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    Pediatric Radiology

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    COMMENT ON NORMAL CHEST:

    Plain X-Rayschest post-anteriorview .

    The patientiscentralized.

    Normal bonystructures.

    Centralmediastinum. Normalcardio-thoracicratio & cardiacposition .

    Bothlung fieldsareclearwithnormalhilarshadow.

    Bothcostopherenicrecessesareclearwithnormalcardio-pherenicangle.

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    NORMAL

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    Rememberineachcase:

    1. Obtaining Clinicalhistory.

    2. Propertechnique. i.e. Goodexposure

    3. Patient positioni.e. centralizedornot?.

    4. Orientationofthe film , i.e. leftorright

    marked.5. Recognitionof filmartifacts.

    6. Systematicapproach.

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    Comment:

    Plain X-rayschestP.A. view.

    Normal bonycage.

    Centralmediastinum. Bilateralhyperinflationof bothlungs.

    Non-homogenousopacityoccupying

    themiddlelobeoftherightlung. Diagnosis: mostly Rt. Middlelobe

    pneumonia.

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    Rightupperlobe pneumonia

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    Comment:

    Plain X-rayschestP.A. view. Tractionofmediastinumtowardsthe

    Rt. Side, withnarrowingofipsilateralribsindicating volumeloss.

    Nonhomogenousopacification fillingthe Rt. Upperhemithorax.

    Compensatoryhyperinflationof Lt.lung. D/ mostlyRt. Upperlobe pneumonia.

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    Rightupperlobe pneumonia

    Trachea

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    Comment:

    Left basalopacificationrisingtowardstheaxilla.

    Oblitrationofthe Lt. costophrenicrecess. Compensatoryhyperinflationof Rt. Lung.

    Dignosis:

    Leftsidedpleuraleffusion, underlyingparenchymallesioncouldnot beexcluded.

    ? SYNPNEUMONIC EMPYEMA

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    Rightupperlobe pneumonia

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    Comment:

    Massivehomogenousopacificationofthelefthemithoraxwithobliterationofthe Lt. costo-phrenonicangle.

    Shiftedmediastinumtowardsthecontrlateral (Rt.) side.

    Underlying pathologyof Lt. lungcouldnot beexcluded.

    D/ Left-sidedmassivepleuraleffusion.

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    Homogenous opacification

    oblitrarating the left costo-phrenic angle.

    Air-fluid level on the leftside.

    Dignosis:Left-sided

    Hydropneumothorax

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    Rt. Lowerlobe pneumonia.Preserved Rt. Costophrenicrecess.ItisNOT acaseof pleuraleffusion.

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    Bilateralmiliaryshadows (highlysuggestiveof MILIARY T.B.)

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    COMMENT:

    ThesePA andlateralchestradiographviewsaretakenina 7-montholdwithmiliary TB.

    Therearemultiplesmallnodulesthroughoutthelungs bilaterally.

    Thereisa focalconsolidationintherightupperlobe.

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    Substantialclearingofthemultiplesmallnodulardensities andclearingoftherightupperlobeconsolidationafteranti-tuberculoustherapy

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    Comment:

    Diffuseairoccupyingthelefthemithorax (Jet black , devoidoflungmarkings).

    Underlyingcollapseofthe Leftlung.

    Mediastinalshifttowards Rt. Side.

    A caseof:Left-sidedtension pneumothorax.

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    Massive pleuraleffusionwithhydropneumothoraxonthe Lt. side.

    Air-fluidlevel

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    Herniationofthe bowelintothelefthemithoraxwithcontralteralmediastinalshift.

    Dignosis:Congenitaldiaphragmatichernia.

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    Congenitaldiaphragmatichernia.

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    Congenitaldiaphragmatichernia.

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    Redarrow pointstoendofnasogastrictubeblocked fromenteringthe

    distalesophagus.

    Notethegaslessabdomen

    (ESOPHAGEALATRESIA)

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    Groundglaasappearance.

    Diminishedlung volume

    Airbronchogram.

    (HYALINE MEMBRANEDISEASE)..

    Versuscongenitalpneumonia..

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    PNEUMOTHORAX

    COLLAPSED

    LUNG

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    HYALINE MEMBRANE DISEASE

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    Rightupperlobelargethin-walled pneumatocele

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    Comment:

    Massivehyperinflationoftheleftlungwithmediastinalherniation.

    Significantmediastinalshiftwithcollapseofthecontralateralrightlung.

    CONGENITAL LOBAR EMPHYSEMA.

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    Chestradiographshowingleftlowerlobeconsolidationwithlargecavitarylesion. (Lungabscess)

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    Rt. upperandmiddlelobemassive pneumonia

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    Comment:

    Jet blackairwithunderlyinglungcollapseofthe Rt. Lung.

    Evidentlineofdemarcation betweenairandthecollapsedlung.

    Nosignificantmediastinalshift.

    Rt-sided pneumothorax.

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    PNEUMOMEDIATINUM

    (A cushion of air delineating the heart)

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    Lt. sided pneumothorax

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    Rt. middlelobe pneumonia

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    Air-fluidlevel- HYDROPNEUMOTHORAX on Rt. side.

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    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.

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    Wavysail appearanceofnormalthymusonright.

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    Left-sided Massive pleuraleffusion

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    Rt. upperlobe pneumoniaHighlysuggestiveofaspiration pneumonia.

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    Bronchial asthma

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    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)

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    Bilateralhyperinflation (asthma)

    with Rtupperlobarconsolidation

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    Comment:

    Patchy or fluffy infiltrates of ill-defined

    margins distributed throughout both lung

    fields.

    Picture of bilateral extensive

    bronchopneumonia

    ? Staphylococcal

    ? Fungal

    ? pneumocystis carinii

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    Lungabscessintherightmiddlelobe

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    Rt. Pleuraleffusionwithshiftedmediastinum

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    Bilateral basal Bronchiactaticchanges

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    Lungabscessinthe Lt. upperlobe

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    Left-sidedPluraleffusion

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    Confluent bronchopneumonicchanges

    onthe Rt. side

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    Bilateralextensive bronchopneumonicchanges fordifferentialdiagnosis

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    Right-sided Pleuraleffusion

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    Rt. upperlobe pneumonia

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    Left-sidedmassive pleuraleffusion

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    SKELETAL SYSTEM

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    Plain X-raywrist jointshowing:

    Decreased bonedensity.

    Broadening, cuppingand frayingofdistalendsofradiusandulna.

    Widedistance betweendistalendsofradiusandulna & carpal & metacarpalbones.

    DIAGNOSIS: ACTIVE RICKETS

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    ACTIVE RICKETS

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    ACTIVE RICKETS

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    ACTIVE RICKETS

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

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    Protrudedmaxilla, andcharacteristic SUN-RAYS appearance.D/ chronichemolyticanemiamostlybeta-thalassemiamajor

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    MULTIPLE OSTEOLYTIC LESIONS

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    H

    AIR STANDING ON AN END ORSUN-RAYS APPEARANCE

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    RACHITIC ROSARIES

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    Bat-manappearanceofskullandseparationofthesutures(OSTEOPETROSIS)

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    LATERAL Plain filmofskullshowinggeneralizedincreaseddensityandthickeningoftheskull baseandcalvarium.

    (OSTEOPETROSIS)

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    Chest filmshowsgeneralizedincreaseddensityofthe bonesandsquaringoffof the

    anterior rib margins. (OSTEOPETROSIS)

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    X-RAY ABDOMEN STANSDING

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    MULTIPLE AIR-FLUID LEVELS.MOSTLY LARGE BOWEL OBSTRUCTION

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    DOUBLE-BUBBLE SIGN.

    CH

    ARACTERISTIC FOR DUODENAL ATRESISA.

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    AIR UNDER DIAPHRAGM

    PERFORATED VISCUS

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

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    AIR UNDER DIAPHRAGM

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    Plainabdomen:Hugelydilatedcolon

    Hirschsprungdisease

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    NORMAL Bariumenema

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    NORMAL Bariumenema

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    Bariumenema:

    Dilatedcolonwithlossofhaustrations.

    Hallmark findingisconicaltransition fromdistalnondilatedrectumto proximaldilatedcolon

    Hirschsprungdisease

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    Hirschsprung disease

    Transition

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    Redarrows pointtolinear bandsofradiolucencywhichparallelthewallofthe bowelindicatingthe presenceof

    pneumatosisintestinalis in necrotizingenterocolitis

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    Necrotizingenterocolitisinlateraldecubitus film

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    HEART

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    Normalcardio-thoracicratiois1:2 (50%)

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    CardiomegalyLobar pneumonia

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    Differentialdiagnosisofcardiomegaly

    Mostimportantcausesare:

    Pericardialeffusion

    Dilatedcardiomyopathy

    RheumaticH.D. withmulti-valvularaffection

    Congestiveheart failure.

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    COMMENT

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    COMMENT:

    Pulmonaryoligemia.

    Small-sizedheartwithright ventricular(supra-diaphragmaticapex).

    Theleftcardio-phrenicangleisacute.

    Heartischaracteristically BOOT-SHAPED. (Coeuren Sabot Sign).

    These findingsarehighlysuggestiveof

    TETRALOGY OF FALLOT

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    DIAGNOSIS: Tetralogyof Fallot (TOF) - Coeuren Sabot Sign

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    Bilateral pulmonary venouscongestion

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    Bilateral pulmonaryedema

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    Huge Cardiomegaly.Theheartis flask-shapedandwell-delineated.Mostlypericardialeffusion.

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    TH

    ANK YOU