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Orbital Cellulitis

KEY FACTS Terminology Preseptal cellulitis: Infection anterior to orbital septum Postseptal cellulitis: Infection posterior to orbital septum Orbital septum: Periosteal reflection from bony orbit to tarsal plates Imaging Thickening & edema of orbital/periorbital soft tissues Preseptal cellulitis: Limited to anterior tissues Postseptal cellulitis Low-attenuation, rim-enhancing collection – Drainable subperiosteal abscess (SPA) in majority – 20% without drainable abscess (phlegmon) Associated myositis common with swollen extraocular muscles,…

Acute Rhinosinusitis

KEY FACTS Terminology Acute inflammatory sinonasal process lasting ≤ 4 weeks Related terms: Acute bacterial sinusitis (ABS), viral upper respiratory infection (URI) Imaging Clinical diagnosis; imaging rarely necessary & does not distinguish bacterial from viral NECT: Confirms diagnosis, evaluates when medical therapy has failed, delineates anatomic variants (especially presurgical) Best sign: Air-fluid level ± aerosolized secretions with mucosal thickening – Most common in ethmoid & maxillary…

Approach to Pediatric Head and Neck

Imaging Modalities Note that the airway, spine, & skull are largely discussed in other sections. Radiography Plain films of the face have limited indications in children. They are often used as a quick screening tool for sinus disease or facial trauma. However, their sensitivity & specificity are low, particularly when the clinical suspicion is low (which is often when such studies are ordered, unfortunately). Regarding the…

Spondylolysis and Spondylolisthesis

KEY FACTS Terminology Spondylolysis: Defect/break in pars interarticularis Spondylolisthesis: Spondylolysis + anterior slippage of vertebra in relation to vertebra below Imaging Radiographs (insensitive): Break in neck of “Scotty dog” (pars interarticularis defect on oblique standing views of lumbar spine) Bone CT Linear lucency or defect in pars interarticularis – Sagittal or oblique sagittal reformatted imaging vital in assessment Incomplete ring sign on axial imaging ± distraction…

Discitis/Osteomyelitis

KEY FACTS Terminology Bacterial suppurative infection of intervertebral disc & adjacent vertebrae Imaging Disc-centered process: Disc space narrowing & adjacent endplate irregularity in young children Lumbosacral (75%) > thoracic > cervical spine Early: MR imaging most sensitive, specific modality Abnormal disc signal & enhancement Ill-defined abnormal marrow signal & enhancement Paraspinal & epidural phlegmon or abscess Subacute Endplate destruction/erosion Chronic Increased bone density ± vertebral fusion…

Approach to Pediatric Spine

Imaging Modalities Ultrasound In the newborn, the spine is most commonly imaged when a cutaneous lesion overlies the lumbosacral spine & implies the presence of an underlying spinal abnormality. Common examples requiring deeper imaging investigation include a cutaneous infantile hemangioma, hairy patch, fatty mass, appendage, forked gluteal crease, or atypical dimple (& do not include the common low-lying, shallow midline dimple near the anus). Within the…