Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: August Cases

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Pediatric Chest X-Rays of the Month
Kendra Jackson, MD & Elizabeth Olson, MD
Department of Pediatrics &
Department of Emer...

Process and Disclosures
This ongoing pediatric chest x-ray
interpretation series is proudly sponsored
by the Emergency Med...

Reading systematically…
A for airway
B for bones
C for cardiac silhouette
D for diaphragm
E for everything else
For more e...

Normal CXR
for your
reference

HPI:
11 yo presenting with
hypertension, a new
murmur, and decreased
femoral pulses
What’s the xray finding?
What’s the di...

REVIEW
HPI:
11 yo presenting with
hypertension, a new
murmur, and decreased
femoral pulses
Xray finding: Rib notching.
Dia...

Coarctation Quick Tips
If the obstruction caused by a
coarc that is not severe, collateral
arteries will enlarge and creat...

Clinical Pearl:
Pediatric
Hypertension
1.Pediatric hypertension is not
always pain. About 3.5% of
kids have hypertension
2...

HPI:
3 mo with history of
CPAM s/p VATS
presents with poor
PO, now intermittently
tachypneic
Spot the abnormality.

HPI:
3 mo with history of
CPAM s/p VATS
presents with poor PO,
now intermittently
tachypneic
Diagnosis: Tension
Pneumothor...

HPI:
3 mo with history of
CPAM s/p VATS
presents with poor PO,
now intermittently
tachypneic. Still on
room air!
Since the...

Kids are not just little
adults!!!
Mandt MJ et al. Appropriate needle length for emergent pediatric needle thoracostomy ut...

REVIEW from July 2020

HPI:
17-year-old with a hx of
lupus presents with
fever and back pain
She later endorsed
chest pain and body
aches
Spot th...

HPI:
17-year-old with a hx of
lupus presents with
fever and back pain
She later endorsed chest
pain and body aches
What co...

HPI:
17-year-old with a hx of
lupus presents with
fever and back pain
She later endorsed chest
pain and body aches
Diagnos...

HPI:
5-month-old with a
history of congenital
heart disease presents
with apnea
Spot the abnormality

HPI:
5-month-old with a
history of congenital
heart disease presents
with apnea
Findings: boot shaped
heart, cardiomegaly,...

HPI:
5-month-old with a
history of congenital
heart disease presents
with apnea
What could this be?
What’s congenital hear...

HPI:
5-month-old with a
history of congenital
heart disease presents
with apnea
Diagnosis: COVID in a
child with a history...

HPI:
4-year-old w/ a h/o
transposition of the
great arteries presents
with worsening difficulty
breathing, wheezing,
and d...

HPI:
4-year-old w/ a h/o
transposition of the
great arteries presents
with worsening difficulty
breathing, wheezing,
and d...

HPI:
4-year-old w/ a h/o
transposition of the
great arteries presents
with worsening difficulty
breathing, wheezing,
and d...

HPI:
4-year-old w/ a h/o
transposition of the
great arteries presents
with worsening difficulty
breathing, wheezing,
and d...

HPI:
4-year-old w/ a
h/o transposition of
the great arteries
presents with worsening
difficulty breathing,
wheezing, and
d...

Additional history:
This child’s father
works in construction
and he takes Lasix
daily.
Diagnosis: COVID and heart
failure...

Sometimes there is more than one diagnosis…

HPI:
10 year old presents
in respiratory distress
What additional history is
needed?

Additional History:
Their entire family
was sick 1 month ago
with URI symptoms
What radiographic findings
are present?
Wha...

Additional History:
Their entire family
was sick 1 month ago
with URI symptoms
Xray finding: bilateral white-out
Diagnosis...

HPI: 10 yo F
previously presenting
in respiratory distress.
Her entire family was
sick 1 month ago with
URI symptoms
Name ...

HPI: 10yo F previously
presenting in
respiratory distress.
Her entire family was
sick 1 month ago with
URI symptoms
A: VA ...

HPI:
23-month-old presents
with coughing after
aspirating a peanut 5
days ago
Spot the abnormalities

HPI:
23-month-old presents
with coughing after
aspirating a peanut 5
days ago
A. Normal thymus
B. Aspiration pneumonia
A
B

Post Op:
After bronchoscpy and
removal of peanut and
was unable to be
extubated.
Exam: Pink froth from
ET tube
What is the...

Post Op: After
bronchoscpy, the
patient was unable to
be extubated
Exam: Pink froth from
ET tube
Diagnosis: Mild
PARDS aft...

New Pediatric ARDS Definition
Cheifetz, IM. Pediatric ARDS. Respiratory Care Jun 2017, 62 (6) 718-731; DOI: 10.4187/respca...

Orloff KE, Turner DA, Rehder KJ. The Current State of Pediatric Acute Respiratory Distress Syndrome. Pediatr Allergy Immun...

HPI:
14-month-old presents
with Fever, Cough, And
Emesis

HPI:
14-month-old presents
with Fever, Cough, And
Emesis
Diagnosis: Aspiration
pneumonia with
foreign body in the
right ma...

HPI: 1-year-old
presents after his
sister was found to be
a victim of NAT
What is the diagnosis?
Differential?

HPI: 1-year-old
presents for NAT
evaluation
Findings: Corner Fracture
of the proximal humerus
and normal thymus tissue

$HPI: 1-year-old presents for NAT evaluation Dedicated humerus x- ray demonstrating corner fracture - High suspicion for NAT$

High Suspicion Findings
on CXR
Advice
Evaluating Children With Fractures for Child Physical Abuse
Emalee G. Flaherty, Jean...

Summary of This Month’s
Diagnoses
• Aortic coarctation (review)
• Tension pneumothorax
• Pneumonia, COVID+
• Tetralogy of ...