Q UIC KI E

PC C F IN AL S RE VIE W E R ( R A DI O L OG Y )
ULTRASOUND
BASIC PRINCIPLES ULTRASOUND MODES
Tissue MORE dense = more echobright • Intensity shown on screen as
Tissue LESS dense = darker SPIKES
A MODE • Higher spikes = higher
SUPERFICIAL STRUCTURES: top of the monitor (amplitude) reflective surfaces
DEEP STRUCTURES: further down on the monitor • Diaphragm > liver > bladder >
fluid
ECHOGENICITY • Real-time grayscale imaging
ANECHOIC HYPERECHOIC • Guided injections &
HYPOECHOIC
(black) (white) catheterizations, detecting
Blood vessels Cartilage Bone fetuses
Air Muscles Fascia 2D OR B MODE • Used to locate STRUCTURAL
Lymph nodes Ligaments (brightness) ABNORMALITIES
Nerves Tendons DOPPLER: COLOR FLOW
Stones • Superimposed to B mode
Metal implants • Red: TOWARDS transducer
Stones: (+) ACOUSTIC SHADOW • Blue: AWAY from transducer

• Very sensitive mode of doppler
TYPES OF TRANSDUCERS
UTZ (5x more sensitive)
• PHASED-ARRAY: low frequency (best for DEEP structures); best POWER DOPPLER
• Detects blood flow in LOW
for cardiac
FLOW ORGANS
• LINEAR: high frequency, best used for ABDOMINAL &
• SEQUENTIAL UTZ PULSE LINE =
VASCULAR exams (best for SUPERFICIAL structures)
M MODE visualization of motion
• CURVILINEAR: basically same w/ linear; used for BLUNT
(motion) • USED IN CARDIAC IMAGING
TRAUMA
• Evaluates organs that move


• CONVEX / CURVILINEAR
Safety of UTZ in Children: ALARA principle (as low as reasonably
• Large footprint, large field of
possible; lowest level of radiation possible)
4C TRANSDUCER view

• Cross-beam technology (better LIMITED DATA ON THE USE OF UTZ IN THE ASSESSMENT OF BILIARY
image resolution) SYSTEM IN PEDIA PATIENTS (RARE IN CHILDREN)
• PHASED-ARRAY • CHOLELITHIASIS
• SMALL footprint, small field CHOLECYSTITIS
3S TRANSDUCER •
• For cardiac, ICS
• NO cross-beam technology FOCUSED ASSESSMENT W/ SONOGRAPHY IN TRAUMA (FAST)
• LINEAR • Soft tissue evaluation
• HIGH FREQUENCY • Vascular access
12L TRANSDUCER
• Large footprint, large field of • ACCURACY in dx PNEUMOTHORAX: LUNG UTZ > SUPINE CXR
view • Sensitivity improves in most severely injured patients
Transducer indicator: always on the RIGHT of the patient INDICATIONS
• HYPOTENSIVE pediatric trauma patient
ARTIFACTS • HEMODYNAMICALLY STABLE patients w/ (+) FAST-CT scan or
• Echoes are DIMINISHED serial FAST
HIGH ATTENUATION posteriorly = ACOUSTIC
SHADOW RUQ LUQ
• Echoes are ENHANCED R-sided hemothorax L-sided hemothorax
LOW ATTENUATION
posteriorly (used as a window) Morrison’s pouch Splenorenal space
• Much of the signal is lost to Fluid in the paracolic gutter LUQ bleed inside or outside
GAS SCATTER scatter = obstruction of the lesser sac
visualization posteriorly L paracolic gutter
• Edge artifact: sound crosses PELVIS SUBCOSTAL
REFRACTION boundary of tissue w/ different Intraperitoneal fluid Intrapericardial fluid
propagation speeds MOST COMMON LOCATION OF
• Recurrent bright arcs at FREE FLUID IN CHILDREN
REVERB equidistant intervals
• Common in phased-array Cellulitis: COBBLESTONE EDEMA ON ULTRASOUND
MIRROR • Sound glances off diaphragm





 Q UIC KI E PC C F IN AL S RE VIE W E R ( R A DI O L OG Y )
PEDIATRIC CHEST RADIOLOGY
THYMUS GLAND • CONSOLIDATION
HOMOGENOUS
• SAIL SIGN: prominent thymus gland • ATELECTASIS
OPACIFICATION
• DOESN’T DISTORT / DISPLACE THE TRACHEA / • LOCULATED EFFUSION
(consider the ff.:)
ESOPHAGUS • SOLID MASS
• Normal until 2 y/o • IPSILATERAL MEDIASTINAL
• Gradually regresses (2 y/o) SHIFT
ATELECTASIS • Narrow ICS
TH th
CARDIAC APEX: 5 ICS, doesn’t extend beyond 6 • Elevated hemidiaphragm
(ipsilateral)
CHILDREN ADULTS • MENISCUS / DAMASCUS SIGN
PLEURAL EFFUSION
Cardio-Thoracic
0.65 0.5 SILHOUETTE SIGN
Ratio •
th PERSISTENT PNEUMONITIS
8 posterior rib th (obliteration of cardiac
Level of Diaphragm 10 posterior rib border)
(until 5 y/o)
• CONSOLIDATION
• Diabetic mothers CHEST & MEDIASTINAL • ATELECTASIS
RESPIRATORY DISTRESS • PREMATURITY: most MASSES • PLEURAL EFFUSION
SYNDROME significant risk/cause (due to:) • MASS
• CS Delivery *Last 2 diagnosed w/ CT & UTZ
• CS = no squeezing effect =
RETAINED FLUIDS PRIMARY PTB IN CHILDREN
TRANSIENT TACHYPNEA • HYPERaeration • PRIMARY FOCUS
OF THE NEWBORN • LINEAR OPACITIES (engorged • ENLARGED REGIONAL LYMPH NODE
pulmo vessels) • LYMPHANGITIS
• Flat diaphragm • PLEURAL EFFUSION
• DECREASED SURFACTANT
• HYPOaeration ANY 3 OF THE FF = (+) PTB
• GROUND GLASS • Hx of EXPOSURE
APPEARANCE (inspiration); • SX (afternoon rise in T, body malaise, cough)
HYALINE MEMBRANE
WIPED OUT APPEARANCE • (+) CXR findings
DISEASE
(expiration) • (+) SPUTUM
• PERIPHERAL AIR
BRONCHOGRAM Calcified Ghon Focus: after > 1 year
• Visible 3º airway
• PROLONGED ARTIFICIAL
VENTILATION W/ HIGH O2
BRONCHOPULMONARY
• BUBBLY LUNG APPEARANCE
DYSPLASIA
o DDx: WILSON MIKITY
(pulmonary dysmaturity)
• Collapsed lung
• RADIOLUCENCY DEVOID
LUNG MARKINGS

• Mgt: EMERGENCY

THORACOSTOMY
PNEUMOTHORAX
TENSION PNEUMOTHORAX

• CONTRALATERAL

MEDIASTINAL SHIFT
ANTERIOR PNEUMOTHORAX
• PSEUDO SNOWMAN
• ANGEL WING
CONFIGURATION: elevation
PNEUMOMEDIASTINUM
of thymus gland d/t air in the
mediastinum
INTERSTITIAL
• SHAGGY HEART PATTERN
ALVEOLAR
PNEUMONIA • HOMOGENOUS
OPACIFICATION
BRONCHOPNEUMONIA
• Etiologic agent: S. aureus


 Q UIC KI E PC C F IN AL S RE VIE W E R ( R A DI O L OG Y )
PEDIATRIC CARDIAC RADIOLOGY

ACYANOTIC (L TO R SHUNT) CHAMBER ENLARGEMENTS
ATRIAL SEPTAL DEFECT • DILATED RA RV PA • PROMINENT R CARDIAC
(ASD) • Small/N LA LV Aorta RA ENLARGEMENT BORDER
• DILATED LA LV RV MPAS • PA view best
• Increased pulmonary • RETROSTERNAL FULLNESS >½
vasculature OF RETROSTERNAL SPACE
• Small/N RA Aorta (lateral view)
RV ENLARGEMENT
VENTRICULAR SEPTAL EISENMENGER’S COMPLEX • Prominent MPAS
DEFECT (VSD) • Long-standing L to R shunt of • Lateral displacement &
VSD à R to L shunt rounding of cardiac apex
• PRUNED TREE CONFIGURATION • DOUBLE CONTOUR OF R
(Pulmo Arterial HTN) CARDIAC BORDER
• Bulging MPAS LA ENLARGEMENT • BULGING LAA
PATENT DUCTUS • DILATED AORTIC KNOB • RETROCARDIAC FULLNESS
ARTERIOSUS (PDA) • DILATED LA LV RV (UPPER ½) - LA
CYANOTIC (R TO L SHUNT) • CARDIAC APEX DISPLACED
TYPE 1 SUPRACARDIAC LATERALLY & DOWNWARDS
• SNOWMAN'S LV ENLARGEMENT • RETROCARDIAC FULLNESS
CONFIGURATION (LOWER ½)
• PV drains into persistent SVC • Rounding of L cardiac border
• Cardiomegaly
• DILATED RA RV PA
TOTAL ANOMALOUS • Small/N LA LV Aorta
PULMONARY VENOUS TYPE 2 CARDIAC
RETURN (TAPVR) • PV drains into coronary sinus
• Cardiomegaly
• DILATED RV
TYPE 3 INFRADIAPHRAGMATIC
• NARROW PULMO VESSELS

• PV drains into a vertical vein

• Heart is small

• CONCAVE MPAS

• OVAL CARDIAC

CONFIGURATION W/
PERSISTENT TRUNCUS
BIVENTRICULAR
ARTERIOSUS (PTA)
ENLARGEMENT

• Failure of TA to divide into
aorta & PA
• COER EN SABOT
• DILATED RA RV
• Small/N LA LV
• Narrow BVs
• Only CHD w/ DECREASED
TETRALOGY OF FALLOT pulmo vascularity
(TOF) TETRAD
• PULMONARY STENOSIS (MOST
IMPORTANT)
• RVH
• OVERRIDING AORTA
• VSD











 Q UIC KI E PC C F IN AL S RE VIE W E R ( R A DI O L OG Y )
PEDIATRIC GASTRIC RADIOLOGY

• TARGET SIGN, BULL’S EYE SIGN BILOUS VOMITING (POST-AMPULLARY)
• Fluid-filled • CORKSCREW APPEARANCE +
• NON-compressible beaking sign
ACUTE APPENDICITIS • XS diameter > 6CM • UGIS: imaging modality of
• APPENDICOLITH: echogenic choice
focus w/ posterior acoustic UTZ
shadowing MIDGUT VOLVULUS • 3 ½ TWISTS BEFORE IT CAN
• DONUT APPEARANCE (axial) IMPAIR VASCULAR SUPPLY
• PSEUDOKIDNEY APPEARANCE • WHIRLPOOL CONFIGURATION
(sagittal) (SMA right, SMV left)
• COILED STRING & NAPKIN
RING & MENISCUS SIGNS
NARROWED DISTAL COLON
•
• Younger: bleeding + vomiting
W/ PROXIMAL DILATION
ILEOCOLIC w/o abdominal pain
(barium enema)
INTUSSUSCEPTION • Older children: pallor,
HIRSCHSPRUNG DISEASE • ABSENT GANGLION CELLS
listlessness, palpable mass w/o
• Dilated intestines
abdominal pain
• Paucity of air or gas (lateral
• HYPOechoic outer
view)
INTUSSUSCIPIENS
• HYPERechoic central BLOODY STOOLS
INTUSSUSCEPTUM • DIVE SEAL REFLEX

• TRIRADIATE FOLD PATTERN EARLY
• Gas-filled viscus seen in the R • SAUSAGE SHAPED ILEUS
MECKEL’S DIVERTICULUM iliac fossa / midabdomen NECROTIZING • Adynamic ileus
• CONTRAST-FILLED ENTEROCOLITIS
OUTPOUCHING LATE
PROJECTILE & NON-BILOUS VOMITING (ABOVE AMPULLA) • PNEUMOPERITONEUM
NUCLEAR SCINTIGRAPHY BARIUM SWALLOW • Portal vein gas
• HIGHLY SENSITIVE IN GRADING OF REFLUX • Pneumatosis intestinalis
rd
EVALUATING • MINOR: MID 3 of the ABDOMINAL TRAUMA
INCOMPLETE esophagus WHOLE ABDOMINAL CT SCAN:
GASTRIC EMPTYING • MAJOR: PROXIMAL esophagus primary imaging modality of choice
• Detect minor reflux & = chronic aspiration & peptic • Classifies traumatic lesions:
aspiration in the stenosis o Contusions
lungs • Evaluates anatomy more than o Lacerations
• Lacks anatomic info it detects reflux o Hematomas
• Rigid esophagus o Fractures
GERD
• Absence of peristalsis FAST:
• BEAKING OF THE DISTAL TRAUMATIC • BEDSIDE
ESOPHAGUS DIAPHRAGMATIC HERNIA • Lacerations in the liver, spleen,
ACHALASIA
• Deficient Auerbach’s plexus kidneys
• Defective CN X function • Hematoma
• Part of the stomach protrudes • Free fluid/blood in the
into the thoracic cavity through peritoneal cavity
SLIDING HIATAL HERNIA
the esophageal hiatus of the • Duodenal hematoma in cases
diaphragm of blunt trauma
• CATERPILLAR SIGN • Disadvantage: can’t evaluate
(hyperperistalsis) solid organs for injury
• RAILROAD TRACK SIGN
(dilated antrum)
• MUSHROOM / UMBRELLA
SHAPED DEFORMITY
HYPERTROPHIC PYLORIC • SINGLE BUBBLE SIGN
STENOSIS • BEAKING SIGN
• Olive-shaped pyloric tumor
after feeding
• CIRCULAR MUSCLE STUDY AT OWN RISK!
• Mucosa becomes redundant I CANNOT STRESS ENOUGH NA QUICKIE REVIEWER LANG TO.
• Pylorus deviates upward YOU STILL HAVE TO READ TALAGA HAHAHA.
toward the GB
GOODLUCK!