Beruflich Dokumente
Kultur Dokumente
Objectives
•Identify the following conditions based on x-ray findings:
– Intussusception – Epiglottitis
– Bowel obstruction – Retropharyngeal abscess
– Congenital hip – C-spine
dislocation pseudosubluxation
– Slipped capital femoral – Hangman fracture
epiphysis – Jefferson fracture
– Pneumonia – Elbow fractures
– Thymus shadow – Monteggia injury
– Appendicitis – fecaliths – Salter-Harris fractures
– Bronchial foreign body – Child abuse
– Croup
X-ray diagnosis?
14-month-old girl
with vomiting.
Target sign
Identify in
the target sign
The crescent sign Target sign
is
inRUQ.
the RUQ again.
formed by the in RUQ.
intussusceptum (lead
point) protruding into Crescent
Intussusceptio
Intussusception
a gas-filled pocket. Crescent
sign in LUQ.
sign in LUQ.
n
Identify crescent sign
in LUQ again.
X-ray diagnosis?
13-month-old boy
with vomiting.
Crescent sign:
Note the
intussusceptum
lead point
ascending into the
hepatic flexure.
The crescent sign may not be crescent shaped.
The gas-filled pocket may be large, as in this case.
Intussusception
Left image:
Right image: Absence of hepatic
Absence of gas in angle (suggests RUQ
RUQ and RLQ mass). Absence of
(suggests a mass gas in RLQ (suggests
effect on right). RLQ mass). Two
Poor distribution dilated (smooth)
of gas in general bowel segments
(suggests bowel (suggests bowel
X-ray diagnosis? 11-month-old boy with vomiting.
obstruction). obstruction).
Bowel obstruction with right-sided mass
effect: Intussusception
X-ray diagnosis?
11-month-old girl
with vomiting.
Possible
target sign Paucity of
in RUQ. bowel gas
suggestive
of right-
sided mass
and bowel
obstruction.
X-ray diagnosis? 7-month-old girl with skull fracture,
lethargy, and vomiting.
Intussusception
Target sign
Absence of hepatic
angle
Paucity of gas
Absence of
hepatic angle.
Paucity of gas.
Target sign
Paucity of
gas in RLQ.
X-ray diagnosis?
Slipped 10-year-old
Capital Femoral obese
Epiphysis
boy with rightof
(SCFE) thigh
the and knee
Right Hip pain
Moderate slip
Severe slip
Bilateral SCFE
X-ray diagnosis?
Appendicitis
Fecalithit
Identify
(appendicolith)
again
RML
infiltrate
X-ray diagnosis? 15-month-old boy LLL & RML
with fever, coughing, tachypnea. Pneumonia
X-ray Normal No
diagnosis?
newborn thymic
2 month thymus
old No shadow
with a VSD
occupies the
presents with thymic
space anterior
recurrent shadow
to the heart
seizures.
Cardiomegaly
(CHF)
Cardiomegaly
(CHF)
Hypocalcemia
found on labsNormal thymus shadows
VSD, Thymic, &
in young infants
Parathyroid Aplasia:
DiGeorge Syndrome
X-ray
diagnosis?
Ventilated
infant with
sudden
deterioration
Pneumopericardium
Air in
pericardium
Revealing the Thymus
reveals
“Sailshape
Sign”of
infant thymus.
Prominent Prominent Thymus Partially Normal
asymmetric thymus
Obscuring a RUL Infiltrate: newborn
Pneumonia thymus
occupies
space
anterior to
heart
Infiltrate
RML atelectasis
Round
Pneumonia:
“Cannonball”
Pneumonia
T
X-ray diagnosis?
15-month-old boy with
fever, mild stridor, and
barking cough.
IdentifyCroup
the: P
Epiglottis
Epiglottis - normal E V
Vallecula Epiglottis (E)
Vallecula - normal
Vocal cords Vallecula (V)
Trachea (T) - narrow, C
Trachea Vocal cords (C)
subglottic edema
Trachea
Prevertebral soft (T)
tissue
Prevertebral soft tissue
Prevertebral soft tissue (P)-
normal
T
X-ray diagnosis? 6-year-old
girl with mild neck pain. C1
Swischuk line criterion:
Line drawn between C2
Malalignment
C2-C3
No recent pseudosubluxation
of C2But
trauma. andshe
C3.
posterior arch of C1 and C2
Is
wasitProbable
characteristics:
athrown intoC2-C3
true subluxation
a or is
posterior arch of C3. C3
it Minimal
a pseudosubluxation?
swimming / pool
mild 30
trauma
hours
Pseudosubluxation
ago
The posterior arch of C2
Minimal
with no / mild pain of
complaint C3
should be within 1 to 2 mm
No signs
neck pain atofthat
a fracture
time. She
of this line.
isNeck is positioned
now brought in ED
in to the
Deviation from this line
flexion
on a spine (notboard.
lordotic), often
suggests a C2 pedicle
due to a spine board.
fracture; however, this
Swischuk line criterion.
criterion is not perfect.
X-ray diagnosis? 2-year-old
C1
boy who fell off his tricycle
is brought in on a spine
board. C2
C2-C3 pseudosubluxation
Swischuk line:
characteristics:
Line drawn between the
Minimal / mild trauma C3
posterior arch of C1 and
Minimal / mild pain
the posterior arch of C3.
No signs of C2-C3
Probable a fracture
The posterior arch of C2
Neck is positioned in
Pseudosubluxation
should be within 1 to 2 mm
flexion (not lordotic), often
of this line.
due to a spine board.
Swischuk line criterion.
X-ray diagnosis? 7-year-old
girl unrestrained in a car
crash brought in on a spine C1
board.
C2
Fracture ofline:
Swischuk C2 pedicle:
satisfactory
Despite a satisfactory
C3
Swischuk line.
There is very slight
Fracture of
subluxation the
of C2 onC2C3 Pedicle
due to the fracture.
“Hangman Fracture”
This odontoid view is still useful
X-ray diagnosis? Two
It’s
The
to normal
hard tothe
lateral
identify odontoid
see
massesanything
lateralare views.
with
masses
7-year-old boy injured his (ringTheJefferson
this lateral
displaced
of C1)
poor Fracture
masses
outward
relative
odontoid of C2
C1The
are
indicating
to
view. as
head and neck diving into outlined
aligned with the base
LMsof C2.
that
odontoid is(C1
the ring
here.of
not ring)
C1
The has
visible. fractured
should
shallow water. anddirectly
be burst open.
over the base of C2.
This CT scan shows a
Better quality open OC1 C1
Jefferson fracture (C1 LM LM
L L
mouth
ring (odontoid)
No definite
fracture) abnormalities.
sustained L L
L M M O
His collar
when
view blowis to
temporarily
ademonstrating
the top of
a M
C
M C aodontoid C2 C2 M
removed
the head
Jefferson for
placesan load
fracture. on C
2 C
(open
the long axis of2
mouth) view.
the spine, 2 C
bursting open the ring of 2 2
C1.
Radius should
Mid-ulna line upfracture.
angulated with capitellum (C).
Misalignment indicates radial head dislocation.
Anything else?
Abnormal C
Olecranon
Elbow Joint Effusion
X-ray diagnosis?
Probable occult
Elbow injury.fracture.
supracondylar
Posterior
Anterior humerus
Supracondylar fat pad
line:
region:
Anterior
misses fat pad
OK capitellum
Both
(not unable
a true to
lateral view)
assess (true
lateral view
required)
Radius-capitellum line:
normal
Olecranon: OK Radial head:
Fracture
Radial Head
Fracture X-ray diagnosis?
Elbow injury
Olecranon Supracondylar region:
fossa cortex cortex disrupted
is fractured
Anterior
fat pad (+)
Posterior
fat pad (+)
Supracondylar Fracture
X-ray diagnosis? Elbow injury
Anterior
fat pad (+)
Radius-capitellum
line is not pointing
at capitellum
Posterior
fat pad (+)
Olecranon
fracture
Joint Effusion, Olecranon Fracture,
Monteggia Injury
X-ray (radial head
diagnosis? dislocation)
Elbow injury
Tenderness
The epiphysis is is elicited
displaced
over distal
Salter-Harris radius
displa ced
type 1
non-displa ced
fracture of
distal radius
physis
should be
suspected
clinically