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Pediatric Pediatric Radiology Radiology

Pediatric Radiology

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Text of Pediatric Radiology

  • Pediatric Radiology

  • Indications for Pediatric Radiographic Examination

    HistoryWill the imaging give you any added clinical data?Benefits vs. riskAmerican College of Radiology (ACR) Appropriateness Criteria available at www.acr.org

  • All radiological exams carry riskgonadsbreastthyroidlungBone

    The concept of ALARA (as low as reasonably achievable) should be applied to all patients

  • Radiation Exposure - ChildrenConsiderably more sensitive to radiation than adults Also have a longer life expectancya larger window of opportunity for expressing radiation damage

    Compared with a 40-year old, the same radiation dose given to a neonate is several times more likely to produce a cancer over the patients lifetimeRetrieved 01-17-05 from http://www.cancer.gov/cancertopics/causes/radiation-risks-pediatric-CT

  • Never radiograph routinely!Will the results change my management?Will the study confirm my clinical suspicions?Is this the appropriate study for what Im trying to confirm?

  • Technical Issues

    Instructional complianceMotionThe child should be stabilized by the parentRecumbent radiographs a necessity in young childrenacute fractures

  • uprightrecumbent

  • Radiographic InterpretationMust know the normal radiographic appearance at each age for accurate interpretationAtlas of normal developmental anatomyConsult a DACCBR?

    Chiropractic line analysisChildren are not small adults Does the technique recognize this?

  • Normal Pediatric Variants

    PseudosubluxationPseudospread of C1 on C2ADI spaceAbsence of cervical lordosisNormal appearance of ossification centers and epiphyses

  • Pseudosubluxation

    Normal variantOccurs most commonly at C2/C340% of normal children

  • Swischuk's line distinguishes pseudosubluxation from pathological subluxationA line drawn connecting the anterior cortices of the spinous processes of C1 and C3 should intersect or lie within 1 mm of the anterior cortex of the spinous process of C2If C2 is >2mm off of this line = true injuryhttp://www.uth.tmc.edu/radiology/test/er_primer/spine/images/csp40.htmlhttp://www.medcyclopaedia.com/library/topics/volume_vii/p/pseudosubluxation.aspx

  • Pseudospread of C1 on C2

    Normal variantLateral mass displacement relative to the dens Up to 6mm is common

  • Pseudospread of C1 on C2

    Lustrin ES, Karakas SP, Ortiz AO et al. Pediatric Cervical Spine: Normal Anatomy, Variants and Trauma. RadioGraphics 2003; 23:539-60.

  • Other Common Variants

    ADI spaceMaximum of 4mm (new literature) in childrenAbsence of cervical lordosisCan be seen in children up to 16 yoaOval/wedge shaped vertebrae are normalNot to be confused with compression fxNormal appearance of ossification centers and epiphyses can simulate fracturesLustrin ES, Karakas SP, Ortiz AO et al. Pediatric Cervical Spine: Normal Anatomy, Variants and Trauma. RadioGraphics 2003; 23:539-60.

  • Copyright Radiological Society of North America, 2003Lustrin, E. S. et al. Radiographics 2003;23:539-560Figure 1bsynchondrosis

  • Copyright Radiological Society of North America, 2003Lustrin, E. S. et al. Radiographics 2003;23:539-560Figure 4

  • The spaces between the sacral segments are synchondroses composed of fibrocartilage, not discsBone starts to be deposited in the fibrocartilage starting at puberty

    *They do not move like vertebraeGray, Henry. Anatomy of the Human Body. Philadelphia: Lea & Febiger, 1918; Bartleby.com, 2000. www.bartleby.com/107/. [January 20, 2006]. http://www.bio.psu.edu/people/faculty/strauss/anatomy/skel/sacrum2.htm

  • Where is the anomaly?

  • Os Odontoideum

    Results from injury at the odontoid synchondrosis

    Flexion/extension radiographsNeurological deficit?Neurologist/orthopedist consult

  • Epiphyseal Plate Injuries

    Salter-Harris Classification

  • http://xray.20m.com/photo4.html

  • Child AbusePhysical, sexual, nutritional abuse or neglect

    Must report to appropriate agency!

    Remain professional and objectiveBe non-judgemental toward parents

  • Radiography plays an important part in documenting physical abuse

    Technical considerationsreveal soft tissues wellhigh detail radiographs sectionals, not babygram

  • Battered child syndromeMetaphyseal corner fracturesMultiple fractures at various stages of healingRibs, scapulaHead injuries Skull fx, subdural hematoma, shearing injuries*MC cause of death + disability in child abuseSoft tissue swelling and injuries i.e. contusions, burns, etc.

  • Oblique fracturePeriosteal reactionMetaphyseal corner fx

  • Linear skull fracturesMultiple metacarpal fractures

  • Rib fracturesEspecially posterior aspect

  • Hx: 2 yo with vomiting and diarrheaInitial abdomen and chest films normalIncreased WBCElevated ESRFindings: -decreased disc height-abnormal signal in two adjacent VB-paraspinal massDx: discitisSwischuk LE. Vomiting, diarrhea and--oh! oh! what is that? Pediatr Emerg Care. 2004 Jan;20(1):54-6

  • Spinal infection

    DiscitisA common problem in infantsMC lumbar region, lower thoracics

    S/S: back pain (often cant directly communicate) and difficulty walking or limping

    Therefore, when one has exhausted all of the more common causes of limping, one should look to the lower thoracic and lumbar spine regions for the presence of discitis.Swischuk LE. Vomiting, diarrhea and--oh! oh! what is that? Pediatr Emerg Care. 2004 Jan;20(1):54-6