Izikhalazo zezilwanyana Izisombululo zokuCinga ukuThengisa | El Paso, TX.

• Olu luhlalutyo olufutshane lwezinye izikhalazo ezibalulekileyo zezingane ezisemthethweni.
• I-Traumatic Acute iquka intlekele enkulu yentloko
• Ingxaki engeyiyo ingozi kubantwana (umntwana ohlaselwe)
• Izikhalazo ze-Musculoskeletal (i-Juvenile Idiopathic Arthritis, i-scoliosis,
• Iimpawu eziqhelekileyo zabantwana (i-CNS kunye nabanye)
• Sulelo
• Isifo seMetabolic

Ulungelelaniso lwezonyango lwezilwanyana:

• Ukonzakala kwe-FOOSH (umzekelo, ukuwa kwi-monkey-bar)
• Supracondylar Fx, elbow. Soloko d / t ukwenzakala ngengozi. <10-yo
• I-Fx eyongezelelweyo
• AmaGartland amacandelo amacandelo amacandelo athatywayo aphucukileyo aphunywe ngokuphathwa okulula kunye ne-posterior elbow dislocation
• Umngcipheko onokuthi ungangqinelani nongxaki xa ukukhathazeka kuphuculwa (isivumelwano seVolkmann)
• Uvavanyo lweRadiological lubalulekile: uphawu lwaseseyile kunye nophawu lwenqatha lwamanqatha angasemva kunye nomgca wangaphandle wokungaphumeleli wehlulekile ukunqumla phakathi / 2/3 weCapitellum.

I-Fx yabantwana abangapheliyo:

• Uninzi kwi <10 yo Greenstick, Torus, Plastic aka Bowing deformity
• Ukuphulukisa ngokuqhelekileyo, unyango ngokuzenzekelayo
• Ukukhubazeka kweplastiki ukuba> iidigri ezingama-20 zifuna ukuncitshiswa okuvaliweyo
• I-Ping pong skull fracture inokukhula emva kokwenzakala, unikezelo lweforceps kunye neengxaki zokwenzakala ekuzalweni. Kusenokufuneka kuvavanywe yi-peediatric neurosurgeo.n

• Iindidi zeSalter-Harris zokulimala kwamacwecwe okukhula
• Uhlobo lwe-1-slip. umzekelo, iSlipped Capital Femoral Epiphysis. Ngokuqhelekileyo akukho catshulwa kwethambo esaziwayo
• Thayipha i-2-M / C ngokuchaneka kakuhle
• Uhlobo lwe-3- intra-articular, ngaloo ndlela lubeka umngcipheko wokukhawuleza osteoarthritis kwaye ingadinga ukunakekelwa kokusebenza d / t ukungaqiniseki
• Uhlobo lwe-4- Fx kuyo yonke imimandla malunga ne-physis. Ukungavumelekanga ukuhlaziya kunye nokunciphisa kwesitho
• Uhlobo lwe-5- kaninzi alukho ubungqina bentshontsho. Ukugqithisa kakubi d / t ukuchoboza umonakalo kunye nomonakalo we-vascular kunye nesincinci sokunciphisa
• Ukuphonononga okubalulekileyo kubalulekile

Ukulimala okungenzile ngengozi (NAI) kubantwana

• Kukho iindlela ezahlukeneyo zokuxhaphazwa kwabantwana. Ukuxhatshazwa ngokwemvelo kungabangela ukulimala kwesikhumba kwiindlela ezahlukeneyo ze-MSK / i-systemic ezithinta amathambo kunye nama-tissue alula. Ukucinga kubalulekile kwaye kunokuchonga izibonakaliso ezicacileyo ezichazela ababoneleli ngezokwelapha kunye nokwazisa iinkonzo zokukhusela abantwana kunye nee-arhente zokunyanzelisa umthetho ngokusetyenziswa kakubi ngokomzimba.
• Kusana: �Isifo somntwana esishukumayo� sinokuvela kunye neempawu ze-CNS d/t ukukrazuka kwemithambo engekavuthwa yokuvala ibridging vein kunye ne-subdural hematoma enokubulala. Ukopha kwiretina kudla ngokuba ngumqondiso. Intloko yeCT ibalulekile.
• I-MSK Radiological Red Flags:
• I-1) ithambo elikhulu Fx kwi-child-ambulatory emncinci kakhulu (0-12 mo)
• I-2) Iimbambo zangasemva Fx: ngokwemvelo ayisoze yavela ngengozi yed / t. Uninzi lwezixhobo: ukumbamba kunye nokucima umntwana okanye utshintshi ngqo.
• I-3) Izihlunu ezininzi ezinamaxesha ahlukeneyo wokuphulukiswa kwamaqondo, oko kukuthi, amathambo e-bonewa abonisa ukukhathazeka ngokuphindaphindiweyo ngokomzimba
• I-4) Ikhonkco le-Metaphyseal Fx aka Ibhakethi yokuphatha i-Fx, ihlala i-pathognomonic kwi-NAI kubantwana. Ivela xa iphetho elichaphazelekayo liqhutywe kwaye lisontekile.
• I-5) Ukuphuka komzimba wamathambo amathambo kumntwana omncinane ngumnye umzekelo we-NAI.
• Ezinye izinto ezibalulekileyo ze-NAI. Iimbali ezingahambelaniyo zinikezelwa ngabalondolozi / abanonophelo. Akukho bungqina bentsholongwane yokuzalwa / ye-metabolic engaqhelekanga njenge-Osteogenesis Imperfecta okanye iRickets / osteomalacia njl.
• Qaphela: Xa abagcini babantwana bechaza imbali yokuba iingxelo zokuwa kunye neengozi endlwini, kubalulekile ukwazi ukuba ngokucacileyo iingozi ezininzi / ukuwa endlwini kunqabile kakhulu okanye akunakwenzeka ukuba kubangele ukuphuka okukhulu kwamathambo.
• Ukuxhatshazwa kwabantwana base-Illinois:
• www2.illinois.gov/dcfs/safekids/reporting/pages/index.aspx

Indlela yokuTyekisa i-MSK kwi-Pediatrics

• I-Juvenile Idiopathic Arthritis (JIA)-Ukuqwalaselwa kwesifo esinganyangekiyo se-M / C sobuntwana. I-Clinical Dx: iintlungu ezidibeneyo / ukudumba iiveki ezi-6 okanye ngaphezulu emntwaneni <16-yo Iifom ezahlukeneyo zikhona: I-Dx yokuqala ibalulekile ekuthinteleni iingxaki ezibambezelekileyo
• Iindlela ezininzi eziqhelekileyo zeJIA:
• I-1) Isifo se-Pauciarticular (40%)- m / c ifom ye-JIA. Amantombazana asengozini enkulu. Ibonisa njenge-arthritis kwi-<4 joints: amadolo, amaqatha, i-wrist. Elbow. Olu hlobo lubonisa ukudibanisa okuphezulu kunye nokubandakanyeka kwe-ocular njenge-iridocyclitis (i-25%) enokuthi ibangele ukungaboni. Labs: RF-ve, ANA positive.
• I-2) Izifo ze-polyarticular (25%): RF-ve. Amantombazana asemngciphekweni omkhulu. Ukuchaphazela amancinci amancinci kunye amaninzi atyhaphazela umgudu wesibeleko
• I-3) Ifom ye-JIA (i-20%): ihlala iveza ngokubonakalisa i-systemic ebonakalayo njengemfiva ye-spiking, i-arthralgias, i-myalgias, i-lymphadeno [i-pathy, i-hepatosplenomegaly, i-polyserositis (i-pericardial / pleural effusion). Iimpawu ezibalulekileyo zeDx iimpawu ezibonakalayo ze-salmon i-salmon i-pink rush in the end and trunk. Ifom ye-Systemic ine- Amalungu amaninzi afake isicathulo, akukho ntshukumo efaniswa nezinye iintlobo. Ngaloo ndlela intshabalalo ehlangeneyo ayibonakaliyo

Ukucinga kwiJIA

• I-bone mix effusion ethwele i-squaring ye-patella cartilage / ukukhukhula kwamathambo e-DJD
• Iminwe kunye namathambo amathambo omdala ukuvalwa kwe-physeal / incinci yokunciphisa
• I-Rad DDx idolo / i-ankle: I-Hemophilic arthropathy Rx: DMARD.
• Iingxaki ezinokuthi zenzeke intshabalalo edibeneyo, ukulinda ukukhula / ukunciphisa umlenze, ukungaboni, ubunzima beenkqubo, ukukhubazeka.

Uninzi oluqhelekileyo lwezilwanyana zezilwanyana ezingcolileyo ze-Bone Neoplasms

• I-Osteosarcoma (OSA) kunye ne-Ewing's sarcoma (ES) i-1 st kunye ne-2nd M / C yamathambo ayisifo esisiswini samathambo ebuntwaneni (ukuphakama kwe-10-20 yo) Kwizonyango: iintlungu zethambo, utshintsho kwintsebenzo, imitha yamastastistim yokuqala, imitha yamapulmoni ingenzeka. Ukugqithisa kakubi
• Ii-Ewings zinokubakho ngeentlungu zamathambo, umkhuhlane kunye ne-ESR/CRP ephakamileyo elinganisa usulelo. I-Dx yangaphambili enemifanekiso kunye nesiteji ibalulekile.
• Ukulinganisa kwe-OSA kunye ne-ES: X-ray, elandelwa yi-MRI, isifuba i-CT, i-PET / i-CT. Kwi-x-reyi: I-OSA inokuchaphazela naliphi na ithambo kodwa uninzi lwayo lubonakala njengamathambo anobundlobongela enza i-neoplasms malunga nedolo (iimeko ezingama-50%) ngakumbi njenge-osteoid eyenza isilonda esinoburhalarhume kwi-metaphysis ene-sunburst periostitis kunye ne-Codman triangle. Ukuhlaselwa kweethishu ezithambileyo.
• I-ES ingabonisa kwi-shaft kwaye ibonise ukusasazeka kwethambo ezincinci. I-MRI ibalulekile ekuboniseni ubungakanani bethambo kunye nokuhlasela kwe-ST, i-MRI efunekayo ekucwangciseni ukucwangcisa
• I-OSA kunye ne-ES Rx: Umdibaniso wotyando, imitha, i-chemo. Iindlela zokulungisa amalungu zenziwa ngamanye amaxesha. Ukuxela kakubi xa kufunyenwe kade.

• Umfanekiso we-Ewing's sarcoma
• Ukuphelisa ukuphazamiseka kwethambo
• Ukuhlasela kwangaphambili kunye neentlobo ezincinci
• Impendulo enokugxothayo ngexesha elimnandi kunye ne-laminated (i-onion skin) impendulo
• I-Saucerisation yetshe ye-cortical (itywala ye-orange)
• Isilonda siqhelekile yi-diaphyseal kunye nokwandiswa kwe-metaphyseal
• Eyaziwa ngokuba yiRound cell tumor kunye neMultiple Myeloma kunye neLymphoma

Izibhambathiso eziqhelekileyo zabantwana

• Neuroblastoma (NBL) Ukuxhatshazwa kwe-M / C ebuntwaneni. Iphuma kwiiseli ze-neural crest aka PNET tumors (umzekelo, i-ganglia enovelwano). Uninzi lwenzeka kubantwana <24-iinyanga. Abanye babonisa i-prognosis elungileyo kodwa> i-50% yeemeko ezikhoyo zinesifo esiphezulu. I-70-80% kwiminyaka eyi-18-inyanga okanye ngaphezulu ikhona kunye ne-metastasis ephezulu. I-NBL inokukhula kwi-adrenal medulla, i-ganglia enovelwano kunye nenye indawo. Ibonisa ubunzima besisu, ukugabha. > i-50% ibonisa iintlungu zethambo d/t metastasis. Ngokonyango: ukuhlolwa komzimba, iilebhu, ukucinga: isifuba kunye ne-abd x-rays, isisu se-CT kunye nesifuba kubalulekile kwi-Dx. I-MRI inokunceda. I-NBL inokumetastaze kukhakhayi kwaye ingene kwimibhobho ebonisa uphawu njenge-pathological sutural diastasis.
• I-Lymphoblastic Leukemia yinto yokutshatyalaliswa komntwana. I-pathology: ukungena kwintsholongwane yamathambo okubangela intlungu yesifo kunye nokutshintshwa kwamanye amangqamuzana e-marrow aemia, i-thrombocytopenia, i-neutropenia kunye neengxaki ezinxulumene nazo. Amaseli enomkhuhlane angangenelela kwezinye iindawo ezibandakanya i-CNS, istile, ithambo kunye neminye imimandla. I-Dx: I-CBC, amazinga e-serum lactate dehydrogenase, i-Bone marrow aspiration biopsy yintloko. Ukucinga kunokunceda kodwa kungabalulekanga ukuxilongwa. Kwi-radiografi, ukungena kwesifo kwethambo kungabonakala njengamaqhekeza adibeneyo kwiplani yokukhula. I-Rx: i-chemotherapy kunye nokunyangwa kweengxaki

• Medulloblastoma: I-CN / ne-CNS engeyiyo i-neoplasm ebantwaneni
• Uninzi lukhula phambi kwe-10-yo
• Indawo ye-M / C: i-cerebellum kunye ne-posterior fossa
• Ubomi bakhe bumele uhlobo lwe-PNET uhlobo lwe-glioma njengoko kwakucingelwa okokuqala
• MBL, kunye ne-Ependymoma kunye ne-CNS i-lymphoma, kunokukhokelela ekuhlahleni i-metastasis nge-CSF kwaye ngokuthe kongeza imele iyingqamaniso engafani nezinye izicathulo ze-CNS zibonisa ukusabalala kwe-metastatic ngaphandle kwe-CNS, m / c kwithambo
• I-50% ye-MBL inokwenziwa ngokutsha
• Ukuba i-Dx kunye nonyango kuqala phambi kwe-metastasis, ukusinda kwe-5-year yi-80%
• Ukucingwa kubalulekile: Ukusetyenziswa kwe-CT kungasetyenziselwa kodwa indlela yokucinga yokuzikhethela yi-MRI eya kuthi yongezelela ukunika uvavanyo oluphezulu kakhulu lwe-neuraxis yonke ye-metastasis.
• I-MBL ibonakala ngathi i-hypo, i-iso kunye ne-hyperintense lesion kwi-T1, T2 kunye ne-FLAIR (umfanekiso ophezulu) xa uthelekisa kumathambo engqondo. Ngokuqhelekileyo icindezela i-4th ventricle ene-hydrocephalus ephazamisayo. I-tumor ngokuqhelekileyo ibonisa ukuphuculwa kokungafani kwi-T1 + C gad (umfanekiso osezantsi osekhohlo). Yehlisa i-metastasis ukusuka kwi-MBL ene-T1 + C yokunyusa isilonda kwintambo

Izifo ezithintekayo zezilwanyana

• Kwi-neonate / kwiintsana <1month: fever> 100.4 (38C) inokubonisa ibhaktiriya kunye nosulelo lwentsholongwane. I-Strep B, i-Listeria, i-E.Coli inokukhokelela kwi-sepsis, meningitis. Inkqubo: I-x-ray yesifuba, ukugqobhoza i-lumbar kunye nenkcubeko, inkcubeko yegazi, i-CBC, uvavanyo lwe-urinalysis
• Kubantwana abancinci, iHemophilus influenza hlobo B (HIB) inakhokelela ku-Epiglottitis ingxaki engabonakaliyo kodwa engathandekiyo. I-vaccine yangoku iyanceda ukunciphisa inani lamatyala e-Epiglottitis kunye nezinye izifo ezihlobene ne-HIB.
• IParainfluenza okanye i-RSV intsholongwane ingakhokelela kwiCroup okanye iLaryngotracheobronchitis.
• I-Epiglottitis neCroup ziyi-Dx ekliniki kodwa i-AP kunye ne-lateral soft tissue neck x-ray zinceda gqitha
• I-Epiglottitis ibonisa uphawu �ubhontsi olufana nokujiya kwe-epiglottis d/t epiglottic edema. Oku kunokuba yimeko kaxakeka ebeka esichengeni iindlela zomoya (phezulu ekhohlo)
• Croup inokubonisa �uphawu lwebhotile yewayini� enophawu lwebhotile yewayini� enehypopharynx ethe qelele njengokucutheka okubukhali kwendlela yomoya engaphantsi kwi-AP kunye nentamo esecaleni ethambileyo yex-reyi (phezulu ekunene)
• I-Syncytia Virus yokuphefumula (RSV) kunye nomkhuhlane ungakhokelela kwipilumoniya yentsholongwane enokubakho ubunzima obusongela ubomi kwi-immunocompromised, incinci kunye nabantwana abanama-comorbidity. I-CXR ibalulekile (ephakathi kwesasekhohlo)
• Streptococcal pharyngitis Usulelo lwe-GABHS lunokukhokelela kwiingxaki eziqatha okanye zilibazisekile (umzekelo, iRheumatic fever)
• I-Peritonsillar abscess (ngasentla ephakathi kwesokudla) inokuphuhliswa kwezinye iimeko kwaye iyanzima ngokusasaza ngeenqwelo ezincinci ezintanyeni entanyeni enokubangela ukusabalalisa kwizikhalazo ezingaphantsi / eziphantsi kwe-submandibular (uLudwig Angina) xa iifudu zomoya zifuna ukulawulwa kwisebe ye-d / t yolwimi i-edema
• Ukuphuhliswa kwekhefu le-retropharyngeal lingakhokelela ekusasazeni intsholongwane ngokuthetha ngokukhululeka kwentamo ye-fascia okubangelwa kukunyanga kwe-mediastinitis, i-Lemmier syndrome kunye nokuhlaselwa kwezikhala ze-carotid (zonke zizinto ezinokubangela ingozi yokuphila)
• I-Griesel syndrome- (ngasentla ngasekhohlo) ukuxhamla okungaqhelekanga kwimiba yesifo somzimba / isifo somzimba esasasazeka kwi-prevertebral space ekhokelela kwi-C1-2 ligaments laxity and instability
• Ezinye izifo ezibalulekileyo kubantwana zifana ne-bacterial (Pneumococcal) pneumonia, ukusuleleka kwe-Urinary tract and Acute Pyelonephritis (ngakumbi kwimantombazana) kunye ne-Meningococcal Meningitis

• Izifo zeMetabolic Disease
• Rickets: kuqwalaselwa i-osteomalacia kwi-skeletally immature. Ummandla wokubalwa kwesikhashana kwiplani yokukhula ye-epiphyseal ichaphazeleka ngokukodwa
• Iiklinikhi iveza ngokulinda ukukhula, ukuqubuda komda, i-rachitic rosary, isifuba se-pigeon, izibilini ezixinezelekileyo, izibilini ezinwebezelekileyo nezikhukhulayo, kunye neenqaqa, i-skull deformity
• I-Pathology: I-vit D kunye ne-calcium engafaniyo yiyo m / c. Ukungabi nelanga lokukhanya kwelanga esp. Umntu omnyama onobuhlungu, iimpahla ezithintekayo ekukhanyiseni ukukhanya, ukuxilisa okwexesha elide, i-veganism, i-malabsorption syndromes ye-gut, umonakalo wenzalo kunye nabanye
• Ukucingela: i-metaphysis yecrafhysis yenziwe ngophawu lokutshiza, i-flaring, ukuphakama kwiplani yokukhula, ikhonkco ye-costochondral njenge-rachitic rosary, igqibe
• I-Rx: ukuphatha izizathu ezingundoqo, ukuchithwa kwesondlo esifanelekileyo, njl

Ucaphulo

• www.radiopaedia.org
• reference.medscape.com