Paediatric Chest X-Rays

Dr Tracy Kilborn

Red Cross War Memorial Children’s Hospital

University of Cape Town

SASPI and WFPI

Points to ponder…….

• When should you X-Ray? What views?

What to look for?

• You have asked for the study – you

need to know what you are looking for.

• Radiation is a BIG issue in paediatrics!

• When should you repeat films?

• Follow up for LRTI?

Technique is most NB!!!

1

2

3

4

5

Rotation – assess anterior ribs

Why is it important?

Lordotic projection

Skin folds

??????

Same child – 1 hour later

RADIOLOGICAL ANATOMY - THE HEART

CTR 0-2yrs: 60%

2-4yrs 50-60%

Over 4 yrs: 50%

© Richard Pitcher 2003

Teratoma

AIRWAYS - Trachea

T4-T6

10-35 35-60

OBSTRUCTION: LUMEN WALL OUTSIDE

Tracheal displacement

Extrinsic Compression

TB

6mo with stridor

A

M

P

MEDIASTINUM

PARENCHYMA/ INTERSTITIUM

• Volume – air trapping uni/bilateral

• Air space opacification

• Nodules

• Mass

• Septal thickening

• Cysts/ cavities

Air trapping - Unilateral

• Left pneumothorax

• Mass

• FB

• CLO

• Hypoplastic right lung

Congenital lobar overinflation

The one to remember…….

Airspace = alveolar

• Cells?

• Fluid?

• Blood?

• Pus?

• Confluent, patchy?

• Lobar?

• Pattern – eg perihilar?

• With volume loss?

Airspace - pulmonary oedema

Airspace - infection

Round pneumonia

Airspace/ interstitium

Hypoxic infant FTT

Nodules Nodules

‘Mass’ Mass

Cysts

Post infectious

Abscess vs pyopneumothorax

Complicated hydatid

Pleura

US – effusion

consolidation fluid

US - empyema

CHEST WALL

What I hope you remember…..

• Evaluating technique first!

• Systematic approach.

• The study is ‘allowed’ to be normal.

• Lifetime of radiation ahead so think

before requesting repeat CXR.

Thank you.