Radiology Flashcards
why are babies and children poor subjects for CXR
inadequate inspiration and rotation may falsely simulate disease
what must you be aware of in CXR of babies and children
thymus
features of the thymus on CXR of children
visible on CXR up to 2 years
often massive in neonates - particularly if unwell
can simulate mediastinal mass or lung opacity
has angel wing morphology
sometimes nodular
common causes of neonatal respiratory distress
transient tachypnoea of the newborn
surfactant deficiency
pneumonia
meconium aspiration
after which gestation is surfactant deficiency rare
> 36/40
CXR features of surfactant deficiency/respiratory distress syndrome/hyaline membrane disease
onset within a few hours small volume lungs (bell shaped thorax) diffuse granular opacification bronchograms ventilation related air leaks
what is TTN
slow clearing of pulmonary fluid
onset and duration of TTN
onset within 24 hours of birth
clears in 1-2 days
CXR findings of TTN
normal/overinflated lungs
interstitial lines and pleural effusions
fluid in fissures
air space opacification
looks like pulmonary oedema you would see in adults
onset of meconium aspiration
onset at birth- must ask if there was meconium at birth in the history
CXR findings of meconium aspiration
patchy opacities
overinflated lungs
air leaks
atelectasis
onset of neonatal pneumonia
from birth to several weeks
CXR findings of neonatal pneumonia
patchy opacities
overinflation
atelectasis
what is the correct tip position for an ET tube in a neonate
2cm above the carina at about T2-3
what happens if you put an ET tube too far down
it can end up in one main bronchus resulting in the non ventilated lung collapsing
neonatal CXR are obtained supine/erect
supine
where does air accumulate in neonatal pneumothorax
anteriorly rather than superiorly, in lateral costophrenic sulci
not over lung apices
features of pneumomediastinum
air may outline the heart, thymus and mediastinal vessels
what is the correct position for the tip of a neonatal NG tube
stomach
where should the tip of an umbilical vein catheter be
at or just above the right hemidiaphragm
where should the tip of an umbilical artery catheter be
lower lumbar in the aorta (L3-4) or above the central branches of the aorta
what are common causes of respiratory symptoms in infants (1-4yr)
viral - bronchiolitis
bacterial pneumonia
inhaled foreign body
CXR signs of bronchiolitis
overinflated lungs / normal
perihilar haze
scattered atelectasis
rarely - diffuse opacifications
CXR signs of bacterial pneumonia
fluffy consolidation with air bronchograms
rounded, lobar or multifocal patterns
effusion
pneumatocele / pneumothorax
is radio opaque seen easily on CXR
no
radiolucent objects are
a coin in the trachea would orientate in the sagittal/coronal plane
sagittal
how can you tell which lung has the inhaled foreign body
the affected lung would be lucent due to air trapping
Role of imaging for childhood UTI
identify structural abnormalities that could predispose to UTI
exclude vesico ureteric reflux
quantify renal scarring from previous UTI
all children under which age should get an USS for UTI
<6 months
4 months later they get a VCUG and renogram if US abnormal
what should be done in the case of suspected NAI
skeletal survey
what would an isotope bone scan show in the case of NAI
increased osteoblastic activity due to healing fractures
skeletal injuries that are suspicious of NAI
metaphyseal corner # (as a result of twisting)
posterior / lateral rib #
multiple # in different healing stages
sternal, scapular and spinous process #
spinal injuries with no clear history
any fracture in a baby who is too young to walk or crawl
fracture patterns specific to children
buckle #
greenstick #
plastic bowing
growth plate injury
childrens bones are soft/hard in comparison to adults
soft therefore bend or bow instead of snapping
in children the physis is lucent and so may mimic a #, true or false
true
what classification is used for growth plate fractures
salter harris 1-5
what is a risk of growth plate injury
growth deformity
difficulties when imaging children
difficulty following instructions high dose ionising studies irritable anatomy varies contrast agents specific disease processes affecting kids
TORCH infections - neonatal pneumonia
toxoplasmosis other (syphilis, VZV, parovirus B19) rubella CMV HSV
which lines are specific to neonates
umbilical vein and artery catheters
path of umbilical artery catheter
umbilicus
R/L internal iliac artery
common iliac artery
aorta
how can you tell between an umbilical artery or venous catheter in a neonate
artery will dip down in pelvis before coming up
how can you tell between an umbilical artery or venous catheter in a neonate
artery will dip down in pelvis before coming up
conditions associated with urine stasis or reflux that could predispose to UTI
ureteral duplication posterior urethral valve spina bifida ureteric calculus horseshoe kidney
conditions associated with urine stasis or reflux that could predispose to UTI
ureteral duplication posterior urethral valve spina bifida ureteric calculus horseshoe kidney
order of ossification centres of the elbow
CRITOL capitellum radial head trochlea olecranon internal epicondyle lateral epicondyle
