SlideShare a Scribd company logo
Pediatric Chest X-Rays Of The Month
Nikki Richardson MD & Jennifer Potter MD
Department of Emergency Medicine
Carolinas Medical Center & Levine Children’s Hospital
Michael Gibbs MD, Faculty Editor
Chest X-Ray Mastery Project
November 2019
Disclosures
 This ongoing chest X-ray interpretation series is proudly sponsored by the
Emergency Medicine Residency Program at Carolinas Medical Center.
 The goal is to promote widespread mastery of CXR interpretation.
 There is no personal health information [PHI] within, and ages have been
changed to protect patient confidentiality.
Process
 Many are providing cases and these slides are shared with all contributors.
 Contributors from many CMC departments, and now… Tanzania and Brazil.
 Cases submitted this week will be distributed monthly.
 When reviewing the presentation, the 1st image will show a chest X-ray
without identifiers and the 2nd image will reveal the diagnosis.
Normal CXR
for your reference
5 month old full term
infant with history of
congenital pulmonary
airway malformation s/p
VATS 10 days prior presents
to his pediatrician for
decreased oral intake and
UOP noted to have mild
increased work of
breathing and a RR of 42.
5 month old full term
infant with history of
congenital pulmonary
airway malformation s/p
VATS 10 days prior presents
to his pediatrician for
decreased oral intake and
UOP noted to have mild
increased work of
breathing and a RR of 42.
Absent lung markings
Leftward mediastinal shift
5 month old full term
infant with history of
congenital pulmonary
airway malformation s/p
VATS 10 days prior presents
to his pediatrician for
decreased oral intake and
UOP noted to have mild
increased work of
breathing and a RR of 42.
Absent lung markings
Leftward mediastinal shift
Dx: Right-sided tension
pneumothorax
14 month old male with a
history of dwarfism seen at
an outside ED for
tachypnea and fever.
Clinical deterioration with
desaturation to 60%. CPR
initiated (6 min prior to
ROSC) with multiple
attempts at endotracheal
intubation prior to
successful passage of a 3.5
uncuffed ETT. Transferred
to our PICU.
Crowded vasculature
Opacity of the right lower lobe
Elevation of right bronchus
14 month old male with a
history of dwarfism seen at
an outside ED for
tachypnea and fever.
Dx: Right Lower Lobe Atelectasis
Crowded vasculature
Opacity of the right lower lobe
Elevation of right bronchus
14 month old male with a
history of dwarfism seen at
an outside ED for
tachypnea and fever.
How do we know that
consolidation isn’t a
pneumonia?!
Here is the same patient’s
CXR the next day…
THE OPACITY MOVED!
Pneumonias don’t
move…atelectasis can!
Elevation of R hemidiaphragm
THE OPACITY MOVED!
Pneumonias don’t
move…atelectasis can!
Triangle shaped opacity in RUL
Elevation of R hemidiaphragm
Rightward shift of mediastinum
THE OPACITY MOVED!
Pneumonias don’t
move…atelectasis can!
Dx: Right Upper Lobe
Atelectasis
Triangle shaped opacity in RUL
Elevation of R hemidiaphragm
Rightward shift of mediastinum
THE OPACITY MOVED!
Pneumonias don’t
move…atelectasis can!
Dx: Right Upper Lobe
Atelectasis
Triangle shaped opacity in RUL
Elevation of R hemidiaphragm
Rightward shift of mediastinum
**For those practicing in the ED…if clinical
clues (like SICK kid with fever) point to
possible pneumonia…TREAT like a
pneumonia**
Atelectasis
• Defined: reduced lung inflation
• CXR features (that distinguish
atelectasis from consolidation):
• Elevation of the hemidiaphragm
• Displaced fissure
• Crowded vasculature
• Mediastinal shift toward the collapse
• Subsegmental, with a linear or band-
like appearance
• Types/Causes:
• Post obstructive
• Mucous plug
• Foreign body aspiration
• Mass
• Compressive
• Mass
• Round/Cicatricle
• Chronic TB or sarcoid
• Adhesive
• ARDS
• Passive
• Pneumothorax
• Pleural effusion
https://litfl.com/cxr-essentials-types-of-atelectasis/
Atelectasis: Patterns Based On Location
• Right Upper Lobe
• Triangular opacity
• Elevation of right hilum
• Rightward mediastinal shift
• Right Middle Lobe
• Loss of right heart border
• BEST seen on lateral film as a wedge pointing toward the hilum
• Right Lower Lobe
• Triangular opacity near the spine
• Silhouetting of right hemidiaphragm
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2714572/
Atelectasis: Patterns Based On Location
• Left Upper Lobe
• Loss of left upper heart border
• Elevated left hilum
• Luftsichel Sign: crescent of air creating
sharp border along the aorta
• Left Lower Lobe
• Triangular opacity creating an oddly
linear left heart border
• Silhouetting of the left
hemidiaphragm
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2714572/
. https://4.bp.blogspot.com/_fBQVVpFhTQs/SjlDlLXAlrI/AAAAAAAAAvU/7By_wSFvB4k/s1600-h/left-upper-lobe-collapse-1.jpg
Patient is a 12 year old
female with past medical
history of eosinophilic
esophagitis who presented
to the ED with feelings of
chest fullness and
difficulty swallowing solids
and liquids. On exam,
noted to have a hoarse
voice with clear lung
sounds.
Patient is a 12 year old
female with past medical
history of eosinophilic
esophagitis who presented
to the ED with feelings of
chest fullness and
difficulty swallowing solids
and liquids. On exam,
noted to have a hoarse
voice with clear lung
sounds.
Dilated tubular structure
Patient is a 12 year old
female with past medical
history of eosinophilic
esophagitis who presented
to the ED with feelings of
chest fullness and
difficulty swallowing solids
and liquids. On exam,
noted to have a hoarse
voice with clear lung
sounds.
Dx: Esophageal obstruction
(achalasia by esophogram)
Abrupt tapering of the
esophagus
Patient is a 12 year old
female with past medical
history of eosinophilic
esophagitis who presented
to the ED with feelings of
chest fullness and
difficulty swallowing solids
and liquids. On exam,
noted to have a hoarse
voice with clear lung
sounds.
7 year old female with no
past medical history
presents with intermittent
chest pain over the last 2
months with a normal
physical exam
Right Upper Lobe Mass
7 year old female with no
past medical history
presents with intermittent
chest pain over the last 2
months with a normal
physical exam
Right Upper Lobe Mass
Dx: further imaging needed
7 year old female with no
past medical history
presents with intermittent
chest pain over the last 2
months with a normal
physical exam
7 year old female with no
past medical history
presents with intermittent
chest pain over the last 2
months with a normal
physical exam
Right Upper Lobe Mass
Dx: Inflammatory
Myofibroblastic Tumor
(biopsy diagnostic)
7 year old female with no
past medical history
presents with intermittent
chest pain over the last 2
months with normal
physical exam
Surgical clips at the right hilum
Same 7 year old female
with now known history of
RUL tumor s/p VATS guided
biopsy 2 weeks later…
Tiny pneumothorax
Decreased lung markings
Surgical clips at the right hilum
Dx: s/p RUL and RML resection
Same 7 year old female
with now known history of
RUL tumor s/p VATS guided
biopsy 2 weeks later…
Tiny pneumothorax
Decreased lung markings
3 year old male reportedly
swallowed a coin who is
now experiencing vomiting
Foreign body
Dx: Esophageal foreign body
(quarter)
3 year old male reportedly
swallowed a coin who is
now experiencing vomiting
5 year old female with
history of Down Syndrome
reportedly swallowed
something and is now
experiencing vomiting
5 year old female with
history of Down Syndrome
reportedly swallowed
something and is now
experiencing vomiting
Foreign body
Dx: Esophageal foreign body
(quarter)
5 year old female with
history of Down Syndrome
reportedly swallowed
something and is now
experiencing vomiting
What’s With These Kids?
For the next section, we will review a series of cases/images with a unifying diagnosis. Try
to identify the similarities and come up with the diagnosis! After each series of cases, we
will discuss the pathophysiology and imaging characteristics of the diagnosis.
These images and cases have been graciously shared with us from our
collogues in the Pediatric Cardiovascular Surgery Department. We thank
this team for their continued support of this project!
1 day old male with known
congenital abnormality
based on prenatal
screening admitted to NICU
Physical Exam: II/VI
holosystolic murmur best
heard at apex; up slanting
palpebral fissures,
trigonocephaly,
micrognathia
1 day old female with
known congenital
abnormality based on
prenatal screening
admitted to NICU
Physical Exam: II/VI
systolic murmur best heard
at LUSB; 1+ peripheral
pulses; capillary refill 4 sec
file:///.file/id=6571367.20974
880
2 day old female with
known congenital
abnormality based on
prenatal screening
admitted to NICU for
hypoxia requiring CPAP
Physical Exam: III/VI
continuous systolic
murmur; coarse lung
sounds
1 day old male transferred
from outside hospital for
hypoxia requiring CPAP and
ultimately intubation with
an elevated lactate
Physical Exam: systolic
murmur; tachypnea with
subcostal retractions
1 day old female with
known congenital
abnormality based on
prenatal screening labs
born with hypoxia to the
80’s
Physical Exam: II/VI
systolic murmur along LSB,
cyanotic
1 day old male with known
congenital abnormality
based on prenatal
screening labs born who
became apneic and
bradycardic ultimately
requiring intubation
Physical Exam: 2+ upper
extremity pulses; 1+ lower
extremity pulses; no
murmur
3 day old male with known
congenital abnormality
based on prenatal
screening labs born who
became apneic and
bradycardic ultimately
requiring intubation
Physical Exam: 2+ upper
extremity pulses; 1+ lower
extremity pulses; no
murmur
1 day old female with
known congenital
abnormality based on
prenatal screening labs
born and taken to NICU for
monitoring
Physical Exam: narrow s2
splitting
So, What’s With These Kids??
Transposition Of The Great Arteries (TGA)
• The two main arteries that carry
blood away from the heart are
swapped:
• Body ⇨ Heart ⇨ Body
• Lungs ⇨ Heart ⇨ Lungs
• Occurs in 1250 US births/year
• Slight male predominance
https://www.heart.org/en/health-topics/congenital-heart-defects/about-
congenital-heart-defects/d-transposition-of-the-great-arteries
https://www.cdc.gov/ncbddd/heartdefects/d-tga.html
TGA: Associated Cardiac Abnormalities
• Isolated TGA is not compatible with life
• These defects allow for the mixing of
oxygenated blood:
• VSD
• ASD
• PDA
• PFO
• Extracardiac anomalies are less common
https://www.cdc.gov/ncbddd/heartdefects/d-tga.html
https://radiopaedia.org/articles/transposition-of-the-great-arteries?lang=us
Martins, Paula, and Eduardo Castela. “Transposition of the Great Arteries.” Orphanet Journal of Rare Diseases, vol. 3, no. 1, 2008, doi:10.1186/1750-1172-3-27.
Yue, Ester L. “Congenital and Acquired Pediatric Heart Disease.” Tintinallis Emergency Medicine, by J. Tintinalli, 8th ed., Mcgraw-Hill 2015, pp. 822–832.
TGA: Risk Factors
• Gestational diabetes
• Maternal exposures:
• Rodenticides
• Herbicides
• Maternal antiepileptic use
• Maternal age >40 years
• Rubella or other viral illnesses during pregnancy
https://www.mayoclinic.org/diseases-conditions/transposition-of-the-great-arteries/symptoms-causes/syc-20350589
Martins, Paula, and Eduardo Castela. “Transposition of the Great Arteries.” Orphanet Journal of Rare Diseases, vol. 3, no. 1, 2008,
doi:10.1186/1750-1172-3-27.
TGA: Clinical Presentation
• History:
• Blue skin
• Labored breathing
• Lack of appetite
• Poor weight gain
• Physical Exam:
• Hypoxia
• Cyanosis
• Single loud S2
• Murmur may be absent
(depending on other cardiac
abnormalities present)
https://www.mayoclinic.org/diseases-conditions/transposition-of-the-great-arteries/symptoms-causes/syc-20350589
Martins, Paula, and Eduardo Castela. “Transposition of the Great Arteries.” Orphanet Journal of Rare Diseases, vol. 3, no. 1, 2008,
doi:10.1186/1750-1172-3-27.
TGA: Evaluation
• Hyperoxia test:
• No improvement in SAO2 after
oxygen administration
• EKG:
• Right axis deviation
• Right ventricular hypertrophy:
• Dominant R wave in V1
• Dominant S wave in V5 or V6
• QRS <120 ms https://litfl.com/right-ventricular-hypertrophy-rvh-ecg-library/
Yue, Ester L, and Garth D Meckler. “Congenital and Acquired Pediatric Heart
Disease.” Tintinallis Emergency Medicine, by Judith Tintinalli, 8th ed.,
Mcgraw-Hill Education, 2015, pp. 822–832.
TGA: Chest X-Ray Findings
• Egg-shaped heart
• Narrow mediastinum
• Increased pulmonary vascular
markings
https://radiopaedia.org/articles/transposition-of-the-
great-arteries?lang=us
Yue, Ester L, and Garth D Meckler. “Congenital and
Acquired Pediatric Heart Disease.” Tintinallis Emergency
Medicine, by Judith Tintinalli, 8th ed., Mcgraw-Hill
Education, 2015, pp. 822–832.
Case courtesy of Dr Vincent Tatco,
<a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case
<a href="https://radiopaedia.org/cases/43062">rID: 43062</a>
Summary of This Month’s Diagnoses
• Tension pneumothorax
• Atelectasis
• Esophageal obstruction/achalasia
• Right upper lobe mass
• Right upper and right middle lobectomies
• Esophageal quarter
• Transposition of the great arteries

More Related Content

What's hot

Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: March Cases
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: March CasesDrs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: March Cases
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: March Cases
Sean M. Fox
 
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: October Cases
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: October CasesDrs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: October Cases
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: October Cases
Sean M. Fox
 
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery week 1
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery week 1Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery week 1
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery week 1
Sean M. Fox
 
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery October Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery October CasesDrs. Potter and Richardson's CMC Pediatric X-Ray Mastery October Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery October Cases
Sean M. Fox
 
EMGuideWire's Radiology Reading Room: Pleural Effusions
EMGuideWire's Radiology Reading Room: Pleural EffusionsEMGuideWire's Radiology Reading Room: Pleural Effusions
EMGuideWire's Radiology Reading Room: Pleural Effusions
Sean M. Fox
 
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery: April Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery: April CasesDrs. Potter and Richardson's CMC Pediatric X-Ray Mastery: April Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery: April Cases
Sean M. Fox
 
CMC Pediatric X-Ray Mastery: January Cases
CMC Pediatric X-Ray Mastery: January CasesCMC Pediatric X-Ray Mastery: January Cases
CMC Pediatric X-Ray Mastery: January Cases
Sean M. Fox
 
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: May Cases
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: May CasesDrs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: May Cases
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: May Cases
Sean M. Fox
 
EMGuideWire's Radiology Reading Room: Pericardial Effusion
EMGuideWire's Radiology Reading Room: Pericardial EffusionEMGuideWire's Radiology Reading Room: Pericardial Effusion
EMGuideWire's Radiology Reading Room: Pericardial Effusion
Sean M. Fox
 
Dr. Michael Gibbs's CMC X-Ray Mastery Project: June cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project: June casesDr. Michael Gibbs's CMC X-Ray Mastery Project: June cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project: June cases
Sean M. Fox
 
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: September Cases
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: September CasesDrs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: September Cases
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: September Cases
Sean M. Fox
 
Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #6 Cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #6 CasesDr. Michael Gibbs's CMC X-Ray Mastery Project - Week #6 Cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #6 Cases
Sean M. Fox
 
Drs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: May Cases
Drs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: May CasesDrs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: May Cases
Drs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: May Cases
Sean M. Fox
 
EMGuideWire's Radiology Reading Room on Pediatric Adult Aortic Coarctation
EMGuideWire's Radiology Reading Room on Pediatric Adult Aortic CoarctationEMGuideWire's Radiology Reading Room on Pediatric Adult Aortic Coarctation
EMGuideWire's Radiology Reading Room on Pediatric Adult Aortic Coarctation
Sean M. Fox
 
EMGuideWire's Radiology Reading Room: Septic Pulmonary Emboli
EMGuideWire's Radiology Reading Room: Septic Pulmonary EmboliEMGuideWire's Radiology Reading Room: Septic Pulmonary Emboli
EMGuideWire's Radiology Reading Room: Septic Pulmonary Emboli
Sean M. Fox
 
EMGuideWire's Radiology Reading Room: Spontaneous Pneumothorax
EMGuideWire's Radiology Reading Room: Spontaneous PneumothoraxEMGuideWire's Radiology Reading Room: Spontaneous Pneumothorax
EMGuideWire's Radiology Reading Room: Spontaneous Pneumothorax
Sean M. Fox
 
EMGuideWire's Radiology Reading Room: Pneumomediastinum
EMGuideWire's Radiology Reading Room: PneumomediastinumEMGuideWire's Radiology Reading Room: Pneumomediastinum
EMGuideWire's Radiology Reading Room: Pneumomediastinum
Sean M. Fox
 
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: April Cases
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: April CasesDrs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: April Cases
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: April Cases
Sean M. Fox
 
EMGuideWire's Radiology Reading Room: Peripartum Cardiomyopathy
EMGuideWire's Radiology Reading Room: Peripartum CardiomyopathyEMGuideWire's Radiology Reading Room: Peripartum Cardiomyopathy
EMGuideWire's Radiology Reading Room: Peripartum Cardiomyopathy
Sean M. Fox
 
Drs. Milam and Thomas's CMC X-Ray Mastery Project: September Cases
Drs. Milam and Thomas's CMC X-Ray Mastery Project: September CasesDrs. Milam and Thomas's CMC X-Ray Mastery Project: September Cases
Drs. Milam and Thomas's CMC X-Ray Mastery Project: September Cases
Sean M. Fox
 

What's hot (20)

Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: March Cases
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: March CasesDrs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: March Cases
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: March Cases
 
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: October Cases
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: October CasesDrs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: October Cases
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: October Cases
 
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery week 1
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery week 1Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery week 1
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery week 1
 
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery October Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery October CasesDrs. Potter and Richardson's CMC Pediatric X-Ray Mastery October Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery October Cases
 
EMGuideWire's Radiology Reading Room: Pleural Effusions
EMGuideWire's Radiology Reading Room: Pleural EffusionsEMGuideWire's Radiology Reading Room: Pleural Effusions
EMGuideWire's Radiology Reading Room: Pleural Effusions
 
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery: April Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery: April CasesDrs. Potter and Richardson's CMC Pediatric X-Ray Mastery: April Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery: April Cases
 
CMC Pediatric X-Ray Mastery: January Cases
CMC Pediatric X-Ray Mastery: January CasesCMC Pediatric X-Ray Mastery: January Cases
CMC Pediatric X-Ray Mastery: January Cases
 
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: May Cases
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: May CasesDrs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: May Cases
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: May Cases
 
EMGuideWire's Radiology Reading Room: Pericardial Effusion
EMGuideWire's Radiology Reading Room: Pericardial EffusionEMGuideWire's Radiology Reading Room: Pericardial Effusion
EMGuideWire's Radiology Reading Room: Pericardial Effusion
 
Dr. Michael Gibbs's CMC X-Ray Mastery Project: June cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project: June casesDr. Michael Gibbs's CMC X-Ray Mastery Project: June cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project: June cases
 
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: September Cases
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: September CasesDrs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: September Cases
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: September Cases
 
Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #6 Cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #6 CasesDr. Michael Gibbs's CMC X-Ray Mastery Project - Week #6 Cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #6 Cases
 
Drs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: May Cases
Drs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: May CasesDrs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: May Cases
Drs. Lorenzen and Barlock’s CMC X-Ray Mastery Project: May Cases
 
EMGuideWire's Radiology Reading Room on Pediatric Adult Aortic Coarctation
EMGuideWire's Radiology Reading Room on Pediatric Adult Aortic CoarctationEMGuideWire's Radiology Reading Room on Pediatric Adult Aortic Coarctation
EMGuideWire's Radiology Reading Room on Pediatric Adult Aortic Coarctation
 
EMGuideWire's Radiology Reading Room: Septic Pulmonary Emboli
EMGuideWire's Radiology Reading Room: Septic Pulmonary EmboliEMGuideWire's Radiology Reading Room: Septic Pulmonary Emboli
EMGuideWire's Radiology Reading Room: Septic Pulmonary Emboli
 
EMGuideWire's Radiology Reading Room: Spontaneous Pneumothorax
EMGuideWire's Radiology Reading Room: Spontaneous PneumothoraxEMGuideWire's Radiology Reading Room: Spontaneous Pneumothorax
EMGuideWire's Radiology Reading Room: Spontaneous Pneumothorax
 
EMGuideWire's Radiology Reading Room: Pneumomediastinum
EMGuideWire's Radiology Reading Room: PneumomediastinumEMGuideWire's Radiology Reading Room: Pneumomediastinum
EMGuideWire's Radiology Reading Room: Pneumomediastinum
 
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: April Cases
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: April CasesDrs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: April Cases
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: April Cases
 
EMGuideWire's Radiology Reading Room: Peripartum Cardiomyopathy
EMGuideWire's Radiology Reading Room: Peripartum CardiomyopathyEMGuideWire's Radiology Reading Room: Peripartum Cardiomyopathy
EMGuideWire's Radiology Reading Room: Peripartum Cardiomyopathy
 
Drs. Milam and Thomas's CMC X-Ray Mastery Project: September Cases
Drs. Milam and Thomas's CMC X-Ray Mastery Project: September CasesDrs. Milam and Thomas's CMC X-Ray Mastery Project: September Cases
Drs. Milam and Thomas's CMC X-Ray Mastery Project: September Cases
 

Similar to Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery November Cases

Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery December Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery December CasesDrs. Potter and Richardson's CMC Pediatric X-Ray Mastery December Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery December Cases
Sean M. Fox
 
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: July Cases
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: July CasesDrs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: July Cases
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: July Cases
Sean M. Fox
 
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery January Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery January CasesDrs. Potter and Richardson's CMC Pediatric X-Ray Mastery January Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery January Cases
Sean M. Fox
 
Dr. Michael Gibbs's CMC X-Ray Mastery Project: Week #12 cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project: Week #12 casesDr. Michael Gibbs's CMC X-Ray Mastery Project: Week #12 cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project: Week #12 cases
Sean M. Fox
 
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery: February Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery: February CasesDrs. Potter and Richardson's CMC Pediatric X-Ray Mastery: February Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery: February Cases
Sean M. Fox
 
Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #7 Cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #7 CasesDr. Michael Gibbs's CMC X-Ray Mastery Project - Week #7 Cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #7 Cases
Sean M. Fox
 
CMC Pediatric X-Ray Mastery: 27th Case Series
CMC Pediatric X-Ray Mastery: 27th Case SeriesCMC Pediatric X-Ray Mastery: 27th Case Series
CMC Pediatric X-Ray Mastery: 27th Case Series
Sean M. Fox
 
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery September Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery September CasesDrs. Potter and Richardson's CMC Pediatric X-Ray Mastery September Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery September Cases
Sean M. Fox
 
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery August Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery August CasesDrs. Potter and Richardson's CMC Pediatric X-Ray Mastery August Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery August Cases
Sean M. Fox
 
Dr. Michael Gibbs's CMC X-Ray Mastery Project: Week #11 cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project: Week #11 casesDr. Michael Gibbs's CMC X-Ray Mastery Project: Week #11 cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project: Week #11 cases
Sean M. Fox
 
CMC Pediatric X-Ray Mastery: February Case
CMC Pediatric X-Ray Mastery: February CaseCMC Pediatric X-Ray Mastery: February Case
CMC Pediatric X-Ray Mastery: February Case
Sean M. Fox
 
CMC Pediatric X-Ray Mastery: 26th Case Series
CMC Pediatric X-Ray Mastery: 26th Case SeriesCMC Pediatric X-Ray Mastery: 26th Case Series
CMC Pediatric X-Ray Mastery: 26th Case Series
Sean M. Fox
 
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: August C...
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: August C...Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: August C...
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: August C...
Sean M. Fox
 
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: April Cases
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: April CasesDrs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: April Cases
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: April Cases
Sean M. Fox
 
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery: May Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery: May CasesDrs. Potter and Richardson's CMC Pediatric X-Ray Mastery: May Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery: May Cases
Sean M. Fox
 
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery July Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery July CasesDrs. Potter and Richardson's CMC Pediatric X-Ray Mastery July Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery July Cases
Sean M. Fox
 
Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...
Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...
Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...
Sean M. Fox
 
Drs. Milam and Thomas's CMC X-Ray Mastery Project: December Cases
Drs. Milam and Thomas's CMC X-Ray Mastery Project: December CasesDrs. Milam and Thomas's CMC X-Ray Mastery Project: December Cases
Drs. Milam and Thomas's CMC X-Ray Mastery Project: December Cases
Sean M. Fox
 
Drs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: February Cases
Drs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: February CasesDrs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: February Cases
Drs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: February Cases
Sean M. Fox
 
Dr. Escobar’s CMC X-Ray Mastery Project: December Cases
Dr. Escobar’s CMC X-Ray Mastery Project: December CasesDr. Escobar’s CMC X-Ray Mastery Project: December Cases
Dr. Escobar’s CMC X-Ray Mastery Project: December Cases
Sean M. Fox
 

Similar to Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery November Cases (20)

Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery December Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery December CasesDrs. Potter and Richardson's CMC Pediatric X-Ray Mastery December Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery December Cases
 
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: July Cases
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: July CasesDrs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: July Cases
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: July Cases
 
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery January Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery January CasesDrs. Potter and Richardson's CMC Pediatric X-Ray Mastery January Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery January Cases
 
Dr. Michael Gibbs's CMC X-Ray Mastery Project: Week #12 cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project: Week #12 casesDr. Michael Gibbs's CMC X-Ray Mastery Project: Week #12 cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project: Week #12 cases
 
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery: February Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery: February CasesDrs. Potter and Richardson's CMC Pediatric X-Ray Mastery: February Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery: February Cases
 
Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #7 Cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #7 CasesDr. Michael Gibbs's CMC X-Ray Mastery Project - Week #7 Cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project - Week #7 Cases
 
CMC Pediatric X-Ray Mastery: 27th Case Series
CMC Pediatric X-Ray Mastery: 27th Case SeriesCMC Pediatric X-Ray Mastery: 27th Case Series
CMC Pediatric X-Ray Mastery: 27th Case Series
 
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery September Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery September CasesDrs. Potter and Richardson's CMC Pediatric X-Ray Mastery September Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery September Cases
 
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery August Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery August CasesDrs. Potter and Richardson's CMC Pediatric X-Ray Mastery August Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery August Cases
 
Dr. Michael Gibbs's CMC X-Ray Mastery Project: Week #11 cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project: Week #11 casesDr. Michael Gibbs's CMC X-Ray Mastery Project: Week #11 cases
Dr. Michael Gibbs's CMC X-Ray Mastery Project: Week #11 cases
 
CMC Pediatric X-Ray Mastery: February Case
CMC Pediatric X-Ray Mastery: February CaseCMC Pediatric X-Ray Mastery: February Case
CMC Pediatric X-Ray Mastery: February Case
 
CMC Pediatric X-Ray Mastery: 26th Case Series
CMC Pediatric X-Ray Mastery: 26th Case SeriesCMC Pediatric X-Ray Mastery: 26th Case Series
CMC Pediatric X-Ray Mastery: 26th Case Series
 
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: August C...
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: August C...Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: August C...
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: August C...
 
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: April Cases
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: April CasesDrs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: April Cases
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: April Cases
 
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery: May Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery: May CasesDrs. Potter and Richardson's CMC Pediatric X-Ray Mastery: May Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery: May Cases
 
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery July Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery July CasesDrs. Potter and Richardson's CMC Pediatric X-Ray Mastery July Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery July Cases
 
Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...
Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...
Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...
 
Drs. Milam and Thomas's CMC X-Ray Mastery Project: December Cases
Drs. Milam and Thomas's CMC X-Ray Mastery Project: December CasesDrs. Milam and Thomas's CMC X-Ray Mastery Project: December Cases
Drs. Milam and Thomas's CMC X-Ray Mastery Project: December Cases
 
Drs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: February Cases
Drs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: February CasesDrs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: February Cases
Drs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: February Cases
 
Dr. Escobar’s CMC X-Ray Mastery Project: December Cases
Dr. Escobar’s CMC X-Ray Mastery Project: December CasesDr. Escobar’s CMC X-Ray Mastery Project: December Cases
Dr. Escobar’s CMC X-Ray Mastery Project: December Cases
 

More from Sean M. Fox

Neuroimaging Mastery Project: Presentation #6 Subarachnoid Hemorrhage
Neuroimaging Mastery Project: Presentation #6 Subarachnoid HemorrhageNeuroimaging Mastery Project: Presentation #6 Subarachnoid Hemorrhage
Neuroimaging Mastery Project: Presentation #6 Subarachnoid Hemorrhage
Sean M. Fox
 
Implanted Devices - VP Shunts: EMGuidewire's Radiology Reading Room
Implanted Devices - VP Shunts: EMGuidewire's Radiology Reading RoomImplanted Devices - VP Shunts: EMGuidewire's Radiology Reading Room
Implanted Devices - VP Shunts: EMGuidewire's Radiology Reading Room
Sean M. Fox
 
Sternal Fractures & Dislocations - EMGuidewire Radiology Reading Room
Sternal Fractures & Dislocations - EMGuidewire Radiology Reading RoomSternal Fractures & Dislocations - EMGuidewire Radiology Reading Room
Sternal Fractures & Dislocations - EMGuidewire Radiology Reading Room
Sean M. Fox
 
Diaphragmatic Injuries - Radiology Reading Room
Diaphragmatic Injuries - Radiology Reading RoomDiaphragmatic Injuries - Radiology Reading Room
Diaphragmatic Injuries - Radiology Reading Room
Sean M. Fox
 
Acute Chest Syndrome - EMGuidewire's Radiology Reading Room
Acute Chest Syndrome - EMGuidewire's Radiology Reading RoomAcute Chest Syndrome - EMGuidewire's Radiology Reading Room
Acute Chest Syndrome - EMGuidewire's Radiology Reading Room
Sean M. Fox
 
Adult Orthopedic Imaging Series: Presentation #2 Native Hip Dislocations
Adult Orthopedic Imaging Series: Presentation #2 Native Hip DislocationsAdult Orthopedic Imaging Series: Presentation #2 Native Hip Dislocations
Adult Orthopedic Imaging Series: Presentation #2 Native Hip Dislocations
Sean M. Fox
 
Neuroimaging Mastery Project: Presentation #5 Subdural Hematomas
Neuroimaging Mastery Project: Presentation #5 Subdural HematomasNeuroimaging Mastery Project: Presentation #5 Subdural Hematomas
Neuroimaging Mastery Project: Presentation #5 Subdural Hematomas
Sean M. Fox
 
Neuroimaging Mastery Project Presentation #4: Acute Epidural Hematomas
Neuroimaging Mastery Project Presentation #4: Acute Epidural HematomasNeuroimaging Mastery Project Presentation #4: Acute Epidural Hematomas
Neuroimaging Mastery Project Presentation #4: Acute Epidural Hematomas
Sean M. Fox
 
Pediatric Orthopedic Imaging Case Studies #7 Pediatric Elbow Fractures
Pediatric Orthopedic Imaging Case Studies #7 Pediatric Elbow FracturesPediatric Orthopedic Imaging Case Studies #7 Pediatric Elbow Fractures
Pediatric Orthopedic Imaging Case Studies #7 Pediatric Elbow Fractures
Sean M. Fox
 
Adult Orthopedic Imaging Mastery Project - Pelvic Ring Fractures
Adult Orthopedic Imaging Mastery Project - Pelvic Ring FracturesAdult Orthopedic Imaging Mastery Project - Pelvic Ring Fractures
Adult Orthopedic Imaging Mastery Project - Pelvic Ring Fractures
Sean M. Fox
 
Neurosurgical Intracranial Infections - FINAL 10-17-23.pptx
Neurosurgical Intracranial Infections - FINAL 10-17-23.pptxNeurosurgical Intracranial Infections - FINAL 10-17-23.pptx
Neurosurgical Intracranial Infections - FINAL 10-17-23.pptx
Sean M. Fox
 
CMC Neuroimaging Case Studies - Cerebral Venous Sinus Thrombosis
CMC Neuroimaging Case Studies - Cerebral Venous Sinus ThrombosisCMC Neuroimaging Case Studies - Cerebral Venous Sinus Thrombosis
CMC Neuroimaging Case Studies - Cerebral Venous Sinus Thrombosis
Sean M. Fox
 
Abdominal Imaging Case Studies #27.pptx
Abdominal Imaging Case Studies #27.pptxAbdominal Imaging Case Studies #27.pptx
Abdominal Imaging Case Studies #27.pptx
Sean M. Fox
 
Blood Can Be Very Very Bad - CMC Neuroimaging Case Studies
Blood Can Be Very Very Bad - CMC Neuroimaging Case StudiesBlood Can Be Very Very Bad - CMC Neuroimaging Case Studies
Blood Can Be Very Very Bad - CMC Neuroimaging Case Studies
Sean M. Fox
 
Adult Chest X-Rays Of The Month - #46
Adult Chest X-Rays Of The Month - #46Adult Chest X-Rays Of The Month - #46
Adult Chest X-Rays Of The Month - #46
Sean M. Fox
 
Medical Device Imaging Mastery Project #4: Extracorporeal Membrane Oxygenation
Medical Device Imaging Mastery Project #4: Extracorporeal Membrane OxygenationMedical Device Imaging Mastery Project #4: Extracorporeal Membrane Oxygenation
Medical Device Imaging Mastery Project #4: Extracorporeal Membrane Oxygenation
Sean M. Fox
 
Drs. Brooks, Hambright, Holland, and Lorenz’s CMC Abdominal Imaging Mastery P...
Drs. Brooks, Hambright, Holland, and Lorenz’s CMC Abdominal Imaging Mastery P...Drs. Brooks, Hambright, Holland, and Lorenz’s CMC Abdominal Imaging Mastery P...
Drs. Brooks, Hambright, Holland, and Lorenz’s CMC Abdominal Imaging Mastery P...
Sean M. Fox
 
Dr. Haley Dusek’s CMC Pediatric Orthopedic X-Ray Mastery Project: #6 Presenta...
Dr. Haley Dusek’s CMC Pediatric Orthopedic X-Ray Mastery Project: #6 Presenta...Dr. Haley Dusek’s CMC Pediatric Orthopedic X-Ray Mastery Project: #6 Presenta...
Dr. Haley Dusek’s CMC Pediatric Orthopedic X-Ray Mastery Project: #6 Presenta...
Sean M. Fox
 
Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...
Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...
Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...
Sean M. Fox
 
Drs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: 43rd Case Series
Drs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: 43rd Case SeriesDrs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: 43rd Case Series
Drs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: 43rd Case Series
Sean M. Fox
 

More from Sean M. Fox (20)

Neuroimaging Mastery Project: Presentation #6 Subarachnoid Hemorrhage
Neuroimaging Mastery Project: Presentation #6 Subarachnoid HemorrhageNeuroimaging Mastery Project: Presentation #6 Subarachnoid Hemorrhage
Neuroimaging Mastery Project: Presentation #6 Subarachnoid Hemorrhage
 
Implanted Devices - VP Shunts: EMGuidewire's Radiology Reading Room
Implanted Devices - VP Shunts: EMGuidewire's Radiology Reading RoomImplanted Devices - VP Shunts: EMGuidewire's Radiology Reading Room
Implanted Devices - VP Shunts: EMGuidewire's Radiology Reading Room
 
Sternal Fractures & Dislocations - EMGuidewire Radiology Reading Room
Sternal Fractures & Dislocations - EMGuidewire Radiology Reading RoomSternal Fractures & Dislocations - EMGuidewire Radiology Reading Room
Sternal Fractures & Dislocations - EMGuidewire Radiology Reading Room
 
Diaphragmatic Injuries - Radiology Reading Room
Diaphragmatic Injuries - Radiology Reading RoomDiaphragmatic Injuries - Radiology Reading Room
Diaphragmatic Injuries - Radiology Reading Room
 
Acute Chest Syndrome - EMGuidewire's Radiology Reading Room
Acute Chest Syndrome - EMGuidewire's Radiology Reading RoomAcute Chest Syndrome - EMGuidewire's Radiology Reading Room
Acute Chest Syndrome - EMGuidewire's Radiology Reading Room
 
Adult Orthopedic Imaging Series: Presentation #2 Native Hip Dislocations
Adult Orthopedic Imaging Series: Presentation #2 Native Hip DislocationsAdult Orthopedic Imaging Series: Presentation #2 Native Hip Dislocations
Adult Orthopedic Imaging Series: Presentation #2 Native Hip Dislocations
 
Neuroimaging Mastery Project: Presentation #5 Subdural Hematomas
Neuroimaging Mastery Project: Presentation #5 Subdural HematomasNeuroimaging Mastery Project: Presentation #5 Subdural Hematomas
Neuroimaging Mastery Project: Presentation #5 Subdural Hematomas
 
Neuroimaging Mastery Project Presentation #4: Acute Epidural Hematomas
Neuroimaging Mastery Project Presentation #4: Acute Epidural HematomasNeuroimaging Mastery Project Presentation #4: Acute Epidural Hematomas
Neuroimaging Mastery Project Presentation #4: Acute Epidural Hematomas
 
Pediatric Orthopedic Imaging Case Studies #7 Pediatric Elbow Fractures
Pediatric Orthopedic Imaging Case Studies #7 Pediatric Elbow FracturesPediatric Orthopedic Imaging Case Studies #7 Pediatric Elbow Fractures
Pediatric Orthopedic Imaging Case Studies #7 Pediatric Elbow Fractures
 
Adult Orthopedic Imaging Mastery Project - Pelvic Ring Fractures
Adult Orthopedic Imaging Mastery Project - Pelvic Ring FracturesAdult Orthopedic Imaging Mastery Project - Pelvic Ring Fractures
Adult Orthopedic Imaging Mastery Project - Pelvic Ring Fractures
 
Neurosurgical Intracranial Infections - FINAL 10-17-23.pptx
Neurosurgical Intracranial Infections - FINAL 10-17-23.pptxNeurosurgical Intracranial Infections - FINAL 10-17-23.pptx
Neurosurgical Intracranial Infections - FINAL 10-17-23.pptx
 
CMC Neuroimaging Case Studies - Cerebral Venous Sinus Thrombosis
CMC Neuroimaging Case Studies - Cerebral Venous Sinus ThrombosisCMC Neuroimaging Case Studies - Cerebral Venous Sinus Thrombosis
CMC Neuroimaging Case Studies - Cerebral Venous Sinus Thrombosis
 
Abdominal Imaging Case Studies #27.pptx
Abdominal Imaging Case Studies #27.pptxAbdominal Imaging Case Studies #27.pptx
Abdominal Imaging Case Studies #27.pptx
 
Blood Can Be Very Very Bad - CMC Neuroimaging Case Studies
Blood Can Be Very Very Bad - CMC Neuroimaging Case StudiesBlood Can Be Very Very Bad - CMC Neuroimaging Case Studies
Blood Can Be Very Very Bad - CMC Neuroimaging Case Studies
 
Adult Chest X-Rays Of The Month - #46
Adult Chest X-Rays Of The Month - #46Adult Chest X-Rays Of The Month - #46
Adult Chest X-Rays Of The Month - #46
 
Medical Device Imaging Mastery Project #4: Extracorporeal Membrane Oxygenation
Medical Device Imaging Mastery Project #4: Extracorporeal Membrane OxygenationMedical Device Imaging Mastery Project #4: Extracorporeal Membrane Oxygenation
Medical Device Imaging Mastery Project #4: Extracorporeal Membrane Oxygenation
 
Drs. Brooks, Hambright, Holland, and Lorenz’s CMC Abdominal Imaging Mastery P...
Drs. Brooks, Hambright, Holland, and Lorenz’s CMC Abdominal Imaging Mastery P...Drs. Brooks, Hambright, Holland, and Lorenz’s CMC Abdominal Imaging Mastery P...
Drs. Brooks, Hambright, Holland, and Lorenz’s CMC Abdominal Imaging Mastery P...
 
Dr. Haley Dusek’s CMC Pediatric Orthopedic X-Ray Mastery Project: #6 Presenta...
Dr. Haley Dusek’s CMC Pediatric Orthopedic X-Ray Mastery Project: #6 Presenta...Dr. Haley Dusek’s CMC Pediatric Orthopedic X-Ray Mastery Project: #6 Presenta...
Dr. Haley Dusek’s CMC Pediatric Orthopedic X-Ray Mastery Project: #6 Presenta...
 
Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...
Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...
Drs. Pikus, Blackwell, Baumgarten, and Malloy-Posts’s CMC X-Ray Mastery Proje...
 
Drs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: 43rd Case Series
Drs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: 43rd Case SeriesDrs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: 43rd Case Series
Drs. Escobar, Pikus, and Blackwell’s CMC X-Ray Mastery Project: 43rd Case Series
 

Recently uploaded

Codeavour 5.0 International Impact Report - The Biggest International AI, Cod...
Codeavour 5.0 International Impact Report - The Biggest International AI, Cod...Codeavour 5.0 International Impact Report - The Biggest International AI, Cod...
Codeavour 5.0 International Impact Report - The Biggest International AI, Cod...
Codeavour International
 
What is Rescue Session in Odoo 17 POS - Odoo 17 Slides
What is Rescue Session in Odoo 17 POS - Odoo 17 SlidesWhat is Rescue Session in Odoo 17 POS - Odoo 17 Slides
What is Rescue Session in Odoo 17 POS - Odoo 17 Slides
Celine George
 
New Features in Odoo 17 Sign - Odoo 17 Slides
New Features in Odoo 17 Sign - Odoo 17 SlidesNew Features in Odoo 17 Sign - Odoo 17 Slides
New Features in Odoo 17 Sign - Odoo 17 Slides
Celine George
 
How to Empty a One2Many Field in Odoo 17
How to Empty a One2Many Field in Odoo 17How to Empty a One2Many Field in Odoo 17
How to Empty a One2Many Field in Odoo 17
Celine George
 
MathematicsGrade7-Presentation-July-12024.pptx
MathematicsGrade7-Presentation-July-12024.pptxMathematicsGrade7-Presentation-July-12024.pptx
MathematicsGrade7-Presentation-July-12024.pptx
nolicaliso1
 
Genetics Teaching Plan: Dr.Kshirsagar R.V.
Genetics Teaching Plan: Dr.Kshirsagar R.V.Genetics Teaching Plan: Dr.Kshirsagar R.V.
Genetics Teaching Plan: Dr.Kshirsagar R.V.
DrRavindrakshirsagar1
 
SD_Integrating 21st Century Skills in Classroom-based Assessment.pptx
SD_Integrating 21st Century Skills in Classroom-based Assessment.pptxSD_Integrating 21st Century Skills in Classroom-based Assessment.pptx
SD_Integrating 21st Century Skills in Classroom-based Assessment.pptx
elwoodprias1
 
Lange and Roberts "DEIA in the Scholarly Landscape Session 5: DEIA in Peer Re...
Lange and Roberts "DEIA in the Scholarly Landscape Session 5: DEIA in Peer Re...Lange and Roberts "DEIA in the Scholarly Landscape Session 5: DEIA in Peer Re...
Lange and Roberts "DEIA in the Scholarly Landscape Session 5: DEIA in Peer Re...
National Information Standards Organization (NISO)
 
Node JS Interview Question PDF By ScholarHat
Node JS Interview Question PDF By ScholarHatNode JS Interview Question PDF By ScholarHat
Node JS Interview Question PDF By ScholarHat
Scholarhat
 
MATATAG CURRICULUM sample lesson exemplar.docx
MATATAG CURRICULUM sample lesson exemplar.docxMATATAG CURRICULUM sample lesson exemplar.docx
MATATAG CURRICULUM sample lesson exemplar.docx
yardenmendoza
 
Demonstration module in Odoo 17 - Odoo 17 Slides
Demonstration module in Odoo 17 - Odoo 17 SlidesDemonstration module in Odoo 17 - Odoo 17 Slides
Demonstration module in Odoo 17 - Odoo 17 Slides
Celine George
 
How to Manage Line Discount in Odoo 17 POS
How to Manage Line Discount in Odoo 17 POSHow to Manage Line Discount in Odoo 17 POS
How to Manage Line Discount in Odoo 17 POS
Celine George
 
BỘ ĐỀ THI HỌC SINH GIỎI CÁC TỈNH MÔN TIẾNG ANH LỚP 9 NĂM HỌC 2023-2024 (CÓ FI...
BỘ ĐỀ THI HỌC SINH GIỎI CÁC TỈNH MÔN TIẾNG ANH LỚP 9 NĂM HỌC 2023-2024 (CÓ FI...BỘ ĐỀ THI HỌC SINH GIỎI CÁC TỈNH MÔN TIẾNG ANH LỚP 9 NĂM HỌC 2023-2024 (CÓ FI...
BỘ ĐỀ THI HỌC SINH GIỎI CÁC TỈNH MÔN TIẾNG ANH LỚP 9 NĂM HỌC 2023-2024 (CÓ FI...
Nguyen Thanh Tu Collection
 
How To Sell Hamster Kombat Coin In Pre-market
How To Sell Hamster Kombat Coin In Pre-marketHow To Sell Hamster Kombat Coin In Pre-market
How To Sell Hamster Kombat Coin In Pre-market
Sikandar Ali
 
RDBMS Lecture Notes Unit4 chapter12 VIEW
RDBMS Lecture Notes Unit4 chapter12 VIEWRDBMS Lecture Notes Unit4 chapter12 VIEW
RDBMS Lecture Notes Unit4 chapter12 VIEW
Murugan Solaiyappan
 
Introduction to Banking System in India.ppt
Introduction to Banking System in India.pptIntroduction to Banking System in India.ppt
Introduction to Banking System in India.ppt
Dr. S. Bulomine Regi
 
How to Add a Filter in the Odoo 17 - Odoo 17 Slides
How to Add a Filter in the Odoo 17 - Odoo 17 SlidesHow to Add a Filter in the Odoo 17 - Odoo 17 Slides
How to Add a Filter in the Odoo 17 - Odoo 17 Slides
Celine George
 
Our Guide to the July 2024 USPS® Rate Change
Our Guide to the July 2024 USPS® Rate ChangeOur Guide to the July 2024 USPS® Rate Change
Our Guide to the July 2024 USPS® Rate Change
Postal Advocate Inc.
 
Imagination in Computer Science Research
Imagination in Computer Science ResearchImagination in Computer Science Research
Imagination in Computer Science Research
Abhik Roychoudhury
 
ASP.NET Core Interview Questions PDF By ScholarHat.pdf
ASP.NET Core Interview Questions PDF By ScholarHat.pdfASP.NET Core Interview Questions PDF By ScholarHat.pdf
ASP.NET Core Interview Questions PDF By ScholarHat.pdf
Scholarhat
 

Recently uploaded (20)

Codeavour 5.0 International Impact Report - The Biggest International AI, Cod...
Codeavour 5.0 International Impact Report - The Biggest International AI, Cod...Codeavour 5.0 International Impact Report - The Biggest International AI, Cod...
Codeavour 5.0 International Impact Report - The Biggest International AI, Cod...
 
What is Rescue Session in Odoo 17 POS - Odoo 17 Slides
What is Rescue Session in Odoo 17 POS - Odoo 17 SlidesWhat is Rescue Session in Odoo 17 POS - Odoo 17 Slides
What is Rescue Session in Odoo 17 POS - Odoo 17 Slides
 
New Features in Odoo 17 Sign - Odoo 17 Slides
New Features in Odoo 17 Sign - Odoo 17 SlidesNew Features in Odoo 17 Sign - Odoo 17 Slides
New Features in Odoo 17 Sign - Odoo 17 Slides
 
How to Empty a One2Many Field in Odoo 17
How to Empty a One2Many Field in Odoo 17How to Empty a One2Many Field in Odoo 17
How to Empty a One2Many Field in Odoo 17
 
MathematicsGrade7-Presentation-July-12024.pptx
MathematicsGrade7-Presentation-July-12024.pptxMathematicsGrade7-Presentation-July-12024.pptx
MathematicsGrade7-Presentation-July-12024.pptx
 
Genetics Teaching Plan: Dr.Kshirsagar R.V.
Genetics Teaching Plan: Dr.Kshirsagar R.V.Genetics Teaching Plan: Dr.Kshirsagar R.V.
Genetics Teaching Plan: Dr.Kshirsagar R.V.
 
SD_Integrating 21st Century Skills in Classroom-based Assessment.pptx
SD_Integrating 21st Century Skills in Classroom-based Assessment.pptxSD_Integrating 21st Century Skills in Classroom-based Assessment.pptx
SD_Integrating 21st Century Skills in Classroom-based Assessment.pptx
 
Lange and Roberts "DEIA in the Scholarly Landscape Session 5: DEIA in Peer Re...
Lange and Roberts "DEIA in the Scholarly Landscape Session 5: DEIA in Peer Re...Lange and Roberts "DEIA in the Scholarly Landscape Session 5: DEIA in Peer Re...
Lange and Roberts "DEIA in the Scholarly Landscape Session 5: DEIA in Peer Re...
 
Node JS Interview Question PDF By ScholarHat
Node JS Interview Question PDF By ScholarHatNode JS Interview Question PDF By ScholarHat
Node JS Interview Question PDF By ScholarHat
 
MATATAG CURRICULUM sample lesson exemplar.docx
MATATAG CURRICULUM sample lesson exemplar.docxMATATAG CURRICULUM sample lesson exemplar.docx
MATATAG CURRICULUM sample lesson exemplar.docx
 
Demonstration module in Odoo 17 - Odoo 17 Slides
Demonstration module in Odoo 17 - Odoo 17 SlidesDemonstration module in Odoo 17 - Odoo 17 Slides
Demonstration module in Odoo 17 - Odoo 17 Slides
 
How to Manage Line Discount in Odoo 17 POS
How to Manage Line Discount in Odoo 17 POSHow to Manage Line Discount in Odoo 17 POS
How to Manage Line Discount in Odoo 17 POS
 
BỘ ĐỀ THI HỌC SINH GIỎI CÁC TỈNH MÔN TIẾNG ANH LỚP 9 NĂM HỌC 2023-2024 (CÓ FI...
BỘ ĐỀ THI HỌC SINH GIỎI CÁC TỈNH MÔN TIẾNG ANH LỚP 9 NĂM HỌC 2023-2024 (CÓ FI...BỘ ĐỀ THI HỌC SINH GIỎI CÁC TỈNH MÔN TIẾNG ANH LỚP 9 NĂM HỌC 2023-2024 (CÓ FI...
BỘ ĐỀ THI HỌC SINH GIỎI CÁC TỈNH MÔN TIẾNG ANH LỚP 9 NĂM HỌC 2023-2024 (CÓ FI...
 
How To Sell Hamster Kombat Coin In Pre-market
How To Sell Hamster Kombat Coin In Pre-marketHow To Sell Hamster Kombat Coin In Pre-market
How To Sell Hamster Kombat Coin In Pre-market
 
RDBMS Lecture Notes Unit4 chapter12 VIEW
RDBMS Lecture Notes Unit4 chapter12 VIEWRDBMS Lecture Notes Unit4 chapter12 VIEW
RDBMS Lecture Notes Unit4 chapter12 VIEW
 
Introduction to Banking System in India.ppt
Introduction to Banking System in India.pptIntroduction to Banking System in India.ppt
Introduction to Banking System in India.ppt
 
How to Add a Filter in the Odoo 17 - Odoo 17 Slides
How to Add a Filter in the Odoo 17 - Odoo 17 SlidesHow to Add a Filter in the Odoo 17 - Odoo 17 Slides
How to Add a Filter in the Odoo 17 - Odoo 17 Slides
 
Our Guide to the July 2024 USPS® Rate Change
Our Guide to the July 2024 USPS® Rate ChangeOur Guide to the July 2024 USPS® Rate Change
Our Guide to the July 2024 USPS® Rate Change
 
Imagination in Computer Science Research
Imagination in Computer Science ResearchImagination in Computer Science Research
Imagination in Computer Science Research
 
ASP.NET Core Interview Questions PDF By ScholarHat.pdf
ASP.NET Core Interview Questions PDF By ScholarHat.pdfASP.NET Core Interview Questions PDF By ScholarHat.pdf
ASP.NET Core Interview Questions PDF By ScholarHat.pdf
 

Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery November Cases

  • 1. Pediatric Chest X-Rays Of The Month Nikki Richardson MD & Jennifer Potter MD Department of Emergency Medicine Carolinas Medical Center & Levine Children’s Hospital Michael Gibbs MD, Faculty Editor Chest X-Ray Mastery Project November 2019
  • 2. Disclosures  This ongoing chest X-ray interpretation series is proudly sponsored by the Emergency Medicine Residency Program at Carolinas Medical Center.  The goal is to promote widespread mastery of CXR interpretation.  There is no personal health information [PHI] within, and ages have been changed to protect patient confidentiality.
  • 3. Process  Many are providing cases and these slides are shared with all contributors.  Contributors from many CMC departments, and now… Tanzania and Brazil.  Cases submitted this week will be distributed monthly.  When reviewing the presentation, the 1st image will show a chest X-ray without identifiers and the 2nd image will reveal the diagnosis.
  • 5. 5 month old full term infant with history of congenital pulmonary airway malformation s/p VATS 10 days prior presents to his pediatrician for decreased oral intake and UOP noted to have mild increased work of breathing and a RR of 42.
  • 6. 5 month old full term infant with history of congenital pulmonary airway malformation s/p VATS 10 days prior presents to his pediatrician for decreased oral intake and UOP noted to have mild increased work of breathing and a RR of 42. Absent lung markings Leftward mediastinal shift
  • 7. 5 month old full term infant with history of congenital pulmonary airway malformation s/p VATS 10 days prior presents to his pediatrician for decreased oral intake and UOP noted to have mild increased work of breathing and a RR of 42. Absent lung markings Leftward mediastinal shift Dx: Right-sided tension pneumothorax
  • 8. 14 month old male with a history of dwarfism seen at an outside ED for tachypnea and fever. Clinical deterioration with desaturation to 60%. CPR initiated (6 min prior to ROSC) with multiple attempts at endotracheal intubation prior to successful passage of a 3.5 uncuffed ETT. Transferred to our PICU.
  • 9. Crowded vasculature Opacity of the right lower lobe Elevation of right bronchus 14 month old male with a history of dwarfism seen at an outside ED for tachypnea and fever.
  • 10. Dx: Right Lower Lobe Atelectasis Crowded vasculature Opacity of the right lower lobe Elevation of right bronchus 14 month old male with a history of dwarfism seen at an outside ED for tachypnea and fever.
  • 11. How do we know that consolidation isn’t a pneumonia?!
  • 12. Here is the same patient’s CXR the next day…
  • 13. THE OPACITY MOVED! Pneumonias don’t move…atelectasis can! Elevation of R hemidiaphragm
  • 14. THE OPACITY MOVED! Pneumonias don’t move…atelectasis can! Triangle shaped opacity in RUL Elevation of R hemidiaphragm Rightward shift of mediastinum
  • 15. THE OPACITY MOVED! Pneumonias don’t move…atelectasis can! Dx: Right Upper Lobe Atelectasis Triangle shaped opacity in RUL Elevation of R hemidiaphragm Rightward shift of mediastinum
  • 16. THE OPACITY MOVED! Pneumonias don’t move…atelectasis can! Dx: Right Upper Lobe Atelectasis Triangle shaped opacity in RUL Elevation of R hemidiaphragm Rightward shift of mediastinum **For those practicing in the ED…if clinical clues (like SICK kid with fever) point to possible pneumonia…TREAT like a pneumonia**
  • 17. Atelectasis • Defined: reduced lung inflation • CXR features (that distinguish atelectasis from consolidation): • Elevation of the hemidiaphragm • Displaced fissure • Crowded vasculature • Mediastinal shift toward the collapse • Subsegmental, with a linear or band- like appearance • Types/Causes: • Post obstructive • Mucous plug • Foreign body aspiration • Mass • Compressive • Mass • Round/Cicatricle • Chronic TB or sarcoid • Adhesive • ARDS • Passive • Pneumothorax • Pleural effusion https://litfl.com/cxr-essentials-types-of-atelectasis/
  • 18. Atelectasis: Patterns Based On Location • Right Upper Lobe • Triangular opacity • Elevation of right hilum • Rightward mediastinal shift • Right Middle Lobe • Loss of right heart border • BEST seen on lateral film as a wedge pointing toward the hilum • Right Lower Lobe • Triangular opacity near the spine • Silhouetting of right hemidiaphragm https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2714572/
  • 19. Atelectasis: Patterns Based On Location • Left Upper Lobe • Loss of left upper heart border • Elevated left hilum • Luftsichel Sign: crescent of air creating sharp border along the aorta • Left Lower Lobe • Triangular opacity creating an oddly linear left heart border • Silhouetting of the left hemidiaphragm https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2714572/ . https://4.bp.blogspot.com/_fBQVVpFhTQs/SjlDlLXAlrI/AAAAAAAAAvU/7By_wSFvB4k/s1600-h/left-upper-lobe-collapse-1.jpg
  • 20. Patient is a 12 year old female with past medical history of eosinophilic esophagitis who presented to the ED with feelings of chest fullness and difficulty swallowing solids and liquids. On exam, noted to have a hoarse voice with clear lung sounds.
  • 21. Patient is a 12 year old female with past medical history of eosinophilic esophagitis who presented to the ED with feelings of chest fullness and difficulty swallowing solids and liquids. On exam, noted to have a hoarse voice with clear lung sounds. Dilated tubular structure
  • 22. Patient is a 12 year old female with past medical history of eosinophilic esophagitis who presented to the ED with feelings of chest fullness and difficulty swallowing solids and liquids. On exam, noted to have a hoarse voice with clear lung sounds.
  • 23. Dx: Esophageal obstruction (achalasia by esophogram) Abrupt tapering of the esophagus Patient is a 12 year old female with past medical history of eosinophilic esophagitis who presented to the ED with feelings of chest fullness and difficulty swallowing solids and liquids. On exam, noted to have a hoarse voice with clear lung sounds.
  • 24. 7 year old female with no past medical history presents with intermittent chest pain over the last 2 months with a normal physical exam
  • 25. Right Upper Lobe Mass 7 year old female with no past medical history presents with intermittent chest pain over the last 2 months with a normal physical exam
  • 26. Right Upper Lobe Mass Dx: further imaging needed 7 year old female with no past medical history presents with intermittent chest pain over the last 2 months with a normal physical exam
  • 27. 7 year old female with no past medical history presents with intermittent chest pain over the last 2 months with a normal physical exam
  • 28. Right Upper Lobe Mass Dx: Inflammatory Myofibroblastic Tumor (biopsy diagnostic) 7 year old female with no past medical history presents with intermittent chest pain over the last 2 months with normal physical exam
  • 29. Surgical clips at the right hilum Same 7 year old female with now known history of RUL tumor s/p VATS guided biopsy 2 weeks later… Tiny pneumothorax Decreased lung markings
  • 30. Surgical clips at the right hilum Dx: s/p RUL and RML resection Same 7 year old female with now known history of RUL tumor s/p VATS guided biopsy 2 weeks later… Tiny pneumothorax Decreased lung markings
  • 31. 3 year old male reportedly swallowed a coin who is now experiencing vomiting
  • 32. Foreign body Dx: Esophageal foreign body (quarter) 3 year old male reportedly swallowed a coin who is now experiencing vomiting
  • 33. 5 year old female with history of Down Syndrome reportedly swallowed something and is now experiencing vomiting
  • 34. 5 year old female with history of Down Syndrome reportedly swallowed something and is now experiencing vomiting
  • 35. Foreign body Dx: Esophageal foreign body (quarter) 5 year old female with history of Down Syndrome reportedly swallowed something and is now experiencing vomiting
  • 36. What’s With These Kids? For the next section, we will review a series of cases/images with a unifying diagnosis. Try to identify the similarities and come up with the diagnosis! After each series of cases, we will discuss the pathophysiology and imaging characteristics of the diagnosis. These images and cases have been graciously shared with us from our collogues in the Pediatric Cardiovascular Surgery Department. We thank this team for their continued support of this project!
  • 37. 1 day old male with known congenital abnormality based on prenatal screening admitted to NICU Physical Exam: II/VI holosystolic murmur best heard at apex; up slanting palpebral fissures, trigonocephaly, micrognathia
  • 38. 1 day old female with known congenital abnormality based on prenatal screening admitted to NICU Physical Exam: II/VI systolic murmur best heard at LUSB; 1+ peripheral pulses; capillary refill 4 sec file:///.file/id=6571367.20974 880
  • 39. 2 day old female with known congenital abnormality based on prenatal screening admitted to NICU for hypoxia requiring CPAP Physical Exam: III/VI continuous systolic murmur; coarse lung sounds
  • 40. 1 day old male transferred from outside hospital for hypoxia requiring CPAP and ultimately intubation with an elevated lactate Physical Exam: systolic murmur; tachypnea with subcostal retractions
  • 41. 1 day old female with known congenital abnormality based on prenatal screening labs born with hypoxia to the 80’s Physical Exam: II/VI systolic murmur along LSB, cyanotic
  • 42. 1 day old male with known congenital abnormality based on prenatal screening labs born who became apneic and bradycardic ultimately requiring intubation Physical Exam: 2+ upper extremity pulses; 1+ lower extremity pulses; no murmur
  • 43. 3 day old male with known congenital abnormality based on prenatal screening labs born who became apneic and bradycardic ultimately requiring intubation Physical Exam: 2+ upper extremity pulses; 1+ lower extremity pulses; no murmur
  • 44. 1 day old female with known congenital abnormality based on prenatal screening labs born and taken to NICU for monitoring Physical Exam: narrow s2 splitting
  • 45. So, What’s With These Kids??
  • 46. Transposition Of The Great Arteries (TGA) • The two main arteries that carry blood away from the heart are swapped: • Body ⇨ Heart ⇨ Body • Lungs ⇨ Heart ⇨ Lungs • Occurs in 1250 US births/year • Slight male predominance https://www.heart.org/en/health-topics/congenital-heart-defects/about- congenital-heart-defects/d-transposition-of-the-great-arteries https://www.cdc.gov/ncbddd/heartdefects/d-tga.html
  • 47. TGA: Associated Cardiac Abnormalities • Isolated TGA is not compatible with life • These defects allow for the mixing of oxygenated blood: • VSD • ASD • PDA • PFO • Extracardiac anomalies are less common https://www.cdc.gov/ncbddd/heartdefects/d-tga.html https://radiopaedia.org/articles/transposition-of-the-great-arteries?lang=us Martins, Paula, and Eduardo Castela. “Transposition of the Great Arteries.” Orphanet Journal of Rare Diseases, vol. 3, no. 1, 2008, doi:10.1186/1750-1172-3-27. Yue, Ester L. “Congenital and Acquired Pediatric Heart Disease.” Tintinallis Emergency Medicine, by J. Tintinalli, 8th ed., Mcgraw-Hill 2015, pp. 822–832.
  • 48. TGA: Risk Factors • Gestational diabetes • Maternal exposures: • Rodenticides • Herbicides • Maternal antiepileptic use • Maternal age >40 years • Rubella or other viral illnesses during pregnancy https://www.mayoclinic.org/diseases-conditions/transposition-of-the-great-arteries/symptoms-causes/syc-20350589 Martins, Paula, and Eduardo Castela. “Transposition of the Great Arteries.” Orphanet Journal of Rare Diseases, vol. 3, no. 1, 2008, doi:10.1186/1750-1172-3-27.
  • 49. TGA: Clinical Presentation • History: • Blue skin • Labored breathing • Lack of appetite • Poor weight gain • Physical Exam: • Hypoxia • Cyanosis • Single loud S2 • Murmur may be absent (depending on other cardiac abnormalities present) https://www.mayoclinic.org/diseases-conditions/transposition-of-the-great-arteries/symptoms-causes/syc-20350589 Martins, Paula, and Eduardo Castela. “Transposition of the Great Arteries.” Orphanet Journal of Rare Diseases, vol. 3, no. 1, 2008, doi:10.1186/1750-1172-3-27.
  • 50. TGA: Evaluation • Hyperoxia test: • No improvement in SAO2 after oxygen administration • EKG: • Right axis deviation • Right ventricular hypertrophy: • Dominant R wave in V1 • Dominant S wave in V5 or V6 • QRS <120 ms https://litfl.com/right-ventricular-hypertrophy-rvh-ecg-library/ Yue, Ester L, and Garth D Meckler. “Congenital and Acquired Pediatric Heart Disease.” Tintinallis Emergency Medicine, by Judith Tintinalli, 8th ed., Mcgraw-Hill Education, 2015, pp. 822–832.
  • 51. TGA: Chest X-Ray Findings • Egg-shaped heart • Narrow mediastinum • Increased pulmonary vascular markings https://radiopaedia.org/articles/transposition-of-the- great-arteries?lang=us Yue, Ester L, and Garth D Meckler. “Congenital and Acquired Pediatric Heart Disease.” Tintinallis Emergency Medicine, by Judith Tintinalli, 8th ed., Mcgraw-Hill Education, 2015, pp. 822–832. Case courtesy of Dr Vincent Tatco, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/43062">rID: 43062</a>
  • 52. Summary of This Month’s Diagnoses • Tension pneumothorax • Atelectasis • Esophageal obstruction/achalasia • Right upper lobe mass • Right upper and right middle lobectomies • Esophageal quarter • Transposition of the great arteries