Pneumotorax:

Cancer de pulmão:

Bifurcação da traqueia:

Cancer de traqueia:

ATLAS:

http://www.anatomyatlases.org/HumanAnatomy/CrossSectionAtlas.shtml

NEUROIMAGEM:

http://rad.usuhs.mil/rad/handouts/jsmirnio/aids-2000/index.htm

DOENÇAS EM IMAGEM:

http://www.gamuts.net/chorus/

CASOS CLINICOS:

http://rad.usuhs.mil/rad/home/peds/index.html

1- HX: 20 month old female admitted for evaluation of low hematocrit.

DX: Abdominal CT shows a left adrenal hematoma (arrow) and retroperitoneal ascites.

Discussion: Children can sustain a variety of abdominal injuries from abuse. The

mechanism may be shaking (which is relatively uncommon) or direct blows (more

commonly). Organs frequently injured include the adrenal in the very young, and the

liver, pancreas, bowel, spleen, kidneys, and bladder

Case 5

HX: 4 month old with cough, chest X-ray request says "rule out pneumonia."

DX: Posterior rib fracture of the left 7th rib (black arrow). This fracture is less than 14 days old as there is

no visible callus. This is a case of child abuse incidentally found on CXR because of the detection of the

rib fracture, which was unrelated to the child's presenting complaint (white arrows).

Discussion: Rib fractures are very common injuries in the young (less than 2 year old) abused child.

Typically, this is part of violent shaking. The infant or young child is held very tightly around the chest

and squeezed while being shaken. This compresses the ribs front to back and tends to break them next

to their attachment to vertebrae and laterally where they are being literally almost folded in half.

Therefore, lateral & posterior rib fractures are highly specific for abuse. CPR is rarely, if ever, a cause of

such fractures (Spevak MR, Kleinman PK, Belanger PL, Primack C, Richmond JM. Cardiopulmonary

resuscitation and rib fractures in infants. JAMA 1994; 272:617-618; Feldman KW, Brewer DK. Child

abuse, cardiopulmonary resuscitation, and rib fractures. Pediatrics 1984; 73:339-342). The extreme

rarity of CPR-related rib fractures in infants and young children is quite different than their incidence in

the adult population, in whom rib fractures are relatively common after CPR.

Case 13

HX: 3 1/2 year old with 4 day history persistent vomiting after eating and abdominal pain.

DX: Upper GI shows a mass in the wall of the descending duodenum (arrow). This is consistent with a

duodenal hematoma.

Discussion: This is the classic presenting symptom complex of a duodenal hematoma, which is a

hematoma (blood collection) in the wall of the bowel. This is, in children, almost always the result of

direct trauma (assault, bicycle handlebar injury, etc.). It is a relatively common injury in abuse and is

typically seen in older children who are punched or kicked in the abdomen (intentionally or

accidentally). It is an unusual injury in very young children (less than 2 years old). Of note, abdominal

injury, such as this duodenal hematoma, is the leading cause of morbidity and mortality in the older

abused child. Because abdominal injuries are usually seen in older children, who ar often quite active,

identifying the injury as abuse-related is mroe difficult. Correlation with history and other evidence of

abuse suggest the diagnosis.

IMAGENS:

http://rad.usuhs.edu/medpix/ipad_image.html?mode=ipad&imid=4284&pt_id=0&quiz=&page=&th=&

map=&skiprows=&this_week=&skipcases=0&maxcases=5&sth=-1#pic

History:

16-year-old with abdominal pain after blunt abdominal trauma during football practice two weeks earlier.

Exam:

Palpable spleen tip with left upper quadrant tenderness

Findings:

• increased enhancement of the right hepatic lobe

• decreased attenuation of the left hepatic lobe

• right portal vein thrombosis

• grossly heterogeneous spleen

Differential:

• Portal vein thrombosis

• Hepatic hypoperfusion

• Splenic infarcts

Diagnosis:

Splenic Laceration => Right portal vein thrombosis => Transient hepatic attenuation difference (THAD)

Confirmed by:Imaging

Treatment and Followup:

Discussion:

This patient has right portal vein thrombosis resulting from a splenic laceration, and causing transient hepatic

attenuation difference (THAD). Transiently increased attenuation to the right lobe on this early phase is due to a

relative increase in hepatic arterial flow to compensate for the decreased portal flow. There is extensive splenic

traumatic injury with multiple areas of decreased splenic attenuation involving more than 50% of the spleen,

representing laceration of the spleen with hematoma and/or infarction. Splenic vein is identified.

Há relativamente aumentado a valorização do lobo direito do fígado e diminuição de atenuação para o lobo hepático esquerdo. Esta descoberta está associada com aumento normal da veia porta esquerda e trombose da veia porta direita. Transitoriamente atenuação aumentada para o lóbulo direito nesta fase inicial é devido a um aumento relativo do influxo arterial hepática para compensar a diminuição do fluxo portal. Há uma extensa lesão traumática do baço com várias áreas de atenuação do baço diminuiu envolvendo mais de 50% do baço, o que representa laceração do baço com hematoma e / ou infarto. Veia esplênica é identificado.

CASOS CLINICOS + IMAGEM:

http://emedicine.medscape.com/radiology#gastrointestinal