Neonatal chest x ray reading


Published on


Published in: Health & Medicine

Neonatal chest x ray reading

  2. 2. In spite of recent modalities like USG, CT SCAN, MRI, conventional radiography is cornerstone of imaging…
  3. 3. Chest should be straight so that both hemi thorax can be visualized equally
  4. 4. Film should be technically satisfactory…
  5. 5. Mediastinum in neonate has much variability and mainly consist of heart and thymus….. Thymus can fill the whole of upper mediastinum or is prominent on right side or left……..
  6. 6. Apart from viewing pulmonary, cardiac, and pleural pathology, neonatal x-ray is used to demonstrate the position of various lines and tubes……
  7. 7. Endotracheal intubation A. Preferred location is halfway between the thoracic inlet and carina B. If ett is too low, it will enter into right main bronchus C. Chest film may show asymmetric aeration with both hyperinflation and atelactasis D. If tube extends below carina and does not match tracheal air column, suspect esophageal intubation E. Ett placed too high has tip above clavicle , x-ray film may show diffuse atelactasis
  8. 8. Nasogastric tube Tip should be in mid stomach
  9. 9. Umblical vein catheterization  At junction of inferior vena cava and right atrium  Degree and position of patient rotation affect how the UVC appears positioned on radiograph……..
  10. 10. Umbilical artery catheterization  Cochrane review states that high catheters should be used exclusively  Recent analysis showed a decreased risk of vascular complications and no increased risk of hypertension, necrotizing enterocolitis, IVH or hematuria….  Low catheters are associated with increased risk of vasospasms………..
  11. 11. PULMONARY DISEASES A. RDS a fine, diffuse reticulogranular pattern is seen secondary to microatelectasis of alveoli. The chest radiograghs reveals radiolucent areas known as air bronchograms, produced by air in major airways and contrasted with the opacified alveoli
  12. 12. B. MECONIUM ASPIRATION SYNDROME Bilateral, patchy, coarse infiltrates and hyperinflation of lungs are present. there is also an increased incidence of pneumothorax…
  13. 13. C. PNEUMONIA Diffuse alveolar or interstitial disease that is usually asymmetric and localized. group b streptococcal pneumonia can appear similar to respiratory distress syndrome (rds).pneumatoceles ( air – filled lung cysts ) can occur with staphylococcal pneumonia. Pleural effusions or empyema may occur with any bacterial pneumonia…
  14. 14.  Extensive bilateral (right greater than left) streaky interstitial pulmonary opacities with airspace opacification at the right base. Features are non-specific.
  15. 15.  48 hours later, there has been an improvement in appearances with reduction in the degree of basal opacification.
  16. 16. D. TRANSIENT TACHYPNEA OF NEWBORN Hyper aeration with symmetric peri hilar interstitial infiltrates are typical. Pleural fluid may occur as well, appear as widening of pleural space or as prominence of the minor fissure
  17. 17.  Bilateral extensive interstitial and alveolar opacities that are predominantly perihilar.
  18. 18.  Nasal oxygen is being delivered. The patient is rotated. Interstitial copacity in all areas both lungs with thickening of horizontal fissure. Note sternal ossification centres projected over right lung. No effusions or pneumothorax.
  19. 19. E. BRONCHOPULMONARY DYSPLASIA Now more commonly referred to as chronic lung disease…. Radiographic appearance is highly variable, from a fine, hazy appearance of the lungs to mildly coarsened lung markings to a coarse, cystic lung pattern.. Typically occurring in ventilated premature neonates. Cld minimally requires a 7-10 days to develop
  20. 20.  Bronchopulmonary Dysplasia. The lungs are usually overaerated, in this case the left more than the right. There are diffuse rope-like densities separated in some areas by zones of hyperlucency. The densities are coalescent in many areas. The heart borders are completely obliterated
  21. 21. F. AIR LEAKY SYNDROMES 1. 2. Pneumopericardium air surrounds the heart, including the inferior border.. cardiac tamponade may result.. Pneumomediastinum a. AP view hyperlucent rim of air is present lateral to the cardiac border and beneath the thymus, displacing the thymus superiorly away from the cardiac silhouette (“angel wing sign” ) b. lateral view an air collection is seen either substernally (anterior pneumomediastinum ) or in the retrocardiac area ( posterior pneumomediastinum)
  22. 22. 3. Pneumothorax lung is typically displaced away from the lateral chest wall by a radiolucent zone of air… Adjacent lung may be collapsed with larger pneumothoraces small pneumothorax may be very difficult to identify with only a subtle zone of air peripherally, a diffusely hyperlucent hemithorax, unusually sharply defined cardiothymic margins or a combination of these…
  23. 23. 4. Tension pneumothorax diaphragm on affected side is depressed mediastinum is shifted to contralateral hemithorax. collapse of ipsilateral lobes is evident…
  24. 24. 5. Pulmonary interstitial emphysema single or multiple circular radiolucencies with well-demarcated walls are seen in a localized or diffuse pattern..the volume of the involved portion of the lung is usually increased. PIE usually occurs in ventilated preemies with RDS within initial few days of life…..
  25. 25. G. ATELECTASIS A decrease in lung volume or collapse of part or all of a lung is apparent, appearing as areas of increased opacity. the mediastinum may be shifted toward the side of collapse. Compensatory hyperinflation of the opposite lung may be present. 1. MICROATELECTASIS non obstructed atelectasis associated with rds..
  26. 26. 2. GENERALIZED ATELECTASIS diffuse increase in opacity (“whiteout”) of lungs is visible on the chest film. It may be seen in severe rds, airway obstruction, if the endotracheal tube is not in the trachea, and hypoventilation… 3. LOBAR ATELECTASIS Atelectasis of one lobe Most common site is right upper lobe Right minor fissure is usually elevated Often occur after extubation
  27. 27. H . Pulmonary hypoplasia small lung volumes and a bell shaped thorax are seen . The lungs usually appear radiolucent
  28. 28. I . Pulmonary oedema lungs appear diffusely hazy with an area of greatest density around the hilum of each lung. Heart size is usually increased…
  29. 29. Cardiothoracic ratio, which normally should be less than 0.6 is the width of the base of the heart divided by the width of the lower thorax  An index more than 0.6 indicate cardiomegaly  Pulmonary vascularity is increased if the diameter of descending branch of right pulmonary artery exceeds that of trachea… 
  30. 30. A . Cardiac dextroversion. • • • Cardiac apex is on right side.. Aortic arch and stomach bubble are On left side.. Incidence of congenital heart disease is very high, more than 90 %.
  31. 31. B . CONGESTIVE HEART FAILURE cardiomegaly, pulmonary venous congestion ( engorgement and increased diameter of the pulmonary veins ), diffuse opacification of perihilar region and pleural effusion are seen..
  32. 32. C . Patent ductus arteriosus Cardiomegaly,, pulmonary edema, ductal haze ( pulmonary edema with a patent ductus arteriosus ), and increased pulmonary vascular markings are evident …
  33. 33. D . Ventricular septal defect Cardiomegaly, an increase in pulmonary vascular density, enlargement of the left ventricle and left atrium, and enlargement of the main pulmonary artery
  34. 34. E . Coarctation of aorta 1. preductal coarctation generalized Cardiomegaly with normal pulmonary vascularity is seen. 2. postductal coarctation enlarged left ventricle and left atrium and a dilating ascending aorta are present
  35. 35. F . Tetrology of fallot heart is boot shaped normal left atrium and left ventricle is associated with an enlarged, hypertrophied right ventricle and a small or absent main pulmonary artery. There is decreased pulmonary vascularity. A right aortic arch occur in approx 25% of patients
  36. 36. G . TRANSP0SITION OF GREAT ARTERIES Cardiomegaly, enlarged right atrium and right ventricle, narrow mediastinum and increase pulmonary vascular markings But in most cases, chest film appears normal.
  37. 37. H . TOTAL ANOMALOUS PULMONARY VENOUS RETURN Pulmonary venous marking are increased… Cardiomegaly is minimal or absent.. Congestive heart failure and pulmonary edema may be present…esp with type 3 TAPVR ( subdiaphragmatic )
  38. 38. I . Hypoplastic left heart syndrome chest film may be normal at first may show cardiomegaly and pulmonary congestion and enlargement of right atrium and ventricle…
  39. 39. J . Tricuspid atresia Heart size is usually normal or small, the main pulmonary artery is concave and pulmonary vascularity is decreased
  40. 40. Truncus arteriosus cardiomegaly, increased pulmonary vascularity , and enlargement of left atrium. a right aortic arch occur in 30% of patients….
  41. 41. I . ATRIAL SEPTAL DEFECT • • • • varying degrees of enlargement of right atrium and ventricle is seen aorta and left ventricle is small pulmonary artery is large increased pulmonary vascularity is evident
  42. 42. M . Ebstein anomaly Gross cardiomegaly and decreased pulmonary vascularity are apparent Right heart border is prominent as a result of right atrial enlargement
  43. 43. N . Valvular pulmonic stenosis Heart size and pulmonary blood flow is usually normal unless the stenosis is severe. Dilatation of main pulmonary artery is main chest film finding
  44. 44. thanks