Pediatric Radiology
Pediatric Radiology
This domain covers age-specific disease, congenital anomalies, infection, trauma, and radiation protection. Findings differ from adults, and normal variants are common traps.
Core rules
- Neonatal chest: respiratory distress syndrome shows low lung volumes, reticulogranular pattern, and air bronchograms; transient tachypnea has perihilar streaking and fluid in fissures; meconium aspiration has coarse patchy opacities and hyperinflation.
- Abdomen: hypertrophic pyloric stenosis shows pyloric muscle thickness >3 mm and length >15 mm; intussusception shows a target sign on ultrasound; malrotation has an abnormal SMA/SMV relationship and duodenal obstruction.
- Skeletal: non-accidental trauma suggests metaphyseal corner fractures, posterior rib fractures, and fractures of differing ages. Consider abuse when the history is inconsistent.
- Pediatric radiation protection: use pediatric protocols, limit scan range, and avoid unnecessary CT.
Worked example
A 6-week-old boy has projectile nonbilious vomiting and a palpable olive. Ultrasound shows a pyloric muscle thickness of 4 mm and length of 18 mm. This confirms hypertrophic pyloric stenosis; the next step is fluid and electrolyte correction before pyloromyotomy.
Traps
Overdiagnosing pneumonia on a crying infant chest radiograph; missing malrotation because the child has only intermittent vomiting; using adult renal stone thresholds; overlooking non-accidental trauma; failing to reduce CT dose.