Zvirwere Zvepabonde Kuona Mafungiro Kusvika | | El Paso, TX.

• Uku ndiko kuongororwa kwenguva pfupi kwezvimwe zviyeuchidzo zvemishonga zvinowanikwa mumakiriniki.
• Acute Trauma kusanganisira acute head trauma
• Kwete-chiitiko chinotambudza muvana (akarwa mwana)
• Musculoskeletal Complaints (Juvenile Idiopathic Arthritis, scoliosis,
• Kazhinji vana mapundu (CNS & vamwe)
• Kurwara
• Chirwere chemagetsi

Zvakanyanya Kurapa kwevana:

• Makuvadzwa eFOOSH (semuenzaniso, akawira pambongoro-bar)
• Supracondylar Fx, murwi. Nguva dzose d / t tsaona inoshungurudza. <10-yo
• Extra-articular Fx
• Gartland maitiro emakoroti minimally evlaced mavanga akavanzika akabatwa nechinhu chisina kumira zvakanaka vs. posterior elbow dislocation treated nenzira
• Izvo zvinogona kuisa njodzi yekunyengedzera kwekwenyengeri kana kucherechedza kunonoka (Volkmann chibvumirano)
• Iyo Radiological bvunzo yakakosha: chikepe chiratidzo & yekumashure mafuta pad chiratidzo pamwe neamberi humeral mutsara yakakundikana kuyambuka pakati / 2/3 yeCapitellum.

Chirwere chisina kukwana Fx:

• Mazhinji mu <10 yo Greenstick, Torus, Plastic aka Kukotama hurema
• Kazhinji kuporesa zvakanaka, kurapwa nekuchengetedza
• Kukanganisa kwepurasitiki kana> makumi maviri-madigiri inoda kudzikiswa kwakapfigwa
• Ping pong skull fracture inogona kukura inotevera kushungurudzika, forceps kubhadhara uye zvinetso zvekurwadziwa kwekuzvarwa. Ingadi inofanira kuongororwa nevana vevana neurosurgeo.n

• Salter-Harris rudzi rwekukuvara kwepasseal kukura
• Tora 1-slip. Somuenzaniso, Slipped Capital Femoral Epiphysis. Kazhinji hapana pfupa rakaputika rakataurwa
• Tora 2-M / C nekutaura zvakanaka
• Ita 3- intra-articular, saka inotakura dambudziko risati rasvika chemajoini uye inogona kutarisirwa kushanda d / t kusagadzikana
• Tora 4- Fx kuburikidza nemativi ose nezve physis. Kusagamuchirwa kusagadzikana uye chidimbu chinopfupisa
• Tora 5- kazhinji hapana uchapupu hwepfupa pfupa rakaputsika. Kutadza kukurumidza kufara d / t kupwanya kukuvadza uye kukuvara kwevascular pamwe nekuderera kwechiso
• Kufungidzira kuongorora kunokosha

Kwete-Kungoerekana Yakuvara (NAI) muvana

• Ikoko maitiro akasiyana-siyana ekudzvinyirirwa kwevana. Kushungurudzwa kwepanyama kunogona kubva pakakuvara kweganda kune zvakasiyana zvakakuvara zve MSK / systemic zvinokanganisa mapfupa uye zvinyoro zvishoma. Kufananidza kwakakosha uye kunogona kuziva zviratidzo zvakajeka zvichiruramisa vatapi vezvechiremba uye kuzivisa mabasa ekudzivirirwa kwevana uye mitemo yekudzivirira mitemo pamusoro pekushandisa zvisina kunaka.
• Mucheche: shaken baby syndrome inogona kuuya neCNS zviratidzo d / t kubvarura kwekukura kusingaiti mutsinga uye subdural hematoma iyo inogona kuuraya. Retinal hemorrhaging kazhinji chiratidzo. Musoro CT wakakosha.
• MSK Radiological Red Flags:
• 1) gurufu pfupa Fx mu mwana asina mwana anovhiringidza (0-12 mo)
• 2) Nhamba dzomumatare Fx: kazhinji hazviitike d / t zviitiko. Zvingangodaro nzira dzekushandisa: kubata uye kufambisa mwana kana kutsvaga zvakananga.
• 3) Fractures dzakawanda dzine maitiro akasiyana-siyana ekuporesa zviyero, kureva, mapfupa emapfupa anoratidza kudzokorora mumuviri
• 4) Kona yemapapanse Fx aka Bucket kubata Fx, kazhinji pathognomonic ye NAI muvana. Inoitika apo migumo yakagadziriswa inobatwa uye ichishungurudzika.
• 5) Kuputsika kwemafupa emapfupa marefu mumwana muduku ndiyo imwe muenzaniso weNaI.
• Zvimwe zvinokosha zvinokosha zve NAI. Kusabvumirana nhoroondo yakapiwa nevarindi / vatarisi. Hapana uchapupu hwehutano hwemapfupa / metabolic husina kunaka sezvakaita Osteogenesis Imperfecta kana Rickets / osteomalacia nezvimwewo.
• NB Kana vachengeti vemwana vakataura nhoroondo inoratidza kuti kudonha uye tsaona mumba, Zvakakosha kuziva kuti zvinoita tsaona / kuwira mumba kazhinji kacho kana zvisingaite zvinoguma nekutyoka kwemapfupa.
• Kuzivisa kushungurudzwa kwevana mu Illinois:
• www2.illinois.gov/dcfs/safekids/reporting/pages/index.aspx

MSK Kufanirwa Kusvika Patiatrics

• Juvenile Idiopathic Arthritis (JIA)-kutarisirwa M / C chirwere chisingaperi chehudiki. Clinical Dx: kurwadziwa pamwe chete / kuzvimba kwemavhiki matanhatu-kana kupfuura mumwana <6-yo Mafomu akasiyana aripo: Pakutanga Dx yakakosha kudzivirira kunonoka kunetseka
• Nzira dzakawanda dzinozivikanwa dzeJIA:
• 1) Pauciarticular chirwere (40%) - m / c chimiro cheJIA. Vasikana vari pangozi huru. Inopa seArthritis mu <4 majoini: mabvi, makumbo, ruoko. Gokora. Rudzi urwu rwunoratidza hukama hwakawanda neunobata uchiita se iridocyclitis (25%) iyo inogona kutungamirira kuhupofu. Labs: RF-ve, ANA yakanaka.
• 2) Polyarticular chirwere (25%): RF-ve. Vasikana vari pangozi huru. Inobata zviduku zviduku uye zvikuru zvinowanzobata Kervical spine
• 3) Chimiro cheJIA (20%): kazhinji chinopa nehukuru systemic kuratidzwa semafuta anopikisa, arthralgias, myalgias, lymphadeno [pathy, hepatosplenomegaly, polyserositis (pericardial / pleural effusion). Zvinonyanya kukosha Dx zvinoratidzika zvinoratidza sevanescent salmon rinopisa pink pamagumo uye mutumbi. Nzira yakarongeka ine kusiyaniswa kwakasiyana kwekuona kusanganisa. Mazamu kazhinji kacho shangu haasi kupesana kunoenzaniswa nemamwe marudzi. Nokudaro kupatsanidza pamwe chete hakusi kuonekwa

Kufungidzira muJIA

• Joint effusion bone inokonzera squaring ye patella cartilage / kuputika kwepasipo DJD yakawanda
• Zvigunwe nemapfupa marefu mapepa ekuvhara muviri wep physeal / mutsva kupfupika
• Rad DDx knee / ankle: Hemophilic arthropathy Rx: DMARD.
• Zvinetso zvinogona kuitika kuparadzana pamwe chete, kukurumidza kukura / kupfupisa kwechimbaridzo, kupofumadza, kunetseka kwemaitiro, kuremara.

Yakawanda Inowanzobatwa Nevana VanaMarignant Bone Neoplasms

• Osteosarcoma (OSA) & Ewing's sarcoma (ES) 1 st uye 2nd M / C primary malignant bone neoplasms youcheche (nheyo pa 10-20 yo) Clinically: kurwadziwa kwepfupa, kuchinja mumabasa, masitasita epakutanga kunyanya mishonga yemapammoni inogona kuitika. Varombo vasina kunaka
• Ewing s inogona kuuya nekurwadziwa kwepfupa, kupisa uye kukwirisa ESR / CRP kuteedzera hutachiona. Pakutanga Dx ine imaging uye staging yakakosha.
• Kufananidza kweOSA & ES: x-ray, inoteverwa neMRI, chifuva CT, PET / CT. Pane x-rays: OSA inogona kukanganisa chero pfupa asi mazhinji aripo seane hasha mapfupa anogadzira mamota pamusoro pemabvi (50% kesi) kunyanya seosteoid inogadzira chironda chine hukasha mune metaphysis ine fungidziro / sunburst periostitis & Codman triangle. Yakaratidzirwa yakapfava tishu inopinda.
• E ES inogona kuisa mumumvuri uye kuratidza mavara ekutanga. MRI inokosha kuti iratidze huwandu hwemapfupa uye ST inopinda, MRI inodikanwa pakugadzira chirongwa
• OSA & ES Rx: Kubatanidzwa kwekuvhiya, radiation, chemo. Limb salvage maitiro anoitwa mune dzimwe nguva. Kufungidzira kwakashata kana kukaonekwa kunonoka.

• Kufungidzira kweEwing's sarcoma
• Kukonzera kuputika kwepfupa
• Pakutanga uye kwakakura kwemavara emhando yepamusoro
• Aggressive periosteal react with laminated (onion skin) response
• Saucerisation ye cortical bone (machungwa museve)
• Chirwere chinowanzoita diaphyseal ine mamwe maitiro ekuwedzera
• Inozivikanwa seRondle sechirwere pamwe chete ne Multiple Myeloma uye Lymphoma

Kazhinji Vechiduku Malignancies

• Neuroblastoma (NBL) M / C yakaipa yehucheche. Inotorwa kubva kune neural crest maseru aka PNET mamota (semuenzaniso, anonzwira tsitsi ganglia). Zvizhinji zvinoitika muvana <24-mwedzi. Vamwe vanoratidzira kufungidzira kwakanaka asi> 50% makesi aripo nechirwere chemberi. 70-80% pazera 18-mwedzi kana mukuru aripo ane advanced metastasis. NBL inogona kukura mune adrenal medulla, inonzwira tsitsi ganglia uye imwe nzvimbo. Inopa seyedumbu dumbu, kurutsa. > 50% inopa nemarwadzo epfupa d / t metastasis. Kiriniki: bvunzo dzemumuviri, marabhu, kufungidzira: chipfuva uye abd x-rays, CT dumbu uye chipfuva kwakakosha kuna Dx. MRI inogona kubatsira. NBL inogona metastasize kune dehenya uye kupinza masuture nehunhu hunoratidzwa sehutachiona sutural diastasis.
• Acute Lymphoblastic Leukemia ndiyo m / c kuipa kwehuduku. Pathology: leukemic cell infiltration marrow bone rinokonzera kurwadziwa kwepfupa uye kushandiswa kwemamwe masero emurairo ane anemia, thrombocytopenia, neutropenia uye zvinetso zvinosanganiswa. Leukemic masero angapinda mune dzimwe nzvimbo kusanganisira CNS, spleen, bone uye dzimwe nzvimbo. Dx: CBC, serum lactate dehydrogenase levels, Bone marrow aspiration biopsy ndicho chinhu chinokosha. Kufungidzira kunogona kubatsira asi kusingakoshi pakuongororwa. Pachando chemafirimusi, marapu ekuputika kwepfupa angangowanzoonekwa sezvikwata zvinokonzera kupisa pamwe nepaseal growth plate. Rx: chemotherapy uye kurapa zvinetso

• Medulloblastoma: M / C yakaipa CNS neoplasm muvana
• Nhamba zhinji dzinokura zvisati zvaitika 10-yo
• M / C nzvimbo: cerebellum uye posterior fossa
• Histologically inomiririra chirwere chePNET kwete glioma sezvaimbofungidzirwa pakutanga
• MBL, pamwe neEpendymoma uye CNS lymphoma, inogona kukonzera kuderedza metastasis kuburikidza neCSF uye kuwedzera kuve yakasiyana yakasiyana nedzimwe zvirume zveCNS zvinoratidza kupararira kwemasasita kunze kweCSS, m / c kusvika pfupa
• 50% ye MBL inogona kunge yakagadziridzwa zvizere
• Kana Dx nemishonga inotanga kusati yasvika metastasis, 5-gore rinopona ndi80%
• Kufananidza kwakakosha: CT scanning inogona kushandiswa asi mafungiro ekufungidzira aunosarudza ndeyeMRI iyo inowedzera kupa tsvakurudzo yepamusoro yeeuraxis yose ye metastasis.
• MBL inowanzoonekwa se hypoterinic hypo, iso uye hyperintense lesion ku T1, T2 uye FLAIR kuongorora (mifananidzo yakakwirira) kana ichienzanisa nehupi hwepfungwa dzehupi. Kakawanda kunokonzera 4th ventricle nevanopisa hydrocephalus. Dumbu racho rinoratidzira kuratidzira kusiyanisa pa T1 + C gad (pasi kuruboshwe mufananidzo). Drop metastasis kubva ku MBL ne T1 + C kukusimudzira chironda mumudonzvo

Chirwere Chetachiona Chinotakurwa

• Mune neonate / mucheche <1month: fever> 100.4 (38C) inogona kuratidza hutachiona uye humwe hutachiona hutachiona. Strep B, Listeria, E. Coli inogona kutungamira kune sepsis, meningitis. Inzira: chest x-ray, lumbar puncture netsika, ropa tsika, CBC, urinalysis.
• Muvana vaduku, Hemophilus influenza type B (HIB) inogona kutungamirira kuEpiglottitis chisingaiti asi chinetso chakakomba. Ikozvino chirwere chinobatsira kuderedza nhamba yemhosva dzeEpiglottitis nedzimwe zvirwere zveHIB zvine chokuita.
• Parainfluenza kana RSV Utachiona hunogona kutungamirira kuCroup kana kuti kuRaryaryototchechebronchitis.
• Epiglottitis neCroup zvinonzi Dx kliniki asi AP uye lateral soft tissue neck x-rays zvinobatsira zvikuru
• Epiglottitis inopa nehunhu thumb sign inoenderana neakakora epiglottis d / t epiglottic edema. Izvi zvinogona kuve zvinotyisidzira hupenyu zvinokanganisa mweya (kumusoro kuruboshwe)
• Croup inogona kuratidza steeple sign kana wine bottle sign ine distended hypopharynx sekukomba kuderera kwe subglottic airway paAP uye yekupedzisira mutsipa nyoro nyama x-ray (kumusoro kurudyi)
• Kuporesa Syncytia Virus (RSV) uye furuwenza inogona kutungamirira kuhutachiona hwepirumoni inogona kuve nehutano hwehupenyu huri muhutachiona husina kunaka, huduku zvikuru uye vana vane comorbidities. CXR inokosha (pakati kuruboshwe)
• Streptococcal pharyngitis nehutachiona hweGABHS inogona kutungamirira kune zvimwe zvakaoma kana kuti kunonoka kunetseka (semuenzaniso, Rheumatic fever)
• Peritonsillar abscess (kumusoro nepakati kurudyi) inogona kukura mune dzimwe mamiriro ezvinhu uye kuomeswa nekupararira pamwe chete nemapuraneti ari nyore mumutsipa zvinogona kutungamirira kupararira mune zvinyorwa zvinyorwa / submandibular (Ludwig Angina) apo mhepo inofanirwa kudzora d / t dhemi rwemirimi edema
• Kubudirira kwekubviswa kwetropharyngeal kunogona kutungamirira pakupararira kwehutachiona kuburikidza nekukurukurirana pachena musungo fascia zvichiita kuti necrotizing mediastinitis, Lemmier syndrome nekupinda kwemahara carotid (zvose zvinogona kutyisa upenyu)
• Griesel syndrome- (kumusoro kumusoro kuruboshwe) kusanzwisisika kusingaitiki kwemasango emunharaunda / pharyngeal mishonga inogona kupararira kune prevertebral nzvimbo inotungamirira kuC1-2 ligaments kusagadzikana uye kusagadzikana
• Zvimwe zvirwere zvinokosha muvana zvinowanzoita mabhakitiriya (Pneumococcal) pneumonia, Urinary tract infection uye Acute Pyelonephritis (zvikurukuru kuvasikana) uye Meningococcal Meningitis

• Chirwere cheMatabolic Disease
• Rickets: inofungidzirwa osteomalacia mumarara asina kuchena. Chikamu chekugadziriswa kwenguva yakareba ye epiphyseal kukura ndiro inonyanya kukanganiswa
• Chipatara chinopa kukura kwekukurumidza, kupera kunamatira, rachitic rosary, pigeon chest, kushushikana nenyundo, kubhururuka uye kubhururuka maziso, uye maziso emakumbo, tsvina
• Pathology: Vit D uye calcium zvisina kufanana ndeyo m / c chikonzero. Kusava kwezuva kusununguka esp. munhu ane ruvara rwemajenya, zvipfeko zvinodzivirira kuti awane chiedza, kuwedzera kwenguva refu kunwisa, veganism, malabsorption syndromes mudumbu, kukuvara kwechimbichimbi nevamwe
• Kufananidza: frayed metaphysis waka aka purasitiki mabheti emasiphysis ane flaring, kuwedzerwa kwepulumu yokukura, bundu rinodhura sorosi yepamusoro se rosary rachitic, kupfugama kunopfugama
• Rx: shandisa zvinokonzera zvikonzero, kukwana kwakakwana kwezvokudya, uye zvimwe.

References

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