Radiology indications in Pediatrics
Indications
Upper airway
Retropharyngeal abscess
Inhaled foreign body
Acute epiglottitis
Chest X-ray frontal view
Respiratory indication:
 Infection – exclude pneumonia
 Inhaled foreign body
 Chest trauma
 Pneumothorax
 Asthma/bronchiolitis
Cardiac indications
 CCF or clinical cardiomegaly
 Heart murmurs
 Hypertension
Neonates (<6wks)
 Septic screen
 Respiratory distress
Limb X-rays
Comparative and stress views
Trauma
X-ray of suspected fracture and joint above
and below.
Additional views if suspected # but initial xray N
Non-accidental injury
Skeletal survey if age >2yrs – limit to sites of
injury
Complete skeletal survey if age <3yrs ± bone
scan
Acutely painful hip
Plain x-rays (AP, lateral and frog-leg lateral)
USS ± bone scans
Acutely swollen joint
X-ray joint and bone above or below
Osteomyelitis
X-ray/ bone scan/ MRI
Septic arthritis
X-ray/US
Metabolic disorders
Rickets
Osteogenesis imperfecta
Pulled elbow
x-ray elbow ± radial head views
Findings
Widened prevertebral shadow (>vertebral width at C4) or
neck flexion
URT signs if sharp FB and consider CT imaging
Radio-opaque vs. translucent shadows
Soft tissue findings
NOT INDICATED








Patchy changes vs. lobar findings
Need inhalation/exhalation films (FB)
Air leak/Haemothorax/widened mediastinum/# ribs
Full inspiratory films (pneumothorax)
Severe attacks of asthma/bronchiolitis, uncertain
diagnosis, focal signs
Large thymic shadow age<2yrs, normal CT ratio 0.5
(infants 0.6)
Seldom helpful for structural heart disease/ HT
To differentiate cardiac vs. resp. cause
Complex fractures
Uncertain diagnosis e.g. elbow fractures
Follow up x-ray post reduction
Bone scan/ CT scan if fracture seriously considered and x-ray
N
Suspect NAI if:
 Metaphyseal fractures
 Marked or unusual epiphyseal separation
 # spine or ribs
 Unexplained skull # or head injury
Slipped capital femoral epiphyses, Perthe’s & #s
Indicated dependent on suspected ∆ and above findings
Fracture/septic arthritis/osteomyelitis/ malignancy
Early x-ray may have only soft tissue swelling. BS and MRI will
detect abnormality earlier
Normal x-ray does not rule out ∆, US may ∆ effusion
X-ray wrist ± one knee
Low threshold for any x-ray
If diagnosis in doubt, failure to reduce or elbow swelling