1. Pediatric Radiology Megan Shuler February 2, 2006

2. 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

4. 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

5. Radiograph findingsSteeple 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

6. 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

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

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

9. Radiograph FindingsThumbprint sign on lateral neck

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

12. 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

13. Radiograph FindingsCXR shows intrathoracic bowel