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

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Pediatric Chest X-Rays Of The Month
Nikki Richardson MD & Jennifer Potter MD
Department of Emergency Medicine
Carolinas Me...

Disclosures
 This ongoing chest X-ray interpretation series is proudly sponsored by the
Emergency Medicine Residency Prog...

Process
 Many are providing cases and these slides are shared with all contributors.
 Contributors from many CMC departm...

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 h...

5 month old full term
infant with history of
congenital pulmonary
airway malformation s/p
VATS 10 days prior presents
to h...

5 month old full term
infant with history of
congenital pulmonary
airway malformation s/p
VATS 10 days prior presents
to h...

14 month old male with a
history of dwarfism seen at
an outside ED for
tachypnea and fever.
Clinical deterioration with
de...

Crowded vasculature
Opacity of the right lower lobe
Elevation of right bronchus
14 month old male with a
history of dwarfi...

Dx: Right Lower Lobe Atelectasis
Crowded vasculature
Opacity of the right lower lobe
Elevation of right bronchus
14 month ...

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
Righ...

THE OPACITY MOVED!
Pneumonias don’t
move…atelectasis can!
Dx: Right Upper Lobe
Atelectasis
Triangle shaped opacity in RUL
...

THE OPACITY MOVED!
Pneumonias don’t
move…atelectasis can!
Dx: Right Upper Lobe
Atelectasis
Triangle shaped opacity in RUL
...

Atelectasis
• Defined: reduced lung inflation
• CXR features (that distinguish
atelectasis from consolidation):
• Elevatio...

Atelectasis: Patterns Based On Location
• Right Upper Lobe
• Triangular opacity
• Elevation of right hilum
• Rightward med...

Atelectasis: Patterns Based On Location
• Left Upper Lobe
• Loss of left upper heart border
• Elevated left hilum
• Luftsi...

Patient is a 12 year old
female with past medical
history of eosinophilic
esophagitis who presented
to the ED with feeling...

Patient is a 12 year old
female with past medical
history of eosinophilic
esophagitis who presented
to the ED with feeling...

Patient is a 12 year old
female with past medical
history of eosinophilic
esophagitis who presented
to the ED with feeling...

Dx: Esophageal obstruction
(achalasia by esophogram)
Abrupt tapering of the
esophagus
Patient is a 12 year old
female with...

7 year old female with no
past medical history
presents with intermittent
chest pain over the last 2
months with a normal
...

Right Upper Lobe Mass
7 year old female with no
past medical history
presents with intermittent
chest pain over the last 2...

Right Upper Lobe Mass
Dx: further imaging needed
7 year old female with no
past medical history
presents with intermittent...

7 year old female with no
past medical history
presents with intermittent
chest pain over the last 2
months with a normal
...

Right Upper Lobe Mass
Dx: Inflammatory
Myofibroblastic Tumor
(biopsy diagnostic)
7 year old female with no
past medical hi...

Surgical clips at the right hilum
Same 7 year old female
with now known history of
RUL tumor s/p VATS guided
biopsy 2 week...

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...

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 vom...

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
so...

What’s With These Kids?
For the next section, we will review a series of cases/images with a unifying diagnosis. Try
to id...

1 day old male with known
congenital abnormality
based on prenatal
screening admitted to NICU
Physical Exam: II/VI
holosys...

1 day old female with
known congenital
abnormality based on
prenatal screening
admitted to NICU
Physical Exam: II/VI
systo...

2 day old female with
known congenital
abnormality based on
prenatal screening
admitted to NICU for
hypoxia requiring CPAP...

1 day old male transferred
from outside hospital for
hypoxia requiring CPAP and
ultimately intubation with
an elevated lac...

1 day old female with
known congenital
abnormality based on
prenatal screening labs
born with hypoxia to the
80’s
Physical...

1 day old male with known
congenital abnormality
based on prenatal
screening labs born who
became apneic and
bradycardic u...

3 day old male with known
congenital abnormality
based on prenatal
screening labs born who
became apneic and
bradycardic u...

1 day old female with
known congenital
abnormality based on
prenatal screening labs
born and taken to NICU for
monitoring
...

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...

TGA: Associated Cardiac Abnormalities
• Isolated TGA is not compatible with life
• These defects allow for the mixing of
o...

TGA: Risk Factors
• Gestational diabetes
• Maternal exposures:
• Rodenticides
• Herbicides
• Maternal antiepileptic use
• ...

TGA: Clinical Presentation
• History:
• Blue skin
• Labored breathing
• Lack of appetite
• Poor weight gain
• Physical Exa...

TGA: Evaluation
• Hyperoxia test:
• No improvement in SAO2 after
oxygen administration
• EKG:
• Right axis deviation
• Rig...

TGA: Chest X-Ray Findings
• Egg-shaped heart
• Narrow mediastinum
• Increased pulmonary vascular
markings
https://radiopae...

Summary of This Month’s Diagnoses
• Tension pneumothorax
• Atelectasis
• Esophageal obstruction/achalasia
• Right upper lo...

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