Final Pediatric Radiology

8/6/2019 Final Pediatric Radiology

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Pediatric Radiology

COMMENT ON NORMAL CHEST:

� Plain X-Rays chest post-anterior view .

� The patient is centralized.

� Normal bony structures.

� Central mediastinum.� Normal cardio-thoracic ratio & cardiac position .

� Both lung f ields are clear with normal hilar shadow.

� Both costopherenic recesses are clear with normal cardio-pherenic angle.

NORMAL

Remember in each case:

1. Obtaining Clinical history.

2. Proper technique. i.e. Good exposure

3. Patient position i.e. centralized or not?.

4. Orientation of the f ilm , i.e. lef t or right

marked.5. Recognition of f ilm artif acts.

6. Systematic approach.

Comment:

� Plain X-rays chest P.A. view.

� Normal bony cage.

� Central mediastinum.� Bilateral hyperinf lation of both lungs.

� Non-homogenous opacity occupying

the middle lobe of the right lung.� Diagnosis: mostly Rt. Middle lobe

pneumonia.

Right upper lobe pneumonia

Comment:

� Plain X-rays chest P.A. view.� Traction of mediastinum towards the

Rt. Side, with narrowing of ipsilateral ribs indicating volume loss.

� Non homogenous opacif ication f illing the Rt. Upper hemithorax.

� Compensatory hyperinf lation of Lt.lung.� D/ mostly Rt. Upper lobe pneumonia.

Trachea

Comment:

� Lef t basal opacif ication rising towards the axilla.

� Oblitration of the Lt. costophrenic recess.� Compensatory hyperinf lation of Rt. Lung.

� Dignosis:

Lef t sided pleural eff usion, underlying parenchymal lesion could not be excluded.

? SYNPNEUMONIC EMP YEMA

Comment:

� Massive homogenous opacif ication of the lef t hemithorax with obliteration of the Lt. costo-phrenonic angle.

� Shif ted mediastinum towards the contrlateral (Rt.) side.

� Underlying pathology of Lt. lung could not be excluded.

� D/ Lef t-sided massive pleural eff usion.

� Homogenous opacification

oblitrarating the left costo-phrenic angle.

� Air-fluid level on the leftside.

� Dignosis:Left-sided

Hydropneumothorax

Rt. Lower lobe pneumonia.Preser ved Rt. Costophrenic recess.It is NOT a case of pleural eff usion.

Bilateral miliary shadows (highly suggestive of MILIARY T.B.)

COMMENT:

� These PA and lateral chest radiograph views are taken in a 7-month old with miliary TB.

� There are multiple small nodules throughout the lungs bilaterally.

� There is a f ocal consolidation in the right upper lobe.

Substantial clearing of the multiple small nodular densities and clearing of the right upper lobe consolidation af ter anti-tuberculous therapy

Comment:

� Diff use air occupying the lef t hemithorax (Jet black , devoid of lung markings).

� Underlying collapse of the Lef t lung.

� Mediastinal shif t towards Rt. Side.

� A case of :Lef t-sided tension pneumothorax.

Massive pleural eff usion with hydropneumothorax on the Lt. side.

Air -f luid level

Herniation of the bowel into the lef t hemithorax with contralteral mediastinal shif t.

Dignosis: Congenital diaphragmatic hernia.

Congenital diaphragmatic hernia.

Red arrow points to end of nasogastric tube blocked f rom entering the

distal esophagus.

Note the gasless abdomen«

(ESOPHAGEALATRESIA)

Ground glaas appearance.

Diminished lung volume

Air bronchogram.

(H YALINE MEMBRANEDISEASE)«..

Versus congenital pneumonia..

PNEUMOTHORAX

COLLAPSED

H YALINE MEMBRANE DISEASE

Right upper lobe large thin-walled pneumatocele

Comment:

� Massive hyperinf lation of the lef t lung with mediastinal herniation.

� Signif icant mediastinal shif t with collapse of the contralateral right lung.

CONGENITAL LOBAR EMPH YSEMA.

Chest radiograph showing lef t lower lobe consolidation with large cavitary lesion. (Lung abscess)

Rt. upper and middle lobe massive pneumonia

Comment:

� Jet black air with underlying lung collapse of the Rt. Lung.

� Evident line of demarcation between air and the collapsed lung.

� No signif icant mediastinal shif t.

Rt-sided pneumothorax.

PNEUMOMEDIATINUM

(A cushion of air delineating the heart)

Lt. sided pneumothorax

Rt. middle lobe pneumonia

Air -f luid level- H YDROPNEUMOTHORAX on Rt. side.

Comment:

� Bilateral nodular opacities with fluffy cottonappearance infiltrating both lung fields.

� Ring shadow with well-delineated wall

occupying the right upper lobe. (lungabscess).

� This picture is highly suggestive of

extensive bronchopneumoniamostly in an immuno-compromisedsubject.

Wavy sail appearance of normal thymus on right.

Lef t-sided Massive pleural eff usion

Rt. upper lobe pneumonia

Highly suggestive of aspiration pneumonia.

Bronchial asthma

Comment:

� Bilateral hyperinflation of both lungs ( jet black

lung fields) with increased volume .

� Flattened copulae of diaphragm .

� widened intercostal spaces .

� Vertical cardiac shadow .

� Features are highly suggestive of air trapping :

1.Bronchial asthma (acute attack)2.Emphysema (older patients)

Bilateral hyperinf lation (asthma)

with Rt upper lobar consolidation

Comment:

� Patchy or fluffy infiltrates of ill-defined

margins distributed throughout both lung

fields.

� Picture of bilateral extensive

bronchopneumonia

? Staphylococcal

? Fungal

? pneumocystis carinii

Lung abscess in the right middle lobe

Rt. Pleural eff usion with shif ted mediastinum

Bilateral basal Bronchiactatic changes

Lung abscess in the Lt. upper lobe

Lef t-sided Plural eff usion

Conf luent bronchopneumonic changes

on the Rt. side

Bilateral extensive bronchopneumonic changes f or diff erential diagnosis

Right-sided Pleural eff usion

Rt. upper lobe pneumonia

Lef t-sided massive pleural eff usion

SKELETAL SYSTEM

� Plain X-ray wrist joint showing:

� Decreased bone density.

� Broadening, cupping and f raying of distal ends of radius and ulna.

� Wide distance between distal ends of radius and ulna & car pal & metacar pal bones.

DIAGNOSIS: ACTIVE RICKETS

ACTIVE RICKETS

AN OSTEOLYTIC LESION OF THE SKULL.D.D. HISTIOCYTOSIS VERSUS METASTASIS

Protruded maxilla, and characteristic SUN-RAYS appearance.D/ chronic hemolytic anemia mostly beta-thalassemia ma jor

MULTIPLE OSTEOLYTIC LESIONS

AIR STANDING ON AN END ORSUN-RAYS APPEARANCE

RACHITIC ROSARIES

Bat-man appearance of skull and separation of the sutures

(OSTEOPETROSIS)

LATERAL Plain f ilm of skull showing generalized increased density and thickening of the skull base and calvarium.

(OSTEOPETROSIS)

Chest f ilm shows generalized increased density of the bones and squaring off of the

anterior rib margins. (OSTEOPETROSIS)

X-RAY ABDOMEN STANSDING

MULTIPLE AIR-FLUID LEVELS.MOSTLY LARGE BOWEL OBSTRUCTION

DOUBLE-BUBBLE SIGN.

ARACTERISTIC FOR DUODENAL ATRESISA.

AIR UNDER DIAPHRAGM

PERFORATED VISCUS

MULTIPLE AIR-FLUID LEVELS (gasless pelvis).MOSTLY INTESTINAL OBSTRUCTION

AIR UNDER DIAPHRAGM

Plain abdomen: Hugely dilated colon

Hirschsprung disease

NORMAL Barium enema

Barium enema:

Dilated colon with loss of haustrations.

Hallmark f inding isconical transition f rom

distal nondilated rectum to proximal dilated colon

Transition

Red arrows point to linear bands of radiolucency which parallel the wall of the bowel indicating the presence of

pneumatosis intestinalis in necrotizing enterocolitis

Necrotizing enterocolitis in lateral decubitus f ilm

Normal cardio-thoracic ratio is 1:2 (50%)

Cardiomegaly

Lobar pneumonia

Diff erential diagnosis of cardiomegaly

� Most important causes are:

Pericardial eff usion

Dilated cardiomyopathy

Rheumatic H.D. with multi-valvular aff ection

Congestive heart f ailure.

COMMENT

COMMENT:

� Pulmonary oligemia.

� Small-sized heart with right ventricular (supra-diaphragmatic apex).

� The lef t cardio-phrenic angle is acute.

� Heart is characteristically BOOT-SHAPED. (Coeur en Sabot Sign).

� These f indings are highly suggestive of

TETRALOGY OF FALLOT

DIAGNOSIS: Tetralogy of Fallot (TOF) - Coeur en Sabot Sign

Bilateral pulmonary venous congestion

Bilateral pulmonary edema

Huge Cardiomegaly.The heart is f lask-shaped and well-delineated.Mostly pericardial eff usion.

ANK YOU

Final Pediatric Radiology

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