Alfred Cheng, MD

Imaging Case: Answer

Answer: False. Infants present with non-bilious vomiting

Diagnosis: Pyloric Stenosis

Pathology: Pyloric stenosis is hypertrophy and hyperplasia of the pylorus with a multifactorial inheritance in families. The incidence is 5/1000 births in males and 2/1000 births in females. It is therefore more common in males; it is also more common in first-born infants, and in Caucasian infants.

Imaging Case: Six Week-Old Infant with Projectile Vomiting

Case: A six week-old previously healthy, term infant via vaginal birth is brought to pediatric ED for repeated episodes of vomiting over a one week period. Vomiting occurs 20-30 min following every episode of feeding and is described as projectile. Parents note decreased urine output over the past two days. Patient is noted to be hungry following vomiting episodes

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Imaging Case: 2 Year Old Male With Abdominal Pain

Case: A 2 year-old male with no significant PMH is brought to the Emergency Department by his mother for intermittent abdominal pain for the past two days. Mom notes that the child will crouch down into a ball when he has pain, which lasts only a few minutes at a time. He has decreased solid food intake but no vomiting or diarrhea and is otherwise well.

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Imaging Case: Answer

Answer: B. It is venous but extends to the right brachiocephalic vein. The central line is inadvertantly deep and likely resulted from the guidewire being displaced by the patient's PICC line. This patient will need the line removed/replaced.

Estimated Central Line Lengths for Correct Placement:
Right Internal Jugular Vein: 13 cm, +/- 2 cm
Right Subclavian Vein: 15 cm, +/- 2 cm
Left Internal Jugular Vein: 15 cm, +/- 2 cm
Left Subclavian Vein: 17 cm, +/- 2 cm

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