ileus, Pneumatosis intestinalis, Gas
in portal vein may be seen transiently,
Radiographic Features (Fig. 11-30)
• Small bowel dilatation: adynamic ileus (first finding), unchanging configuration over serial radiographs
• Pneumatosis intestinalis, 80% (second most common sign)
• Gas in portal vein may be seen transiently (US more sensitive than plain film); this finding does not imply as bad an outcome as it does in adults.
• Pneumoperitoneum (20%) indicates bowel perforation: football sign (floating air and ascites give the appearance of a large elliptical lucency in supine position).
• Barium is contraindicated; use water-soluble contrast if a bowel obstruction or Hirschsprung disease needs to be ruled out.
|Bilateral. C sign in subtalar bony coalition.||tarsal CoalitioN (Fig.
Fusion of 2 or more tarsal bones. Union may be complete, partial, bony, cartilaginous, or fibrous. Present at birth but usually asymptomatic until early adulthood.
• Calcaneonavicular (most common)
• Talocalcaneal (common)
Commonly results in spastic flatfoot. Bilateral. C sign in subtalar bony coalition.
|doublebubble sign||CoNgeNital duodeNal atresia,
Results from failure of recanalization (around 10 weeks).
Incidence: 1:3500 live births. Atresia : stenosis = 2:1.
Common cause of bowel obstruction. Bilious vomiting occurs within 24 hours after birth. Treatment
is with duodenojejunostomy or duodeno duo denostomy.
• 30% have Down syndrome.
• 40% have polyhydramnios and are premature.
• Malrotation, EA, biliary atresia, renal anomalies, imperforate anus with or without sacral anomalies,
• Enlarged duodenal bulb and stomach (doublebubble sign)
• Small amount of air in distal small bowel does
not exclude diagnosis of duodenal atresia
(hepatopancreatic duct may bifurcate in “Y”
shape and insert above and below atresia).
|drooping lily sign||• Diminished number of calyces
compared with normal side;
drooping lily sign
|fallen fragment sign||CommoN pediatriC boNe
• Ewing sarcoma
• Bone cysts
UBC: single cavity, fallen fragment sign
• Neuroblastoma metastases
|Fat pad sign||Fat pad sign (posterior pad is
normally absent, anterior fat pad is usually present); absence of the
posterior fat pad sign virtually excludes a fracture (90% of patients with
fat pad sign have a fracture)
|hematogeNous osteomyelitis||Plain film (Fig. 11-57)
• Soft tissue swelling (earliest sign; often in metaphyseal region), blurring of fat planes, sinus tract formation, soft tissue abscess
• Cortical loss (5 to 7 days after infection), bone destruction
|Neuhauser's sign||Plain film
• Neuhauser's sign: “Soap bubble” appearance (air mixed with meconium)
• Small bowel obstruction
• Calcification due to meconium peritonitis, 15%
Enema with water-soluble contrast medium
• Microcolon is typical: small unused colon
• Distal 10 to 30 cm of ileum is larger than colon.
• Inspissated meconium in terminal ileum
• Hyperosmolar contrast may stimulate passage of meconium.
jerk or click sign
|Clinical Findings deVelopmeNtal
dysplasia oF the hip (ddh) (CoNgeNital disloCatioN oF the hip)
• Ortolani's jerk or click sign: relocation click while abducting hip with thumb and placing pressure on greater trochanter
• Barlow's sign: dislocation click while adducting hip with pressure on knee
• Limited abduction of flexed hip
• Shortening of one leg
• Waddling gait
|Upper gastrointestinal (UGI)
findings of HPS:
• Indented gastric antrum (shoulder sign)
• Compression of duodenal bulb
• Narrow and elongated pylorus: string sign
hypertrophiC pyloriC steNosis (hps)
|Steeple sign:||Radiographic Features (Fig.
• Subglottic narrowing (inverted “V” or “steeple sign”)
• Key view: AP view
• Lateral view should be obtained to exclude epiglottitis.
• Steeple sign: loss of subglottic shoulders
|Stripe Sign||Stripe Sign (Fig. 12-4)
This sign refers to a perfusion abnormality with a zone of preserved peripheral perfusion. Because PE is pleural based, presence of this sign makes PE unlikely.
1. Normal perfusion
2. Very low probability
3. Nonsegmental lesion; e.g., prominent hilum, cardiomegaly, elevated diaphragm, linear atelectasis
4. Perfusion defect smaller than radiographic lesion
5. A solitary CXR-Q matched defect in the mid or upper lung confined to a single segment
6. Stripe sign around the perfusion defect
7. Pleural effusion ≥ one third of the pleural cavity with no other perfusion defect in either lung
|Target or doughnut sign||IntussusCeption
• Frequently normal (50%)
• Intraluminal convex filling defect in partially air-filled bowel loop (commonly at hepatic flexure)
• Target or doughnut sign
|Widened joint||Radiographic Features (Fig.
• Widened joint: may be due to increased cartilage or joint effusion (earliest sign)
• Subchondral fissure fracture, best seen on frogleg view (tangential view of cartilage)
• Increase in bone density Intermediate phase
• Granular, fragmented appearance of femoral epiphysis due to calcification of avascular cartilage (no fracture of epiphysis)
• Lateralization of ossification center
• Cysts of demineralization (30%)
• Apposition of new bone makes the femoral head appear dense.
• Flattened and distorted femoral head
• Osteoarthritis (OA)
legg-CalVé-perthes (lCp) disease