损伤患儿骨骼影像学评估.pdfVIP

Efren Gutierrez, MS III Gillian Lieberman, MD May 2006 The Skeletal Survey: Radiographic Evaluation Efren Gutierrez, Harvard Medical School, Year III Gillian Lieberman, MD Efren Gutierrez, MS III Gillian Lieberman, MD Introduction • The Patient • Child abuse • What is a skeletal survey? • Evaluation of the skeletal survey – Multiple types of fractures • Long bones • Rib fractures • Bone Scintigraphy • Differential Diagnosis 2 Efren Gutierrez, MS III Gillian Lieberman, MD The Patient • 5 wk old infant transferred from OSH for “breathing difficulties” • PMHx: FT, C/S, no other hx provided • SH: Lives at home with mother, father (mother’s boyfriend) and 1y/o brother, mother has an older child in DSS custody • FH: non-contributory – At OSH: T:102.3, 86%RA • Sepsis workup started • CXR unremarkable • CT of head found bilateral subarachnoid and R intraparenchymal hemorrhages – 51A filed – At Children’s: • Afebrile, HR:170, BP:121/80, RR:51 O2 sat:100% • HEENT: PERRL but sluggish • Neuro: CN II-XII grossly intact, DTRs: Knees, Ankles 2+ bilat; downgoing toes 3 Efren Gutierrez, MS III Gillian Lieberman, MD Child Abuse • Accounts for approximately 1200 deaths/year in U.S. – About half occur among children younger than one year of age. – Incidence ranges from 15-42 per 1000 children • Radiographically described by Caff