Pediatric Pulses

Question 1

CXR for a neonate with high RR, differentials

Answer 1

-RDS: (aka Hyaline Membrane disease *preterms)
Bilateral, granular opacities sec to surfactant deficiency

-TTN: (?born via CSec or low birth wt) bilateral perihilar streakiness, prominent vascular markings due to retained fetal fluid /interstitial edema, +/- effusion > resolves within 48hrs

MAS: bilateral patchy opacities with coarse reticular markings

Neonatal Pneumonia: unilateral, patchy, confluence opacity

*BPD: form of chronic lung disease…in premature and prolonged ventilation
Patchy opacities with rounded (bubbly) lucencies, coarse lung markings

Question 2

Identify UVC from UAC on CXR

Answer 2

UVC: “no V in UVC” >straight up!
Umb vein > portal vein >ductus venosus > hepatic vein > IVC&raquo_space; tip at IVC/aotrial junction

UAC: “loops down and up”
Umb art > internal iliac > common iliac > aorta&raquo_space; tip at T6-T10 or L3-L5
*no intermediate placement due to thromboses risk of major vessels

Question 3

CXR clue to preterm child

Answer 3

Humeral head ossification is absent

Question 4

Hypertrophic Pyloric Stenosis:
Age range
Optimal imaging and findings

Answer 4

3-12 wks
USS (100% sensitive and specific)
Findings:
>3mm thick, 14-17mm long,
cervix sign: indentation of the pylorus into the fluid-filled antrum
**a distended fluid filled duodenum excludes pathology

Question 5

X-ray lines used in the diagnosis of developmental dysplasia of the hip (DDH)/ position of femoral head

Answer 5

The Hilgenreiner line is a line drawn horizontally through the inferior aspect of both triradiate cartilages

Perkin’s line is drawn vertically though the lateral most aspect of the acetabular roof, perpendicular to Hilgenreiner’s line.

The ossified femoral head should be located in the inferomedial quadrant

Dislocation of the femoral head is usually posteriorly and superiorly

Question 6

A young adult with partial complex seizures

Answer 6

Dysembryoplastic neuroepithelial tumours (DNET) are benign (WHO Grade 1) slow growing glioneuronal tumours arising from either cortical or deep grey matter

Classic findings:

• Cortically based, wedge shaped, multilobulated, “bubbly” lesion without mass effect
• a third of cases may show focal punctate enhancements
• as it is slow growing,» causes remodeling or scalloping of the inner table of the adjacent calvarium in~ 40% to 60%