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

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Ad

Pediatric Chest X-Rays of the Month
Taylor Anderson, MD & Kendra Jackson, MD
Departments of Pediatrics & Emergency Medicin...

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

3-year-old girl presents
after falling on a hunting
knife at home.
Spot the abnormality
Review

3-year-old girl presents
after falling on a hunting
knife at home.
Subcutaneous air present
Note: Lung herniation on
physi...

Don’t forget to consult
Social Work and the Child
Protection Team to rule
out non-accidental trauma
(NAT).
Review

2.5-year-old
female presents after
ROSC following a cardiac
arrest at home.
Spot the abnormality

Remember Your ABCs!
Airway: ET tube in R main stem
Bone: severe ostepenia
Cardiac: no cardiomegaly
Diaphragm: symmetric
Ef...

Additional history: She
lived on an all-vegan diet.
Her height and weight
were at the 50th percentile
for an 8-month-old.
...

• Child abuse
• Severe neglect
• Osteogenesis Imperfecta
• Rickets
• Osteitis fibrosa cystica
• Renal osteodystrophy
• Chr...

Additional imaging was
obtained because the
patient had disfigurement
of all extremities. Of note,
the child was never bee...

Child's siblings were UTD on
vaccines and healthy.
SW and the Child Protection
team were consulted.
Concern for neglect an...

10-month-old female with
a history of epilepsy,
microcephaly, G-tube
dependence, and
developmental delay who
presents with...

10-month-old female with
a history of epilepsy,
microcephaly, G-tube
dependence, and
developmental delay who
presents with...

ED Course: Respiratory
status improved after
deep suctioning, chest
physiotherapy and Zofran.
She tolerated continuous
Ped...

She returns to the ED four
days later with lethargy,
cyanosis and tachypnea.
On exam bilateral course
breath sounds are no...

A
A
B
A. B/L pneumothoraces
B. Right pleural effusion
C. Mild cardiomegaly
She returns to the ED four
days later with leth...

PICU course: Infant was
briefly of BiPAP and was
found to be Rhino and
RSV positive. COVID
negative
Diagnosis?

PICU course: Infant was
briefly of BiPAP and was
found to be Rhino and
RSV positive. COVID
negative
Bronchiolitis

1.5-year-old male with
history of trisomy 18
presents with fever and
constipation.
What are the ABCDE.....

$Airway: patent Bone: no fractures Cardiac: cardiomegaly Diaphragm: symmetric Effusions: none Fields: diffuse opacities GI:...$

Hospital course:
Respiratory distress
resolved after manual
decompression.
Respiratory viral panel
and covid negative.
Dia...

5-year-old male with a
history of asthma presents
in respiratory distress.
T: 99.8 °F HR: 153 RR:
44 BP: 116/61 SpO2:
93%
...

He was recently weaned off
of his Flovent and has had
itchy eyes with the weather
change. He was admitted to
the PICU.
Hyp...

17-year-old boy with
history of alveolar
rhabdomyosarcoma
presents with dyspnea.
Interpret the CXR

$Airway: Patent? Bone: Good mineralization. No fractures Cardiac: Obscured Diaphragm: L lower than R Effusions: Difficult t...$

Click to add text
Diagnosis: Recurrence of Alveolar Rhabdomyosarcoma

1-year-old male presents
with drooling after playing
with his sister's jewelry.
Name that character!

1-year-old male presents
with drooling after playing
with his sister's jewelry.
Oh boy, oh boy, oh boy...

2-year-old female
presenting to ED with 5
days of cough, emesis with
meals, and recurrent fever
after failing oral antibio...

What is your
management plan?
Screw in right bronchus.
Inflammation
and consolidation in the
right middle and right
lower ...

ED Course: IV ceftriaxone
and pediatric surgery
consult. Recommended
emergent surgical removal
via rigid bronchoscopy.
ED ...

Hospital Course
In the OR the screw was
removed, and large
amount of purulent
material suctioned distally.
Received dexame...

13-year-old female presented
to ED with fever, abdominal
pain, and vomiting for 4-5
days.
VS: T 98.4, HR 104, RR 18, BP
13...

Additional history
This patient had presented to
ED three days prior with fever,
emesis x2, decreased oral
intake, and lef...

Differential diagnosis at initial
presentation:
- Viral gastroenteritis
- Acute cystitis
- Pyelonephritis
- Appendicitis
-...

Lateral film reveals
multiple air fluid levels!
Now what are you worried
about? Diagnosis?

KUB demonstrates
numerous dilated loops of
small bowel, and the
lateral film shows multiple
air fluid levels.
Diagnosis? H...

The Radiologist felt that the
process was most likely
caused by a perforation such
as a perforated appendicitis.
A CT then...

12-year-old male with
history of
myelomeningocele who
was admitted with hypoxia
Interpret the X-ray

Spot the abnormality
Airway: Patent
Bone: kyphoscoliosis
Cardiac: no cardiomegaly
Diaphragm: left obscured by
atelectasis/...

$Spot the abnormality Clinical pearl: Don't forget the BONES. Missing a rib fracture could be the only sign of child abuse....$

11-year-old female who
presented with dyspnea
after jumping on a
trampoline.
HR 127, RR 24, SpO2 96%
Spot the abnormality

Differential diagnosis?
11-year-old female
who presented with
dyspnea after jumping
on trampoline

Differential and
associated conditions
Lung abscess
Bronchial cyst
Pneumatocele
Tuberculosis
Mycosis
Marfan syndrome
Pneum...

Pneumatocele
Thin-walled, air-
containing cyst of the
lung. Can be of
infectious (tuberculosis,
staph aureus, etc) or
noni...

Pneumatocele:
Risk factors
Young age, post-traumatic,
post-infectious, post
pneumonic, HIV, IV drug
use, Hyper IgE syndrom...

These resolve spontaneously in up to
90% of children. Needle decompression
is recommended if the lesion is:
occupying >50%...

Interpret the chest X-ray
10-year-old male with
complex medical history due
to bacterial meningitis in
infancy presented w...

$Remember Your ABCs Airway: ET tube in mid trachea Bone: no fracture Cardiac: no cardiomegaly Diaphragm: symmetric Effusion...$

What has changed on
his chest X-ray?
2 days later the patient has
been extubated and
transferred to the floor. His
NG tube...

- ET tube removed
- Right arm PICC over right
atrium (A)
- Left internal jugular CVC
terminates at level of left
innominat...

Summary of This Month’s Diagnoses
• Subcutaneous air and lung herniation
• Severe osteopenia
• Bronchiolitis
• Severe Cons...