3. Objectives
On completion of this lecture, you will be able to:
• Identify proper comment to different radiological x-ray films in
pediatrics
• Describe and distinguish different pathological findings in different
forms of X-ray in pediatrics with examples.
4. To comment on x-ray you must fulfill:
1. Quality.
2. Centralization.
3. Type.
4. View.
5. Bone
6. Tracheal air column.
6. Cardiac shadow.
7. Cardiothoraxic ratio
8. Lung field
9. Mediastinum
10. Costophrenic angle
11. Diaphragm
12. Any device
Centralization when the
medial ends of both
clavicles at same level
If Not Centralized: so we
Can not comment on
Position of Mediastinum.
5. Quality: determined by intervertebral disk & Soft tissue of the axilla
Good quality if can differentiate Intervertebral disks behind the heart
Soft x-ray: Intervertebral disks not seen.
Hard x-ray: Intervertebral disks hardly seen
9. Tracheal air column: Normally central or slightly to the right.
Brocho-vascular makings:-
• Clearly seen in the medial 1/3.
• May be seen (hazy) in the middle 1/3.
• Not seen in the lateral 1/3.
14. Cardiac shadow:-
• Normally to the left.
• 2/3 to the left, Less than 1/3
to the right side.
• Cardio-thorathic ratio ≤50%
(higher if recumbent or AP view)
31. Full term = group B
strept infection
Preterm = RDS
32. • Jet black with shift of
mediastinum to opposite side
• Pneumothorax
33. • Hyperlucent with mediastinal
shift but contain lung tissue
• Emphysema
• Either congenital or
compensatory to other lung
pathology or ball valve effect
(suggest FB)
56. Broadening, fraying ,
cubing = Active rickets
Broadening, fraying, cubing
+ line of calcification =
healing rickets
No broadening + line of
calcification = healed rickets
109. Loss of stria with
strengthening of colon
suggest IBD (UC)
Dilated colon with
irregular mucosa suggest
IBD (chon's disease)
Aganglionic segment
(Hirschsprung disease)
110. IVP
• Filling time reflect renal function (replaced by DMSA)
• Empty to urinary bladder (reflect narrowing of ureter or PU junction)
• Renal calyceal system (displaced , ballooning)
• Renal pelvis (dilatation or filling defect)
• Ureter (displaced, dilated, tortious, abnormal insersion)
• Bladder (if can hold urine = filling defect, diverticulum)
111. An x-ray image of the upper abdomen 10 minutes after
the injection of contrast material shows normal
kidneys, collecting systems and upper ureters.
خد فكره وبعدها ارفع مقاسات
Poor quality & distorted anatomy ≠ interpretation
Abnormal bone, un centralization distort anatomy
Determine type, view to allow right interpretation
PA determine rt & lf
Lat determine ant & post
Trachea ant, esophagus post
Normal
Cardiomegally is important key DD BV marking from reticulation
Age is important key in reticulation DD interstial lung disease vs BPD
Prominent BV marking at hilum = asthma
Right copula of diaphragm at anterior rib 8 , left copula at anterior rib 7
Rt upper lobe suggest aspiration
Upper lope collapse
Left side is 2 lobes so no middle lobe pneumonia in the left side
Compare lung to soft tissue and heart
Can not see heart
Full term = group B strept infection
Preterm = RDS
Emphysema
pneumothorax
Not cyst as not rounded
Note the relative hyperexpansion of the right chest and the flattening of the right hemidiaphragm.
PA view can not differentiate ant from post mediastinal mass
Elevated copula of diaphragm
According to history (-ve = eventration/ trauma or surgery = nerve injury)=Phrenic nerve paralysis
Pul edema
Bronchopneumonia
ARDS
Dots rather than reticulation
Devices
Central line
Chest tube
Nasogastric tube
Endotracheal; tube
UVC
UAC
Bone age 1 year
Bone rarefaction = osteopenia
Normal
Lf ventricular enlargement
Apex down, out
Cardiophrinic angle obtuse
Air below heart encircle it = pneumopericardium
Air at sides of hear but not below it = pneumomediastinum
Evaluate by mark , relation to gastric bubbles
Differentiate dextroposition from dextrocardia (dextroversion is by echo in which apex in position but structurally formed by rt ventricle in isomerism)
Now evaluated by echo, spiral virtual CT chest so no need for contrast for patient safety
IVP or ascending cystourethrogram if I see catheter
Ballooning then dilated pelvis then dilated ureter then tortious ureter