Pediatric Radiology

Megan Shuler
February 2, 2006

Case 1
18 month old male presents with 12 hour
history of increasingly labored
respirations, fever, and barking cough
Exam significant for temp 101 F,
inspiratory stridor, and suprasternal
retractions

Croup
Acute laryngotracheobronchitis
Etiology: Parainfluenza virus
Commonly affects patients aged 6 months
to 3 years during fall/winter months
Clinically barking cough with inspiratory
stridor secondary to subglottic narrowing
from soft tissue edema
Treatment typically includes Racemic epi

Radiograph findings
Steeple Sign

AP view of neck showing narrowing of laryngeal

air column 5-10 mm below vocal cords
Steeple sign seen on x-ray in 50-60% of cases

Case 2
3 year old female presents with fever,
worsening sore throat, and respiratory
distress
Exam reveals toxic appearing child, temp
102 F, sitting in tripod position, drooling,
and stridor

Lateral neck radiograph

of a child. Notice the
hypopharyngeal
dilatation, the swollen
epiglottis, and the lack of
definable aryepiglottic
folds.

Epiglottitis
Etiology: Haemophilus influenzae B,
Streptococcus, Staph aureus
Medical emergency
Not as common due to HIB vaccine;
typical age 2 to 7 years

Radiograph Findings
Thumbprint sign on lateral neck

Case 3
Newborn with progressive respiratory
distress, scaphoid abdomen, unilaterally
diminished breath sounds, displaced PMI

Congenital Diaphragmatic Hernia

Secondary to posterolateral defect of
diaphragm
80-90% occur on left side
Resultant pulmonary atelectasis and
hypoplasia combined with circulatory
problems (pulm HTN) lead to severe,
hypoxia, cyanosis, and persistent fetal
circulation
Treatment: surgical repair

Radiograph Findings
CXR shows intrathoracic bowel