final pediatric radiology
TRANSCRIPT
8/6/2019 Final Pediatric Radiology
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Pediatric Radiology
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COMMENT ON NORMAL CHEST:
� Plain X-Rays chest post-anterior view .
� The patient is centralized.
� Normal bony structures.
� Central mediastinum.� Normal cardio-thoracic ratio & cardiac position .
� Both lung f ields are clear with normal hilar shadow.
� Both costopherenic recesses are clear with normal cardio-pherenic angle.
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NORMAL
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Remember in each case:
1. Obtaining Clinical history.
2. Proper technique. i.e. Good exposure
3. Patient position i.e. centralized or not?.
4. Orientation of the f ilm , i.e. lef t or right
marked.5. Recognition of f ilm artif acts.
6. Systematic approach.
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Comment:
� Plain X-rays chest P.A. view.
� Normal bony cage.
� Central mediastinum.� Bilateral hyperinf lation of both lungs.
� Non-homogenous opacity occupying
the middle lobe of the right lung.� Diagnosis: mostly Rt. Middle lobe
pneumonia.
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Right upper lobe pneumonia
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Comment:
� Plain X-rays chest P.A. view.� Traction of mediastinum towards the
Rt. Side, with narrowing of ipsilateral ribs indicating volume loss.
� Non homogenous opacif ication f illing the Rt. Upper hemithorax.
� Compensatory hyperinf lation of Lt.lung.� D/ mostly Rt. Upper lobe pneumonia.
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Right upper lobe pneumonia
Trachea
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Comment:
� Lef t basal opacif ication rising towards the axilla.
� Oblitration of the Lt. costophrenic recess.� Compensatory hyperinf lation of Rt. Lung.
� Dignosis:
Lef t sided pleural eff usion, underlying parenchymal lesion could not be excluded.
? SYNPNEUMONIC EMP YEMA
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Right upper lobe pneumonia
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Comment:
� Massive homogenous opacif ication of the lef t hemithorax with obliteration of the Lt. costo-phrenonic angle.
� Shif ted mediastinum towards the contrlateral (Rt.) side.
� Underlying pathology of Lt. lung could not be excluded.
� D/ Lef t-sided massive pleural eff usion.
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� Homogenous opacification
oblitrarating the left costo-phrenic angle.
� Air-fluid level on the leftside.
� Dignosis:Left-sided
Hydropneumothorax
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Rt. Lower lobe pneumonia.Preser ved Rt. Costophrenic recess.It is NOT a case of pleural eff usion.
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Bilateral miliary shadows (highly suggestive of MILIARY T.B.)
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COMMENT:
� These PA and lateral chest radiograph views are taken in a 7-month old with miliary TB.
� There are multiple small nodules throughout the lungs bilaterally.
� There is a f ocal consolidation in the right upper lobe.
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Substantial clearing of the multiple small nodular densities and clearing of the right upper lobe consolidation af ter anti-tuberculous therapy
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Comment:
� Diff use air occupying the lef t hemithorax (Jet black , devoid of lung markings).
� Underlying collapse of the Lef t lung.
� Mediastinal shif t towards Rt. Side.
� A case of :Lef t-sided tension pneumothorax.
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Massive pleural eff usion with hydropneumothorax on the Lt. side.
Air -f luid level
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Herniation of the bowel into the lef t hemithorax with contralteral mediastinal shif t.
Dignosis: Congenital diaphragmatic hernia.
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Congenital diaphragmatic hernia.
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Congenital diaphragmatic hernia.
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Red arrow points to end of nasogastric tube blocked f rom entering the
distal esophagus.
Note the gasless abdomen«
(ESOPHAGEALATRESIA)
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Ground glaas appearance.
Diminished lung volume
Air bronchogram.
(H YALINE MEMBRANEDISEASE)«..
Versus congenital pneumonia..
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PNEUMOTHORAX
COLLAPSED
LUNG
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H YALINE MEMBRANE DISEASE
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Right upper lobe large thin-walled pneumatocele
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Comment:
� Massive hyperinf lation of the lef t lung with mediastinal herniation.
� Signif icant mediastinal shif t with collapse of the contralateral right lung.
CONGENITAL LOBAR EMPH YSEMA.
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Chest radiograph showing lef t lower lobe consolidation with large cavitary lesion. (Lung abscess)
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Rt. upper and middle lobe massive pneumonia
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Comment:
� Jet black air with underlying lung collapse of the Rt. Lung.
� Evident line of demarcation between air and the collapsed lung.
� No signif icant mediastinal shif t.
Rt-sided pneumothorax.
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PNEUMOMEDIATINUM
(A cushion of air delineating the heart)
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Lt. sided pneumothorax
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Rt. middle lobe pneumonia
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Air -f luid level- H YDROPNEUMOTHORAX on Rt. side.
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Comment:
� Bilateral nodular opacities with fluffy cottonappearance infiltrating both lung fields.
� Ring shadow with well-delineated wall
occupying the right upper lobe. (lungabscess).
� This picture is highly suggestive of
extensive bronchopneumoniamostly in an immuno-compromisedsubject.
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Wavy sail appearance of normal thymus on right.
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Lef t-sided Massive pleural eff usion
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Rt. upper lobe pneumonia
Highly suggestive of aspiration pneumonia.
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Bronchial asthma
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Comment:
� Bilateral hyperinflation of both lungs ( jet black
lung fields) with increased volume .
� Flattened copulae of diaphragm .
� widened intercostal spaces .
� Vertical cardiac shadow .
� Features are highly suggestive of air trapping :
1.Bronchial asthma (acute attack)2.Emphysema (older patients)
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Bilateral hyperinf lation (asthma)
with Rt upper lobar consolidation
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Comment:
� Patchy or fluffy infiltrates of ill-defined
margins distributed throughout both lung
fields.
� Picture of bilateral extensive
bronchopneumonia
? Staphylococcal
? Fungal
? pneumocystis carinii
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Lung abscess in the right middle lobe
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Rt. Pleural eff usion with shif ted mediastinum
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Bilateral basal Bronchiactatic changes
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Lung abscess in the Lt. upper lobe
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Lef t-sided Plural eff usion
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Conf luent bronchopneumonic changes
on the Rt. side
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Bilateral extensive bronchopneumonic changes f or diff erential diagnosis
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Right-sided Pleural eff usion
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Rt. upper lobe pneumonia
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Lef t-sided massive pleural eff usion
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SKELETAL SYSTEM
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� Plain X-ray wrist joint showing:
� Decreased bone density.
� Broadening, cupping and f raying of distal ends of radius and ulna.
� Wide distance between distal ends of radius and ulna & car pal & metacar pal bones.
DIAGNOSIS: ACTIVE RICKETS
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ACTIVE RICKETS
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ACTIVE RICKETS
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ACTIVE RICKETS
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AN OSTEOLYTIC LESION OF THE SKULL.D.D. HISTIOCYTOSIS VERSUS METASTASIS
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Protruded maxilla, and characteristic SUN-RAYS appearance.D/ chronic hemolytic anemia mostly beta-thalassemia ma jor
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MULTIPLE OSTEOLYTIC LESIONS
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H
AIR STANDING ON AN END ORSUN-RAYS APPEARANCE
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RACHITIC ROSARIES
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Bat-man appearance of skull and separation of the sutures
(OSTEOPETROSIS)
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LATERAL Plain f ilm of skull showing generalized increased density and thickening of the skull base and calvarium.
(OSTEOPETROSIS)
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Chest f ilm shows generalized increased density of the bones and squaring off of the
anterior rib margins. (OSTEOPETROSIS)
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X-RAY ABDOMEN STANSDING
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MULTIPLE AIR-FLUID LEVELS.MOSTLY LARGE BOWEL OBSTRUCTION
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DOUBLE-BUBBLE SIGN.
CH
ARACTERISTIC FOR DUODENAL ATRESISA.
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AIR UNDER DIAPHRAGM
PERFORATED VISCUS
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MULTIPLE AIR-FLUID LEVELS (gasless pelvis).MOSTLY INTESTINAL OBSTRUCTION
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AIR UNDER DIAPHRAGM
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Plain abdomen: Hugely dilated colon
Hirschsprung disease
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NORMAL Barium enema
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NORMAL Barium enema
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Barium enema:
Dilated colon with loss of haustrations.
Hallmark f inding isconical transition f rom
distal nondilated rectum to proximal dilated colon
Hirschsprung disease
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Hirschsprung disease
Transition
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Red arrows point to linear bands of radiolucency which parallel the wall of the bowel indicating the presence of
pneumatosis intestinalis in necrotizing enterocolitis
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Necrotizing enterocolitis in lateral decubitus f ilm
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HEART
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Normal cardio-thoracic ratio is 1:2 (50%)
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Cardiomegaly
Lobar pneumonia
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Diff erential diagnosis of cardiomegaly
� Most important causes are:
Pericardial eff usion
Dilated cardiomyopathy
Rheumatic H.D. with multi-valvular aff ection
Congestive heart f ailure.
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COMMENT
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COMMENT:
� Pulmonary oligemia.
� Small-sized heart with right ventricular (supra-diaphragmatic apex).
� The lef t cardio-phrenic angle is acute.
� Heart is characteristically BOOT-SHAPED. (Coeur en Sabot Sign).
� These f indings are highly suggestive of
TETRALOGY OF FALLOT
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DIAGNOSIS: Tetralogy of Fallot (TOF) - Coeur en Sabot Sign
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Bilateral pulmonary venous congestion
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Bilateral pulmonary edema
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Huge Cardiomegaly.The heart is f lask-shaped and well-delineated.Mostly pericardial eff usion.
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TH
ANK YOU