Pediatric Radiology Quizes

Chest cases

Case 1: Chest

• This is a 6-week old male infant. His parents brought him to the E.D. because of coughing and congestion.

The upper mediastinum shows the usual prominent thymus for this age.

Impression: Normal Chest x-ray

Case 2: Chest

• 15-month old male with fever, coughing, and tachypnea

Bilateral central pulmonary infiltrates, but most markedin the right middle and left lower lobes.

Impression: Right middle and left lower lobe infiltrates

Case 3: Chest

• 3 year old female complaining of coughing and difficulty breathing.

No infiltrates are noted. The right side is morelucent (darker)compared to the left. The right hemidiaphragm is slightly higher than the left, however it should be higher than this.

Impression: Right sided hyperexpansion

• More clinical history …. she was jumping on a bed while eating some food , when she began choking.

• Bronchoscopy revealed bilateral bronchial peanut fragment foreign bodies

Case 4: Chest

• A 3-month old female with fever and coughing.

There is a faintly visible infiltrate in the rightupper lobe. Subtle findings may be more difficultto appreciate on dark films.

Impression: Right upper lobe infiltrate.

Case 5: Chest

• This is an 11-year old female with a history of fever and coughing for 5 days.

There is a patchy infiltrate at the left lung base.This is seen on the lateral view obliquely over theheart and on the PA view as haziness in the left lower lung.

Patchy area of consolidation at the left lung base.

The prominence of the right perihilar region is probably due to rotation. Note the asymmetry of the spinal column and the ribs. This rotation exposes more of the right hilum in the radiograph, making it appear more prominent.

Case 6: Chest

• This is a 9-year old male with a history of fever, headache, nausea, and coughing.

There is a circular density in the right lung. This is the superior segment of the right lower lobe. Although this has the appearance of a mass, it is most likely an infectious process.

Spherical consolidation in the right lower lobe (round pneumonia).

Case 7 :

• 5 years old patient C/O stridor.

Epiglottitis

MSK cases

Case 7:

• This is a 10-year old male who presents to the acute care clinic with a two week history of right thigh and knee pain.

• He states that the pain is mainly in his thigh (points to his upper thigh) but radiates down to his knee.

His hip radiographs show a slipped capital femoral epiphysis on the right

Some cases of SCFE are very obvious.

SCFE

• In subtle cases, the epiphyseal plate (physis) may be widened or irregular compared to the normal side

• In other subtle cases, the physis may appear to be thinner than the normal side

Case 8: elbow

• 3 yr male with complaints of right elbow pain after falling off bed while jumping.

C-R-I-T-O-E

• The mnemonic of the order of appearance of the individual ossification centers is C-R-I-T-O-E: Capitellum, Radial head, Internal (medial) epicondyle, Trochlea, Olecranon, External (lateral) epicondyle.

• The ages at which these ossification centers appear are highly variable, but as a general guide, remember 1-3-5-7-9-11 years.

C – R – I – T – 0 - E

1 – 3 – 5 – 7 – 9 - 11

Knowing the C-R-I-T-O-E mnemonic is helpful in determining whether a small piece of bone about the elbow joint represents an avulsion fragment or an ossification center.

cr

c

r

Both anterior fad pad (with sail sign) and posterior fat pads are present.

Rule :No visible fracture. Possible radial head fracture

Case 9:

• 14-year old male with an ankle injury.

AP, mortise, and lateral views are displayed. There is a vertical lucency through the distal tibial epiphysis extending from the physis to the mortise joint space.

Salter Harris Type III fracture of the distal tibia.

Tillaux Fracture

Case 10:

• This is a 3-year old female who sustained an inversion injury while running downhill. She is limping and has tenderness over her lateral malleolus.

There are no definite bony abnormalities seen on these radiographs

• On closer examination, her pain is mostly over the fibular physis rather than the tip of the fibula. Because of this, she is suspected as having a Salter Harris Type I fracture through the fibular physis.

Case 11:

• This is a 4 year old female who presents to the emergency department with a forearm injury after falling off the jungle gym (playground bars) at the park. Her mother noted that her forearm was deformed and she was complaining of persistent pain. She denies trauma or pain elsewhere.

Radiographs of her left forearm

Although there is an obvious deformity of her forearm on exam,no fracture is evident here. Her elbow does not demonstrate a joint effusion and her radial head is of normal contour and iswell aligned with the capitellum

Note the curvature of the ulna which is excessive. This represents a "bowing fracture" of the ulna.

View comparison of the other forearm.

Arrows point to the bowing deformity of the ulna.

Case 12:

• A 16 year old girl presents with increasing knee pain and posterior swelling.

Impression: Osteosarcoma

Bone is visible within the mass which has elevated the periosteum of both anterior and posterior cortices of the distal femur

(Normal knee)

Case 13:

• A 2 year old boy falls out of bed and afterward refuses to use his right hand.

Impression: There is a buckle fracture of both the distal radius and ulna. The fractures are not displaced.

Case 14:

• This is a 6-year old male who presents with a chief complaint of a limp which began 6 months ago.

The right hip (left on the image) shows widening of the joint space. The femoral epiphysis is fragmented and flattened. The physis appears narrow. The femoral neck is short and wide (Coxa magna). There is flattening of the femoral capitellum (Coxa plana).

Impression: Avascular necrosis (AVN) of the femoral head may be idiopathic (Legg-Calve-Perthe's Disease) or due to some insult to the vascular supply of the femur.

• Eponyms for Osteochondroses (Avascular Necrosis)

• Adams Disease -- avascular necrosis (AVN) of the medial epicondyle of the humerus

• Ahlback Disease -- spontaneous avascular necrosis (AVN) of the femoral condyle in adults

• Breck Disease-- AVN of the medial malleolus• Chandler Disease -- Idiopathic AVN of the

femoral head in adult Diaz Disease -- AVN of the talus

• Freiberg Infraction -- avascular necrosis (AVN) of the head of the 2nd or 3rd metatarsal

• Iselin Disease -- AVN of base of 5th metatarsal apohysis in children

• Keinbock Disease -- AVN of carpal lunate• Kohler Disease -- (AKA Mueller-Weiss Syndrome) -- AVN of tarsal

navicular• LaNec Disease -- AVN of ischiopubic synchondrosis• Madelung Disease-- AVN of distal radial epihysis• Osgood-Schlatter Disease -- AVN of the tibial tubercle• Panner Disease -- AVN of capitellum of the humerus• Perthe Disease -- (Legg-Calve-Perthe Disease) -- AVN of femoral

head in a child; idiopathic AVN of the femoral head in adult =Chandler Disease

• Scheuermann Disease -- AVN of the ring epiphyses of the spine• Sever Disease -- AVN of the calcaneus• Sindig-Larsen-Johanssen Disease -- AVN of distal pole of patella• Theeman Disease-- AVN of phalangeal epiphysis