Christopher Schelvan Eig 2 . Annabel Copeman = i lai-m(elelare) Jacqueline Davisnm ROYAL Socterrs PRESS net 202 Roa Sc of Maine Pr Ed | Winpole Suet, Lanlon WIG OA “ " Aa foamy Birding fr the pps of earch or pate ay sci ot ‘sven pried uke the UK cpyigh Desig and Pts Act 1K 0 pat "he pblaon maybe epics neo ae. ay ir yy es ‘at the poe pian in VaR DCI ete ce prac reproluion im sconce with the teams Heenecs ued by the propre Repriton Ongnacon oui the UR. Estes concern ra ‘het ted ha hol be we he pula the UX aes ed ots The gh of Cis Shaan, Annabel Capea, Je Vou nd cq Dito be ee atom of te work ie beon ane By them ss atone eh he (Copy, Des sr Pac At, 198 ih Liteey Ciao Pion Data A cage on rth boo aii othe Bh Libary Type by Phocix Phsoncing, Chat, Kent ‘ated by Bella Ban lagone Price Ford e Andes ‘ aes and tools ¢ Cues 5 Bibogaphy 2S Index xHow to look at a paediatric chest HOW TO LOOK AT A PAEDIATRIC CHEST X-RAY Phere isa lot of information on a chest X-ray and it helps to have a routine. This takes less time than you think and avoids basic mistakes, for example ny the wrong patient, You will ao start to look at all the information «instead of just looking at the heart and lung fields 1, Elementary stuff. Check the name, date, si written on che film (e.g. ‘film in e 2, Technical matters. Ask yourself the film is technically adequate. This sounds boring and unnecessary but this is why you most ide markers, and anything ration’, ‘lateral decubitos) ‘kex-X sau 2uneIpaed B 3B 00} 02 MOH This child was admitted with a cough, and a chest X-ray was performed. What does it show? What i the diagnosThere is mothing the matter with the eis chest. The First film was taken in expire Qoob far sc tapping. This fka-wa taken tamedicy a must aes the fl fr 1. Adequate inspiration—ive anterior bs shove the diaphragm 2, Rotation— fhe Kidney Image of the renal ac are prodced, and the prsage of Seer trough the kidney s mapped by 1 graph, called arenogram. foe oe ah Ig 2 ee In obstruction, the acer accumulates inthe collecting sytem and is not hed Uselal tips thet ere n Hoot (Ga apward pre! ego ier ty projected over the fm—there is almost fhe cence oon Tbjece dat cannor be apated or swallowed ‘sarin bat Beware the child with ae X-ray afr that shis appearance is ue vo abstr father dha 3 “gay” sow peanNuclear eystogram ied inthe detection of veicoureterc refx. The eysragram canbe diet wen the traces introdaced directly into the badder, or indict, performed ir the end ofthe ec eam (vedi phase. A orcas eprom ‘An increme in the kidney activity during the voiding indicates reflux Somerines this x evident even prior to voiding. A small ‘blip’ atthe end of dng soften sen when refx is present a acer retums to the bladdet STATIC SCANS DMsA Tihs tracer is taken up by the renal parcchyma (proximal table). ‘© erection ofa abnormal located kidney. pric dpa ki act infection (UTD I fnesion in abnormal kidneys, for example uli suypauu s9janpy| Sees GASTROINTESTINAL STUDIES Barium meal © Usally performed looking for abnormalities of che ossoplages (6g reo, vaculr ring), ad to exclode malrtation 4 Videofloroxcopy can be hepfil inthe investigation of chikren with feeding dicaltis (eg assent of swallowing and recutent spi ” ‘es showy ouapag tamach id uotram. Os = Onoptagns “Dace 9) oj Rome wel studies (barium or water-soluble contrast) 1 Can be therapeutic (eg, meconiam i INTRAVENOUS UROGRAMS (1VU) ving been superceded. by “ultrwound be util in defining anatomy. paieulary | Mowever they can Occ MICTURATING CYSTOGRAM | Performed to look for tetas and to asese mae‘003 pur sony neck eee GT seam are thon exciting eadilogy investigations that produce pleny of pct logit to get ut of bed in the night feast PHYSICS FOR DUMMIES. CT is exentlly glove 3 ine fom each rotanion (a lie ta that can be ‘manipulated to look at bone, soft tisue, kings, and brain (different windows asic concepts Appearance oflesion CT number (density on CT (sof tissue or attenuation) windows) Wiie High Bone, alee ote haemorrhage Ineermediate (between Wate, sft sue : Lowe fat air BUT REMEMBER: The relative density of eictures on CT depends on the window stingy — the same sructures wl ave completely diferent brightnes levels on bone ANATOMY FOR DUMMIES. We cannot teach you erotesctinal anatomy Chest (Nori appen Recon the sscular sce mal medina conta tio Conasentnced CT dat et oh is) Lng we on afew nefAbdomen Normal appearance are shown below Key poines Bria [Normal CT appearances ate showin below. © be systematic: ch ong i tar Aas th regulates in and density of each ong. fy puired or symmetncal sructurs (kidneys, adrenals, brais) compare the xn given? Look athe blood veils of contra, of Gave high deny represents aleification or haemorthage 1 Inthe chest, look for abnormal sft sue inthe mediastinum Gs anu rnph nodes should not be greater than Teo in ameter) and ngs © Inthe abdomen look for abnorm sori lymphadenopathy (dhe Lem rule 1 athe brn, ook for midline shit and make sre the lateral ventils a tse mas, re Hid and par normal size ad symmetrical, Lot-attensaton lesions may represen tumours, ines, or oedema, Do not fonget have aqui look 2¢ the Sings and orbits, Bone windows are important in tao case. (i) dpinteenaiiiieseeu me ka) MII fightens everyone (including fs 8 sophisticated om-radicion imaging modalry that may eventually become the bread nd butter radlogy PHYSICS FOR DUMMIES. MBI mes 0 cota ire sing. magnetism instead of radiation, Diffrent tues is applied, the diflerenc uae have diferent magnetic properties This sus it che exquisite soft Gwe difeentntion achieved with MR Ti and ‘2 simply refer to diferent eacthods of sampling the magnetic rmsonance sigl-meaning that the tame soft dowe may have different nce for istance, fl so lena The useful thie about ML is that you cin obtain images i any plane tne so-ealed“uliplanar capacity’ of MRI}—sully agit, condo, oF KEY POINTS. © mt A of tis ere isn signal fom bone—te CT to evaluate bone therfore cede + low sign (dael) on nding mass or within infiams ot hig sana anes (white) on Tt sca (Fi enh had 20 Olea‘1003 pu s2jmy PePereacr ans fae Nees es The btery of tess avaible increses yearby year, Selection of particular xt depends on many fctors. The aaibiity, accuracy, dese of invasive new and cost of the investigation will ll iafluence che choice, Remember some general principles 1. The more information you give 4 radologi, the beter the qulty of report You get. Discusing 4 dck/ worrying child with dhe radiologist tsually helps beh pores. They ae the exper in imaging 3 use chem 2. The chance of a fee yielding a postive result increases ifthe clinical evidence ofthe condision s high (known a 3 high pretest probability) For example, 2 child with abdominal pain is more Hkely to have sppendiis stey have 3 high white cell count, localised guarding and fever, than child with vague asominal pain and no fever If the result ‘of testy suprising given the elinial ndings, check your findings and ‘icus the eae with the radiologe 3. Some tess are very good a confirming or excluding the dlagnoni, for ‘example ulersound fra hip efision (a sensitive and specific et). Some teat ae very good at eling you i something is prevent (nse) but a negative reste does not exelide the diagnosis (nt specific), for example (CT vean for thtrachnoid aemorta nanan gaan ion ot eopcanraertione invention Radiation dene sua Seco ores Geks/sboen wai None Relative costs of imaging investigations Investigation Cost : 5 ‘Ghew/abilomen Xy x {Cervical spine/skull ZL Bari contrast stdies ELLIE Bone scan kek [Needle biopsy LLL Lh Thee TELL, CTches/abdotnen LILLIES. MRI kkk 1 i dt ‘This term baby was amie tothe neonatal unie with respiratory dss 1. What sbnormaliies ae seen on the font chest radiograph 2. What isthe diagnosis?ANSWERS 1. Thete is gas in the stamach and proximal duodenum but none eke: where, giving the ‘double bubble’ sgn 2, Duodenal ates, 3. Down's syndrome, RADIOLOGY HOT LIST (©The abdominal X-ray is diagno and a contrast study is rarely required (danger of spiraion. ‘© The condition may be detected antenatal © Ifthe abdominal mdiogrph suggests incomplete obsruction (with 2 soull amount of as inthe dsl bowel) a cael upper Gl contas udp 1, cat be performed o aes the site of oberuction, Je Other ess of neonstal duodenal obstruction include duodenal eno, Asodenal web, annolar pancreas, Lad bands and midgut volvakas CLINICAL HoT List (9 Incidence 1:3400 live bint (© Early developmental nsule accounts for mote cates, There is a high sociation with other abooraliti, e.g wore, esophageal, candic, dae renal | (© Mose atresias occur distal co the ampull of Vater, thus causing bilious 2 Up to. 306 have Dowa’s syndtome, This 4 day old boy is in ena fire bilateral hylonephross What inventigation shi? What doe it show? 3. Whats the dino? Antenatal ultrasound had shown,ANSWERS 1. Armicturating eysto-urethrogeam (MCU 2. There ivan abrupt change in clbre ofthe urethra, with dilatation of the poster urethra. The bladder wall i tabecubted, There is bilateral orterie reflux into dilated and tortious ucts. There RADIOLOGY HOT LIST “The diagnos of posterior uretheal valves sully made on a MCUG: dilatation of the posterior urethra, 4 transvene filling of the urethral caine data to. the is wil sh defect (valves), and redaction fe Thee may be trabecuaton of the bladder wall and «lange residual sane 9 Vescouretcrc reflax is comman, and bs awociated with « wore prog enatlultasound may suggest the diagnosis, showing dilatation ofthe da thick-walled, ditended blade. reer and pevialyeal systems Zier findings ina male Cid should always prope farther abeaent by MCUG. ‘6 Al chk hylctc anbiotics atthe time of| the MCUG. Te investigation should not be perform shouldbe eeeeving in the presence CLINICAL HOT LIST 1 Valves are mucosal folds, which cose on voiding, leading 10 obstruction. oye (1800, 40% present cis the commonest obstructive uropathy i in the fist 2 weeks of if, moat before 6 months of ag ‘© Neonatal presentation miy be with winay reeiton, p infection or ursemin. Infins present more commonly with UTE ‘© There is an asociation with renal dyspavia and ‘pre belly’ syndrome (© Trestment is By surgical disruption ofthe valves Prognosis depends on {he duration and seventy of obstruction prior to corecive surgery. ad the rowence of wescoareenc reiANSWERS 1. Thee i + midline solid mas in the posterior fo, arbing fm the vermis and extending superiony. Ie i parialy cacfied. and shows marked enhancement after contrat. This ie casing obstructive bydeo- Pepfdleelioe etc eslew denaty ices re Oo rs 2, Medallobastoma RADIOLOGY HOT LIST © Medallobisioma is unually 4 well-defined posterior fous mas arising from the cerebellar vennis inthe midline. CT cawically shows a ineeonely enbaneing ental eld a, © Encroachment on the IVth venticle/agueduct can cause hydrocephalis present in 85-95 (© Subarachnoid metastatic spread revuks in deposit is aud equi and intracranial CSP spaces. Those ae bes assed with IMI) Metaxes ako occur to bone, mph nodes and lang. Le The sitscoen dingnois of childhood posterior fa raves includ F, peak incidence mud deca {© Ic arses from primitive mesenclymal strana ’e Predspostions and asocations- chronic extomyets, previous rao. Je “Trese: raga! easton nl cemsttiey. © Five yearsurvial 5% if thereat no metstes a presentation = one scan show che etsy tums ee a af fer 1. What abnormal is seen on the X-ry 2, Whats the dingnonis? the forearms and hand?ANSWERS 1. The ead i abs and them shor om both sides. Both dhimbs xe hrypopltic 2 Thrombocytopenia-Abset Radios (TAR) syndrome RADIOLOGY HOT LIST © Aplasia/hypoplsia of the radiut i one of several limb reduction anomalies Radial ray anomalies refer to she rcv, fst metacarpal, nd hum CLINICAL HOT LIST © tobetance is mostly porate 1 © Absent rachis sociated with —Thromboctyopeni-Abscot Racks (TAR) syndrome “Hlt-Orun syndrome VATER/VACTERL Acro dyson tur old baby was admitted to the neonatal unit with choking and {fates during his fist fed 1. Wha abnormal 2 Whats the diagnos?ANSWERS 1. The nogatrc tube is coiled in a blind-ending proximal esophageal pouch. The gutec ar bubble i present. The hing. ae cer, With ae Giidencs of pire 2. Oesophageal atresia with a tmacheo-oesophagel ft RADIOLOGY HOT List 1 Thesite ofthe atresia is usually apparent, though air can be injoced to ddszend the bind-ending pouch (wully at the junction ofthe upper ind and lower two-thirds ofthe oeophas} {© The presence of sir in the stomach it indicative wa tacheo-oesaphageal foul, : ‘Avoid conta sides when oesophageal atresia present, 3 thve isa Significant rik of aspatio ' Arfossophagoprain stad is required to identify an H-rype fala (2%), When theres 3nonmally patent octophages ¢ Remember the VATERVVACTERL anocition and ook for other anomalies, CLINICAL HOT List 8 Incidence i 1:3000, with associated milormations i up to SOM (© There ae five anatomical Varian ital racheo-oerophageal ful © Nunc prone and head vp, with a Repolge tub ‘esophageal pouch t prevent spratio have ocsophageal atresia witha 0 suction in the (© Sunpcal tepair depends on ociophageal length: primary end.to-end anatomon, oF 2 saged repair wallow growth of segment followed By sptric/colonic interposition This. regan ol boy was cen in ARE with incomolable crying, abdominal F Whe stmormiicies B What isthe diameANSWERS 1. There are cently leated and ised bowel loop, with no gin the recto. There 2 gas shadowe project over the scrotum. No ce ai 2, Small bowel cbyriction scecidary 0 et inguinal beri RADIOLOGY HOT LIST © Ke & dieu wo detingiah berween small and lange bowel (central complete micas young pe more key fold (al bowel) OF ‘tilren. Clues clude anatomical lato Eset) ahpectince incomplete hasta Gage bowel 1 Ifthe distended bowel loops are fd fll, the omen may have a © Alva look for intrscrotl airs incarcerated emia ate the most common came rl obaruction in inGats under 6 mona (excluding the neonsal period), {ook fr ie intraperitoneal i secondary to pesforation CLINICAL HOT List € Adhesions arethe mort common cause of obstruction in babies who ae faa previous neonstal surgery © Other eames of oheruction to consider inchade extrinsic mass (ei tumour or appendix absces), incususeeption, Lads bands, and smal bowel volvulus secondary to malrtation, 2 of boy i reviewed on the pointe wad. Bread well SSblshed and he fas pased a small amount of meconium on day one There is now a6 hour history of tile-sained vomiting 1 What isis se % What abmormaly is Aémonstrated 3. Whats theANSWERS 1, An upper gutroinieinal contrast std 2 The duodehio-jjunal (D)) flexure and proximal small bowel Jontally site yng to the ight of the midline RADIOLOGY HOT List on ofthe duodeno-je in the diagnos of ralotation. I shoald he tothe le of the midline athe level of the por. The proximal jejunal loops shouldbe lee side. Beare es oper cones sy en ray en) ere © Mid-gut volvulus may occur, reuting in the small bowel having @ corkscrew" appearance, a it fits around the superior mesenteric © Rew sia al of the postion of the superior mesenteric artery and vein on jad may suggest malrotaton, but i ot defini CLINICAL HOT LIST be excladed in ] © Mslrotaton sa neonatal sui emergency and needs t vation isa abnommaliy of small bowel rotation and fixation. The sentry shouldbe fined fom the Dflenure in the leading to small bowel achenia and potential infarct ‘© Obsenction may be intermittent, and the dgnosts should be considered a 1° jm older childrom with similar symptoms. This 14 Year old gt, with an inherited Bilateral sensory neural deafnen. An MAL Wiha abnormalities are seen on the anu pos-enhancement? 2 Whar isthe dingnont bts the underlying coniion? coat TH-weighted iANSWERS 1. ‘There ae biter soimtense mates (on T1 weighting) at the ere bellon ontne ages, which show sntente enhancement with gadelinium, The frases extend into and expand the internal auditory canal biter The pone i compre > Wlsterl aco RADIOLOGY HOT LIST © Acoustic neuromas are schvwannomas, which aie fom the vestibule Vill) nerve. They say arte within, oF atthe opening of the itera sadizory canal, an clsically expand and crode the inermal scowste © ‘There may be obliteration ofthe psiltnal cerebellopontine (CE) angh ‘ister, compresion of ae poms el dtc ofthe IVC tei wal rsoctatedydrocephals © The mys is naslly non-clefed, and shows intense enhancement on both Cand MRL Acoustic nearomas account fr 80% of CP angle tanouis, Other cea CLINICAL HOT LIST © Bilateral aeons euromas allow 2 presciptive diagnosis of send fibromatois ype 2 (NF2} © NF2 an autosomal dominant disorder, disine: fom NEI. Gene location: chromowame 224, otic reitman ae doy progrenive daft © Chisel Sates aba imbalance, sianivo, cerebellar stan, fvtures of raked inacramil presure and other cranial nerve pase. ‘© NE2is sociated with a ew café-au-ait spots (5), and subeuesneous ral in sige and mule). Meningiomac and ependy= ‘ewefibonna BT «yeu a following. : 8. What ithe mont ike oy presented to A&E with pain in the Tet per am ively tii Bil Wha docs the X-ty sonANSWERS 1. There factiredangugh the proximal humerus atthe sve of well defined se lesa 2. A pathological genre trough a simple bone ys | rapioLocy HoT List Simple bone cysts afe characteriaically well-d lesions, with a ein But sear bony cortx { They ate commonly found in the proximal homens and proximal femur, and are usualy asymptomatic unles pathological facture ‘occurs. They may be ineidenal findings on pin radiographs. ed, expanded Iti n dyes ead ionic thse appearence rdilogialy, CLINICAL HOT LIST © Simple bype cyst orifinate tthe epipnieal plate in long bones and etal maton row inks the Saf EB, cao pom With se They ae rarcly sen after the age of 3 fo ifsytpromatie dhe may require curetage and bone packing His taby was admited having colle at home. There was a history of a Pibt to another caualty department wih asi Hotbeton il pide, Thief a post B We soonnaty sc Wht spre 9 Wc foreher imaging shoul be perk the chest Xera ANSWERS, 1, "here are healing acum ofthe posterior ib on both Side, 2, This highly suggewive af non-aceidenal injury (NAD. 3. A dedicated skeletal survey will be rested. RADIOLOGY HOT LIST {Ri ecturs in chldres! under the age of 2 yeas are almost always de to NAL (Rib lactis ie are ia childhood 2 the compressive forces required ar condone: Usiew ther it x hitoey of signiGicant tania eg aa teallic accident) always be sxpicions Posterior i races ate specific for NAL. They result from severe Come reson ofthe nb cage, anally ding a shaking episode Rub facares miy not be ible immediately, but delyed fins 240 dye will show calls formation and penal reaction, Always considen ‘elayes fms i there a high nde of suspicion wth a normal chet X-nyy. A bone scan may be postive within hours of inary and’ may CLINICAL HOT LIST 18 The reported incidence of NAL vanes fFom 15 10 42 eases per 1000 ‘he rs ikl that there gifeat underreporting of ei abuse Tee major cause of morbidity and mortality ‘Young children may present with collapse of neat-mis ot death duet) cerebral injury 19 There iv oer inadequate explanation for injures, inconsistencies in th hiseory and delayed presentation. There may be mle mjonce with presentation to dierent hospitals After desing wath the injuries, management is t0 keep the child i a place of sey with anesenent bythe child protection tea. {© Outcome: death 2%, severe injory 30%, reviury 10-30% reared #0 ABs paca ofthis 3 yea old boy noticed an abdominal mass when they Mer ving him a bac, E Whe abeoricn Wha iste dignosi Bare dhe ashociated rk factors for this continANSWERS 1. Ther sarge, non-enhancing and mixed-attenuation mas ating fom the right kidney. No ealeficaton is sen, Theresa filing defect within the eight renal vei ad inferior vena cava (IVC) representing mou invasion, The other blood veel are displaced by che mas. The ver and) Ik kidney appear sonal on these images 2, Wil’ our 3. Chromosome 11 point deleion, anv, hemibypertrophy, geminornary sbnormalides, Beebwith-Wiedematn yi RADIOLOGY HOT LIST ‘Wiles tumours ae bilan 5% ally has well-dersed margins and clsiclly displ adjacent ves, as opposed to crissng them (as with neuroblastoma), 165% have eumour thrombus in the renal vein and IVC ‘The pin abdominal radiograph may show enlargement of che renal ot line and displacement of the adjacent bowel gas. Cakficat 10% {© Chest CT is sed to detect pulmonary metastases (present in 10% a8 CLINICAL HOT LIST © Incidence 1: 1000 ive births, M=F, most under 7 yeas (peak 3 yean) resentation is tually ina wel cid with a non-tenderablonsiul mas 25% have haematuria, 8% hypertension © Staging of ise ‘One kids, apa inact, complete exelion Extension beyond capsule, complete excision, HL Residual amour within abdomen IV \ Hacmategenous spread, 6 hing bone iver Bilateral renal amour Ths 8 year old boy asa ange head and mild developmental dey B Prscribe the abnormalities on the CT san. 2 Whats the condition Whar isthe mos likey case| ANSWers. | 1c othre is marked distation of the lateral and hind venticles with @ h vente. There is no mis lesion 2. Non-commiinicatig hydrocephalus RADIOLOGY HOT LIST F the Iateral (pote the dilsed temporal hors) and hid ize fourth venice indicates chat the levelal © Dib, ventricles with 3 nom tbstruction atthe aqueduct of Sv. # Congenial aquedact tenons is the commonest cane of congenial trocephalis © There is no periventricular Tow density (which would indicate acute hydrocephalus, implsing a Tonestnding abnormality CLINICAL HOT LIST ©: Hyroctphats is due o an imbalance of CSF production and seal © Otneructive hydrocephalus iv duc to obstruction ofthe normal CSF AH ction of CSF (secondary to onl Picts fap) rare Example “Type of obstructive Pathophysiology hydrocephalus Communicating scraventicular blockage Pos- mening jesus beyond the fourth post haem venizicl whi the ‘ubatachoid pathways ad arschnoidyrilations All vente ated Veutricular blockage Amol-Chia with dliaxion of rnaformaiony ” Non-communicst ventricles primal co Dandy-Walkte sintcton, snallormaciom, of Gale ane el tc, bom 3t 27 weeks’ gestation and ventitted for most Fee 836 has abdominal! distension, metabolic aeidogs and 1 | © the clinical presentation will vary with age and acti ppt deste abdominal adiograph show presentation may ince incessing head cieumfetence, develop a it ely and havioual changes An acute decompensition may Pel ith sgn of raised intracranial pressure, eiues and acute squintANSWERS. 1. There lange amount of fee intraperitoneal air he diaphragm and liver, There sai inthe scrotum (bilateral patent Moceutn vaginal). The bowel loops are not well seen. There i an Piiouncheal tube, NG tube snd umbilical vein catheter in situ, Both fang show patchy intleates 2, acute Gi perforation (usually This baby survived ondary to necrotiing enterocolitis) RADIOLOGY HOT LIST ‘@ Frce intraperitoneal ait may not lie under dhe diaphragm vehen the fosent is supine, Fae ai wil collect the leat dependent area (jacent Bithe anterior abdominal wal, resuking ina central rounded lucency ctl sgn), This may be quite sube fe Air may outline the fl ligament which appear a 4 dem linear pacity due to free air either se of i) inthe midline or tight upper quant fo The bowel wall may be seen clearly ata thin white line i there is iron both sides oF it (Riles sign). Look for interval air in premature ab f¢ A horizontal beam ‘shoot through’ film of the spine baby wail shove fe air adjacent ta the anterior abdominal wall in equivocal ca CLINICAL HOT LIST # Nijor caves of neomal perfortion ince uecrtsing enterocolitis, Hinchsprong’s dese, bowel area, imperforate a ew. ind meson© A. yea old Afro-Caribbean git was brought ro the ABE department with 2 high temperature and a psinfl right arm. The an was tender and fythematows, The Xeray normal 1. What i this investigation? 2 Whit doe it show 3. Wha the diagnos?ANSWERS 1, Bone san using technerism-99e MDP. 2. Ther is increaed uptake of tracer throughout the nigh humeras RADIOLOGY HOT LIST ‘@-Xays are usually normal in acute osteomyelitis ad it may eke up 0 10) days before pain fin changes ae see f@ Aone canis wsalythe feline investigation, andi enerlly posi ‘within hours of the clinical signs appeating. Tei wef to iden hl Se) of the infection 1A white cell sein can be wed to confimn pyoggnic oeomvelits where the bone scan 8 egaivocal © MRI will demonsirate the soft tisue extent of the infection, I a sensitive for oxtcomelt asthe bone xan, but cannot cover the entre Skeleton, and may sequie sedation. CLINICAL HOT LIST © Oneonysis occurs secondary to haematogenous spread or penetrating injury. Chron presentation may be dve to Bile adequate weatmen for underlying immunodeficiency Population Tone ‘Stopyloenet exes, group B Shp G negative bacteria cod S. aureus (1000), Sree, Hamas Sickle cs dscse Salmons TPN dependent Gaudide Ic present with sudden onset of local pan, swelling, erythema, atl immobiity. The chi is ssencally unwell with fever and mais Blood cultures ae postive in 50% (© Parental bactenocidal antibioris are nceded inilly, Six wecks of anubiotc therapy are wally required © eradicate infection. Eat fonhopaedic involvement is necessary a srgical decompression may Be requited, and may aida microbiologieal diagnosis, BEES yw operated on in ba Ys operated on in the neonatal pried or areal ate, adi Thic radiograph ofthe spine was taken at 4 mony of age Whar sb Bt abnormality s seen onthe pli ratoraph? the undevying digmoss?ANSWERS 1. There thoracolambsr scoliosis centred at 'T8/9, which is concave the night. There ae mulkiple abnormal vertebrae between T6 and TH, 2, VATER or VACTERL asocaton, RADIOLOGY HOT LIST ‘© Scoliosis ia lateral curvature ofthe spine, which maybe sracural (oa Jf teal bending abiiy) or non-straccual (normal mobil). Je Causes ince: idiopathic (most common), congenital, newromuscaae cae, skeletal dysplisin,post-raumnai, poxe-inlammatory © Congenital solos is due to vertebral sbormaltes, with 2 progres curve and often requiring operative intervention | © Congenital scoliosis often sociated wih other anomalies, particu cardiac and genitourinary. CLINICAL HOT LIST’ (© VATER and VACTERL ate asociations; combinations of congenital sbomraies that occur ata higher frequency than by chance alone ‘© Vericiral anormal, Anal ates, TracheoBophageal, Radi, Fe abuormalses, © Vertebral, Anorectal, Cardise, TracheoEsophagea, Renal and Li abnormal. BE This 9 year old gil has sight hip pain, hyporpigmented areas of skin, and Fpeeciiis purr Bp What does the plain X-ay 2. What the disgncn: 5. What he underying conacion?ANSWERS 1. There ae resulting in biter coxa hin th defined, expan Ite lesions i both proxiol eal rs. Simiit lesions ae sen the ie bom ction, oF sociated sol There i Ho bre wice percael 2, Polyostotic brous dysplas RADIOLOGY HOT List hogy lesion are clasilly well defined (4 “narow zone gb They typically expand the bone (implying slow growl There should be no. asocated apart rita seaction or sft ue mam present father than destroying i spl, where nay fate modeling deformities lating toa “phen! e17 mm i longitudinal ec cor > 13mm ia tansveresetion, The pyocie muscle thicknes ism €¢-The are should be scanned continaowslydring 2 fed co demons lack of opening of the pyloric canal with exaggerated pera the mow sensive imaging finding foe sis condition (© Abarium meal may show showering ofthe sneram with elongation narowing of dhe pylori canal (sing sign) CLINICAL HOT LIST The codon is duc to idiopathic hypertrophy ofthe circular muscle the pylons Iglesia ffs from males at 2-8 wosks of hit Presentation is with non billows projectile vomiting, imdequate si and a hungry baby Cinical examination ofthe abdemen may demonstrate visible pts andthe enlarged pylorus may be fla palpable ‘olive -shaped! mas Sangieal prlromsyocomy is curve ) | tc pyle milo 4 fed rMRATORY AL This 3 year old b Yea ol hoy was seen in ASE with sudden onset of coughing and Aske resptory domes. im B Whe does the chest dog ° Fyfe te chs aiogay showANSWERS 1. The ef right, As the fl zapping 65th left. The norma right hing i amler because tout ~ it ean be dificult ell whl g sof greater volume and is hypetucent compared tdi detibertely take in expinion, chit impli al 2, Inhaled feign body in the let main b RADIOLOGY HOT LIST tion bodies can cause three adil 1d decrees in expiration. For Snail Tomval CXR, wo beacon w tr Raw Tacermediat (80%) byperinfaton de wo air trpping Oxchason ‘occurs im expiration only, dive to normal de i bronchial chameter around the foreign body en disel goniolidation and atelectas due fo Shacection of eT Late © Chien onable to cooperite with expiratory fms cn beaeed fl trapping ith screening or decubitas views (ying on gpa ide ‘would normally reduce in volume but remains hypeinfated dae il resence of foreign body vnpliaions CLINICAL HOT LIST [Usnlly occurs in hikren under year (M (© They-commnonly present with sudden ch oemlysetle, Delayed presentation occur i MP 1 ih and wheat which may sub ‘© The weatment of choice bronchoscopic removal of the forcgn BOEANSWERS, 1. There are multiple calied sabependymal nodule with ae Jppings appearence along the lining ofthe eral enticles Thal eal cover hick a several Towatenuaton areas in th Cortical tuber, ote of which i cakified RADIOLOGICAL HOT LIST ©The typical findings in tubers sclronis ate subependymal haat protraing into the literal ventricle, These ealcfy with increasing al {© Conta subcortical hamartoma cubes) are sen on CT a yp lesions (ypieally non-caltie), {65-15% wll develop giant cell strocytoma at the foramen of Muy manly og (© Other cates of imrecerebalclcication this ag: inckad mm cytomeglorins and wxoplammoss infection. "Thee wil nae seal ‘ypicalsbependymalloction. CLINICAL HOT LIST (© Tuberous sclerosis tan auonomal dominant condition, 50% spontaneous mutavon. ‘© Cardinal fearres include mukiple fal angiofibromas (de ial rut scbaccum), sabung fibroma, retinal hamartomas and ‘© Cutaneous features include white macules, which Avorece Ua Woods light and shagreen patches. Cardiac shabdomyomae and tumours (angiomyofibromas and renal ey) may occur (© Seiares re dhe tort common presenting omptoen Geen eB Innes may present with ifatle sposms, Ealy seizures corte siguiicantleamiag diticules. B01 ty hs sank pun and haematuria a aston. ae seen on the pin fil and intavenows urogramANSWERS ‘On the pin film there ate opacities projected over the lef rel il an the lower poe of the let kidney. On the 1VU, che ight kidng txereres normaly. No contrast is seen in de let pevicalyecal system 2 Left taghorn ealkulis with an obsracted kidney. Farther call in hl Jet lower pole RADIOLOGY HOT LIST (6 1VUs ave performed infiequenty in children (ultasound and mac redicne ae the investaons of choice) but are usefl n ase of ¢/ Smal nl calcul maybe dificult to se on leasound but 9% oF sal Calell ae viable on the plain film ‘@- Aways as the prelititary abdominal X-ray for evidence of real a Caleificaion, which may be obscured by © Otsraccion reuls in delayed or absent excretion of contrast on fected side CLINICAL HOT LisT © Renal calculi are rare in children: the majoriiy are related 40) ‘secondary to obstruction, of infection. Patents with congenital abnor nals such os blader diverticulum, horseshoe Kidney and she sponge kidney have an increased incklence. (© 6 ofall are due to menboic causes Seone ope Ee Geo sons ype, hyperascmin secondary thyroad,cxcen aeamin D CGysame tones yuna wi em eubular defct oF amino enor q (Oxalate ones primary hyperon, or seconde smal bo ‘acne and nerd sborpoon, eg CHOKNS, porn s Une asi nee snduction therapy fr leukemia ae’? Presented to his GP with 32 week history of le gro 1d inp, k eft groin AP ana, Fler pelvic X-rays were cbse 1 Pi do they show bats the diagnos? Mare the seq Pe ae if treated?ANSWERS 1. There i ate subchondral sre aid slerss ofthe let femoral capital epipha 21 Deries dese (idiopathic avascular nocroniof the femoral ed) 3. Abnormal bony remodelling with sere degenerative joint dia carly adukood RADIOLOGY HOT LIST fe In the caly phase the pin film is normal, but MIR wil she Baal narrow changes and a bone sean may show a focal photopente debe ‘© Pain Gm changes reflect the healing proces 8A fiogrtcral Xray may be more sensitive than the AP view oF tl {© Consider underlying phology such a sickle cell disease, steroid dbo bod Gaucher's dease. Avatcolar necrosis can abo occur secondary trauma, infection, srgery and action Wha isthe mot likly dagn Whar the diferent diag this tateal kal Xen CLINICAL HOT LIST 18 iopathic avacularnectoss ofthe femoral headin eildlnood de® Jnerption of the blood sappy to the femoral epipyss © Ie most commonly occurs in boys (4:1) aged between 4 and 10 Ym and blr in 1 © Clinica symptoms are gradual in ontct with no recalled hin Of rama, Ir may present wath goin pain, mp, or Kmited ip movene ‘Treatment may inclade res, tation, abduction bring and stenoANSWERS Wel-defined, rovniled lucent lesions ate seen throughout the sll 2 Langethas’ cll hiticytons 3, Bone metastases most commonly from neuroblastoms or leuksemi RADIOLOGY HOT LIST {© The skal is the most common site for bone involvement in Lang call hstocytoi 1¢ The lesions are usually well defined and may have sclerotic Fim gi a bevelled” edge appearance The spine and ribs are abo commonly involved, Radiological ndings Ie spine include lytic lesions and vertebral colpse(Yertebra plana). © Lyi lesions and perosteslresetons may be sen in dhe long bones radiologically 4 polmonary inter CLINICAL HOT LIST © Langerhans’ cel hitioeyoss isa dseue of unknown aetiology amoral proliferation of phagocytic hitiocytes There may be mulkiytem involvement, and the cinta course af "elatvely benign to highly malignant and fal © The disease proces may involve skin, lungs, bone marow, hm shadenopatiy and heptosplonomegal), bone the ptr (Sabets sips) f¢ The teatment may include chemotherapy ad radiotherapy $i 12 yer old ye had aches infection when this X-ray was ake, Te Wha absonnatiics 2 What isthe diognei seen on the chest X-ray| ANSWERS RADIOLOGY HOT LIST The caves may be hy 18 The chose may be narrow oe bell shaped, with supernumerary sb, (92 'The skal epiclly sho deficient osifiation, widened tore andl Fananeli, and Wormian bones mal accesory bone wihin dhe nang | cunicat HoT List ‘© Autosomal dominant diease with dlayed/defective osiication of ine structures (particuiry membranous bone Face Trypoplatie mail, broad depressed bridge of bypenel Teeth Aye Petes hypoplastic pubic rami, pubic disses Hands tong sec orn and sbnorial denon, malocclusion cond mctacapal Other feaunes shore satu, cosa vara hopaedic and dene i This 3 monn Le Whit 2 Wht is I baby presented ASE w hs itory of inconsohble ination, fhe was not moving his sight leg, which appeared sv injory ears the week while nn acral views ofthe rightANSWERS 1 There are metaphyseal facture ofthe disal sight femur and pi ight ubia, with an exuberant els response and periosteal eae ong the shat of both bones. There i more recent tine i theme ofthe righ bu 2, Now accidental njry RADIOLOGY HOT LIST Rasfologicl features als femation ¢ Meee nomic of aon-acesental fnjury, radiography is requ PO TREB year ol Crock gil has chronic anaemia B Whar does the acc shale 2 Whe the disronis aah he appropriateness of thei and the his i in recarded cn itive injury and/or a lack @ WARNING: th 2y be ocnal ~ late fl sential if NAI n may show abnormalities bell he plain iesANSWERS 1 Theres sll vaul thickening, with widening ofthe diploc spa thinning of the cortical marge ofthe ier and outer ble oF the The parnaglarsinases and muni ai cell are radio-opade 2. BeThalisatmin RADIOLOGY HOT LIST (© Skul ue thickening occurs de to marrow hyperplasia (eta haemopoies. The cortex ofthe ice and outer tables sp thinned, and neat nvsbe ~fonly the coarsened verti a ate sen, eis ead toa“! rina ai sinuses an mastoid air cl The stall hones of the hands and fee may show modeling defo cotta thinning and coarscned tabeculr pater, _Extrmedllary bacmopocas nay case a parverchral ms a al Xn CLINICAL HoT LIST © -Thalssicmia 4 hacmoglabinopathy caused by abnormal B gi chain synthesis Is commonly Find in people of Mester Allan descent Ir presen inthe fine year of fe (hen Hb A replaces Hb Fe Inchide anaemia, hepatesplenomegaly, recurrent fever and ie thas Skeléal deformities may be prevented by 4 fegular ansiod il | gramme. Haemesideross may occur due to frequent Hams Incresed irom absorption. It can he prevented by ion cheb Aesfernoxamine, smy may be required when spesomegaly and increasing fasion requirements become problematia | © Bone marrow tranplinestion is potentially curt PTs 4, Hoops, and th. ws appeared patentANSWERS 1 There are dite loops of small and large bowel within the abd The signioid colon appear dilsted. No gas is seen in the rectum 2, Hinchaprng’s disease 3. The diferentl diagnosis of nconatal Inge howsl obstruct functional immaturity Gnclading-meconiam plag. syndrome) anorectal asia RADIOLOGY HOT LIST illeremtating berwecn small and lage bowel obsuction i dif rieonates, Look for anatomical location of bowel loops: Hf cena are tore key to be eral Boel © A content enc wil diferente between the mujor causes af bowel obsruction; Hischsprung’s, atesia, meconium ius, Fine motley dorders (meconium plug syndrome) 19 A conast enema in Hinchsprung’s disease may delineate the one between normal Ganervated) died colon and the ‘Segment of ganglionic bowel. Theis val in the ectosigmoid CLINICAL HOT LIST © Pachology: absent gangliayin both _myenicrc ple (Asal Meisner), The dienbution i from the nim proxy, expaiied flue of atadl migntion of neural cet cells 1 Presentation varies with length of afeced bowel: 70% shor se 25% long segment, 5% ttl colon (short segment may present a6 / constipation in the olde child). 9 The diagnosis is made by rectal biopsy. Management ie ‘her prniity pall though, or colostomy and) debijed procedure PT 0 year (0(59% albo have Downs sydrome old boy was being investigated fr headaches. On examination © Complications include necronsing enterocolitis (the rik persis Befada bitempora emianop afte Surgery) perforation and fine to thrive BD esenke ow radiological sbnon ? hanced CT B What te dngnosisANSWERS 1. There sa densely clei supra present. Thee i ile the lncrl vereriles (obstructive hydrocephals). Periventculag crenustion indicates acute hydrocephalsreoising urgent shun 2. Craniopharygiona RADIOLOGY HOT LIST Skull X-rays may be normal or show an enlarged or expded pl 1@ CTrahows a eystic (75) of mixed solid/estic spells mas Wi ‘Gleied in 2% Large lesions may cause obssuciveydrocepbalg f¢- MIR is performed oases Joel spread, iemen of ope ch CLINICAL HOT LIST © Criniopharyngiomas ate che commonest cnuse of eildhood sue mas (median age of presentation 8 year) 9 Precatng features inchode sigs of raed ineracranial prestre fuructve,Iydrocephals, and visual field defies (li ‘© Endocrine dysfunction may occurs rest of abnormal level hormone. ACTH, TSH, TRH and ADH. The chil may preentl rom tctandation or diabetes inspids ¢ Management is suygcal resection, radiotherapy and endoctine feenage Bana £2! combine of continuo in. Bit dogyorst enous urogram (IVU) was pero i,| ANSWERS: There 3 duplex ight side with two non-diatd tal The left Kacy i sal 2, Duplex right kidney. The presence of continnows incontinence Sia Shred Kf Kidney is de t severe refx nephropathy om this ia) RADIOLOGY HOT LIST Clas Ths an ectopic inseton, analy er neck, urethra or vag Tei rontinence. T : upper moiety prone © There may be ss filing dfece ade chsmicted upper mosey displacing mid qeenvard) ands prone co vescoureterc eux and real Sein CLINICAL HOT LISTANSWERS 1. There is a joint efsion present in the right hip. The joie 6 inde sterioly with uid lying beeween thal The lef hip jones normal sient synovitis of the right hip (erable hip), howg RADIOLOGY HOT LIsT # Ulraound isthe examination of choise fr th detent CLINICAL HOT LIST © iriable hip ogg © The prima © Hip ptANSWERS Theres Pacing Of the comet othe del eatin ned lea its Tl tramvene lncency set inthe dial adi 2, Ton factres of te distal rave and aa RADIOLOGY HOT LIST The cortex ofa bonis normally a smooth unbroken line © timpacton rele in conical buckling ands tone facture (onal derived fom the Lan word meaning prtruberance or bug). © A gaeenick factre (les common) occurs ifthe bone is angulated beyond it capacity for bending, leading to a factor on the convex si of the bend, Muscular spasm imay then hold che fracture open at Hal CGREENGTION FRACTURE omen Buon = TORUS FRACTURE weeks’ gestation, is noted to be pale and CLINICAL HOT LIST 1 Tons fiactures ae treated with immobiliation and pain reef © Greensick facares with pronounced angulition may reqirereduct foning prior to mmobilation and healing ogical sign i seen on the plain abdominal adiograph? ole ik factors fr this and correctANSWERS 1. "There ae linear Icencies within the bowel wall representing ina ‘ (pueunatons intestinal). There i no evidence ofp ‘within the poral venous sytem 1. Risk ficton include prematurity, intauterine growth retardation, pe fae aphyxi, Hypoxia and sock, sei, poleythaemia, tbl fatheteriion and hypertonic feeds RADIOLOGY HOT LIST ©The inal plain ln may be normal. Early radiological ited loops of bowel se ic rad bows! wall thickening, ‘The colon terminal lew are mest commonly alec. (¢ Jomamursl gx characteristic of NEC, aid may appear at 1 Foams” coll (Search for tice ai, which may appear aa cent lucency overlying abdomen (a dhe baby i supine), or outlining the fleiform liam {orhich appears a an opaque line sn the mide o ight per guadean (Look for portal venous ja (near lscencen within dhe iver wl extend peniphieraly {6 This 13 your old boy was involved in a road afi accden, and complained CLINICAL HOT LIST fight per quadran pin is primarily a condition of preterm and low birthweight babies wh immature gue is vulnerible fo 4 varity of inal, which mani © Candinal mechanisms are gut bypoperision and ischaemia, though infective proces ao implicated © Clinical presentation ranges fom systemic features (cthargy,hypotr shock amd apnoco) to abdominal dsension, blows vomiting and bleeding © Management of NEC is usully conservative (resuscitation, ss suppor, total parenteral nutrition and ancbiois). Surgical interven nay be required for perforation of flue of medical management, © Late complications inchide intestinal stricture (20%) and shor syoveome (pox-surgcal ection), > I, Whac does 2 Whac isthe ontnat-eahasced CT sein ofthe abo sion?ANSWERS 1, ‘There ae muliple, regular, low-atenuaton areas within the ght lobe ofthe ver. The intrahepatic veal are normally opacted, No re Said is present, The intra-abdominal appearances are otherwise normal 2. Multiple liver laertions with haematoma secondary to blu uma RADIOLOGY HOT LIST ’ (Liver lcerations ate typically branching or rounded low atencution (© Hacmatomas wsly appear a poorly defined ares of low attenuation | © High aemation areas may represent active haemershage ‘© A subcapsular haematoma stlly his @ lenicula or crescent-shaped {© Look fr fie Aid (haemoperitoncum) and other vscer injures, There is an amodiated splenic injary tn CLINICAL HOT LIST 1© ‘The iver i the second most Requendy injured inu-abdominal viscus {afer the spleen) in blunt rams, The sigh lobe i most commonly afore ‘© Liver trauma is ually managed conservatively (in >90% children), Enboliation or sagery i indicated for continued bleeding (Complications occur up to 20% (delayed mipture, haemo, infected 16 year old oy presented to ARE with an acute onset of dyspnoea and ite chese pin, 1. What does the chest X-ray show? 2. Whats che diagnos?‘ANSWERS 1. The right hemithorx is hyperacen with complete absence of pulmonary ‘markings. The eight hemidiaphragm is depresed and the medntnu i placed to the let 2. Right tension paumothorsx, RADIOLOGY HOT LIST a (© Always ases the pulmonary vaiculitiy whien comidcring uneqdl luceney om the CXR. ~ ie ie normal, reiaeedGmplying abnormal ang or absent (neumothorss)? 1 Look for a ee ang edge. Mediastinal shift and/or a depres diaphragm indiate the presence of 2 tension pacumothorss (© Other causes of a unter hyperkicent hemthorax include patent rotation, ait trapping (eg. sconary to foreign body, congenital cmpysema), reduced. pulmonary perfusion, and chest wall abnor CLINICAL HOT LIST fe Chilshopd pneumothorax i avociated with trauma, aha, cys fibrosis pulmonary infections Gnclading, TB), Marfan’ syndrome ail mechanieal ventilation, (© Treatment options ined observation, simple apiation and chest dail insertion, The choice wil depend on clinical presentation and seve © Lifethreatening tension pneumothorax needs immediate inerveaHal do not wit for an X-ray A'3 year old gil was admitted vin ARE with fever and cough. On exami= tion shes pyrexia, with tachypuces an } Whar abmommaiy i seen onthe AP and lateral CXR: What is the mont tikely diagnosANSWERS 1. The pulmonary, and clely separated fo fs a rounded opaciey in th he, which is nea There sno aim fial lef lower the spine 2, Let lower Tobe mand poten RADIOLOGY HOT LIST 5 © Rs won ema of ah parent as ell inthe focdiattic chest. In the appro ate clinical sting follow i approach. Wit time, the initally round pnesmonia develope into more typi 1st Xay afer nt i thespy isthe mot pragm ‘consolidation before event resoltion. The le iy not parserecral, making neurogenic tumours peaspital abies of extramedullary haematopotesis unlikely. (© Other cases of solr lang nodule: ‘Congeniad” bronchogenic oy, lung sequestation, aneriovenous ‘malformation, bronchial sues Infection absces, granuloma ‘Tumour primary long tomour: primitive neuroectodermal sm (PNET), pulwonary bhstoma, mecatases (eg. Wiln's ‘amour CLINICAL HOT LIST orumonia is wmlly sen it ve eatly consoliacive pl neumocacel pacwmonn, Aay, gil has fever and sore throat; On examination she pyre and drooling. J} Whac sbuorinaity does the lateral X-ray of he ® What isthe diagnose GisANSWERS 1. The epigitti enlarged and indinct and encroaches on dhe pharynx ‘The upper airway & distended. 2, Acute epigotis. RADIOLOGY HOT LIST cy. Radio (¢Epiglotits is 4 cinisl diagnosis and agpaedtic emer spas are nox required to make the dias! If X-rays ar performed the child most be accompanied by a physician skilled in managing a pass Alia airway —the xk of complete airway obstruction very real ‘¢ The uownal epiglots hae a well-defined slender shape ~ in ace spi ori dis shape i lost as the epigonts becomes swollen, with swellings of the adjacent ayepilotic folds, leading to airway obsrction This 6 year old HIV-positive boy has 3 cough, 1. What does the chest radiograph show? 2, What ihe diagnos? Lae fh shor om poe {© The upper airway may be ditended (away obstruction) and the m held enteaion (co Keep airway pate) CLINICAL HOT LIST © eis du toa severe bacteria infection, usually occursing in 2 co 7 yell folds. Is now ae dite to the Haemophilus inlenzae B yaccinaion (@ Chinieal presentation: siden onset of sore throat and dysphagia, PAO teeing to signs of upper ary obseucton ia a eb oxi chil © No iiwestigitions are necesury prior t0 agnosie laryngoscopy Ineabation may be required, This mest be underaken ina contol el anacahetist avaible manner in theatre with the most experi (9 Purter nianagement snladesineavenous 2ANSWERS 1. The Hari ie shadowing Wiener tc ne, ol Sema 2, Lymphoid itera! pneumonitis (IP) . RADIOLOGY HOT LisT © The appearances are variable, but there i ually reticular nodulag shadowing (opacities up to Smm) present. This may progres o aca more confluent airspace shadowing The chest Xoray may be now (© High-resolution CT chest scans may show extensive bronchovasculae micromoles and grovind-glas tention, (© These appearances he required to make the diagnos be mimicked by infection anda hung biopy saa CLINICAL HOT LIST © ‘cis Iymphoproiferative disorder charscored by difuse lymphocyte infileadon of the pulmonary insu, porsby secondary 10 dire pulmonary HIV infection: «© Tei indicative of AIDS when present in children (much less common i HIV positive aduls), and is present in 55% of children with AIDS wl ave pulmonary disease [Je tis s slowly progrenive disorder with dy os generalised lymphadenopathy an hepatorplen asocated with bier chronic paras, (© Tehua visable incl couse, bot overall these children develop fev Thi ar old gi was brought to A&E afer a sudden ‘was unresponsive to pn with badyearda, apse, On exam 1 Name three abmoemalies seen on the non-enhinved CT «an of the head 2. What isthe diagnosis 4 he i What sche most likely undying cae?There is mothing the matter with the eis chest. The First film was taken in expire Qoob far sc tapping. This fka-wa taken tamedicy a must aes the fl fr 1. Adequate inspiration—ive anterior bs shove the diaphragm 2, Rotation— 30g/1)” infection, malignancy, indtion ‘Hacmontagic trauma, bleeding chordsANSWERS 1. Ther isa round, well-ctcumscibed and hyperdense lesion inthe temponl lobe I's easing mas fect with midline sift and eficem fof the anterior hor ofthe righ lateral weneil, Afr contrast isha intense uniform enkancement, with mukiple jacent abaonmal The superior sgt sins shows early enhancement 2. Right temporal arteriovenous malformation (AVM) with shunting. RADIOLOGY HOT LisT Contrat-enhanced CT of an AVM vail usally demonsiate d fcahancement. with lage feeding vesek and draining veins. MRI ‘Show character areas oF ial Yo i che ves fA linge AVM snay cause obstactve hydrocephals. Other compleai include haemorrhage, ifrction and local arophy €¢A in of Galen malformation att AVM which arses in the midline dine direay into an enlarged vein of Galen Ie may be detected antenaél ultrasound. {¢ Anziogmphy may be necessary to define the vascular anatomy pio surgery or embolistion, CLINICAL HOT LIST AVMs are congenital sbnormalitis consisting of anomalous tor aceries and veins, creating an arteriovenous shunt without am i ‘dary capillary bed, Modes of presentation: GATS child tas be Infcsions 1 under long term follow-up for recurent chest 1 Whac abnormalities ae seem of the chet raograph 2 Whats the diagnosis ‘Neonatal (0-1 mands) high outpur cardiac flare dew ma shunting j || tnsine (1-12 month) obseuctive hydrocephalus, sizures > year headaches, oe neurology, hydrocep hemorrhage z © Therapeutic options include fnbolsatiog of aren feeding vesels complex neuronugery tANSWERS: 1. The lungs are hyperinflated, with widespread pulonary inflates roves and bronchial wal chickening. There isting shadowing due bronehicetanis There right-sided portacath in place 2. Cy Fibrosis RADIOLOGY HOT LIST Typical features of pte fibrosis on CXR include Beonchiccass parle "am in, ng Perbonchial ehickening thickened bronchial walls Hypernfaion owe, Hatened diaphragms Maces logging collapse, consolidation, ai Fiber cage seticula-ystic pare of Hic Iymphadenopathy and/or prominent hla pulmonary ary laarion econsary to pulmonary hypertension ecutrent pneumonia acl areas ofcollpse/consll Longeterm intravenous access central ¥enous lines, (© Be aware that inthe carly stages hyperinfution may be dhe only abn inal $2 This wo an a half year old boy presented this GP wit oflehargy, Fever and night wens 4 week history '© Think ofthe diagnenis ina child with recument chest infetions 2. Wha abnomay is seen om the chest X-ray? 2. What isthe most key disgnont CLINICAL HOT LIST 3, Whats the diercacal diagno © Ics an aucosmal recessive mulinystem dvorder, and the comma fause of chronic hing deme and exocrine panctextc insuficieney childhood. 1 Incidence (UK) is 1:2500, heteroaygores 1:25. © cdc eo a gene mtason om che long arm of hronsome 7, ene for the cite fibrous transmembrane conductance relator. 480 mutations idensiied, 70% AFSOS, © Preentations include chronic repiratory symptoms, recurent infections, fle to thrive, meconiim lus, malabsorpsion with ea thc, sec prolapee and nal polyp. © Management stategcs inlode dict, pancreatic wapplements, phy therapy, appropriate abiotic, bronchexblaton and DNAS. 6 Sorvival is 75% to 18 yeas with god care,ANSWERS heart border and superior medistial outtines are obscured, but the hil s winble through the mas, This indicate the mis in the antetoe 3, Ledkarnia, inflammatory lymphadenopathy Gecondir to tuberculosis) RADIOLOGY HOT LIST © Msisial mayees have wide diferent, and it wel to conser tien acconding to heir anatomical location ~supevor, amerior, mide, ‘or posterior mediastinum, This can often be detemined onthe plain X= tay, but most children will proceed to CT sca for further assesment © Hodgiin's disete accounts for the myjomty of neoplasic anterior ‘distin macs in children, TI i a common non-neoplastic eatse of ‘edad node enlargement CLINICAL HOT LIST 1 Arde dine of presntation, mediainl lymph nodes ate scon in 25% of hidden with Hod oma, 15% with non-Hodgkin's japon, and 5-10% wth leakaemia, A residual mass (which Tay of Hodgkin's dea, but is more ommon in non-Hodgkin's Iymphoua(dssatinated 9¢ presen i nal ukrasound ws performed on a2 day ol ected condition. 1. What abnormal is secs in the left Key 2. What isthe diagnons? baby gi or anANSWERS: There i dilatation of he left plvicaycea yt 2. Hydrouephtons ack anechoic ea) RADIOLOGY HOT LisT ©The calyees are only seen on ultrssound when dténded by Aid. (© Ulrasouind cannot realy distinguish betwecn the 80 mos important {hydronephrowe obsrucion and vecourctenc ret. Futhee rurating eystourethrogram and/or nuclear medicing studies) ae required to dilleenvate the conditions 18 1faptenstal hyueonephroni detected, posal Zllos-up i tandatoryy ie orc to cxcluce rales (up to 3099), and other arcligicl dal malities sich 2 posterior urcthal valves and. pelveuetenic junction ‘obstruction Local practice vais, (A doe pottetl ulrasound dost wot exciade P te wveek old boy owas noted by d jaundice. Ulrasound showed 4 now-tiated biliary tee but the inuniey midwife 49 have his HIDA sean (hepatic nuclear medicine Joes ie show tis the diagnose? avis the dierent ons for this presentation?ANSWERS 1. The HIDA scan shows uptake of tracer by the liver, but no excreta inuo the small bowel. The appearance remaite unchanged over 24 hou (Normal setivty seen in che urinary bladder) adie Nel HOA an showing avy ac pla ada 2 Bilany sei 3. Other causes for penitent neonatal jaundice include "breast milk jaundice, hepatica and choledecal est. RADIOLOGY HOT LisT © Ukrasound examination i the inital radiological investigation persiing jaundice, in order to diferente between obstuctive a on-obstractive causes, fe The presence of» gllladder makes biliary atresia much les likely ‘ladder only presen in 20%), The biliary ee ws cypically not ciated bilayers, 1 A choledocal esis usualy sopecte from the ultrasound appearances Jo MR cholangiopancrestography may demonstrate the into and exe hepatic bar wee ‘© Polsplenin ie asocaced wil iar areata (10) CLINICAL HOT LIST © Causes of pening jaundice nde — bret Seng (up 10 6 wee hepatitis (ine eo fetions sch as cxoplamoss, rubeland imeglvin),choedoal cs, meio abnormal ad nbor emai of metabolism, + Bil are occurs more common in male nn (2:1). = Liver blopry may be ncesary to distinguish beeen bilary ata al Carta develops if unened within 60 days. Eaty sumery (Ca procedure ~ poncnterontmy) ithe definive westment. Where ¢is tot ponte (ortow nt) eanphenttion th ey erative This baby ge presented with repratory ii which : ne < in the neonatal period, which have pried. The midwife had noted that her bs were shor, but there were no other dymnomphic features. 1. Comment on the CXR. 2 Wha isthe mont ely diagnos? Whats the propos?ANSWERS 1. The thoracic cage marrow ith small volume lungs. The ribs ae sh and horizontal with broad and expanded anterior ends. Thete is cons tation in he ight upper lobe 2, Jeue's dhoracie dsttophy 3. Generally poor prognosis ~ most die from resptatory lure betore RADIOLOGY HOT LIST {© Chisically elongate and bell-shaped chest with normal heart sic, la ing ite oan for ee hang, Short horizontal ribs and aregulr bulbous cosochondr junctions Other skeleal abnormaliues "wineglss’ pelvis with short Aare i thes and reduced acetabolar angle, shizomelia, postaxsl hexadacth shor phalanges and mitaphyselsereulary Look for features of respirtory tat infection. CLINICAL HOT LisT 1 Tes sutxomal receive chondrodysplasia, predominantly affecting ovtochondal junctions. ‘¢ The difeenrial dng for a small thorax with odher skeletal bao males inchs thasstophori darian and Elie wan Creveld yd sented to ARE with a2 week hisory of lesided Se This 14 yea lip gi 1. Whar is the diagnoANSWERS, 1. There ie slipped femoral capital epiphysis onthe lft RADIOLOGY HOT LisT {© Epiphytal lip may be dificulk to identify on the plsin AP X-ny. le ‘sully more obvious on the frog lteral view, sehich shouldbe obtain in okey children with hip pai, © The lpi poteromel in 99% of cases, # Radiographic signs widening ofthe epiphyseal plate redaction nthe apparent height ofthe epiphysis line devw tangential tothe lateral border ofthe femoral nec shoul ‘ponmally pas though the lateral pect ofthe femoral atl epiphy —diplicement of the medal femoral metaphysis so that ino Tong Sree ts cele 9 FA nner pon lk show pai i of sp a CLINICAL HOT LIST 1 Ic clasically occurs atthe time of the pubertal growths spurt (gi ae 10-13 year, hoys age 12-15 year). There is am increased incidenee boys and overweight culdren. Bltra slip is present 20-40% cates 4 Treament aims to prevent frtherdippage eather than repositioning the slipped femoral hod. There mise be lation of acs but prop lati surgical pinning may be required. The pins are wally remo fer growth plate fasion. © Complications include avacular ncroti seute catelage necro premature physcl closure with subsequent ablength dic tency Premature estconthrt This 18 month old baby has swollen wrists 1. What does the X-ray show? 2. What isthe diggnoni?ANSWERS 1. ‘There s Cupping, ying and irepulasity ofthe metaphyse ofthe ds raise and na 2, Rickes RADIOLOGY HOT LisT «# Radiological change issen atthe distal ends oflong bones a the sts most rapad growth: changes are mest evident at the wat and kn There may be cupping of the aterioe ris at che costochondral junet (sickey rary) 1 Look for lg bowing in weight-bearing children, pathological fac generalied osteopenia and ull Dosing in severe eases The radologieal manifestations of rickets cannot relbly distin lesen the dierent aetiologies (¢ Rickets may bean incidental finding on the chest X-ray ~ always look the humeral metaphyse, CLINICAL HOT LIST € Failure of mincraaron of osteoid leads to bone softening and defo = Chalioag ot poke Thin 2 year old oy has a cough and fever 1. Wha does the chest X-ray show? Nocioni icary dehioncy of amin D or ck of soa 2 What i Malabsorption coeliac dicise, hepatobiliary disease Heredia royal Xtakehypophoshatsemis, vim D ‘nck, Faconts sydrome, ital eal bala soso J Acquired rel conic eal are J Neo des ec, ey eT far) sexteomabcais Combliaton in the right tid none which obscures thal | ANSWERS RADIOLOGY HOT LIST (© The heare borders and diaphrag ate clear and distinct on a chest Xo ws they ae intecfices between radiokicent ar (unig) and radio-ol (Gpacfication ofthe hing secondary to consolation or collapse resi oat of the isso tiie imertce — hence the ikdcfined mangan sis oElg pbolegy can be preci by which neces Gk “Lung lobe involved Tighe hear border igh ial lobe Right hemiiaphiragm Right lower lobe Right partaches! Right upper lobe Left heart border Lingus ef upper lobe) Left hemidiaphragm Left lower lobe oma atl khong eos © Children may ako develop round prcumonias ~ rounded focal ares of onsolidation, which have che appestance of amass lesion. Fllow up host X-ray show resolution air antibiotic thera CLINICAL HOT List cus most commonly impicted. Haemophihs, myeplama and rimary tuberculosis can ive a simile appearance, Kid lusialy shows "bulging" of aac sures pepe to ih ie[ANSWERS 1. There a lage well-circumseribed sof tse mas onthe lf side of he neck, extending into the axila and into the superior mediastinum, I apices the races to the righ. 2. Cystic hygroma RADIOLOGY HOT LIST © The mas extends fom the neck into dhe superior modistinany a 50h, bu he presence sn appendicolit in child with abdominal pain gives >P%6 probabgg of appendici Tere may be sl bowel distatin secondary to an ileus An append abces may be detected a sot tante mis, a paucity of | hovel loops in he righ ae fowa, and may be asocated with extra Tein a. | © itso may be 2 ypc tubule soeture with» cromsecion Ghimeter >6mm, a complex mis, appendicaith, ee id The diagnos not exchaded by negative imo ingoste and may demomsiite any ofthe followings CLINICAL HOT LIST cis the commonest sungical Gmergency of childhood. ‘© Sympioms it older children are similar to thove seen in aduls, Thi infinal sgn tendemess at MeBumey’s point. However, in younge thildren, presentation may be with anorexia, fever, dirhoes and The ferential diognoss includes non-specific abdominal pin, spsttor tein, mesenteric aden, Henocl-Schéalein purpr, compton ‘urinary tac fection, lower lobe pneumonia and dbetes fe Treatment consis of reaseitation and appendcoctomy. An append mas may be managed conserratively his 2 year old oy is under investigation for progresive developmental p lopmen tardation, On exantination be is short, has coarse facial fates and patsplenonieply What does the lateral X-ray f the lumbar spine sh F Whats the mort likely diagnos? 3. Whats the diferent dagenANSWERS 1. There ita mild kyphosis a the thoracolumbar junction, The vertebra sodies ate abnormal with anterior inferior besking and long slendee peices Mucopolysaccharido Other ents of ante Hue’ syndrome, Je iaferior besking ofthe vertebral bots ince schondroplas and hypothyroiian, / Death in chilood, Gone ‘marow ranplanation Prognosis RADIOLOGY HOT LIST 1 Skelea dephsia sa component of Hurlr’s syndrome, with widespread sdiographic abnormalities volving the axial deleton and the extremities © The eles radiographic changes involve the skull frontal boning calvrilthickening and J-shaped sells, The characterise feseoes in the ‘pine are desenbed shove, The sae bones ate fied. The tbe ate “oar shaped ‘© The bands ate abnormal (trident hands): broad expanded metacarpal ‘with epered proximal ends, ‘Goan icc, shor satire; skcletad Somatic features yep, comes! ouding, Neurological signs ‘Marked retantation al reccuive CLINICAL HOT LIST ‘Au eo polnaccarileg he paricular enzyme deficiency. There are ‘Type Husker seven typer in tora. Babies ate wally normal at bith, but devel inlisendscae by 2 yeas. Gavive to slaticod ‘Surive to adulthood [Noma fe, short stare, marked Iyphoss, hypotona, contractures tepatesplenongaly, valvlar heart dene ‘As foe Hus’ ut no comeal Mild cetardation loading) Autosomal dominant Normal biked H-Humer NeMorguioANSWERS. 1. There is posterior diplcement of the dtl radial epiphyig only appreciated on the lateral view. This lsat the imp "sco views a ght angles shen sewing tama, [A Salter Hares ype | epiphyseal injury. Epiphyealfactues may require open reduction to avoid and/or premature fasion with consequent mb shortening. RADIOLOGY HOT LIST 18 The epiphyseal complex (epiphysis, cartgenows growth pl ritaphyss) involved in 6-15% of paediare acre, mont a the writ andthe ankle Ic is important to recognise facture involving the growth “orthopaedic intervention may be required. H [el | Pr old boy presented with right-sided hip palo and bruising. The vue ' BE eS cectssl ecmcepeeci er chat tae es ek \ see = a ‘on che X-ray of the pelvis. Wace the diagnos SALTR — This is wef mnemonic, describing the relation ofthe co dhe epiphyseal pie CLINICAL HoT List © Types 1, IU and HIE factres are treated by closed reduc mmobilsaion © Types IV and V fsctutes require open reduction and internal prevent premature growth plate fasion with subvequent limb do ant angulation,ANSWERS 1, The bo mothvesten appearance, There are bilteral sjmmetial” perio reattion along both femoral sha, 2, Ace lmphoblati leukaemia, RADIOLOGY HOT LIST ‘e Skgtetal maifenstons occur in 50-90% of leukactia patens sal ‘sully due eo leukaemic inflation. X-ray changes may precede bla film abnonnaies, and resolve with succesfal therapy. ‘© The appearances may include osteoporosis, ransvers cent metaph tod oc cata ye lek and peroneal (© Similar rasological features ae seen with metstatic neu CLINICAL HOT LIST [Bone marrow fllure Anaemia, chrombocytopaeni, neutropenia ise and organ _Splenomeyaly,Iymphadenopat snietion involvement Systemic effets __ Fever, lechargy, anorexia © Treatment includes chemotherapy, radiocherspy, bone marrow tai lzmation ind supportive measures (blood trasfsions and prevent See ce iad ei oa This 3 diy okd aby was bor at 27 week gesation and vented for valine membrane ds don the venieor with Hypotersi and hypotonia, A cranial ultrwcund 1, Wha aboriality is cen? 2, What are the posible sequela t this?ANSWERS: 1. There i a mas of increased echogenicity seen in the lf lateral vente sith extension into the lf fontl lobe, Thi represents» grade IV inte ‘ventricular haemorrhage with parchyual extension There i dilatation lof ee le temporal hom secondary tothe obatrcting clot. [Lange haemorrnages may cause hydrocephals,encephalomalica, neuro loghal impairment and death, RADIOLOGY HOT List i 1 The echogenic choroid plewus docs not extend beyontt he calles sic groove, so any high echogenic seen in the anesir bom the lateral ventricles i pathological 19 The blood clor appears 2s an amorphous mass of high cchogenicny which may fl che venticle, or lnyer in che dependent pan of the ventricle © Asis venticlar distation, andthe adjoining cerebral parenchyma periventculr involvement © Chisitiition ‘Conlied wo subependyal minal matte Gaie2._ Extension into non-iaced venti Extension into dite ventricles “Massive inuaventiula and intraparnchynal haem “This eck old baby wan born a¢ 26 wees’ gevtstion ands been vente lated since bit 1, Whe abnormalities are sen on the chest X-ray? cee saiuer 2 What isthe diagnon? (© Haemorhage occu the germinal layer (ecular nctwork, Hoor of t= «ral venules). This normally involutes inthe Later part of presnyy and thus periventricular hicmorthage (PVH) is not ually seen in inf over 32 weeks gestation. © Ic afecr 20% of nonates with birth weight below 15k, © ‘is commonly asymptomatic, particularly grade t and 2, and cherefone routine scanning is necesary on neonatal intensive care wit. © Risk factors include hypotension, byponi, acidon respiratory disres syanrome snd pneumothorax © Grades 1 and 2 have a good prognosis. Viewally all those with grade 4 lesions wall have nearologia impairmentANSWERS, 1, The lungs are hypernfated. There Ws coane reticular shadowing yal rounded lucent areas both lun, The hear and chaphragmtic outings dre defined 2, Bronchopulnionary dysplas, RADIOLOGY HOT LIST 1 Bronchopulnonary dysplasia is defined as onygen dependency aier 2 days, or afler 56 weeks corrected getation. However, the radilogsell changes develop during thie perag, ustlly fllowing sentation foe Iyaline membrane diese 1 Stags of bronchopulmonary dysplasia Hmonth as abive with raphyscmanous change 1¢ ‘There may he complete radiological resolution aver months or year i some cates. Others may have tetained linear dersites and upper all rophyera CLINICAL HOT LIST dsewe is seen following ventlition of the premutufe med incidence due to improved surseal ‘This 1 week ald kaby, hom at 28 weeks" gettin, i bein ‘oxyuen requirement his increased ince re-intubation, and 2 repeat chest © Chronic hn very low birth yeight ints, © Acdological Aco include ang immaturity, baromums, oxyuel Xray was requested rent ducts aterious, Aid overload, pulmonary orm sorbctant. Thee lead ventited, His liner emphysema and person ab to abnormal repair wth broprolérative regeneration 1. Wht abnormalts are seen om the chest X-ray What isthe appropriate next step?ANSWERS 1 The pot enocchal be OE) it lows a teva Ths ho eed in Slap conclon of lll Ting sn the oper be, Only here mide nd oe wrt. 2 The mbes ahs the edematous soft tics eto fai ovedaa ald be pled back ito a more sactory pion RADIOLOGY HOT LIST {© The ETT may be imerted too fr at incubation. The correct posto the ETT tips halfway between the thoracic inlet ad the eaiag xT). sion ofthe baby's neck may cause 3 Joly tube ta li ik right main bronchus. The righ upper lbe bronchus may be oe the ETT (f the Gp lies a the bronchus intermedi) collipte/eomolidton ofthe right upper lobe CLINICAL HOT LIST | © Beware! Absent chest movement may indicate an ocsophageat | ion. Asyonmetrical chet movement and breath sounds should ‘spicion of malposioned ETT (Always obtain a chest X-Foy post intuba Fl This 6 yer ol child was referred for assent fom abroad. He hi lrge Bred, mid developmental delay and convuls MRI Ti-weighted sagittal and T2-weight sins 4 What abnormal is demonstrate 2 Wha ic the diagnos?ANSWERS: 1, Theres éysic dilation of the IVth ventricle, which fll the entire cevition poserior few. There i agenesis of the cerebele veri, and of he tentoriech feb N 2. Dandy-Walker maltomation, s asocinted hytocephalis, RADIOLOGY HOTLIST (© ei characterised by the absence/hypopasia ofthe cerebellar vermis nd moxiated cercbellar hypoplasia. (6h vik yporl ply Sd, Sead the eng keg esi cys cates elevation oF © Hydrocephalus occur secondary to ates of the 1Vuh veuticle foramina, aqueduct enc, or compresion of the aqueduct by the 1 Ieimay be asociatd with neuromigrationsl dkorders or agenesis ofthe np callout CLINICAL HOT LIST © Mont cas are i (uncommon in she UK) with lrg head, developments osed on antenatal ultrasound. Ie may preset Tote © 507% have learning dificult, © Tes csuily sporadic, hut occasionally asaciated with abnormalities of © Te may be asociatd with other CNS malformations and midline fai palate defers (© Hydrocephalus may require venticlo-pertones year old boy has a hiary of chronic cough with copious green ef a 2 What isthe diagnosis?ANSWERS “There is dextrocadia and situs inverus (aote right-sided stomach (angie density ‘medially a the left base, There are bubble), There is collapse of the sight lower lot behind the heat) and comolit ated bronchi with fing shadows inthe If lower none cons onchiectiss, There i calcified lymph node adjacent to the si 2, Kareageners symdrome with right lower lobe callipse and evidence of infection RADIOLOGY HOT LIST (©The combination of bronchi oF Karagenc's syadeome saad dehoeetar agi vegetive © Cuses of childhood bronchiecs Cougenial Dymo iia syndrome (chao : Kartagener'), cystic fibrosis (abnormal secresions), stucnial defects of branch Immunodeficiency Hypogamimaglobubinensia, cone sranulomatons divaxe Poxcronchil obsraction _ Aspirted foreign body fection ‘Meas, whooping cough, post-vial CLINICAL HOT LIST ©. Kartgerer’s syadrome consits of a clinical tad: st inveran ( bronchiectasis and sinusitis, There may b nerve defcicney of dynein a ofthe eis) sect the epiatory and andory epithelium, and sper Incidence 1:40000, with» high familial incdenc 1 There may be anocited catchac abnormalities (most commonly Want position ofthe pret arteries). There is mucoxilary dysfunction This 8 year old oy sles fom weight I What investigation has be Wht ab 3. What she diagnos? performed abdominal pain and diarthoeANSWERS A basa follow With contrast in the eum, cascum, and leone” appearance, There 8 mucou ulertion, RADIOLOGY HOT List © Chofn’s disease fects the small bowel in 80% of ese andthe terminal eum is the cominones ste of di © The ‘cobblestone’ parte is due a combination of mucosal oedema and (Other features include thickened and distorted sll bowl fold (caches sign), ‘ose thom" ulers and “kip ns of a bows) Jl loops may Be widely separated (du to bowel wall thickening) Seictures and false may be present. © Other diseases atcesing the termina lum include tu infection and lymphoma CLINICAL HOT LIST © Incidence: 10-20: 10004 inthe childhood population. Up 10 40% fs ‘© Preentation depends on the ste of involvement (any 1 of the GL #). The commonest presentation is with colicky abominal pal wth. Subile presenatons may accor ith 1c, abscess formation and toxic megicolon ‘nd (0 th. Strategies include steroids, alphas induce and maintain emision of des al a immunosippression and nutronal modification, Oceaionally anger 2. Wha the diagnos? is bik al history wa elicited of abdominal paThere isa Iicent line sero the parietal one indicating 4 pail sll RADIOLOGY HOT LIST | © tei offen ditficule ro diferetiate between factors, vascular markings © Fractures ate huallyseaight laent lines, Sore ines are interdigiated nn characteristic locations. Vacule markings usully have 3 tortwous and braiching 15 Depeesir aceus sully peat as dense sng cleric ints FEATURES OF SKULL FRACTURES WHICH ARE SUSPI (OF NON-ACCIDENTAL INJURY IOUS 2, Multiple frctors, 4 Fractures of diferent ages 5. Deprewed factues, especially occipital - CLINICAL HOT LIST 1 Simple skull Eacrores in accidental trauma have a very low sk of intracranial sequclie. They usally involve fill fom short ditaney which impart near {© A deuiled history & mandatory, 36a simple skull facture remains the most common injury seen in non-accdental head tau, This the X-ruy of both hands of an 18 year old wom What abnormality is presen? 2. What isthe diferent diagnosisANSWERS, 1. The fouith metacarpal are short ~ a tangential line daw between the third and ih metacanpal heads should incest the forth 2. Pesusohypoparachyrodim,psewdopsevdohypoparathyridisn, Tamers syndrome idiopathic RADIOLOGY HOT LIST ¢ Preudotypopinthyroidian and pseudopseuschypopanidhyrudin have simula radiological ndings including shore meteapas and metstaal (CT my ib bal gla caeiica bn: ‘© Raciologiel findings in Tuer’ syndrome (45X0) include delayed cpiphyscl Gsion, otcopoross duc to gonadal honinone deficiency, ‘Madelung deform, coarctation of the sorts horseshoe kidney, lymph ¢ Previows infrcton (eg, sickle ell anaemia) and growth plate injury ean pve a simular appearance, but usally unioterd CLINICAL HOT LIST © Preudohypopsrathyroidim is an inherited diorder of “pusthyroid hormone (PTH) end organ resstnce. PTH production i+ normal, Clinical features include hypocalcaemia, short secure, obesity, and a ‘rte agree 1 Penis with preudopreudohypoparathyroidan have the sume phenom leasing dicts. ‘ype, but without the metabolic abnor, This baby was b 7 by was bom at a specialist wnt became of an antenaally diagnosed ondiion, and ventilated from bith 1 Wat nora ten on the het raioggh and CT sc? 2. What is the diagnosis? ‘ANSWERS: There ate muliple lange esic spaces within the lft hemithora, which are causing mas effet with mediastinal shi They do not extend below aphragm. The tp ofthe nasogastc tube lies below the daphragm, 2. Congenital sie adenonatoid malformation, RADIOLOGY HOT LIST It epielly an expanse cystic: mas (amos always uate) with well-defined margis. Te is wsully id filed intially, and becomes lucent as ar replaces the fu © Medicinal shif, compresion of adjacent hung and pulmonary hyp pba are common. The abdovninal visor ae normally sted 1 Ic often decscted anconatly, but may regres during the coune of preguancy and be bacly detectable at bath. In tis ee postnatal imaging shoul inca tsoind oF CT scan a the chest Xray may appear oral © The iferendal dijgnoss includes congomital diphrgmatic hernia, congenial lobar emphysema and a pneumothorax ‘Type Incidence Appearance Prognosis Type! 50H ‘Single/muliple lange Excellent wich wagicl ‘ss >20 1m) resection Type? 40% Mullple ye (6-2) Poor ~ may be seocited wih congewea abaommaites Type3 10% Large solid mam with oor due to asocite no macroscopic __pomonary hypoplais CLINICAL HOT LisT This js 2 congenial hamarcomatous Iesion, which communicates with the bronehial te an has 3 normal arterial supply and venous deitage. The chanterie yc appearance develops postnatally aait-apping curs within the abnormal pulmonary tse, 1 The lesion i associated with a high morality: 25% are stillborn; 2086 hive other congenital abnormalities (cardiac, renal, chromosomal anomie). {© Potential antenatal inerventions inchade apiaton,eystoumnioi sunt and feo 1 There hns been a recent increase in sngcal excision of small and large lesions becatte ofthe small sk of malignant transformation, A.9 month ol baby ha been noticed to have asymmetrical hig 1. What does the pin 2. What ithe diagnosis? 3, Name three asocated fron, ray ofthe pelvis show?ANSWERS 1. The right femur i duplaced upwards and Itty. The right femoral apitl epiphysis is seen, and the acetabulum on this se i poony ‘eveloped (with steep angulation ofthe acetabular roof) Developmental dysplasia of the right hip, resalking in didocation 3. Family history, breech postion in utero, other congenital limb abnor ‘nals, oligohydramine, RADIOLOGY HOT LIST © The pin riograph is useful afer che femoral capil epiphysis has conified (4-6 month) © Prior wo this, uleasound is dhe invesigation of choice (no sadiaton and good visalation of the caruginous femoral head and acetabulum) UUnrasound demonseates the degree of coverage of the head by the aceebulumn, and the angle ofthe sceabulr roof Jason findings from mild dysplasia co frank Jslocation-Mos mil dy 0 Thee 3 spectrum CLINICAL HOT LIST 1 incidence 1: 100 a inh, 11000 a year, E> M, bilateral in. 10 {© There is a spectrum from docatible to frank dislocation at rest (© The ditiel manifeeatons depend on age: anyrametial thigh creates, ayed walking, Trendlenbung dip and wadding gait ‘© Management depends on age at detection: persistent dlocation requires reduction and splinting or Pavlik harness for 3-6 months, After 6 months of age, an abuction later for 3 months or open redacton/ fermeThis 9 cay old» Iyaline membrane diese cnate, boon at 28 weeks’ gestation, wis ventlted for 1. What abnormality e som on the ches radiograph? 2 WheANSWERS 1. The lunge ate hyperinated (ine posterior nibs visible and atened aphrgps). Maple, small, cystic sie spaces are seen throughout both Jung. There 0 pneumothorax present. There san endotracheal tube, 2 anogatic tube anda UAC inst, 2. Pulnonaryintertiial emphysema (PIE). RADIOLOGY HOT LIST 1 PIE i radiologial diagnosis in a il, venlated neonate wll with HMD, occasionally pis or meconiom apiraion (© The changes may be bilerl, but are often aiieral with medial shi towards ce unafcted ide. (© Pacumothorax and paeumomediatinum are Fequene complications, CLINICAL HoT LIST © PIE occ ‘of uconates. Small sirways rupee, causing ait leak inc the broncho- ‘asculatsheas © Changes of PIE occur within the fix 2 weeks of fe. Ealy presentation i sociated with a wone prognoss, and i indicative of more severe underlying pulmonary disease /e PIE is sociated with high ventbato presutes, miplaced endowncheal tube and other ar leas. te may lead t0 pulmonary hypertension and right-to-left ductal shunting. Theve is a high incidence of sobsequent chronic hing disease. ‘© Management includes heeping presures ta minimum and decompees= sion sates, eur with the affected side down, plerotomy, and sclecive incubation predominanly a consequence of mechanical ventilationANSWERS region. The sal vals markedly 2. Starge-Weber sy tion in the Roatal and occipital hickened RADIOLOGY HOT List ogical appearances inch gyrfonm intrarenal alii ‘on, conical hemiatrophy with thickened skull vault om the side ofthe roi (© Tran-trick ealeication following the contours of the gy ot ually diogzphs unl dhe age of 2 years CT scans may show angioma, and dated ventricles with choroid plex hy aera venice Thre ene ror ann ihe oko ot ehevaae CLINICAL HoT List {A congenital vascular anemly ivolving the eye, skin and brain © tis charcteried by a port wine niewus ofthe face in the distribution of trigeminal nerve (sce and forehead), ith a venows angioma of the ipsilateral cerebral meninges. Thee are thin-walled ese within dhe pla rental retardation, seeures (290%), dnt ler hemiparesis and hem (© Management strategies include anciepileptic therapy and ccaionaly neurosurgeal procedures for itractableeplepy This 18-mo rophy and ipulteral acon Ph old oy presented with fever ad weight low. O fran had palpable 1. What abormaltes re shown on the contstenhanced CT scan of th abdomen? 2, Whats the diagnos?ANSWERS 1. There ta lange left suprarenal mas containing amorphons clciiaton and low-aneatation ass (consinent with central necros) It ences the aor and coelae a, which retched anteriorly, The inferior vena ‘ava (IVC) i displaced the lee while the lef kidney i dnplaced RADIOLOGY HOT LIST © Neuroblastoma i the commonest exticanis! malignant tumour of shildhood. @ aries in the abdomen in 60%, usualy in the adrenal gland. 65% of patients have mensatic disesse at presentation (bone, spi cana, ympl odes, hig dod liven. ‘© Uescound ml contin the presence and Ine bot CT/MRL is required for aging (© Nuclear tedicine scans (MIBG and bone scans) ae performed to detect Jeane metres, and to evaluate response 1 chematherpy ‘© Fearresdingushing Wiln'stomovr from neuroblast ion ofan sdominal masa Wilms Neuroblastoma Tne real mae “exeral compresion/sapacement oF kadacy 107% biter nicl but usually erases idine <10%6 contain calefiation 89% contain cakificaion Displcss vowels Renal yes! encasement ein invasion in 510% \Whae does the plain abdeminal X-ray ‘vith an inherited condition ha ena ilsANSWERS 1, There i bilateral nephtocalcinous (widespread calcification throughout here the region ofthe left renal pels. The metaphyes show changes of renal osteodystrophy. 2, Medullary sponge kidney, renal tubular acidosis, hyperparahyroidisn and byperorauna, This child has primary hyperoralrs, nl parenchyma) and there i a age calculus RADIOLOGY HOT LIST © Nephroclcinoss is the deposion of calcium sks in the renal parenchyma. eis subdivided ito coral mepbrocalinoss 5% peripheral Cslefcation sparing medullary pyramic) and medllary nephrocalinoss 95%, eakifiation of medulary pyri). © The caeificaton occur in the parenchyma ofthe kidney, a opposed she collecting sytem as with real calcul), Renal all may avo occur in some of the conditions causing nephrocalcinoss, Cau ‘Medullary nephroccinoss any ems of hyperealacmial hypercalaria ‘yperpathyroidsm, byperstaminoss D), ‘ena tubolar acidosis, medullary sponge Fedey and hyperoxalria Conical nephrocacinesis chronic glomerslonephrits, cortical ery primary hypeomalr and Alpon’s syndrome s/- CLINICAL HOT LIST © Primary hyperosalurs is 2 ire autora recessive condition which ‘of oxalate in the Kidaess, heat, lung, spleen sad causes diffine dep (© Presentation occurs at <5 yeas old, with ealy death occursng in eid ndary hyperoxia occurs where thee is dirupion of the bile acid femteroceculation. Caines ince ile resection and Crohn's disease This 1 day old term baby has tachypmoes and cyanosis du tmidwives ae unable to pass 4 nasogatec tube 1 Hliate What dos the CT scan through the nsopharyns show? 2. What isthe diagnosis?ANSWERS, here are membranous septa occluding the posterior spect ofthe nasal sir passages bilateral, The lateral walls of the nial cavity are deviated tesa 2, Bilger membranous choanal area, RADIOLOGY HOT LIST {© The occlusion may be hony (85%) or membranous (15%), © ACT scan ofthe nal airways (fine cus) i the examination of choice caine seretons are not tisierpreted a membranous pt. CLINICAL HOT LIST Incidence 1:8000, uniter more common than bilterl. 50% are sociated with CHARGE syndrome (Coloboma, Hear dest, choanal ‘Aves, Reared growth, Genial hypoplasia, Er abnormalities). There {sao an sociation with Trescher-Colis syndrome Teuwully presents with spaces, cysnoss, respiatory distress and feeding {iets in a neonate, Unilateral stress may present later with mulder symptoms or nasal discharge Babies are obligatory now-breather unl 3-month of ags,unles they are erying. These babies may therfore be pink whet crying and ree sky a vest "The diagnosis ay be suspected by the inbiiy to pas a nasogastictube The airway may teqire protection (oral drwy Of inubation) prior, dente surgANSWERS There is soft sue swelling around the wrist. The bones are esteopente be carpal bones Fé salad ieregula, with rile erosions, There are futher-etodionm Of the bus of the second, thie and. Rourh Imeticarpalt and of many ofthe sl joins. There & Tom ofthe joint sal joint Space atthe radical and ine 2. Juvenile Sonate artis UA RADIOLOGY HOT LIST (© The Sek nats tn the wel cde pchiaticllr cucopeni end st tinue swelling Later changes include erosions, periosteal reactions, joint space los, and jine desertion (© Spinal changes clade dite ankylosis of the posterior articular joins (epee etcetera (¢ Hypernemia ofthe affected joints may cause over preston closae ofthe grow ples (and th ofthe epiphyss re bone shoxten ing, (e Gadaiateeene SURORL ee can tect spore ype al CLINICAL HoT List (© JIA has an onset below the age of 16. Symptoms must be present fo ‘more than 3 months (© Three clini eateries ‘Syren omer 1M ‘ingng ver penance, Iympladcnopacy, satis may | Iniglly be absent five or more join affected, syonmetrcal iavolvesent of tal joins of har and fot a well x Tage joints 10% are rheumatoid factor postive | Potaricuar 40%, F>M Pouciaicular 30%, ealy onset <5 le joins acted, sytemic FM, hae onsee M> F features usually absent sociated with uveits law oust asociated swith HILA-B27 and epnal dies (Gioular wo ankylosing spony) © JA cequires enidcptinary management i steroid, methoursat) phy ge sie fotherpy, oocupstonal eapy and psycho. This 6 month old baby bas rae inherited disorder, On examination he ha epatoeplenomeg 1. What abmoraies are seen on the X-ray? 2 What isthe digoANSWERS 1. The bones are difssly selerotc; with obliteration. of the normal trabecular puter, There ix a’ optics! Seecaeencs bes prevated inthe pelvis and proximal femora: "Thee i diplacement of the bowel as by at enlagad iver and aplee, 2, Oseopetons (AlbeorSth RADIOLOGY HOT List 6 i cheeteeee feeingy a ae coronene cond tactcog mes appear dense with ls ofthe sul medillary encrotchment. The b oral frabecilar potter, ‘The ‘bone-withi-bone’ appearance sical © Though appearing sclerotic, the bones are actly brite and weak ~ al factures, which usually heal with exoberan calls © Onconslerods cases oblitcration oF the paranial sinscs, mstoid ie ll and kl base Frac CLINICAL HOT List (© This is a re hereditary disomder with both recenive and dominant inheritance ~ thie later being Clinically let severe (© There is Gilure of crteoclat rseption causing penitence of the catlaginots and caked bone mutt. The bones are abnormally ‘elerotie but uctoaly weak ity causes marrow depression with stall cmspahss ach epetuplncely © Bony overgrowth cans narrowing ofthe neural foramina reting in ies. Optic atrophy and datnes are common findings in 9°%a the scesive frm suri beyond sable age & someon and rT is 18 year old gi is paraplegic, with urinary and fecal incontinence Wha does the X-ray ofthe lumbar spine show? ‘Wnts the dagen?ANSWERS, sd spinous procenes) witha widened spinal canal. Note the widening tthe interpediculr distance Spins bt 1. The posterioe clement of the lumbar spine are absent ( RADIOLOGY HOT List (© Remember tates the spine on plain film of the abdomen! lentfy he pedicles, laminae and apinow procests ~ if these are abut, oF incompletely fie, a ciagnost of sina dystaphin can be made (©The didgnosis is offen mace by antenual ultrwoud (commplex nas en outside spinal canal wih separation ofthe poten line). There ba high incidence of asocnted hydroceptalos(wsualy detected antentaly), © There miy be other CNS abmounabticy including Araok-Chiai malformation, intaspnal dermoid and lipoms, tetiered cond and disstematomyelia. These can be firth avesed with ME Ulexound, an be wie te/ ates the sinc in young babies. CLINICAL HOT LIST | © spinal dyarphim ie a spectrum of disorders ranging from mildly |, defies mts spinon proces (pins bids ocala) an open defect with exposed abnormal spina cord and CSF leakage (ina Bia oe) | # Gini manieaon depend on te ste andoxeat ofthe on Thee may be complete lot of motor, seasry and reflex function below the |. Asedevel: volvement othe cr ro ado bowel nd Bader Sysfuncir ‘© Neurosurgical repair sims to achieve a water-tight clnure of the defict ‘without worsening the neurological saus. Ventricular shunting may be euied for hydrocepbas © Mulidisciplinay managment should include neurosngcal, onthopsedic and urological input as well at physiotherapy and occupational therpy This 2 year old boy has fever and dysphags 1. What abnormality is seen o 2. What is the dagroni? the eral X-ray of thANSWERS 1. Thee & Swelling ofthe preversbral soft tieues ih anterior dpace- dons but the nent of the tachea. Thete is los ofthe nodal cervical Sones appear noe 2, Resropharygeal abcess RADIOLOGY HOT LisT Swelling ofthe prevertebral sis implies infston or aemorahage Ina cl the thickness ofthe normal prevertebral soft dou f 3-Sunm between C1 nd Gf (2-3 in an ada) and the wideh ofthe vertebral body BeloweC. (© Bere aay be reversal ofthe notmal cervical oro the head is held in an abmommal poston, Erosion of bone or dic height reduction indi- ey anuidaying oxeomyelts or disci, {© Gos or am aiid leel in the reropharyngesl taste highly sopgesive of an abies, '9,A const-enhancedCT scan will confirm the dignosis in equivocal ests al deine the superior and inferior mediastinal extent Te diferent diagnos inclides haematoma, Iymphae ily) neoplum (chabdomyosarcoma) pathy, and CLINICAL HOT LisT # Rare ipfétion of the posterior pharyngcal wall occurring im young tilde snd babs. © Astiology: ‘uber respiratory tract infection, extension of suppurative sera pipers, or pos Srating injry of the phary or esoghg drooling ae withthe ead led back uc fa Important diferent diagnoses include epglotts and Typical ongnigas: tpl, septaacu, mixed Bora This 4 month old gil ad been te rniturating eysourethrogram was performed ss part of her investigations 1. What abnormalities ate sen 2. What isthe diagnos AANSWERS 4. Conast has refed into dilated collecting systems and ureters blter- aly, The renal elyces are chibbed 2) Bibteral vesicouretei refx (VUR) RADIOLOGY HOT LisT 1 There is sill controversy over the strategy foe investigation of urinary tract infection, with debate over the choice of investigation used to

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