Lecture Day 2 Paediatric Radiology Flashcards
Why is imagining children difference
Range of body sight different spectrums of disease normal development & developmental variation radiation protection movement sedation/GA dealing with parents non accidental injury
Why are children more sensitive to radiation
a whole life to manifest changes
developing tissue are more radiosensitive
same parameters, child will get greater radiation dose
radiation dose is cumulative over lifetime.
How many how many times greater is a dose for a abdo CT than an x-ray
250.
Have caution when referring for CT.
How to minimise radiation risk
- only image if there is clear medical benefit
- obtain outside images
- use alternative imaging modality
- use lowest dose for adequate images
- only image indicated areas
- avoid multiple scams
When is CT used?
What must the child do?
- Staging malgnancy, emergency, lung parenchyma
- Stay still & hold breath
- high dose
What is fluoroscopy used for
What interventions can be done
obtain functional/dynamic images, contrast study of GI & urinary tracy
Placement for metal work & lines & insertion of catheters.
Ultrasound:
- main benefit
- whats the resolution
- what are other benefits
- no radiation, first line imaging in children
- high resolution in children
- information on blood flow, easily repeated
What is nuclear medicine
- main benefit
- radiation dose
- use
isotope injected into body, radiation emitted observed with gamma
- functional images
- amount of dose varies, but can be high
- bone growth, excretion from kidney
MRI
- Main benefit
- problem in children
- no ionising radiation & high contrast resolution
- long examination time (30-90 mins) children must be still
- claustrophobia, movement artefact, sedition/GA, contrast administration, breath hold
When GA required
Long examinations
MR < 6 yrs
CT < 3yrs
Risks of GA vs. radiation vs. expected benefit
cost, manpower (anaesthetist, OTA, radiographer, radiologist), time on scanner
alternatives? e.g. ultrasound
Vomiting child, what would you like to know?
Age? A.S? Bilious or non-bilious? Examination findings? What imaging?
Causes of vomiting
GORD
Pyloric stenosis
Malrotation with volvulus
bowel obstruction (congenital)
How does GORD present
recurrent vomit after feeds, non-bilious, crying & difficult sleep
How to test for GORD
Contrast swallow + tracheal aspiration, pH probe
How does pyloric stenosis present
2-8 weeks, vomiting after feed
weight loss, metabolic alkalosis
Investigations
US, shows thicken pylorus
How does malrotations of volvulus present
young child, green bilious vomit, abnormal fixation of small bowel mesentery making it prone to twisting
Investigation
Upper GI study shows corkscrew appearance
Surgical emergency
Bowel obstruction presentation
Infants, bilious vomiting
abdominal distentension
double bubble (duodenal atresia)
Investigations
AXR to evaluate level of obstruction
Causes of abdo pain
Intussusception
appendicitis
ovarian cyst
Intussusception
3 months - 1 month
seasonal after viral
invagination of proximal bowel into distal (lead-point in older children)
Investigation & Tx
US: mass with donut appearance
Tx: Air enema radiation
Should you do x-ray
no
could colon filling defect in colon or normal
appendicitis
older children
periembilical pain migrating to RIF, nausea, vomiting, fever
investigation
- US: non-compressible blind ending structure > 6mm
US!!!!!
- AXR: appendicloth - not helpful
ovarian cyst
Girls
Lower abdo pain, RIF pain
most cyst are physiological
Investigate
US + repeat after 6 weeks to ensure resolution of cyst
avoid unnecessary operation
Causes of breathless child
Chest infection Foreign body aspiration asthma CF Tumour
chest infection
clinical unwell, fever, sputum
investigation & Tx
CRX: consolidation, air bronchograms, silhouette sign
Tx: AB
Viral pneumonia
fluffyness in hilar and upper lobe
bronchopneumonia
more central pneumonia
Recurrent chest infections
Underlying causes?
- aspiration seizires
- Myotonic dystrophy (no cough)
- Achalasia
- Vascular ring
- CF
Foreign body aspiration
Lodges in bronchus
Investigation
CRX: asymmetric lung volumes, hyperinflation
asthma, why CXR
Looking for complications not diagnosis
overinflation, collapse due to mucous plucking or pneumorax
CF
Recessive, muscle build up leads to recurrent infections (atypical)
- poor growth, infertile, meconium ileus, diabetes
CXR
upper lobe bronchiectasis
brochial thickening, infection, central lines
Tumour
rare in children, tracheal deviation or obstruction
which is the most common cancer
neuroblastoma
What investigation
CXR & CT
When to image with child with UTI
atypical
recurrent ui
children < 6 months
What imaging can you use
US
MCUG (assess reflux)
DMSA (assess scaring)
What is vesicoureteric reflux
retrograde flow of urine from bladder to under, associated with pyelonephritis, scanning
DMSA scan or MCUG ( contras outlines ureters & renal collecting systems)
Posterior urethral valves
chronic obstruction due to fold in urethra
- only males (young)
- clinical: sepsis, uti, abnormal voiding
imaginge: US mCUG
Tx: endoscopic valve resection
PUJ obstruction
obstruction to urine at ureteropelvic junction
- antenatal dilatation, UTI, abdo pain
Imaging: US dilated renal pelvis but not ureter
- MAG 3 venogram
Limping child
Developmental hip dysplasia Hip effusion parthes disease slipped capital femoral epiphysis non accidental injury
Developmental hip dysplasia
- what is it
- who is screened at 6 weeks
- how is the screening done
- what happens if its left untreated
abnormal position of the femoral head relative to acetabulum, US at 6 weeks at risk group (Fhx, breech)
If untreated: limping, leg shortening, degeneration AVB
Hip effusion
- what is it
- what normal proceeds it
- whats an import D.D to exclude
- How to detect it
Cause synovitis or infection
Transient synovitis is common in children after viral infection but child is systemically well
Caution: septic arthritis: fever, systemic symptoms, pain
US to detect effusion
Perthes disease
- what is it
- what age does it present in
- what does it look like on X-Ray
idiopathic avascular necrosis/infarction of hip
age: 5-8 yrs
13% bilateral
image: fragmented flatterened femoral head
slipped capital femoral epiphysis
- what is it
- what age does it present in
- how does it present clinically
- who is it at high risk
- describe the x ray
teenager: idiopathic fracture through the proximal growth plate
Age: 12-15 years
Clinically: hip pain bur can be referred to knee
↑ in obesity & steroids
bilateral in 1/3
non accidental injury
abuse at any age
