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Approach to Pediatric Elbow

The elbow is complex in its multiple articulations, which allow for flexion and extension, as well as supination and pronation. Imaging of the pediatric elbow is deceptively simple: two conventional radiographic orthogonal views are all that is required to diagnose most pediatric elbow fractures. The challenge lays in the radiographic interpretation of a joint with evolving ossification whose appearance changes significantly as the child’s skeleton matures.…

Approach to Pediatric Foot

The pediatric foot can be complex, from both clinical and imaging perspectives. Acquired and congenital diseases can affect the foot, especially during early childhood development. Because radiographs are often first line in imaging, having an appreciation for the normal appearance of the developing foot and, similarly, what can go wrong, is paramount. Laying the Groundwork Technique When imaging the foot, weight-bearing views (or simulated weight-bearing views…

Skeletal Dysplasias

Skeletal dysplasias are bone and cartilage disorders that result in abnormal skeletal development and often, short stature. Skeletal dysplasias and syndromes with bony involvement are not uncommonly seen in pediatric populations. The differential diagnosis of dysplasias includes more than 450 heritable disorders. Early and accurate diagnosis of skeletal dysplasia/syndrome is essential to determining prognosis, receiving appropriate treatment and management of associated complications, and obtaining referral to…

Imaging the Limping Child

The observation that a child has a limp is not a diagnosis, but rather a manifestation of an underlying problem. A limping child has altered gait, which may or may not also be antalgic. This is a commonly encountered phenomenon in pediatric medicine, and ~4% of all pediatric patient visits are related to acute onset of limp or refusal to ambulate. The causes of limp in…

Pelvic Pain

Pelvic pain in a preadolescent or adolescent girl can be a diagnostic challenge. Ovarian causes, including torsion of the ovary, ovarian cysts, and paraovarian cysts, must be distinguished from nonovarian diagnoses, such as appendicitis, renal calculi, urinary tract infection, and even intussusception in younger children. Because ovarian or fallopian tube torsion are emergent situations, rapid diagnosis is key. What Imaging Modality Is Best to Assess Pelvic…

Imaging Approach to Urinary Tract Dilation

Acknowledgments I am grateful to Robert Lebowitz, Rhonda Johnson, and Jane Choura for their invaluable help in preparing this chapter and, always, for their friendship. Key point: Distinguishing normal from pathological causes of urinary tract dilation (UTD) is one of the most important topics in pediatric uroradiology. Most etiologies of UTD in children are congenital. Understanding UTD is one of the primary indications for radiological evaluation…

Scrotal Pain and Swelling

When a child presents with scrotal pain and swelling, the most important determination is between surgical and nonsurgical causes of the symptoms. This often cannot be differentiated with certainty from the physical examination and clinical history. Imaging can, therefore, be crucial to management. The term acute scrotum refers to sudden-onset scrotal pain, erythema, and/or swelling. The most common causes of acute scrotum are torsion of the…

Abdominal Masses in Children

Abdominal masses in children present with variable symptoms, including abdominal pain, abdominal distention, and palpable mass on physical examination. Palpable abdominal masses are a common presenting problem on pediatric outpatient services. Although many pediatric patients ultimately have benign causes for their palpable abdominal masses, such as constipation (in fact, up to 3% of all pediatric outpatient visits are thought to be secondary to constipation), there is…

Pediatric Abdominal Pain

In pediatrics, one of the most common presenting symptoms to the pediatrician or emergency department is abdominal pain. It is a source of much consternation for parents and is often an extrapolated symptom by the parent based on how the child is behaving. Nearly one-fourth of patients younger than 15 years will have seen a physician for this problem. Abdominal pain may be defined as any…

Vomiting Infant

Vomiting is common in infancy. Parents reporting that their infant is vomiting may be dealing with regurgitation from nonpathological “spitting up” after feeds, which can be normal in newborns and usually resolves over time. Clinicians fear vomiting secondary to obstruction, which can be a life-threatening emergency. Imaging evaluation aids the clinician, in conjunction with the history and physical examination, in distinguishing between these causes. The choice…

Approach to Congenital Heart Disease

Congenital heart disease (CHD) can be a challenge for the imagers because it requires a profound knowledge of the morphological and functional characteristics of a broad range of heart defects. Moreover, complex CHD often involves palliative or corrective surgical intervention that can significantly alter the anatomy and blood flow patterns. Therefore complete knowledge of these surgical palliations and repairs is essential to accurately identify associated problems…

Mediastinal Masses

The mediastinum is the most common location for intrathoracic masses in children. Mediastinal masses in pediatric patients are composed of a heterogeneous group of lesions ranging from benign, asymptomatic, and incidentally detected lesions to malignant, symptomatic, and potentially life-threatening masses. Evaluation of the patient with a mediastinal mass often requires a multidisciplinary approach, with imaging playing a critical role in detection, characterization, and monitoring of disease.…

Imaging the Child With Respiratory Distress

Respiratory distress is one of the most common complaints seen in the pediatric urgent care or emergency department setting. Clinically, respiratory distress is characterized by tachypnea, increased respiratory effort, and poor oxygenation. Radiographs remain the primary imaging modality for evaluation of the pediatric chest because of low cost and easy availability. A full understanding of normal anatomy on chest radiograph is necessary to recognize important pathology…

Emergent Soft Tissue Conditions

Acute inflammatory and infectious soft tissue disorders are important conditions that affect nearly 2 million people in the United States every year. Inflammation versus infection of the skin, subcutaneous tissues, and muscles is often difficult to differentiate clinically, and early detection and accurate diagnosis have a significant impact on the immediate course of treatment and on the magnitude of any subsequent complication and morbidity. Although many…

Pelvis

Pelvic Fractures Howard J. O’Rourke Georges Y. El-Khoury Osseous Emergencies Mechanisms and Patterns of Fractures of the Pelvis The pelvis is a complex series of articulations supported by a strong ligamentous network. The posterior ligaments are the strongest ( Fig. 16-1 ). The sacroiliac joint has thin anterior and thick posterior ligaments. The sacrospinous and sacrotuberous ligaments are additional posterior ligaments that primarily serve to resist rotational deformity…

Lower Extremity

Hip/Proximal Femur Alan Rogers Joseph S. Yu The hip is a common site of trauma and when injured can have a significant impact on the patient’s well-being. Worldwide the total number of hip fractures is expected to exceed 6 million by the year 2050. In 2003 over 300,000 patients were hospitalized with hip fractures in the United States, accounting for 30% of all hospitalized patients according to data…

Upper Extremity

Shoulder Hamid Torshizy Tudor H. Hughes Christine B. Chung The shoulder girdle is a general term describing a complex network of soft tissue and osseous structures, demarcated by numerous joints, which serve to both suspend and connect the upper extremity to the torso. Injuries of the shoulder girdle are common, with sites of injury varying with the age of the patient. In general, whereas fractures of the clavicle are…

Nontraumatic Abdominal Emergencies

Gastric and Duodenal Emergencies Vincent M. Mellnick Christine Menias The upper gastrointestinal (GI) tract, including the esophagus, stomach, and duodenum, is a common but potentially overlooked site of disease that may prompt presentation to the emergency department (ED), including inflammation and infection, obstruction, and perforation. Although these organs have traditionally been evaluated by fluoroscopy, which offers mucosal detail, computed tomography (CT) is now the first-line imaging modality in…

Imaging of Penetrating Trauma to the Torso and Chest

Firearm-related injury is the second leading cause of death following motor vehicle collision. For every firearm death it is estimated that there are three to five other nonfatal firearm injuries. These injuries have become a major public health problem, creating a devastating impact on U.S. society with substantial emotional and financial cost. This chapter will describe the role of imaging in evaluating patients admitted with penetrating…

Blunt Abdominal and Retroperitoneal Trauma

Computed Tomography Protocols and Scan Optimization Thorsten R. Fleiter Krystal Archer-Arroyo Trauma is one of the leading causes of mortality in the United States, responsible for approximately 100,000 deaths per year. The majority of the trauma cases are due to blunt force, with more than two thirds of these caused by motor vehicle collisions. Additional causes of blunt trauma include falls and assaults. Penetrating trauma, including stab and…