BbygfctygvcddddxfffffffffPediatric imaging.

Huh

1. Pediatric imaging

2. Imaging modality:
Conventional radiology(X-ray)
Ultrasound.
Fluoroscopy.
CT.
MRI
Neuclearmedicine.

3. Conventional radiology
Indications:
Initial examination of chest, abdomen and bones.
Particularly important in skeletal trauma, infection,
dysplasia.

4. ultrasound
Indications:
Foetalpathology
Neonatal brain and spinal cord
Palpable lumps including neck lesions.
Suspected abdominal anomalies including
pelvis and bowel.
Musculoskeletal system abnormalities
including neonatal hips.
Vascular anomalies–Doppler applications
Guidance or interventional procedures.

5. Fluoroscopy:
Indications:
Real-time contrast examinations of the
gastro-intestinal (GI) tract, for example
GI stenoses.
Real time contrast examinations of the
urinary tract, for example voiding
cystourethrography, including critical
diagnoses such as posterior urethral
valves (PUV).

6. CT
Indications:
Trauma and acute presentations in any
area of thebody.
Neurological and chest disease.
Oncological diagnosis and staging when
MRI are not available or when lung
staging is necessary.
Detailed magingof cortical bone.

7. MRI
Indications:
The first line tool for all paediatriccross
–sectional imaging e.g. , CNS, MSK,
abdomen, pelvic, cardiac, vascular
pathologies.
Antenatal imaging of the foetusin
selected cases.
FoetalMRI,T2Wsequence,coronalplaneof
a28-week-
oldfoetus.Thereisahuge,mostlycystic,pelvi
candexophyticmass(arrows),indicativeofa
sacro-coccygealteratoma

8. Neuclearmedicine
Indications:
FunctionalstudiesoftheurinaryandGItrac
ts,skeletalandendocrinesystem.
Tumourstaging,e.g.,MIBGinneuroblasto
ma.
Investigationofpain(MSK)andoccultfract
ures.
neuroblastoma

9. Respiratory system
The thymus gland is prominent in infants
It has variable size and shape, sharp contour, and causes anterior
mediastinal widening.

10. follow thymus
Pneumomediastinum
6-year-old 13-year-old

11. Normal chest X-RAY
Chest
Thymusmaybeprominent.
Heart shadow is quite prominent
normalcardiothoracicratio up to 65 per
cent.
Airbronchogrmsmaybeseeninthe
medialthirdofthelungfields.
Diaphragmsnormallylieatthelevel
ofthesixthribanteriorly.

12. Tubes and lines
Nasogastric tube
Endotracheal tube
Umbilical vein catheter
Umbilical artery catheter

13. Hyaline membrane disease
Disease of premature infants
due to deficiency of surfactant in the lungs
which is produced by pneumocytetype II cells
The CXR:
Reduced lung volume
widespread, very small pulmonary opacities
air bronchograms
Poor pulmonary expansion
Treatment:
Antenantalsteroids
Surfactant

14. Hyaline membrane disease

15. Transient tachypneaof newborns
Delayed clearance of intrauterine pulmonary fluid
Respiratory distress in the first 4 to 6 hrs, usually in term infants
Resolved within 48-72 hrs
C.sectionis a risk factor
CXR:
Fluid overload( interstitial oedema), vascular congestion and small pleural
effusion,rapidlyclears to normal within 48-72 hrs

17. Meconium aspiration
More common in post term and term neonates
Due to aspiration of meconium
CXR
Large lung volume: hyperinflation
flat diaphragm ,lower than normal due to airways obstruction
associated with sticky meconium in the bronchi.
Patchy asymmetrical pulmonary opacification( atelectasis)
Air bronchogramsare not an obvious.

18. After 2 day

20. Pneumonia
Group b streptococcus is the most common cause in neonates
CXR in non specific:
Diffuse reticulonodulardensities
Patch involving lobe or less common round patch.
Patchy, asymmetrical infiltrate
Small pleural effusion

22. Congenital Diaphragmatic Hernia
posterior defect in the
diaphragm(Bockdalek hernia)
more at Lt. Side.
CXR:
Hemidiaphragm not visualized
Multicystic mass in chest
Hemithoraxfilled with stomach &
gut leads to respiratory distress

24. Foreign body aspiration
Age: 6months to 4years .
Location: right bronchi > left bronchi >
larynx, trachea.
Unilateral air tapping causing hyperlucent
lung, 90% laretal ro mlif yrotaripxE(
)tnerappa erom gnippart ria sekam sutibuced
lung collapse is uncommon, 10%
Only 10%of foreign bodies are radiopaque

25. Foreign body aspiration

27. Gastrointestinal system
Oesophageal Atresia/ tracheooesophagealfistula
Doudenalatresia
Hypertrophic pyloric stenosis
Intussusception
Hirschsprung,sdisease

28. oesophageal atresia/ TOF
Failure of complete separation of dorsal and ventral foregut into
tracheal and esophagus
Presentation : aspiration during early feading, inability to swallow
saliva or milk,failureto pass NGT
Can be diagnosed prenatalyby maternal USS (polyhydrominus)
Many types the most common type is proximal atresia with distal
fistula

29. (a) Oesophageal atresiawith no fistula: 9 per cent, (b) Oesophageal atresiawith
distal fistula: 82 per cent, (c) Oesophageal atresiawith proximal and distal fistulas: 2
per cent, (d) Oesophageal atresiawith proximal fistula: 1 percent, (e) Fistula without
oesophageal atresia('H' type fistula): 6 percent.
A B C D E

31. Duodenal obstruction
Presentation at First few days of life
Persistent bilious vomiting
50-60%associated with other anomalies like Down syndrome and
CHD.
Double bubble sign on plain film.

34. Hypertrophic pyloric stenosis
Age of presentation 2 to 8 wks
Presentation usually non bilious
projectile vomiting
Palpable olive shaped mass
Plain abdomen:
Single bubble sign
USS:
Thick elongated pylorus

37. Intussusception
An intussusception is the invagination of one segment of the bowel into another.
more in Infants and young children than adults.
Types of intussusception:
Ileocolic( the most common type)
colocolic
ileo-ileal
Classic presentation sever abdominal pain, sausage shaped abdominal mass, red
current stool.
Diagnosed by USS,plainfilm , CT

38. CT scan : multiple rings
Target or doughnut sign , psuedokidney sign

39. Hirschsprung’sdisease
Absence of ganglia (mucosal and submucosal plexus
cells) in distal colon resulting in functional obstruction
present in the first 6weeks of life with obstruction,
intermittent diarrhea, or constipation .
Diagnosis is by rectal biopsy
Treatment is with colostomy

40. imaging finding
Abdominal x-ray and barium enema are used.
Sign of large bowel obstruction.
The affected segment is of small caliber with proximal
dilatation.
Fasciculation/saw-tooth irregularity of the aganglionic
segment is frequently seen.

42. Genitourinary system
Congenital anomalies of the urinary tract:
Bifid collecting system
Ectopic kidney
Horseshoe kidney
Inherited cystic disease of the kidneys
Renal agenesis
Vasicouretericreflex
Posterior urethral valve

43. Bifid collecting system
The two ureters may join at
any level between the renal
hilum and the bladder or may
insert separately into the
bladder
Complication:
ureterocele(the dilated
lower ureter may prolapse
into the bladder,)

44. Hoarse shoe kidney
Failure of kidneys to separate
almost lower poles that
remain Fused. may be an
incidental finding and of no
significance
Complications:
PUJ obstruction ,calculi
formation

47. Ectopic kidney
Abnormal location of one or both
kidneys due to arrested ascend of
kidney during fetaldevelopment
Most often asymptomatic or
presents with copmlications
(hydronephrosis,chronic
pyelonephritis, calculi)
Best modality is USS

48. Posterior urethral valve
Congenital valves in the posterior
urethra
commonest cause of bladder
outflow obstruction in male
children
Ante natal diagnosis (bilateral
hydronephrosis)
demonstrated at micturating
cystourethrography(MCUG)

49. bladder is typically
thick-walled and
trabeculatedwith an
elongated and dilated
posterior urethra
(keyhole sign)on both
ultrasound and MCU

51. Vesicouretericreflux
Incompetence of the ureterovasical
junction(UVJ),leading to retrograde passge
of urine from the urinary bladder into the
ureter
Presentation: recurrent UTI
MCUG used in detection and grading of
vesicouretericreflux

53. Respiratory distress in neonate

54. Respiratory distress in neonate

55. Foreign body aspiration/ingestion

56. Gastrointestinal tract

57. Genitourinary system

58. Down syndrome presented
with bilious vomiting

59. Dyspneaafter
eating carrots
immediately
followed by
coughing from 2
days

60. 4 years old with increasing cough

61. Sever abdominal pain with red current stool
Name the sign
How treated?

62. Female presented with recurrent UTI

63. Post term neonate presented with cyanosis

64. 7 wksold presented
with projectile vomiting

65. Premature infant with decreased
O2 sats

66. History of cough and fever
which type of pneumonia?

67. H/O Constipation
what is the best diagnostic procedure ?

68. Thanks