intercatuve pediatric radiology quize cases

1. Pediatric Radiology Quizes

2. Chest cases

3. Case 1: Chest
• This is a 6-week old male infant. His
parents brought him to the E.D. because
of coughing and congestion.

5. The upper mediastinum shows the usual prominent
thymus for this age.
Impression: Normal Chest x-ray

7. Case 2: Chest
• 15-month old male with fever, coughing,
and tachypnea

9. Bilateral central pulmonary infiltrates, but most marked
in the right middle and left lower lobes.
Impression: Right middle and left lower lobe infiltrates

10. Case 3: Chest
• 3 year old female complaining of
coughing and difficulty breathing.

12. No infiltrates are noted. The right side is more
lucent (darker)compared to the left. The right
hemidiaphragm is slightly higher than the left,
however it should be higher than this.
Impression: Right sided hyperexpansion

13. • More clinical history …. she was jumping
on a bed while eating some food , when
she began choking.
• Bronchoscopy revealed bilateral bronchial
peanut fragment foreign bodies

14. Case 4: Chest
• A 3-month old female with fever and
coughing.

16. There is a faintly visible infiltrate in the right
upper lobe. Subtle findings may be more difficult
to appreciate on dark films.
Impression: Right upper lobe infiltrate.

17. Case 5: Chest
• This is an 11-year old female with a
history of fever and coughing for 5 days.

19. There is a patchy infiltrate at the left lung base.
This is seen on the lateral view obliquely over the
heart and on the PA view as haziness in the left
lower lung.
Patchy area of consolidation at the left lung base.

20. The prominence of the right perihilar region is probably
due to rotation. Note the asymmetry of the spinal column
and the ribs. This rotation exposes more of the right hilum
n the radiograph, making it appear more prominent.

21. Case 6: Chest
• This is a 9-year old male with a history of
fever, headache, nausea, and coughing.

23. There is a circular density in the right lung. This is
the superior segment of the right lower lobe. Although
this has the appearance of a mass, it is most likely an
infectious process.
Spherical consolidation in the right
lower lobe (round pneumonia).

24. Case 7 :
• 5 years old patient C/O stridor.

26. Epiglottitis

27. MSK cases

28. Case 7:
• This is a 10-year old male who presents
to the acute care clinic with a two week
history of right thigh and knee pain.
• He states that the pain is mainly in his
thigh (points to his upper thigh) but
radiates down to his knee.

30. His hip radiographs show a slipped capital
femoral epiphysis on the right

31. Some cases of SCFE are very obvious.

32. SCFE
• In subtle cases, the epiphyseal plate (physis) may be
widened or irregular compared to the normal side
• In other subtle cases, the physis may appear to be
thinner than the normal side

33. Case 8: elbow
• 3 yr male with complaints of right elbow
pain after falling off bed while jumping.

35. C-R-I-T-O-E
• The mnemonic of the order of appearance
of the individual ossification centers is C-
R-I-T-O-E: Capitellum, Radial head,
Internal (medial) epicondyle, Trochlea,
Olecranon, External (lateral) epicondyle.
• The ages at which these ossification
centers appear are highly variable, but as
a general guide, remember 1-3-5-7-9-11
years.

36. C–R–I–T–0-E
1 – 3 – 5 – 7 – 9 - 11
Knowing the C-R-I-T-O-E mnemonic is helpful in determining
whether a small piece of bone about the elbow joint represents an
avulsion fragment or an ossification center.

37. c
r
c
r

38. Both anterior fad pad (with sail sign) and posterior fat
pads are present.
Rule :No visible fracture. Possible radial head fracture

39. Case 9:
• 14-year old male with an ankle injury.

41. mortise, and lateral views are displayed. There is a vertic
ency through the distal tibial epiphysis extending from the
sis to the mortise joint space.
Salter Harris Type III fracture of the distal tibia.
Tillaux Fracture

42. Case 10:
• This is a 3-year old female who sustained
an inversion injury while running downhill.
She is limping and has tenderness over
her lateral malleolus.

44. are no definite bony abnormalities seen on these radiogra

45. • On closer examination, her pain is mostly
over the fibular physis rather than the tip
of the fibula. Because of this, she is
suspected as having a Salter Harris Type I
fracture through the fibular physis.

47. Case 11:
• This is a 4 year old female who presents
to the emergency department with a
forearm injury after falling off the jungle
gym (playground bars) at the park. Her
mother noted that her forearm was
deformed and she was complaining of
persistent pain. She denies trauma or pain
elsewhere.

48. Radiographs of her left forearm

49. Although there is an obvious deformity of her forearm on exam,
no fracture is evident here. Her elbow does not demonstrate a
joint effusion and her radial head is of normal contour and is
well aligned with the capitellum
Note the curvature of the ulna which is excessive. This represents
a "bowing fracture" of the ulna.

50. View comparison of the other forearm.

51. Arrows point to the bowing deformity of the ulna.

52. Case 12:
• A 16 year old girl presents with increasing
knee pain and posterior swelling.

54. Bone is visible within the mass which has elevated the periosteum
of both anterior and posterior cortices of the distal femur
(Normal knee)
Impression: Osteosarcoma

55. Case 13:
• A 2 year old boy falls out of bed and
afterward refuses to use his right hand.

57. Impression: There is a buckle fracture of both the distal
radius and ulna. The fractures are not displaced.

58. Case 14:
• This is a 6-year old male who presents with a
chief complaint of a limp which began 6 months
ago.

60. he right hip (left on the image) shows widening of the
int space. The femoral epiphysis is fragmented and flatte
he physis appears narrow. The femoral neck is short and
de (Coxa magna). There is flattening of the femoral
pitellum (Coxa plana).

61. Impression: Avascular necrosis (AVN) of the femoral head
may be idiopathic (Legg-Calve-Perthe's Disease) or due to
some insult to the vascular supply of the femur.

62. • Eponyms for Osteochondroses (Avascular
Necrosis)
• Adams Disease -- avascular necrosis (AVN) of
the medial epicondyle of the humerus
• Ahlback Disease -- spontaneous avascular
necrosis (AVN) of the femoral condyle in adults
• Breck Disease-- AVN of the medial malleolus
• Chandler Disease -- Idiopathic AVN of the
femoral head in adult Diaz Disease -- AVN of
the talus
• Freiberg Infraction -- avascular necrosis (AVN)
of the head of the 2nd or 3rd metatarsal
• Iselin Disease -- AVN of base of 5th metatarsal
apohysis in children

63. • Keinbock Disease -- AVN of carpal lunate
• Kohler Disease -- (AKA Mueller-Weiss Syndrome) -- AVN of tarsal
navicular
• LaNec Disease -- AVN of ischiopubic synchondrosis
• Madelung Disease-- AVN of distal radial epihysis
• Osgood-Schlatter Disease -- AVN of the tibial tubercle
• Panner Disease -- AVN of capitellum of the humerus
• Perthe Disease -- (Legg-Calve-Perthe Disease) -- AVN of femoral
head in a child; idiopathic AVN of the femoral head in adult
=Chandler Disease
• Scheuermann Disease -- AVN of the ring epiphyses of the spine
• Sever Disease -- AVN of the calcaneus
• Sindig-Larsen-Johanssen Disease -- AVN of distal pole of patella
• Theeman Disease-- AVN of phalangeal epiphysis