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Differentiating Normal from Abnormal Inferior Thoracic Paravertebral Soft Tissues on Chest Radiography in Children

¹ Division of Pediatric Radiology, Department of Radiology, Duke University Medical Center, Durham, NC 27710.
² Present address: Department of Radiology, Children's Hospital Medical Center and the University of Cincinnati, 3333 Burnet Ave., Cincinnati, OH 45229-3039.

View larger version (115K): [in a new window]   Fig. 1A. —2-year-old girl with neuroblastoma who presented with malaise and abdominal pain. Radiograph shows bilateral paraspinal soft tissues (large arrows), both of which are oriented inferolaterally and greater in width than width of adjacent pedicles (small arrows).

View larger version (115K): [in a new window]   Fig. 1B. —2-year-old girl with neuroblastoma who presented with malaise and abdominal pain. CT scan, obtained same day as A, at most inferior level of posterior lung shows large heterogeneous mass, representing neuroblastoma, engulfing aorta and celiac artery. Mass contributes to widening of paraspinal soft tissues.

View larger version (143K): [in a new window]   Fig. 2A. —7-month-old girl who presented with malaise and weight loss and was falsely thought to have paraspinal mass on radiography. Radiograph shows left paraspinal soft tissues (arrow) to be oriented inferolaterally. Width of left paravertebral soft tissues is slightly less than that of adjacent pedicle. No right paravertebral soft tissues are visualized. Note right aortic arch.

View larger version (96K): [in a new window]   Fig. 2B. —7-month-old girl who presented with malaise and weight loss and was falsely thought to have paraspinal mass on radiography. CT scan, obtained within 1 hr of chest radiograph, shows normal findings. There is no paraspinal mass or other explanation for appearance of left paraspinal soft tissues.

View larger version (118K): [in a new window]   Fig. 3A. —14-year-old girl with left paraspinal ganglioneuroma. Radiograph shows inferolateral course of left paraspinal soft tissues. Width of left paravertebral soft tissues (arrows) is greater than width of adjacent bony pedicle (arrowheads). No right paraspinal soft tissues are visualized.

View larger version (118K): [in a new window]   Fig. 3B. —14-year-old girl with left paraspinal ganglioneuroma. Coronal fast spin-echo MR image (TR/TE, 4000/40) shows high-signal-intensity left-sided paraspinal mass (arrow).

View larger version (138K): [in a new window]   Fig. 4A. —2-year-old girl with right paraspinal neuroblastoma. Radiograph shows presence of right paravertebral soft tissues (arrows). Paravertebral soft tissues are wider than adjacent pedicle (arrowheads). No left paravertebral soft tissues are present.

View larger version (138K): [in a new window]   Fig. 4B. —2-year-old girl with right paraspinal neuroblastoma. CT scan shows paravertebral mass (m).

View larger version (136K): [in a new window]   Fig. 5A. —15-year-old girl with mediastinal hematoma after high-speed motor vehicle collision. Radiograph shows widening of left paraspinal soft tissues (arrows), which are vertically oriented and more than twice width of adjacent pedicle. No right paraspinal soft tissues are visualized.

View larger version (127K): [in a new window]   Fig. 5B. —15-year-old girl with mediastinal hematoma after high-speed motor vehicle collision. CT scan shows abnormal paravertebral soft tissues (arrow) elevating descending aorta away from adjacent vertebral body and causing appearance seen on radiography. Aortogram (not shown) showed normal findings. Abnormal soft tissue was presumed to be hematoma related to venous bleeding.

View larger version (127K): [in a new window]   Fig. 6A. —15-year-old girl with abnormal course of hepatic vein confluence to right atrium caused by azygous continuation of inferior vena cava. Radiograph shows presence of right paraspinal soft tissues (arrows), which are oriented inferolaterally and are wider than adjacent pedicle.

View larger version (161K): [in a new window]   Fig. 6B. —15-year-old girl with abnormal course of hepatic vein confluence to right atrium caused by azygous continuation of inferior vena cava. Axial T1-weighted MR image (TR/TE, 869/16) shows confluence of hepatic veins (H) forming interface with aerated lung. Azygous continuation of inferior vena cava is evident by enlarged azygous vein (V). A = aorta.

View larger version (115K): [in a new window]   Fig. 7. —Nonvisualization of paravertebral soft tissues in 3-year-old boy. Radiograph shows no perceptible right or left paraspinal soft tissues.

View larger version (99K): [in a new window]   Fig. 8A. —Change in appearance of paraspinal soft tissue with different radiographic technique and patient positioning in 14-year-old girl. Radiograph obtained with anteroposterior technique and supine positioning shows left paraspinal soft tissues (arrows) as prominent with inferolateral orientation and width greater than adjacent pedicle.

View larger version (97K): [in a new window]   Fig. 8B. —Change in appearance of paraspinal soft tissue with different radiographic technique and patient positioning in 14-year-old girl. Radiograph obtained with posteroanterior technique and upright positioning shows resolution of prominence of left paraspinal soft tissues (arrows) with inferomedial course and minimal width, which is less than that of adjacent pedicle.

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