Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery week 1

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Pediatric Chest X-Ray Case Studies
Dr. Nikki Richardson and Dr. Jennifer Potter
CMC Emergency Medicine
Carolinas Medical C...

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...

It’s All About The Anatomy!

3yo male with PMHx Down
Syndrome and AV canal
defect s/p repair presents
with cough and fever

RML infiltrates

3yo from urgent care with fever and vomiting

3yo from urgent care with fever and vomiting
LLL PNA

2yo ex 33wk premie with
fever x 7d, lethargy and
decreased PO intake
HR 190
Temp 105

2yo ex 33wk premie with
fever x 7d, lethargy and
decreased PO intake
HR 190
Temp 105
RUL PNA

12mo seen out OSH 3d prior with CXR
reported to show mild PNA and started on
azithromycin, presents today with labored
bre...

12mo seen out OSH 3d prior with CXR
reported to show mild PNA and started on
azithromycin, presents today with labored
bre...

500 cc Of
Purulent
Chest Tube
Output
DX: Parapneumonic effusion with shift
s/p pigtail thorocostomy
with significant
impro...

Healthy 5 Year Old
Treated With
Tamiflu For Flu
Symptoms,
Admitted With
Pneumonia

Healthy 5 Year Old
Treated With
Tamiflu For Flu
Symptoms,
Admitted With
Pneumonia
HD #1: LLL Pneumonia

Healthy 5 Year Old
Admitted With
Pneumonia

Healthy 5 Year Old
Admitted With
Pneumonia
HD #4: Chest Tube With Purulent Drainage

Healthy 5 Year Old
Admitted With
Pneumonia

Healthy 5 Year Old
Admitted With
Pneumonia
HD #14: After Video Assisted Thoracoscopic Surgery [VATS]
One Liter Of Pus Remo...

Air-Fluid Level: If It’s Flat There’s Air In There!

Healthy 5 Year Old Admitted With Pneumonia
HD #14: Pneumohydrothorax And Severe Pulmonary Necrosis/Trapped Lung (*)
Discha...

Pediatric Chest Tube Recommendations
• Consider what is it you have to drain
• Acute blood or air can easily be drained wi...

Cardiomegaly?
17mo previously healthy male presenting
with 2wks URI symptoms. Clinically well
appearing with stable VS
17y...

Cardiomegaly?
CXR = Enlarged cardiothymic silhouette,
normal pulmonary vascularity
CXR = prominent cardiac silhouette with...

Differentiating the Thymic Shadow
“thymic sail sign” is a triangular extension of the
normal thymus laterally
The anterior...

CXR Formal Read: “Impression:
Pulmonary vascular congestion
without focal consolidation”

$CXR Formal Read: “Impression: Pulmonary vascular congestion without focal consolidation” Review of imaging reveals fractur...$

9 yo male with hx of ASD and ADHD
presenting today after inhaling vs.
swallowing a thumbtack

Plastic thumbtack noted in the right hilum region on CXR,
discovered in the R mainstem bronchus on bronchoscopy

16mo female presents
with intermittent
inspiratory stridor x 3
days after an episode
of vomiting
Case 1

Initial CXR =
Hyperlucency and
increase in volume
of L lung when
compared to R lung
16mo female presents
with intermittent...

16mo male presents
with 3 days of fever
and wheezing
Case 2

Initial CXR =
No acute disease in
the chest
16mo male presents
with 3 days of fever
and wheezing
Case 2

Repeat CXR =
Hyperinflation of R
lung
16mo male presents
with 3 days of fever
and wheezing
Case 2 – Repeat Imaging

Next Step?

Next Step?
Lateral Decubitus Films

Next Step?
• Bilateral decubitus lateral films allows assessment of air-trapping caused by
an inhaled foreign body. The ex...

Case 1

R lateral decubitus film normalCase 1

R lateral decubitus film normalCase 1L lateral decubitus film = Relative Increase in
volume of L lung, raising concern for...

L lateral decubitus film normalCase 2R lateral decubitus film = Relative Increase in
volume of R lung, raising concern for...

Airway Foreign Body

Airway Foreign Body
Coin In The Esophagus

Airway Foreign Body

Coin In The Esophagus
Airway Foreign Body

Airway Foreign Body

Coin In The Esophagus
Airway Foreign Body

Airway Foreign Body

Button Battery In The Esophagus
Airway Foreign Body

Adults Aspirate Things To!

Coin Vs. Button Battery
• Why does it matter?
• An electric current is generated when the battery comes in contact with mu...

CXR are not only for pulmonary pathology
8mo present with fever and
cough, CXR obtained to r/o
infectious etiology. Lungs ...