what's going on but the readers do not—a situation which
should not be allowed to happen. Rather than offer you my full
explanation of PHONE, I offer you my apology instead. Ghu forgive
me. ### Toby Duane's COLIN AND THE LEPRECHAUN was well-
written and capably handled. Ken Krueger's SOLUTION T-400 was
an amusing play on words. The best item was Al Leverentz' TARRY
THOU HERE, which though unoriginal, was masterfully pulled-off.
INTRANSIGEANT impressed me with its Nietzschean bitterness.
Can't say that I agree with him.... Who gives a faint, unheated damn
whether sf is "respectable" or not? If I want to read something
respectable I can turn to Dostoyevsky, Balzac, Dickens, Hardy, or
even Nietzsche. As for the song RUDOLPH—well I can't stand it
either, but not for the same reason. The song just is no good—it
stinks. The majority of commercial songs do. I listened to this tripe all
my life and it had no apparent affect on me. I just outgrew it. Now
instead of the current Hit Parade, it's Brahms, Bruckner, Mahler,
Handel, Nielson, Strauss, etc.——Larry Saunders, 170 Washington
Avenue, Stamford, Connecticut.
Cheerio: About the matter of Al Leverentz' red-nosed reindeer. This
is a version of Rudolph's birth that I picked up somewhere, I don't
remember just where, but it sounds only too true. You might check
with Bob Bloch—he's in the advertising business and will probably
know the score. ### My understanding is that the song was
deliberately written a few Christmasses ago to promote Sears-
Roebuck merchandise. [Am inclined to think it was Montgomery
Ward rather than Sears—I can remember when the first rash of that
Rudolph bilge came out.—Ed.] Some bright advertising genius sold
that company a package deal: a song to do the plugging, and
"Rudolph" toys, books, soap, clothing, etc. It worked very well, too,
with perhaps hundreds of thousands of dollars worth of junk being
palmed off on the kids and their helpless parents. ### That sort of
promoting is done all the time to sell many products. When one of
George Pal's interplanetary movies, WHEN WORLDS COLLIDE,
was being readied for the theaters, one of the movie trade journals I
subscribe to reported that Paramount had arranged to plant an
article on how the picture was made, in ASTOUNDING. And that's
just what happened. At least, friend Campbell printed it. ###
Meanwhile, they've got a new picture coming up next May, WAR OF
THE WORLDS, and the publicity men are bust again. One of them
has been in contact with me, getting names and addresses of both
pro and fan magazines, so there's no telling what kind of
propaganda barrage is about to come our way!——Bob Tucker, P.O.
Box 702, Bloomington, Illinois.
Dear Bob: I'm a little confused about the Lovecraft Collectors'
Library. On the contents page of F-F it states that one volume has
been published and there are six more to go, the set to sell for $2.25.
On page 18, it says the set will consist of six volumes and sell for
$1.20. I'd like to get the set, but ... well, could you clear up the
confusion? And what about GROTESQUE? I'd like to sub, but how
much does it cost and how often is it published?——Richard Billings,
610 E. Street, North Wilkesboro, North Carolina.
[The true state of affairs with regard to the Lovecraft Library is as
follows: there are seven volumes in the set, one of which has been
published and a second of which is about to appear. Price for the set
of seven is $2.25, or 35¢ per volume if purchased separately. As for
GROTESQUE: as was stated in F-F, the magazine is now defunct,
due to the induction of the editor into the Army. The first three issues
of the magazine, however, are still available from the editor of FAN-
FARE @ 50¢. Take it from us, they are well worth getting!—Ed.]
Dear Bob: On the pleasant side of the ledger, the fiction. A PHONE
IS RINGING——a rather excellently integrated yarn. A certain
resource of technique and imagination definitely present. TARRY
THOU HERE—well done. Maybe I had better say no more, except
that to the best of my knowledge my reason for the placing of this
story is entirely aesthetic. COLIN & THE LEPRECHAUN—clever.
SOLUTION T-400—this is a story? The title was good enough as a
pun, but that was about the best part of the whole thing. ### Now for
the CAT. If this were the only communication I ever received from Al
Leverentz (direct or indirect), I would think him a terrible fellow
indeed. Actually, he seems to be a rather nice guy. However, I can't
let a challenge of this magnitude go by without some response. Case
I: My reaction is entirely wrong. Conclusion: Al was deducing entirely
too much from my short remarks, and his lack of acquaintance with
my personality at the time. Case II: Al is completely wrong.
Conclusion: of my remarks in preceding FAN-FARE. I probably erred
in the direction of charity. Case III: Article fails insofar as it led to
individual interpretations on the part of the reader—interpretations
which were false, but please! not maliciously so. Conclusion: Al errs
by excess in his reaction. This I think is the most probable. There
may be many more positions, but I think I've covered the ground
sufficiently. Now that the fiery one is in the Army, it may not be just to
get the last word by default, but there seemed no other course. I
trust Al Leverentz will forgive me.—Keran O'Brien, 186-29 Avon
Road, Jamaica 32, New York.
*** END OF THE PROJECT GUTENBERG EBOOK FAN FARE,
MAY 1953 ***
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IMAGING IN PEDIATRICS ISBN: 978-0-323-47778-9

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Names: Names: Merrow, A. Carlson, Jr. (Arnold Carlson) I Hariharan, Selena.

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Thank you to my parents, P.R. and Brindha Hariharan, for

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Art Direction and Design

NEWBORN AIRWAY OBSTRUCTION II SECTION 2: CHEST

INTRODUCTION & NORMALS ADRENAL ABNORMALITIES

... and the Nov.-Jan.:

"Hello, Joe, how's the missus?"

"Probably Nothing, they're always

"That's what they say about any

It was in the purple evening, as the moon rose on the sand,

How the surges roared to greet me, soared to meet me as I

Updated editions will replace the previous one—the old editions

Creating the works from print editions not protected by U.S.

START: FULL LICENSE

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Section 1. General Terms of Use and

1.B. “Project Gutenberg” is a registered trademark. It may only

1.E. Unless you have removed all references to Project

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