Peds Radiology (Clin Reasoning)

Presentation of Malrotation / Volvulus

Distended abdomen

Fussy infant

Vomiting

Malrotation

Malrotation

How is malrotation / volvus dx

XR → Cutoff wth promixal dilation

Follow with NG tube with barium

Ladd’s procedure

Untwisting of volvulus

Ladd’s bands divided

Tack down small and large bowel

Presentation of Kawasaki Disease

Fever for > 5 days

Bilateral conjunctivitis

Changes to lips and oral cavity (starwberry tongue_

Cervical lymphadenopathy

extremity changes

Polymorphous rash

What is the risk of untreatd Kawsaki disease

coronary aneurysms

Treaetment for Malrotation

Labb’s Procedure

Treatment of Kawasaki Disease

IVIG within 10 days

Steroids

Aspirin

Risk Factors for Intussusception

Males

Viral illness

Presentation of Intussception

Vomiting

Inconsable infant

Bloody Stools

How is intussception dx

XR → Dense intestinal

US → Telescoping of intestine

Treaetment for Intussceoption

Air enema

Surgery if fail

Risk of Air enema

Perforation

Presentation of Orbital Blowout Fracture

Eye pain

Nausea and vomiting

Strabismus

Oribtal Blowout

Pnuemonia

Treatment for Peds Pneumonia

PO Amoxicillin x 7days for

Managment for Septic Shock

O2

Vanco + Ceftriaxone

40cc/kg blous

Epi Drip

ETCO2 Montioring

Treatment for Pleural Effusion

Chest Tube

What abnormality

Cardiomegaly

Pnuemothorax

Esophageal Foreign Body

Disc Battery in Esophagus

Anterior mediastinal mass

What is the ddx for an anterior mediastinal mass

Thymoma

Teratoma

Thyroid

Terrible Lymphoma

What is the general approach to evaluating an ill infant

ABC’s

O2, IV, monitor

D-stick

CXR

EKG

Chemistry, CBC, UA, urine and blood cultures, Utox

Consider LP and head CT

Antibiotics

Slipped Capital Femoral Epiphysis (SCFE)

Most common hip condition in adolescents

Slipped Capital Femoral Epiphysis (SCFE)

Treatment for Slipped Capital Femoral Epiphysis (SCFE)

femoral osteotomy

Psoas Sign

Pain with thigh extension (iliopsoas muscle irritation)

Obturator Sign

Pain with internal rotation of flexed hip (obturator internus muscle irritation)

Rovsing’s Irritation

Pain in RLQ with palpation in LLQ (peritoneal irritation)

Pediatric Appendicitis Score

An approach to working up cases of possible appendicitis

What are signs of peds appendicitis

Anorexia

Migration of pain to RLQ

N/V

RLQ pain with coughing or hopping

Fever > 38 C

RLQ tenderness

WBC > 10

ANC > 7500

How does appendicitis appear on US

Noncompressible, blind-ending tubular structure with diameter > 6 mm

Target-like appearance in transverse view

Intraluminal hyperechoic foci may represent appendicolith

Most common surgical cause of abdominal pain

Appendicitis

Management of Appendicitis

Morphine (does not alter exam findings)

NPO

Antibiotics

Appendectomy

Thymu

Congenital diaphragmatic hernia

Eczema herpeticum

Buccal cellulitis

Erythema migrans-

Herpes zoster

Pyogenic granuloma

varicella

SSSS

Erythema multiforme

Cradle cap, seborrheic dermatitis

Herpetic whitlow