13 March 2011

This week I was in the Royal Hospital for Sick Kids. It was a very interesting week with me experiencing and learning a lot. Paediatric radiography is very different to general adult radiography. Rules and protocols are strictly defined for paediatric radiography and students who are on placement are made aware of them very quickly.
While there I was able to attend the weekly A & E meeting. This meeting allows the A & E consultants and the radiologists to discuss any interesting cases or cases where there are questions surrounding patients’ diagnosis or follow up. Being able to sit in on these meetings, from a student’s point of view, was extremely interesting and very useful. One patient on the list of discussion was a two year old who had ingested a liquid tab designed for washing machines. What made this particularly interesting was a feature on the x-ray that was pointed out and referred to as a steeple sign. They explained this sign is usual in children with croup or children who have experienced near drowning and referred to it as being laryngotracheobronchitis. This steeple sign is a tapering of the trachea which can be seen superiorly on a frontal chest radiograph and is reminiscient of a church steeple.
Another case that was discussed was regarding a possible non accidental injury (NAI) of a 7 month old child who had been brought in by his parents due to continued crying and seemed to show signs of a sore arm. It was discovered on x-ray the patient had a spiral fracture of the humerus with minimal displacement. However the fracture travelled from the distal humerus and ran over half way up the shaft of the humerus. It was highlighted by the consultant at the meeting as the patient had been seen previously with a case of severe scabies and also the patient had multiple bruises along with a number of other suspicions which were not discussed. The consultant also questioned the mechanism of injury and said the story did not seem to relate to the extent of the injury. He went on to inform the radiologist that he had reported the case to the child protection team for further investigation.
Later on in the week I was in ITU performing a chest x-ray on an 18 month old patient. The little girl suffered from a rare condition called Jeune syndrome and had previously undergone surgery at Great Ormond Street Hospital to reduce the restriction of her breathing due to her ribs not growing and crushing her lungs. The consultant had informed us that he was extremely concerned for the child and he was unsure if she was going to recover. She had now had a tracheostomy performed to try and assist with her breathing however this didn’t seem to be helping.
An article from emedicine refers to Jeune syndrome as a disorder of bone growth caused by changes in the IFT80 gene. Common signs include a small chest and short ribs which restrict the growth and expansion of the lungs often causing life threatening complications. Other symptoms can include shortened bones in the arms and legs, unusually shaped pelvic bones, and extra fingers and/or toes (polydactyl). Children that survive the difficulties of the breathing and lung challenges at infancy, can then go on to later develop life-threatening kidney problems or heart defects and a narrowing of the airway. Less common features of Jeune syndrome can include liver disease, pancreatic cysts, dental abnormalities, and an eye disease called retinal dystrophy that can lead to vision loss.

Attached to this writing are images on the various topics discussed above.

Children’s Specialists. 2011. Musculoskeletal Tumors and Infections. [online] Available at: http://www.cssd.us/body.cfm?id=1238 [Accessed March 27]

Aswcpoets. 2011. Steeple sign. [online] Available at:http://www.aswcpoets.com/wp-content/uploads/2011/01/croup_steeple_sign.jpg [Accessed March 12]

Radiopaedia. 2011. Croup – steeple sign. [online] Available at:http://radiopaedia.org/cases/croup-steeple-sign [Accessed March 12]

Radiopaedia. 2011. Skeletal dysplasia. [online] Available at:http://radiopaedia.org/articles/skeletal-dysplasia [Accessed March 12]

Dukes Orthopaedics. 2011. Pediatric Supracondylar Fractures of the Humerus [online] Available at: http://www.wheelessonline.com/ortho/pediatric_supracondylar_fractures_of_the_humerus [Accessed March 12]

Emedicine. 2011. Genetics of Asphyxiating Thoracic Dystrophy (Jeune Syndrome)
[online] Available at:http://emedicine.medscape.com/article/945537-overview [Accessed March 12]

 

 

 

 

This entry was posted on Monday, March 14th, 2011 at 11:12 am and is filed under Reflectives. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.