Pediatric radiology quizes chest and msk


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Pediatric radiology quizes chest and msk

  1. 1. Pediatric Radiology Quizes
  2. 2. Chest cases
  3. 3. Case 1: Chest• This is a 6-week old male infant. His parents brought him to the E.D. because of coughing and congestion.
  4. 4. The upper mediastinum shows the usual prominentthymus for this age. Impression: Normal Chest x-ray
  5. 5. Case 2: Chest• 15-month old male with fever, coughing, and tachypnea
  6. 6. Bilateral central pulmonary infiltrates, but most marked in the right middle and left lower lobes.Impression: Right middle and left lower lobe infiltrates
  7. 7. Case 3: Chest• 3 year old female complaining of coughing and difficulty breathing.
  8. 8. No infiltrates are noted. The right side is more lucent (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
  9. 9. • 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
  10. 10. Case 4: Chest• A 3-month old female with fever and coughing.
  11. 11. 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.
  12. 12. Case 5: Chest• This is an 11-year old female with a history of fever and coughing for 5 days.
  13. 13. There is a patchy infiltrate at the left lung base. This is seen on the lateral view obliquely over the heart and on the PA view as haziness in the left lower lung.Patchy area of consolidation at the left lung base.
  14. 14. The prominence of the right perihilar region is probablydue to rotation. Note the asymmetry of the spinal columnand the ribs. This rotation exposes more of the right hilumn the radiograph, making it appear more prominent.
  15. 15. Case 6: Chest• This is a 9-year old male with a history of fever, headache, nausea, and coughing.
  16. 16. There is a circular density in the right lung. This isthe superior segment of the right lower lobe. Althoughthis has the appearance of a mass, it is most likely aninfectious process. Spherical consolidation in the right lower lobe (round pneumonia).
  17. 17. Case 7 :• 5 years old patient C/O stridor.
  18. 18. Epiglottitis
  19. 19. MSK cases
  20. 20. 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.
  21. 21. His hip radiographs show a slipped capitalfemoral epiphysis on the right
  22. 22. Some cases of SCFE are very obvious.
  23. 23. 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
  24. 24. Case 8: elbow• 3 yr male with complaints of right elbow pain after falling off bed while jumping.
  25. 25. 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.
  26. 26. C–R–I–T–0-E 1 – 3 – 5 – 7 – 9 - 11Knowing the C-R-I-T-O-E mnemonic is helpful in determiningwhether a small piece of bone about the elbow joint represents anavulsion fragment or an ossification center.
  27. 27. c rc r
  28. 28. Both anterior fad pad (with sail sign) and posterior fat pads are present.Rule :No visible fracture. Possible radial head fracture
  29. 29. Case 9:• 14-year old male with an ankle injury.
  30. 30. mortise, and lateral views are displayed. There is a verticency through the distal tibial epiphysis extending from the sis to the mortise joint space. Salter Harris Type III fracture of the distal tibia. Tillaux Fracture
  31. 31. 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.
  32. 32. are no definite bony abnormalities seen on these radiogra
  33. 33. • 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.
  34. 34. 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.
  35. 35. Radiographs of her left forearm
  36. 36. 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 is well aligned with the capitellumNote the curvature of the ulna which is excessive. This representsa "bowing fracture" of the ulna.
  37. 37. View comparison of the other forearm.
  38. 38. Arrows point to the bowing deformity of the ulna.
  39. 39. Case 12:• A 16 year old girl presents with increasing knee pain and posterior swelling.
  40. 40. Bone is visible within the mass which has elevated the periosteumof both anterior and posterior cortices of the distal femur (Normal knee) Impression: Osteosarcoma
  41. 41. Case 13:• A 2 year old boy falls out of bed and afterward refuses to use his right hand.
  42. 42. Impression: There is a buckle fracture of both the distalradius and ulna. The fractures are not displaced.
  43. 43. Case 14:• This is a 6-year old male who presents with a chief complaint of a limp which began 6 months ago.
  44. 44. he right hip (left on the image) shows widening of theint space. The femoral epiphysis is fragmented and flattehe physis appears narrow. The femoral neck is short and de (Coxa magna). There is flattening of the femoralpitellum (Coxa plana).
  45. 45. Impression: Avascular necrosis (AVN) of the femoral headmay be idiopathic (Legg-Calve-Perthes Disease) or due tosome insult to the vascular supply of the femur.
  46. 46. • 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
  47. 47. • 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