Paeds Cases

Question 1

1 yr old with abdominal pain and bloody stools

Answer 1

Ileocecal intussusception

Key Imaging fx: Bowel within bowel or a “target sign.”

CT:

• Alternating layers of low attenuating fat and high attenuating bowel wall.
• Enhancing vessels can be seen within the hypo attenuating fat.
• Proximal small bowel obstruction may or may not be present.

US:

• Concentric, alternating hyper and hypoechogenicity on transverse imaging.
• Longitudinal imaging has been described as the “pseudokidney sign.”
• Color Doppler shows vessels between the oedematous, hypo echoic bowel walls.

Question 2

CXR: Term baby born via C-Section due to foetal distress

Answer 2

Meconium Aspiration

Radiograph Fx:

• Bilateral diffuse grossly patchy opacities (atelectasis and consolidation)
• Hyperinflation of lungs
• Areas of emphysema (air-trapping)
• Spontaneous pneumothorax and pneumomediastinum
• Small pleural effusions (20%)

DDx:

1. Transient tachypnea of the newborn: Patchy opacities; Follow-up radiographs show rapid clearing of infiltrates, cf meconium aspiration.
2. Neonatal pneumonia usually has patchy opacities representing consolidation, with pleural effusion present in up to two thirds of cases. Lung volumes are usually normal, but the lung fields may be hyperinflated.
3. Respiratory distress syndrome: Usually has a uniform distribution of opacities, classically with a ground-glass appearance and decreased lung volumes due to alveolar collapse. Air bronchograms may be seen. Pleural effusions are rare. This is most often seen in preterm infants

Mx:

• ABx + Supportive therapy
• Sometimes ECMO

Question 3

CXR: 2 day old baby with respiratory distress

Answer 3

Congenital Cystic Adenomatoid Malformation now referred to as congenital pulmonary airway malformation

CR Fx:

• Unilateral multicystic (due to numerous air-containing cysts) mass
• Mediastinal shift away from lesion.
• May occasionally present initially as solid mass which evolves into cystic mass

DDx:

1. Pulmonary sequestration (usu intralobar)
2. Congenital Lobar emphysema
3. Bronchogenic cyst
4. Congenital diaphragmatic herniation