12.08.31 Paediatric images

Erythema nodosum

    • Raised rash on shins

    • Causes

      • Strep.

      • Drugs

    • Check ASOT

Erythema multiforme

    • Causes

      • Strep.

      • Mycoplasma

      • Herpes

      • EBV

    • Appearance

      • Confluent rash over whole body

      • Some central areas spared

    • Life-threatening complication

      • Steven-Johnson syndrome

        • Spread to mucous membranes

Parvovirus

    • Slapped cheek

    • Also mac-pap rash over trunk

    • Can cause aplastic crisis in sickle cell disease

Roseola infantum

    • Usually HHV-6

    • Easily confused with measles

Measles

    • Koplik spots are pathognomonic

    • Miserable

    • Red, watery eyes

    • Complications

      • Sub-acute sclerosing panencephalitis

        • Virus remains dormant for 2-20 years

        • Then => seizures, jerks, developmental regression

        • Irreversible

      • Ototis media

      • Encephalitis

      • Pericarditis

      • Myocarditis

      • Bronchopneumonia

Scarlet fever

    • From group A beta hemolytic Strep

    • Strawberry tongue, palatal petechiae

    • Complication

      • GAS sepsis has 50% mortality

Hand foot and mouth disease

    • Coxackie virus

Molluscum contagiosum

    • Pearl-shaped lesion, with central depression

    • From pox virus

Birth marks

    • Mongolian blue spot

      • Usually resolve spontaneously

    • Strawberry naevus

      • Benign

      • Resolve spontaneously

    • Port wine stain

      • Do not resolve

      • If seizures, check for AV malformation (Sterge-Webber syndrome)

    • Cafe au lait spot

      • cf Neurofibromatosis

      • If associated with precocious puberty => McCune Albright Syndrome

Neuroblastoma

    • Tumour tissue around eyes => Racoon eyes

Sacral defect

    • Usually benign

    • Worry if..

      • You can't see the base

      • Anything coming out

      • Any hair (cf spina bifida)

Congenital cystic adenomatoid malformation (CCAM)

    • Big air-filled cysts in lung

      • Look black on Xray

    • Push lung/heart out of the way

    • Causes breathing trouble

Neurofibromatosis

    • Leish nodules

      • On iris

    • Axillary freckling

    • Cafe at lait spots

NAI

    • Metaphyseal fractures

      • Usually very hard to break

    • Spiral fractures

    • Posterior rib fractures

Other notes

    • Gastroschisis

    • Imperforate anus associations

      • TOF

      • VATER

    • Pre-auricular sinus or skin tag => Check hearing

    • Club foot

      • Congenital talipes equinovarus

      • If you can move it back, probably fixable with physio

  • Kartagener Syndrome / Primary ciliary dyskinesia

    • cf Dextocardia

    • Necrotising enterocolitis => Lots of gas on AXR

    • Brushfield spots on iris => Downs'

    • CHARGE syndrome

      • Coloboma

      • Heart defect

      • Atresia of coanae

      • Retarded growth

      • Genital abnormalities

      • Ear abnormalities

    • Turners syndrome => Coarctation of aorta