Paediatric

Question 1

Contrast media for X Ray & CT
2 types :
- water soluble :
- water insoluble :

Can also be divided into oral & IV
Oral :
IV :

Answer 1

Contrast media for X Ray & CT
2 types :
- water soluble “ iodine based contrast media , Gastrograffin”
- water insoluble “ Barium sulphate”

Can also be divided into oral & IV

Oral : barium sulphate , iodine based contrast
IV : iodine based contrast

Barium very irritant not given if suspect bowel perforation
Iodine based cause renal failure in renal impairement & allergy

Question 2

Paediatric CXR
Normal finding

Answer 2

Thymus May be prominent
Heart shadow may be prominent
Clinical history is important
Check the position of the tube & vascular catheter

Question 3

Hyaline membrane disease
In preterms
Description:

Answer 3

Bilateral granular opacity
Diffuse lung opacity
Air bronchogram

Question 4

Meconium aspiration syndrome
Term stressed baby
Description :

Answer 4

• obstruction of small airways
  Streaky perihilar densities , hyper-lucency” hyperinflation “ horizontal ribs - flat diaphragm , pleural effusion , pneumothorax

Question 5

Congenital lobar emphysema
Common sites :

Answer 5

Left upper lobe
Right middle lobe
Right upper lobe

Question 6

Newborn
Initial opacity then hyperluceny with midline shifting
This case is ………
By CT you see :
Management :

Answer 6

Congenital lobar emphysema

Focal hypodensity with peripheral arranged septa & bronchvascular bundles
Lobectomy

Question 7

Congenital diaphragmatic hernia
CXR describe:

Occur due to :
Common at which side ?

Management :

Answer 7

Hemidiaphragm not visualized
Multi cystic mass in chest
Mass effect “ mediastinal shifting

Posterior defect in diaphragm “ bockdalek hernia”
Common at left side

Question 8

Foreign body aspiration
Age
Common site
..% radioopaque foreign body
CXR :

Answer 8

Foreign body aspiration
6 m to 4 yrs
RT bronchus ,left , larynx , trachea
10% radioopaque foreign body
Unilateral air trapping causing hyperlucent lung ( with EXPIRATION)
“10% lung collapse”

Question 9

Complete white lung
4 DDX:

Answer 9

Complete collapsed lung
Massive pleural effusion
Massive pneumonia
Pneumectomy
“ differentiation by mediastinal shifting “

Question 10

Cause of complete collapse
In adult
Children

Answer 10

Bronchogenic CA
Foreign body

Question 11

Radiology of patient with esophaugeal atresia
Antenatal Uss
Plain film

Answer 11

Polyhydramnios
NGT coils in the blind pouch
Excessive air in stomach “ H type or lower fistula”
Gasless abdomen “ esophaugeal atresia “
Aspiration pneumonia

Question 12

Deudenal atresia
Persistent bilious vomiting
Very early presentation
Associated with other anomaly like :

Signs on plain film :

Answer 12

Down syndrome
CHD

Double bouble sign

Question 13

Hypertrophic pyloric stenosis
Age of presentation 2-8 weeks
Projector non billious vomiting
Palpable olive shaped mass in epigastrium

Plain film :
Uss:

Answer 13

No polyhydramnios !
Single bubble sign

Uss gold standard : thickened & elongated pylorus

Question 14

Congenital string sign on barium meal seen in :
+ …… sign
+……..sign

Answer 14

Pyloric stenosis
Mushroom cap sign
Triple track sign

Question 15

Malrotation & midgut Volvulus
Sign in x Ray ;
InContrast study :
Uss & CT :

Answer 15

No specific sign , Dilation of deudenum

Deudenal fold thickening &thumb printing sign , abnormal position of bowel loops, corkscrew or apple peel or twisted ribbon sign

Whirlpool sign , SMV to the left of SMA

Question 16

Hirschprung’s disease
Diagnosis by :
Treatement with
Modality : , you see : …..

Answer 16

Rectal biopsy

colostomy

Gastrographin enema
Abrupt transition zone form small aganglionic segment to dilated normal bowel.

Question 17

Intussusception
Plain film :

Uss “ gold standard “ :

CT scan :

Answer 17

Frequently normal , intraluminal filling convex filling defect in partially air-filled bowel loop “ common at hepatic flexture”

Target or doughnut sign , pseudokidney sign

Multiple concentric rings . Done in adults to see leading point

Question 18

Necrotizing enterocolitis
X ray :

Answer 18

Small bowel dilation , pneumatosis intestinalis , thick wall , air in portal vein

Question 19

Medical importance of ectopic kidney :

Answer 19

More vulnerable to Trauma
Be cautious in female with Cesarean section

Question 20

MCUG
Done only in two cases :

Answer 20

Posterior urethral valve “ male , oligohydramnios”
Reflux

Question 21

Describe
Zenker’s diverticulum
Barium swallow

Answer 21

Saccular outpouching at middle eaophaugus
False diverticulum

Question 22

Esophaugeal CA
Modality
Describe :
Signs :
Next step :

Answer 22

Barium swallow
Sudden narrowing
Apple core sign , shouldering sign
CT mediastinal window with IV contrast

Question 23

Diverticulosis
CT pelvis axial
Describe :

Answer 23

Multiple saccular outpouching of sigmoid colon

Question 24

A …………………… is the most common cause of bowel perforation.

Answer 24

A perforated peptic ulcer is the most common cause of bowel perforation.

Question 25

Charcot’s triad for acute cholangitis: ……….,……..,……..

Answer 25

Charcot’s triad for acute cholangitis: fever, right upper quadrant pain, and jaundice.

Question 26

This patient with colicky abdominal pain relieved with flexion of the knees, currant jelly stools, and a target sign on ultrasound likely has intussusception. Approximately 75% of intussusception cases are ……….

Answer 26

This patient with colicky abdominal pain relieved with flexion of the knees, currant jelly stools, and a target sign on ultrasound likely has intussusception. Approximately 75% of intussusception cases are idiopathic.