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