Diagnostics Radiology Exam 3 Flashcards
1
Q
• 40yo male in ED with Hx of right flank pain radiating to scrotum for 1 day and hematuria.
Pain came on gradually and is 10/10. Naturally, you suspect kidney stone.
Patient reports Hx of exploratory laparotomy following splenic rupture from MVC.
Patient reports subjective fever and has RLQ abdominal tenderness on exam.
Abdomen is soft. Patient refuses genitalia exam.
Blood work and UA does not show anything exciting. His BMI is 20.
What 2 imaging studies will cover all bases and exclude all most likely pathology in this patient?
A
CT abdomen and pelvis with IV and PO contrast
US scrotum and testes with duplex
2
Q
Thin patients need what kind of contrast for CT
A
IV due to low fat content
3
Q
Imaging for kidneys
A
Normal IVU (intravenous urogram) on KUB phase and horseshoe kidney on CT
CT with contrast is diagnostic imaging of choice in most GU imaging
4
Q
Imaging for renal disease
- Renal cysts
- Nephroureterolithiasis
- Polycystic renal disease
- Pyelonephritis
- Renal masses
A
CT abdomen and pelvis with and without IV contrast is study of choice
(With only in ER)
(couple of exceptions)
5
Q
Renal Parenchymal Disease (renal disease)
A
• Involves Cortex and Medulla
Renal Disease involving glomeruli, interstitium, tubules, and small blood vessels of the kidneys.
Could always start with US but CT with and without contrast is the study of choice
6
Q
Polycystic kidney disease may be similar to?
A
May have similar appearance to
malignancy
7
Q
Polycystic kidney disease vs malignancy
A
Polycystic kidney disease usually bi lateral
Malignancy usually unilateral
8
Q
Pyelonephritis can appear similar to?
A
Appears similar to Renal Cell Carcinoma or renal
lymphoma
9
Q
Blood in peritoneal space can mean?
A
Lacerated or fractured kidney
10
Q
Nephroureterolithiasis
A
Kidney Stones
Rule of thumb, anything under 5mm
passes
10% of ureterolithiasis cause no
hematuria
11
Q
Nephroureterolithiasis imaging
A
CT without contrast
Consider contrast if something else is suspected
12
Q
Nephroureterolithiasis when to use US
A
Young patient
Repeat visits with known stones
looking for obstructed stone, hydronephrosis or distended ureter.
If ureter is normal, probably not obstructed stone
13
Q
When to consider pheochromocytoma
A
if adrenal lesions and unexplained HTN
check vanillylmandelic acid levels
14
Q
Imaging for Adrenal Gland
A
CT or MRI are both suitable to image this pathology
15
Q
What do vanillylmandelic acid levels represent
A
Pheochromocytoma
16
Q
Causes of pre renal hematuria
A
Vascular trauma, septicemia, purpura hemorrhagica, hemophilia Renal Cell Carcinoma
17
Q
Causes of Post Renal hematuria
A
cystitis
urolithiasis
malignancy
fistula
18
Q
Causes of Renal hematuria
A
Acute Glomerular Nephritis,
renal infarct/embolism,
ATN
pyelonephritis
19
Q
What do you always consider in hematuria
A
smoking history
if hematuria and smoker, cancer until proven otherwise
20
Q
Painless hematuria
A
Cancer until proven otherwise
21
Q
IV pyelogram
A
Can show stones
phlebolith
hydro nephrosis
22
Q
Retrograde urethrogram
A
Inject the contrast through the meatus and travels into up urethra and into the bladder
Used to evaluate any flow problems
Usually done in pediatric or elderly populations
Can show prostatic hypertrophy
23
Q
Retrograde cystogram
A
Used to evaluate the anterior urethra
or
Bladder abnormalities
24
Q
What evaluates anterior urethra
A
Retrograde cystogram
25
Voiding cystourethrogram
Used to look at posterior urethra
Insert foley
infuse contrast straight into bladder,
remove foley
let them urinate and view the outflow
26
What evaluates posterior urethra
Voiding cystourethrogram
27
What can cause prolapse of the bladder
straining to urinate can cause prolapse when cystocele is present
28
Cystocele
Bladder herniation/diverticulum
Can be caused by straining to urinate
Seen with Voiding cystourethrogram
29
CT Urography
Can be ordered before any other tests to globally screen patient for renal and nonrenal abnormalities and explain symptoms
CT will have higher resolution and identify problems not found on Urography
30
Which study involves injection of contrast locally (not
intravenously) to evaluate for urologic abnormalities in a male patient?
1. Pelvic Ultrasound
2. Voiding Cystourethrogram
3. CT abdomen and pelvis with contrast
4. Intravenous Pyelogram
2. Voiding Cystourethrogram
31
What is the primary imaging method for the female
| pelvis
Ultrasound
Great for ovaries, pregnancy
A wide variety of benign pelvic conditions can be diagnosed with ultrasound including
ovariancysts
PID
endometriosis
benign tumors of the uterus (leiomyomas)
benign tumors of the ovaries (cystadenomas, cystic
teratomas)
MRI should be preferred if US is not definitive
32
How is Transabdominal pelvic ultrasound is performed
using the patient’s full bladder as an acoustic window
33
Is bladder better full or empty for transvaginal US
Empty
34
When is Transvaginal pelvic ultrasound specifically useful?
Visualization of small structures and is especially valuable in obstetrical imaging to depict first trimester development
diagnose ectopic pregnancy
Bladder is preferably empty
35
US • Hypoechoic
Tissues that do not reflect but absorb sound waves and therefore appear black (anechoic)
– Cysts, leiomyomas, fat
36
US • Hyperechoic
– Tissues that reflect sound waves and therefore appear white
– Renal stones, calcified lesions, teratomas, inflammatory change (PID), ectopic pregnancy
37
Are ovarian masses cystic, solid or complex?
All three
Ovarian masses may be cystic, solid, or complex.
38
What can show the flow to the ovary?
US with duplex
CT/MRI/ X-ray cannot show flow
39
What should you always order if you are considering torsion? (Ovary/Teste)
US duplex to show flow
40
Does absence of flow confirm torsion? (Ovary/Teste)
no
Flow may be intermittent or torsion may come and go
absence of flow does not rule out torsion
41
Leiomyomatous Disease
Uterine fibroid disease
large fibroids may need surgery
small fibroids may be managed with IR uterine artery embolization (cut off blood flow to fibroid)
42
What is helpful in staging pelvic malignancies
CT and MRI
MRI should be preferred if US is not definitive
43
Hysterosalpingogram (HSG)
outpatient OBGYN procedure
Contrast is injected up through the cervix
coats the uterus and is then expelled
NO barium (can cause peritonitis)
Abnormal will be unilateral or no extravasation out of uterus into peritoneal cavity.
Common in chlamydia
44
Hydorsalpinx
Dilation of the fallopian tubes
can be caused by ectopic pregnancy or other things
45
Obstetrical (fetal) imaging
US does not cause damage to fetus
(can raise temp if too long)
```
US can detect:
accurate date the pregnancy,
multiple pregnancies
monitor fetal growth
assess fetal wellbeing
fetal cardiac motion
fetal movements
```
46
Ectopic Pregnancy
Usually presents with abdominal pain and vaginal bleeding.
* + HCG test
* PID is a risk factor
47
What does post menopausal bleeding DDX always include?
Malignancy
48
Post menopausal bleeding Study of choice
Ultrasound
MRI should be preferred if US is not definitive
49
Endometrium measurements
Endometrium is thickened if
greater than 15mm in pre menopause
greater than 5mm in post menopause
50
scrotal imaging of choice
Ultrasound
due to:
general availability
low cost
high accuracy
utilization of nonionizing radiation.
51
US imaging in men can identify
```
inguinal hernias
testicular tumors
testicular torsion (Duplex)
testicular trauma
hydrocele
and many other conditions
```
MRI is alternative
52
Indications for US in men
acute testicular pain
palpable mass
scrotal swelling
53
How is the prostate evaluated
IVP (intravenous pyelogram)
US
CT
54
You are seeing a 16yo sexually active WM with complaints of RLQ abdominal pain radiating to right scrotum. No prior surgical history is reported. What study will be most important to order to screen for potential issues considering patients age?
1. CT abdomen and Pelvis with IV and Oral Contrast
2. CT abdomen and Pelvis without contrast
3. KUB
4. Ultrasound of scrotum and testes
4. Ultrasound of scrotum and testes
55
What imaging for men when looking for scrotal, testicular, penile cancer
MRI
56
Leading cause of non-preventable cancer death in
| women
Breast Cancer
57
How early can mammograms detect cancer
early at non palpable stage
58
Can Mammogram rule out cancer
Mammograms can rule in cancer
but
cannot rule it out
Cannot rule out cancer
59
Two types of Mammograms
Screening
used on asymptomatic women to detect unseen cancer
Diagnostic
Used to evaluate abnormal findings
60
Mammogram ages recommended annual screenings
over 50 should get bi annual screenings
(some say over 40)
American academy of oncologist recommend 40
61
Breast Imaging in Average Risk of Cancer
• Mammography is for patients older than 30 with a palpable breast mass
Ultrasound is for women younger than 30 with a palpable breast mass
30-39 could have either one
62
Negative Predictive Value
A value of combined mammography and sonography in patients with focal / diffuse breast pain but without highly suspicious exam findings is nearly 100%
63
Highly suspicious exam findings that warrant biopsy
Skin tethering
Peau d' orange (orange peal)
nipple inversion
axilla lymphadenitis
64
Mammography imaging views
mediolateral oblique (MLO)
craniocaudad (CC) view
Top boob, side boob
65
What imaging is used in augmented breasts (implants)
MRI
66
What imaging is used to detect implant leakage
Ultrasound
67
kVp and mAs in mammogram?
Low KVP
| High MAS
68
Breast Cancer Risk Factors
▪ Maternal relative with breast cancer
▪ Longer reproductive span
▪ Obesity
▪ Nulliparity
▪ Later age at pregnancy
▪ Atypical hyperplasia
▪ Previous breast or uterine cancer
69
What makes cancer easier or more difficult to see in the breast tissue
Fatty tissue is easier to see through than fibrocystic tissue or calcified tissue
70
BIRADS
Breast imaging reporting and Data system
5 types
```
Circumscribed
Obscured
Micro-lobulated
Ill-defined
Spiculated
```
71
BIRADS 5 types
```
Circumscribed
Obscured
Micro-lobulated
Ill-defined
Spiculated
```
72
BIRADS Categories
Category 0 (need more imaging)
Category 1 (negative)
Category 2 (Benign)
Category 3 (Probably benign)
Category 4 (suspicious)
Category 5 (Highly suggestive of cancer)
Category 6 (Known biopsy, proven cancer)
73
When is a mass almost always cnacer
Spiculated
74
Case:
You are seeing a middle-aged female with breast pain.
* Mammography shows an oval, isodense mass with obscured margins measuring 1 cm.
* Ultrasound shows a lobular, mixed echogenic mass with well-defined margins and no significant associated findings.
Diagnosis:
– Hematoma from seatbelt injury in MVA
– Additional history-taking raised the possibility of a seatbelt injury about 2 weeks prior to the examination. Clinical follow-up showed complete resolution after six months.
BIRADS doesn't apply here
75
Skin Calcification description
Skin calcifications have a typical lucent center and polygonal shape
76
Vascular Calcification description
Vascular calcifications can be seen as parallel tracks or linear tubular calcifications that run along a blood vessel.
77
Coarse or Popcorn-like Calcifications
Typically found in involuting fibroadenomas
Fibroadenomas usually regress with menopause
78
Rod-Shaped Calcifications
Typical of secretory disease but not of breast cancer
Usually >1mm, are occasionally branching, and may have lucent centers
79
Round Calcifications and Smooth round calcifications
Associated with a benign process
When <1mm they are often found in the acini of lobules
When <0.5mm the term punctate is used.
80
Spherical or Lucent Centered Calcifications
Spherical or lucent centered calcifications can range from <1mm to >1cm.
They may be found as debris collected in a duct, in areas of fat necrosis and Fibroadenomas.
81
When should MRI be done on breasts
• Should be done on a selective group of patients (including breast augmentation) with inconclusive evaluation of mammography identified noncalcified nonpalpable findings
82
What is the diagnostic study of choice for a palpable breast mass in a 23yo female?
1. Mammogram
2. Ultrasound
3. MRI
4. CT
2. Ultrasound
83
Why does MRI increase your chances of?
Biopsy
84
Standard skull View
AP or PA
Lateral
Oblique
Trauma views must include 2 views 90 degrees from each other so you can see all of the structures
i.e. Lateral and AP
85
Is there strong correlation between skull fracture and brain injury?
No
there is little correlation
X-ray not helpful for brain injury, need CT
86
What is the mainstay of emergent diagnostic neuro radiology?
CT
87
Best imaging for facial bones
CT (without contrast)
| anything but nasal bone, then x-ray
88
What is waters view, and what is it used for?
Skull x ray that looks at the air-fluid levels of the maxillary sinuses
Patient must be upright to evaluate air/fluid levels
89
Fuchs view
Fuchs view is used on patients who are in a a c collar and cannot open their mouths to evaluate the dens
Modified waters view is a fuchs view to look at dens
90
Sinus series
X ray use is limited
CT is better for sinuses
Patient must be upright
91
What imaging is for
Uncomplicated sinusitis
i.e. 3 days of sinus congestion and fever
does not require imaging for sinues
92
Sinus Submentovortex
Looks at Ethmoid and Sphenoid
sinuses from under patients' chin
CT is better
93
Nasal Bone Series
• Waters and Lateral views
excellent for just nasal bone
94
Mandible series
For mandible trauma, always look for a fracture in two places,
because ring-shaped structures, when they break, break in TWO places.
Hard to X ray due to its contours
and round shape.
PA Mandible, oblique use multiple views
CT is better
Panorex mandible (Dental)
95
Zygoma Fractures
2 major components:
▪ Zygomatic arch
▪ Zygomatic body
Caused by blunt trauma
▪ Arch fracture (most common)
▪ Tripod fracture (most serious)
96
Zygoma Tripod Fractures
– 1. Zygomatic arch
– 2. Zygomaticofrontal suture
– 3. Inferior orbital rim and floor
97
Orbital Blowout Fractures
Blunt Trauma (usually small like a fist or golf ball)
```
Periorbital tenderness,
swelling
ecchymosis
Enopthalmus
sunken eyes
```
SQ emphysema
CT
98
Le Fort Fracture
Type 1,2 or 3
– I: Maxilla fracture (floating palate)
– II: Maxilla, orbital rim and nasal bones
(floating maxilla)
– III: II+ zygomatic arch fracture (floating
face)
patient has a dish face appearance (flat face)
99
You are seeing a 75yo AAM in a c-collar following MVC where patient struck a steering wheel with his face. Airbags did not deploy. Exam shows entrapment of superior oblique muscle. You also note smell of ETOH from patient's breath. Exam of torso/abdomen and all extremities show no abnormalities. What combination of imaging studies should you order to rule out pathology?
1. CT Facial bones without contrast
2. CT Facial bones with contrast, CT Brain with contrast and CT C-Spine with
contrast
3. CT Orbit without contrast
4. CT Facial bones without contrast, CT Brain without contrast and CT C-Spine
without contrast
```
4.
CT Facial bones without contrast,
CT Brain without contrast
and
CT C-Spine without contrast
```
No contrast to look at bones
No contrast when looking at brain (bleeding will look like contrast)
100
Thyroid Imaging
Ultrasound
combine with TSH (Lab)
Benign tumors are more likely (Thyroid Adenomas or cysts)
US will identify the blood flow
Nodules that appear unstable will require aspiration
101
TI-RADS
TR1 = 0 (benign)
TR2 = 2 (not suspicious)
TR3 = 3 (Mildly suspicious) (1.5-2.5cmm-)
TR4 = 4-6 ( moderately suspicious) (1-1.5cm)
TR5 = 7 & up( Highly suspicious) (0.5 cm & up)
102
Parathyroid Imaging
Nuclear PTH Tc-99m Sestamibi
Study of choice if US is inconclusive
(correlates with calcium)
103
Primary vs secondary headaches
Primary headaches have no cause
secondary headaches have an underlying issue
104
Imaging for primary headache?
No imaging if no red flags
i.e. worst, thunderclap, trauma, etc.
CT if reason
105
Sensitivity percentage to rule out bleeding in head trauma
A CT is 58% sensitive for infarction within the first 24 hours.
MRI is 82% sensitive.
If the patient is imaged greater than 24 hours after the event, both CT and MR are greater than 90% sensitive
106
CT brain is usually combined with what?
CT Brain usually combined with CT C-Spine,
both without contrast,
and are imaging modalities of choice in a trauma patient.
107
Basic CT interpretation
Check the name and the date
Scout film
Window width (bone or soft tissue)
Imaging plane
Radiologic images are simply black or white images where abnormalities can be described as:
too white, too black, too large, wrong place
108
Brain CT colors
White matter will appear darker on CT
CSF in the ventricles and subarachnoid space appears black
Gray matter appears gray
Acute hemorrhage will appear white
IV contrast, vascular structures appear white
109
On brain CT Acute hemorrhage will appear?
white
110
On brain CT CSF in the ventricles and subarachnoid space appears?
black
111
On brain CT IV contrast, vascular structures appear?
White
112
Brain CT Key Concepts
1. The X (base of skull)
2. The Star
3. The Happy Face
4. The Sad Face
5. The Worms
6. The Coffee Bean
113
Brain CT Key Concepts
The X
Base of skull
114
Brain CT Key Concepts
The Happy face
Ventricles
115
Brain CT Key Concepts
The Sad Face
Ventricles
Choroid plexus
116
Brain CT Key Concepts
The Worms
The Worms
Ventricles, great for looking at midline shift
117
Brain CT Key Concepts
The Coffee Bean
Coffee bean is top of cerebral cortex
118
Subarachnoid hemorrhage
Blood in CSF
aneurysm or trauma
119
Intraventricular hemorrhage
seen in trauma or hypertensive issues
Frequently have subarachnoid bleeds as well
120
Epidural Hematoma
Football sign
middle meningeal artery(origin)
LOC, brain herniation, delerium (lucid)
121
Football sign
Epidural Hematoma
middle meningeal artery(origin)
122
Subdural Hematoma
crescent-shaped lesion on CT Scan
Usually a venous origin
can occur very slowly hours/days
alcoholic/elderly/under 2
123
Hemorrhagic Stroke
Account for 16% of all strokes
Appear white on CT (blood)
Can stem from berry aneurisms, drug abuse, HTN or coagulopathy
124
Ischemic Stroke
Reduced blood flow to area of stroke
absence of hemorrhage, not bright white
greyish, darker discoloration
Non-contrast CT
125
Brain Tumors
Present with a focal neurological deficit, seizure, or headache.
Slow growers, not acute
Can be confused with ischemic or hemorrhagic strokes
Correlate clinically to diagnose
126
Extra-axial empyema
* 50% are from frontal sinusitis
* 30% are post-craniotomy
* Rest are infectious – meningitis
enhancing rim (crescent shape along frontal skull)
127
Cerebral abscess
HIV patients mostly
also
lymphoma or
toxoplasmosis
128
Meningitis
fever, headache and neck pain
petechia
MRI brain with and without contrast is the study of choice
129
Alzheimer's
Affects >65% of patients with known dementia
Caused by neuronal degeneration from amyloid precursor protein
See marked diffuse atrophy of brain mass, enlarged lateral ventricles and widened Sulci on CT
MRI is more sensitive
130
Parkinsons
loss of neuromelanin containing dopaminergic neurons
Triad of bradykinesia and hypokinesia, resting tremor
CT similar to Alzheimer's
MRI more sensitive
131
Huntingtons
Triad of choreoathetoid movements, behavioral disturbances, and progressive dementia
Genetic
significant brain mass loss and atrophy
• MRI is more sensitive
132
Picks Disease
Third most common cause of dementia
– After Alzheimers and Lewy body
Tau-protein degeneration causing atrophy of tissue
• MRI is more sensitive
133
MS
Dawson fingers is diagnostic for MS
MRI brain with & without contrast is best
• Middle-aged women with monocular vision loss
134
You are evaluating a 90yo male with sudden onset
of facial droop and right arm weakness. You obtain a
CT scan but the connection to remote radiologist is
lost and he cannot read the CT. Your attending is in a
code. You review the CT scan and see this-->
Would the patient be a candidate for
tPA/anticoagulation therapy assuming he meets all
the criteria?
1. Yes
2. No
2. No
huge bleed
135
Carotid Screening
typically 55 and up (40 if risk factors)
Can differentiate between Calcified plaque, soft plaque
Ultrasound (doppler)
136
MR Angiography
MRA great for people with kidney problems
Gadolinium
great for neurovasculization
image blood vessels of patients in renal failure
137
Conscious sedation NPO for how long
8 hours
138
Interventional Neuroradiology
great for two conditions
cerebral aneurysms
cerebral arteriovenous malformations
139
Transcatheter embolization
Great for aneurysms
occlude vessel to prevent rupture or bleed
140
Macaroni sign
concentric thickening of aortic wall
141
Bleeding
– Intraperitoneal will require laparotomy
– Extraperitoneal areas you can inject gel foam slurry or metallic coils into affected vessels
• In this case femoral artery
142
temporary percutaneous nephrostomy tube
Tube through the skin into the renal pelvis to drain the urine
Done with US or Fluoroscopy
143
```
Virtual Endoscopy
Virtual Colonoscopy (CT colonoscopy)
Virtual Bronchoscopy (CT Bronchoscopy)
```
three-dimensional computer models
data combined from ct scans
less expensive, noninvasive examination
no reactions, perforations
Used for low risk
144
Colon cancer
third leading cause of cancer deaths in both men and women in the United States
145
3D ultrasound
Most commonly used today in obstetrical imaging
3D ultrasound can enhance the visualization of uterine polyps, uterine fibroids, and congenital uterine abnormalities
146
PET (Positron Emission Tomography)
Cancer cells require a great deal of sugar (glucose)
uses flourine molecule that tags the glucose
This then accumulates in malignant cells
Shows up on PET scan
147
Fusion imaging
PET and CT scan combined
PET can see cancer CT cannot, CT can pinpoint where it is.
148
What is PET or PET-CT used for?
1. Detection of primary tumors or metastases to lymph nodes or other organs.
2. Detection of decreased blood flow to heart muscle.
149
Pediatric imaging
least amount of radiation
1 day old to 1 year don’t move much
over 4 years are usually cooperative
1 to 3 usually need to be restrained for x-ray
sedated for MRI or CT
150
Most Common Pediatric pathology
* Croup and epiglottitis
* Viral pneumonia
* Bronchitis
* Cystic fibrosis
* Foreign bodies
* Retropharyngeal abscess
151
Pediatric foreign body imaging
Nose to anus in 1 view
152
Croup
Causes acute airway obstruction;
caused by influenza and parainfluenza viruses
6 months -3 years
Steeple sign (inverted "V") just below larynx
153
Epiglottitis
Hemophilus influenza
much more dangerous(life threatening) than croup
film must be taken upright
lateral soft tissue neck film
marked enlargement of the epiglottis, and thickening of the surrounding tissues
"thumb sign"
154
Airway abscess
Can be peritonsillar or retropharyngeal
CT neck (NOT cervical) with contrast preferred
present with fever, difficulty swallowing & lymphadenitis
155
Pneumonia
```
Chest films show
thickening of the bronchial wall,
hyperaeration,
and
increased lung markings
```
156
Bronchiolitis Age
occurs in infants (less than 1 year old),
157
Bronchitis Age
in toddlers and children
158
Bronchitis VS Bronchiolitis ages
Bronchiolitis occurs in infants
(less than 1 year old), (under 3 per Sereda)
bronchitis
in toddlers and children
159
Round Pneumonia
Not typical after about 8 years old
can be confused with a mass
antibiotics, repeat x-ray 7-10 days
160
Cystic Fibrosis
Chest film may be normal
present with chronic cough
repeated pneumonia, bronchitis
old children may have scarring
Pseudomonas
161
Abdominal Masses in Infants and Children
Almost half of the abdominal masses in children are renal (kidney)
most of these are benign
Hydronephrosis is the most common cause of neonatal abdominal mass
in older infants/children
22% are wilms tumor, hydronephrosis 20%
Ultrasound is study of choice
162
You are evaluating a 5yo male child with
complaints of cough and shortness of breath.
You note musical sounds from upper airway
and decide to order a neck xray. On the
image you see this--->
What is the most likely pathogen involved?
1. Ricketsia ricketsii
2. Parainfluenza
3. Plasmodium vivax
4. Hemophilus influenza
2. Parainfluenza
Steeple sign
Influenza and para influenza are causes of croup
163
Best imaging to evaluate normal healing progression of fractures
Plain x-ray evaluation is the GOLD STANDARD
* Inflammatory phase: 1-4 days (shows a radiolucent fracture line)
* Reparative phase: 1-3 weeks (shows callus formation, slight widening of the fracture line)
* Remodeling phase: 3-4 weeks
164
Why do pediatric fractures differ from adult fractures
young bones are more pliable than older ones related to calcium content.
165
Child Abuse
| imaging signs
healing fractures of various stages
fractures at the edges of the metaphysis
epiphyseal and metaphyseal fractures
posterior rib fractures
compression fractures of the vertebral bodies
166
Common child abuse fx's
Torus fracture (aka “buckle” fracture)
Bowing Fracture
Greenstick Fracture
167
```
If suspected child abuse
Skeletal survey (x-rays)
```
1. AP and Lat skull
2. AP views of the chest, abdomen, and pelvis
3. AP views of all the long bones of the extremities, including the hands and feet
4. You may need a CT head depending on other injuries
168
The vast majority of Child Abuse fractures occur in patients aged?
under 3 years of age, and half of them are in infants.
extremity fractures are most common
169
metaphyseal lesion
The metaphyseal lesion of child abuse is virtually pathognomonic
The fracture extends transversely across the extreme end of the metaphysis
may appear as a chip fracture
(secondary to pulling extremity)
170
Diaphyseal spiral fractures
highly suggestive of abuse,
especially in the non-ambulatory child
171
Transverse long bone fractures
have a high specificity for child abuse
172
Rib fractures
Rib fractures are highly suggestive of child abuse
– Seen in excessive squeezing
Rib fractures are practically never seen after resuscitative efforts in children
Nuclear medicine bone scans are ideal for detecting rib fractures
173
Calluses on ribs
Can be seen in Shaken Baby Syndrome
174
Fractures of the sternum and spinous processes of the spine
A high specificity for child abuse
175
The most common cause of death from child abuse
trauma to the head
176
• A linear skull fracture
not highly suggestive of child abuse
the level of suspicion should increase with complex skull fractures
177
A frequent site of abusive trauma,
| particularly after the child becomes ambulatory?
• The abdomen
178
The most common abdominal injury seen in child abuse
Intramural hematoma of the duodenum
Laceration of the liver and pancreas are also common
179
You are seeing a 3yo WM in the ER with leg pain. Father reports that patient slid off the lazy boy and fell under the chair which is the only mechanism of injury. XR reveals midshaft femur fracture. What should be the next step?
1. Try to investigate further and confront the father
2. Call the Department of Children and Family Services
3. Splint the patient and discharge home
4. Call mother to confirm
2. Call the Department of Children and Family Services
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hi
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