Pediatric RadiologyPediatric Radiology

Megan ShulerMegan ShulerFebruary 2, 2006February 2, 2006

Case 1Case 1

18 month old male presents with 12 hour 18 month old male presents with 12 hour history of increasingly labored respirations, history of increasingly labored respirations, fever, and barking coughfever, and barking coughExam significant for temp 101 F, Exam significant for temp 101 F, inspiratory stridor, and suprasternal inspiratory stridor, and suprasternal retractionsretractions

CroupCroup

Acute laryngotracheobronchitisAcute laryngotracheobronchitisEtiology: Parainfluenza virusEtiology: Parainfluenza virusCommonly affects patients aged 6 months Commonly affects patients aged 6 months to 3 years during fall/winter monthsto 3 years during fall/winter monthsClinically barking cough with inspiratory Clinically barking cough with inspiratory stridor secondary to subglottic narrowing stridor secondary to subglottic narrowing from soft tissue edemafrom soft tissue edemaTreatment typically includes Racemic epiTreatment typically includes Racemic epi

Radiograph findingsRadiograph findingsSteeple SignSteeple Sign

AP view of neck showing narrowing of laryngeal air column 5-10 mm below vocal cords

Steeple sign seen on x-ray in 50-60% of cases

Case 2Case 2

3 year old female presents with fever, 3 year old female presents with fever, worsening sore throat, and respiratory worsening sore throat, and respiratory distressdistressExam reveals toxic appearing child, temp Exam reveals toxic appearing child, temp 102 F, sitting in tripod position, drooling, 102 F, sitting in tripod position, drooling, and stridorand stridor

Lateral neck radiograph of a child. Notice the hypopharyngeal dilatation, the swollen epiglottis, and the lack of definable aryepiglottic folds.

EpiglottitisEpiglottitis

Etiology: Haemophilus influenzae B, Etiology: Haemophilus influenzae B, Streptococcus, Staph aureusStreptococcus, Staph aureusMedical emergencyMedical emergencyNot as common due to HIB vaccine; Not as common due to HIB vaccine; typical age 2 to 7 yearstypical age 2 to 7 years

Radiograph FindingsRadiograph FindingsThumbprint sign on lateral neckThumbprint sign on lateral neck

Case 3Case 3

Newborn with progressive respiratory Newborn with progressive respiratory distress, scaphoid abdomen, unilaterally distress, scaphoid abdomen, unilaterally diminished breath sounds, displaced PMIdiminished breath sounds, displaced PMI

Congenital Diaphragmatic HerniaCongenital Diaphragmatic Hernia

Secondary to posterolateral defect of Secondary to posterolateral defect of diaphragmdiaphragm80-90% occur on left side80-90% occur on left sideResultant pulmonary atelectasis and Resultant pulmonary atelectasis and hypoplasia combined with circulatory hypoplasia combined with circulatory problems (pulm HTN) lead to severe, problems (pulm HTN) lead to severe, hypoxia, cyanosis, and persistent fetal hypoxia, cyanosis, and persistent fetal circulationcirculationTreatment: surgical repairTreatment: surgical repair

Radiograph FindingsRadiograph FindingsCXR shows intrathoracic bowelCXR shows intrathoracic bowel