Thursday, February 13, 2014

Tips about Pediatric Radiology and "Image Gently"

1. If not 100% sure about a fracture, always check the Atlas of Normal
Variants That May Simulate Disease. I have a copy of it on my iPad and
it's invaluable, especially for peds.

2. Pay close attention to the non-solid organs on abdominal
ultrasounds (including targeted ones for the appendix and
intussusception). Findings that we would never miss on CT are
frequently overlooked on US, especially: thick-walled, fluid-filled
bowel; fat stranding; and lymphadenopathy.

3. Don't stress about over or undercalling perihilar/peribronchial
thickening and viral bronchiolitis vs hyperactive airway disease.
Everyone has a different threshold for calling it and it doesn't get
treated differently.

4. Flat and upright KUBs are much more valuable in peds than in
adults, so try to glean more information from them. Look for
organomegaly as well as small air-fluid levels (which can occur in

5. Soft tissue ultrasounds in the head and neck are primarily looking
for abscess so don't forget to mention the presence or absence. To
determine whether lymph nodes are reactive vs malignant, look for
periadenitis, degree of hypoechogenicity, loss of/compression of the
hilum, rounded shape, and increased/abnormal vascularity.

6. Where I work, we do NOT routinely obtain contralateral views for
comparison, but in a very few cases they can be immensely helpful to

7. If a testicular US looks like epididymo-orchitis but the patient is
not yet sexually active, then the diagnosis is mostly likely torsion
of an appendix testis. Scan yourself or have the tech look harder, but
sometimes you may not see it.

8. Understand "Image Gently" and the radiation doses each procedure
will cause to pediatric patients.  Children are very radio-sensitive, so you
have to be very careful not to order too many high radiation scans.


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