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Paeds > Lecture Day 2 Paediatric Radiology > Flashcards

Lecture Day 2 Paediatric Radiology Flashcards

1
Q

Why is imagining children difference

A 
Range of body sight 
different spectrums of disease 
normal development & developmental variation
radiation protection
movement 
sedation/GA
dealing with parents
non accidental injury
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2
Q

Why are children more sensitive to radiation

A

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.

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3
Q

How many how many times greater is a dose for a abdo CT than an x-ray

A

250.

Have caution when referring for CT.

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4
Q

How to minimise radiation risk

A
  • 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
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5
Q

When is CT used?

What must the child do?

A
  • Staging malgnancy, emergency, lung parenchyma
  • Stay still & hold breath
  • high dose
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6
Q

What is fluoroscopy used for

What interventions can be done

A

obtain functional/dynamic images, contrast study of GI & urinary tracy

Placement for metal work & lines & insertion of catheters.

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7
Q

Ultrasound:

  • main benefit
  • whats the resolution
  • what are other benefits
A
  • no radiation, first line imaging in children
  • high resolution in children
  • information on blood flow, easily repeated
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8
Q

What is nuclear medicine

  • main benefit
  • radiation dose
  • use
A

isotope injected into body, radiation emitted observed with gamma

  • functional images
  • amount of dose varies, but can be high
  • bone growth, excretion from kidney
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9
Q

MRI

  • Main benefit
  • problem in children
A
  • 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
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10
Q

When GA required

A

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

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11
Q

Vomiting child, what would you like to know?

A 
Age?
A.S?
Bilious or non-bilious?
Examination findings?
What imaging?
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12
Q

Causes of vomiting

A

GORD
Pyloric stenosis
Malrotation with volvulus
bowel obstruction (congenital)

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13
Q

How does GORD present

A

recurrent vomit after feeds, non-bilious, crying & difficult sleep

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14
Q

How to test for GORD

A

Contrast swallow + tracheal aspiration, pH probe

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15
Q

How does pyloric stenosis present

A

2-8 weeks, vomiting after feed

weight loss, metabolic alkalosis

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16
Q

Investigations

A

US, shows thicken pylorus

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17
Q

How does malrotations of volvulus present

A

young child, green bilious vomit, abnormal fixation of small bowel mesentery making it prone to twisting

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18
Q

Investigation

A

Upper GI study shows corkscrew appearance

Surgical emergency

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19
Q

Bowel obstruction presentation

A

Infants, bilious vomiting
abdominal distentension

double bubble (duodenal atresia)

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20
Q

Investigations

A

AXR to evaluate level of obstruction

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21
Q

Causes of abdo pain

A

Intussusception
appendicitis
ovarian cyst

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22
Q

Intussusception

A

3 months - 1 month
seasonal after viral
invagination of proximal bowel into distal (lead-point in older children)

23
Q

Investigation & Tx

A

US: mass with donut appearance
Tx: Air enema radiation

24
Q

Should you do x-ray

A

no

could colon filling defect in colon or normal

25
Q

appendicitis

A

older children

periembilical pain migrating to RIF, nausea, vomiting, fever

26
Q

investigation

A
  1. US: non-compressible blind ending structure > 6mm

US!!!!!

  1. AXR: appendicloth - not helpful
27
Q

ovarian cyst

A

Girls
Lower abdo pain, RIF pain
most cyst are physiological

28
Q

Investigate

A

US + repeat after 6 weeks to ensure resolution of cyst

avoid unnecessary operation

29
Q

Causes of breathless child

A 
Chest infection
Foreign body aspiration
asthma
CF
Tumour
30
Q

chest infection

A

clinical unwell, fever, sputum

31
Q

investigation & Tx

A

CRX: consolidation, air bronchograms, silhouette sign

Tx: AB

32
Q

Viral pneumonia

A

fluffyness in hilar and upper lobe

33
Q

bronchopneumonia

A

more central pneumonia

34
Q

Recurrent chest infections

A

Underlying causes?

  • aspiration seizires
  • Myotonic dystrophy (no cough)
  • Achalasia
  • Vascular ring
  • CF
35
Q

Foreign body aspiration

A

Lodges in bronchus

36
Q

Investigation

A

CRX: asymmetric lung volumes, hyperinflation

37
Q

asthma, why CXR

A

Looking for complications not diagnosis

overinflation, collapse due to mucous plucking or pneumorax

38
Q

CF

A

Recessive, muscle build up leads to recurrent infections (atypical)
- poor growth, infertile, meconium ileus, diabetes

39
Q

CXR

A

upper lobe bronchiectasis

brochial thickening, infection, central lines

40
Q

Tumour

A

rare in children, tracheal deviation or obstruction

41
Q

which is the most common cancer

A

neuroblastoma

42
Q

What investigation

A

CXR & CT

43
Q

When to image with child with UTI

A

atypical
recurrent ui
children < 6 months

44
Q

What imaging can you use

A

US
MCUG (assess reflux)
DMSA (assess scaring)

45
Q

What is vesicoureteric reflux

A

retrograde flow of urine from bladder to under, associated with pyelonephritis, scanning

DMSA scan or MCUG ( contras outlines ureters & renal collecting systems)

46
Q

Posterior urethral valves

A

chronic obstruction due to fold in urethra

  • only males (young)
  • clinical: sepsis, uti, abnormal voiding

imaginge: US mCUG
Tx: endoscopic valve resection

47
Q

PUJ obstruction

A

obstruction to urine at ureteropelvic junction
- antenatal dilatation, UTI, abdo pain

Imaging: US dilated renal pelvis but not ureter
- MAG 3 venogram

48
Q

Limping child

A 
Developmental hip dysplasia
Hip effusion 
parthes disease
slipped capital femoral epiphysis 
non accidental injury
49
Q

Developmental hip dysplasia

  • what is it
  • who is screened at 6 weeks
  • how is the screening done
  • what happens if its left untreated
A

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

50
Q

Hip effusion

  • what is it
  • what normal proceeds it
  • whats an import D.D to exclude
  • How to detect it
A

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

51
Q

Perthes disease

  • what is it
  • what age does it present in
  • what does it look like on X-Ray
A

idiopathic avascular necrosis/infarction of hip

age: 5-8 yrs
13% bilateral

image: fragmented flatterened femoral head

52
Q

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
A

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

53
Q

non accidental injury

A

abuse at any age

Paeds (20 decks)

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