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Michael A. Di Pietro, MD, FAIUM
Sonography of the Pediatric Spine and Hip
Michael A. Di Pietro, MD, FAIUM
02/16/2014 | Time : 78 min
About This Lecture:

The speaker discusses how ultrasound is used in diagnosing common anomalies of the pediatric spine and hip. Discuss the clinical indications for ultrasound of the spinal canal. Discuss ultrasound techniques for diagnosing a tethered cord. Discuss how to sonographically diagnose a hip effusion. Describe both dynamic and static aspects of developmental dysplasia of the pediatric hip.

Topics mentioned in this video : What's the line on the spine? Tips for good pics,Spinal canal sonography,Pediatric spine sonography,Occult tethered spinal cord,Back mass,Tethered cord lipoma,How do I do it?,Successful pediatric spinal canal ultrasound,Pediatric spinal canal ultrasound,Successful spine ultrasound,Obtained from back,Normal,Neonate & young infant,Locate conus medullaris tip - 2 views,Patient postition,4 months,Burp position,Sitting,Lateral decubitus - flexion "LP",This won't work,Normal anatomy,Neonate & young infant,Locate conus medullaris tip - 2 views,Thoraco Lumbar/Lumbo Sacral,Conus tip,Low thoracic to cauda equina sweep,Sagittal sweep through conus,Lumbo - sacral,Coccyx/sacrum,Lumbosacral junction,Mid to low lumbar,High lumbar,Can scan entire spinal canal,Why spinal canal US?,Definition tethered cord,Occult tethered spinal cord,Neonate - VACTERL/ anal atresia,Occult tethered spinal cord,Cord oscillation,Conus tip,Correlate with lowest rib,Correlate with LS junction,Count back from coccyx/sacrum,End of thecal sac,Occult tethered spinal cord,Normal conus tip level with age,Occult tethered spinal cord,Conus tip vertebral level,Neonate - VACTERL/ anal atresia,Top pf psoas M. - L1,Prone post transverse,Older child,Size limit for US?,Older child,Adequate flexion,“Interlaminar” – off midline,8 yo normal conus tip position,Similarly with transverse,Cauda equine,Cord – conus – CE sweep,How do I do it?,Filar cyst,Another case,However,Filar cyst – common,Case to OR – Ped Surg,Pre-natal to post-natal,History,Fetal MRI – bladder,Fetal MRI – mass,Day 2,Initial pelvic US – anterior via bladder,Sag/trans,Post natal MRI protocol,Posterior US – r/o tethered cord,Sonographic images,Not cephalad to S5,Sonographic images,Reviewed US with surgeon,Pathology,The point of that case,US and MRI,In summary,Successful spine ultrasound,Painful hip – joint effusion,Static and dynamic,Coronal scanning,Coronal view,Coronal US orientation,Ball in a socket,Key concept,Normal,Slightly subluxed,Subluxing right hip,Dislocated right hip,Coronal dislocated hip,Coronal – acetabulum immature,Coronal – posterior cartilaginous acetabulum,Newborn – bilateral dislocated “teratologic” hips,Coronal – dislocated,Transverse – dislocated,Image,Key concept,Axial CT,Key concept,Axial CT,Sonographic image,Subluxing left hip,Subluxed hip,Coronal – posterior acetabular cartilage,Transverse - posterior acetabular cartilage,Trans normal cine,Trans normal abd/add – cine,Barlow maneuver,Dynamic case studies,Coronal normal - cine,Cine cases,Missed DDH,Good judgement comes from experience,DDH ultrasound,Some pitfalls,Transducer misalignment,Coronal false abnormal - true normal – cine,Older patient,Coronal,14 month normal coronal – cine,Impressions,Hip flexion contracture or bowing,Right hip – in or out?,Error,Arthrogram,New topic,Painful hip – joint effusion,The child with a painful hip,Question septic hip,“In a nutshell” hip effusion,Anterior longitudinal hip US,Right hip effusion,Hip joint fluid,Septic,Septic right hip,Septic arthritis,Septic left hip,Septic arthritis,Pediatric musculoskeletal ultrasound,Septic?,Clinical predictors,Papers on hip effusion – septic arthritis vs. transient synovitis,Clinical criteria,Good judgement comes from experience,Sonographic and clinical criteria,Alignment for aspiration,Animation – hip effusion aspiration,Needle placement 1,Needle placement 2,Painful left hip,Caveat regarding hypoechoic cartilage,Normal right hip,Case,XR- neg,US rt hip,Also overlying right soft tissues are abnormal,Antero-lateral RT thigh,Antero-lateral normal left thigh,Sonographic image,US cine loop,Taken to OR,Possibilities,Other diagnoses,Differential diagnosis,Psoas abscess,Long axis anterior to femoral head/neck,CT at femoral heads,CT at groin,US at groin,CT at ilia,CT detail of rt psoas abscess,Comparable transverse US,Another hip pain case,Differential diagnosis,10 yo right hip pain X 3 days,RLQ neuroblastoma met causing hip pain,Other cases,Differential diagnosis,13 yo swollen right knee,What next?,US tissue layers – normal reference,US - thigh,US with power Doppler,Distal tibia sub-periosteal fluid US long axis,Distal tibia sub-periosteal fluid US short axis,Sonography in osteomyelitis,In conclusion,End

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Keywords : acetabulum, AIUM, American Institute of Ultrasound in Medicine, anal atresia, arthrogryposis, aspiration of joint effusion, Barlow maneuver, Cardiac defects, cauda equina, caudal thecal sac, coccyx, conus medullaris, cord oscillation, coxa vara, DDH, developmental dysplasia of hip, dislocated pediatric hip, dorsal dura, EFOV, esophageal atresia, extended field of view, femoral head, femoral neck, femoral shaft, filar cyst, greater trochanter, hip abduction, hip adduction, hip joint fluid, joint effusion, linear array transducer, lumbosacral junction, M mode, occult tethered spinal cord, Osteomyelitis, pediatric hip sonography, PEDIATRIC, PFFD, posterior acetabular cartilage, posterior cartilaginous acetabulum, power Doppler, proximal femoral focal deficiency, psoas abscess, Renal & Radial anomalies and Limb defects, sacrum, septic arthritis, septic hip, spinal cord lipoma, spinal fluid, spinal processes, spinal sonography, spine ultrasound, subluxation of hip, subluxed hip, tethered spinal cord, tracheoesophageal fistula, transient synovitis, ultrasound guided aspiration of joint effusion, VATERL, ventral dura, Vertebral anomalies, vertebral bodies

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