Ectopic cervical thymus: Recognising the characteristic 'embroidery yarn' appearance on ultrasound.

Introduction: The thymus normally forms in the neck from the third pharyngeal pouch and descends to its normal position in the mediastinum. Arrest of descent or sequestration of thymic tissue can occur at any point along its path leading to an ectopic thymus which can present as a neck mass, usually in the paediatric age group. Purpose and Case Report: Ultrasound is generally performed in the presence of a neck mass in children. Although a characteristic 'starry sky' appearance of the thymus has been described on ultrasound, it is not considered sufficiently specific and cross-sectional imaging with magnetic resonance imaging is usually performed. On magnetic resonance imaging, the ectopic thymus appears as a homogeneous T1 isointense and T2 hyperintense mass and may actually appear ominous due to the tendency of ectopic thymus to sometimes show diffusion restriction unlike the normal thymus. Subsequent invasive biopsy or surgical removal is usually necessary to rule out a neoplastic lesion. In our observation, the ultrasound appearance of thymus is sufficiently distinctive to be confidently diagnosed as ectopic thymic tissue. This appearance is similar to the high-resolution appearance of an embroidery yarn. The reason most radiologists are not aware of the same is because the normal mediastinal thymus is not usually imaged by ultrasound. Conclusion: An accurate diagnosis on ultrasound would mean avoidance of expensive cross-sectional imaging and invasive biopsy or surgical excision in favour of regular non-invasive follow-up ultrasound scans until the lesion involutes in late childhood.

Collapse or distention of the perioptic space in children - What does it mean to pediatric radiologists? Comprehensive review of perioptic space evaluation.

The perioptic space comprises the subarachnoid space [SAS] of the optic nerve communicating with the SAS of the central nervous system. Pressure variations in the SAS of the central nervous system can be transmitted to the optic papilla through the perioptic space. Variations in the diameter of the perioptic space serve as an important indicator for select intracranial pathologies in the pediatric population. Though the perioptic space can be evaluated using various imaging modalities, MRI is considered highly effective due to its superior soft tissue resolution. With advancement in MR imaging techniques, high-resolution images of the orbits can provide improved visualization of the perioptic space. It is imperative for the pediatric radiologist to routinely assess the perioptic space on brain and orbit MR imaging, as it can prompt exploration for additional features associated with select intracranial pathologies, thus improving diagnostic accuracy. This article reviews basic anatomy of the perioptic space, current understanding of the CSF dynamics between the perioptic space and central nervous system SAS, various imaging modalities utilized in the assessment of the perioptic space, MRI sequences and the optimal parameters of specific sequences, normal appearance of the perioptic space on MR imaging, and various common pediatric pathologies which cause alteration in the perioptic space.