E5480. Pediatric Radiology Emergencies: A Primer for the On-Call Resident
  1. Sammar Ghannam; UT Health Sciences Center at San Antonio
  2. Megan Gainer; Creighton University School of Medicine
  3. Cerys Arnold; Creighton University School of Medicine
  4. Jack Kirsch; Creighton University School of Medicine
  5. Ami Gokli; Staten Island University Hospital
  6. Angel Gómez-Cintrón; UT Health Sciences Center at San Antonio
  7. Cory Pfeifer; Phoenix Children's
Trauma in children may present unique challenges for radiologists unfamiliar with pediatric anatomy. Due to radiation exposure and a propensity for traumatic injuries to involve soft tissues and ligamentous structures, children with extremity and spine injuries may be less likely to undergo CT imaging, a modality primarily focused on osseous abnormalities. General radiologists and residents working primarily at facilities that treat adults may not be familiar with common patterns of pediatric acute illness. This educational exhibit serves to demonstrate normal findings in the child to inform viewers of normal relationships, common emergencies, and pitfalls.

Educational Goals / Teaching Points
Sonographic criteria for pediatric acute abdominal pain are covered. Intussusception diagnosis and treatment is included. Normal and abnormal bowel gas patterns are discussed. Normal relationships in the pediatric cervical spine are depicted including key anatomic landmarks. The pediatric elbow is highlighted. Imaging technique is detailed with particular regard to radiography. Abnormal imaging findings in injured children are also highlighted. The role of the Pediatric Emergency Care Applied Research Network (PECARN) is incorporated, including the utility of MRI in pediatric trauma.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Common causes of acute pediatric abdominal emergencies are age-specific and include pyloric stenosis in the first year of life, intussusception in the first few years of life, and appendicitis, which can occur at any age but is more common later in the first decade. Wall air is becoming a common method of intussusception reduction. Ultrasound is supplanting emergent upper gastrointestinal in the diagnosis of volvulus. Mesenteric adenitis may be suggested when there is an enlarged cluster of lymph nodes in the right lower quadrant with a normal appendix. Displacement of ossification centers in the elbow can be elucidated based on an age-related pattern. Children are unique in their propensity to have buckle fractures, which require close inspection to uncover. Normal relationships in the pediatric cervical spine are depicted including key anatomic landmarks. Head injuries are detailed, particularly with respect to nonaccidental trauma. The difference between calvarial fractures and suture/suture variants is depicted. Pitfalls in the cervical spine are described including pseudosubluxation, ossification of the dens, absence of lordosis, anterior wedging of the vertebral bodies, and pseudo thickening of the prevertebral soft tissues. Spinal canal stenosis and atlantoaxial instability are described in the context of achondroplasia and trisomy 21.

Pediatric patients present challenges to the radiologist unfamiliar with normal and abnormal findings in children. Understanding normal and abnormal anatomy and pathology in children is crucial in recognizing injuries.