Peds lecture pt 2 (rev 5/12)

1. Peds lecture pt 2 (rev 5/12)

2. PATH REVIEW (VOL3 pg 179) • Congential: Club Foot & Hip Dysplasia • Fractures: Greenstick, Torus or buckle • Hirschsprung’s (Megacolon) • INTUSSUSCEPTION • Hylaine Membrane Disease • CROUP • Osgood-Schlatters Disease • Pyloric Stenosis • Slipped Epiphysis • REFLUX • R/O FOREIGN BODY

3. IMAGING PEDS • How does techniques • Differ from • ADULTS / CHILDREN • INFANTS

4. This CXR is within normal limits; however, when a clinical suspicion of an airway foreign body is present, a standard PA and lateral CXR are an insufficient evaluation. A lateral neck film should be obtained toexamine the upper airway for evidence of swelling or foreign body.

5. RDS – Respiratory Distress

7. Hyaline Membrane Disease • Acute pulmonary disorder of the newborn characterized by • Generalized atelectasis • Ventilation-perfusion abnormalities • Reduced lung compliance • M:F =1.8:1 – slightly more common in males

8. Cause Immature surfactant production (usually begins at 18-20 weeks of gestational age) CLINICAL SIGNS Abnormal retraction of chest wall Cyanosis Expiratory grunting Increased respiratory rate Hyaline Membrane Disease

9. Hyaline Membrane Disease • Predispositions • Premature infants • Cesarean section • Infants of diabetic mothers • Perinatal asphyxia • Onset • Usually less than 2-5 hours after birth • Increases in severity from 24 to 48 hours • Then, gradual improvement after 48-72 hours

10. Hyaline Membrane Disease Imaging findings • Typically, diffuse “ground-glass” opacification of both lungs with air bronchograms and hypoaeration • Hypoaeration from loss of lung volume (may be counteracted by respiratory therapy) • Fine granular pattern • Prominent air bronchograms • Bilateral and symmetrical distribution • Prognosis • Spontaneous clearing within 7-10 days (mild course in untreated survivors) • Death in 18%

11. Hyaline Membrane Disease

12. Hyaline Membrane Disease

13. c/o stomach ache x 1 week ?problem Tension pneumothorax

14. IniencephalyHistory:Newborn girl with short neck and head tilted up toward the sky. She died approximately 24 hours after birth due to multiple anomalies

15. ST NECK • R/o • CROUP • ABCESS • AP & LAT done • & poss CXR • ? Symptoms ?

16. “BABYGRAM” FOR FB From Mouth to Anus - AP & possible Lateral

17. BLOCKER PLACEMENT GRID OR NO GRID?

19. INTUSSUSCEPTION A barium enema demonstrated an intussusception at the hepatic flexure which was successfully reduced

20. Intussuception Volvulus

21. More common in males Projectile vomiting Failure to thrive Pyloric stenosis

22. ABSENCE OF DIAPHRAM

23. Hirschsprung’s diseasemegacolon • Most of the time, when a doctor is concerned about the possibility of Hirschsprung's disease, he or she will have a barium enema performed. 

24. Hirschsprung's disease is a rare disorder occurring in about 1 out of every 5,000 to 10,000 newborn babies constipation occurs in as many as 1 out of every 5 to 10 children). This disease is much more common in boys than girls.

25. Hirschsprung’s diseasemegacolon • Hirschsprung's disease is a blockage of the large intestine due to improper muscle movement in the bowel. • It is a congenital condition, which means it is present from birth

26. Hirschsprung’s diseasemegacolon • The intestine is constantly squeezed tight, preventing stool from passing. • Almost all children with Hirschsprung's disease have problems with constipation from the day they are born; as many as half of babies with Hirschsprung's disease will not pass their first bowel movement during the first 36 hours of life • There is currently no evidence to indicate that Hirschsprung's disease is caused by any medications or exposures to toxins during pregnancy. • If a child has Hirschsprung's disease, some form of surgery is usually required to eliminate the problems with constipation.

27. Hirschsprung’s diseasemegacolon

29. Megacolon can also occur in adults

30. CONDITION? REFLUX

31. NOTE OPEN JOINT SPACES DO NOT NEED ALL PROJECTIONS AS DONE WITH ADULTS!

32. Osgood-Schlatter disease • is an overuse condition or injury of the knee that causes pain and swelling below the knee area over the tibia.

33. Osgood-Schlatter disease • Growth spurts can begin any time between the ages of 8-13 for girls and 10-15 for boys. • OSD is most common in 11 to 14 y/o • OSD is more likely in teens who participate in sports that involve running, twisting, and jumping, such as basketball, football, volleyball, soccer, tennis, figure skating, and gymnastics. • With exercise, the muscles place increased stress on the growth plate

34. Osgood-Schlatter disease

35. GREENSTICK- Incomplete fracture TORUS OR BUCKLE- Impacted FRACTURES IN CHILDREN

36. POSITIONING FAT PADS

37. 10 yo – Pain no trauma Problem? These radiographs demonstrate a pathologic fracture through a bone cyst of the proximal humerus.

40. GREENSTICK TORUS OR BUCKLE FRACTURES IN CHILDREN

41. GREENSTICK- /Incomplete TORUS OR BUCKLE FRACTURES IN CHILDREN

42. Slipped Epiphysis • The head of femur dislocates into the epiphysis

43. Slipped Epiphysis • One foot might point outward more than the other, or one leg may be slightly longer than the other.

44. Slipped Epiphysis 11 yo with a limp Bilateral with worse on the right side

46. R/O Child Abuse • Skeletal Survey • Bone Scan

48. Buckle or Corner Fx’s