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8/3/2019 Interpretacin de la Radiografa de Trax en Pediatra
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Alan S. Brody September 8, 2005
Interpreting Pediatric
Chest X-Rays
Alan S. Brody, M.D
Professor of Radiology and Pediatrics
Chief, Thoracic ImagingCincinnati Childrens Hospital
Cincinnati, OhioUSA
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Alan S. Brody September 8, 2005
For People Who Write Notes
Write down my email address:[email protected]
Put down your pen or pencil
Write me for anything you need
Slides at:http://www.cincinnatichildrens.org/research/div/radiology/present.htm
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Alan S. Brody September 8, 2005
Three Talks This Morning
Interpreting pediatric chest X-rays High-resolution CT scanning in children
After the chest X-ray, what to do next
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Alan S. Brody September 8, 2005
Interpreting Pediatric
Chest X-Rays
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Alan S. Brody September 8, 2005
Chest X-rays
Provide a great deal of information Are less expensive than other imaging
and use very, very little radiation
Often provide the information that tellsus we need to do additional imaging
Can be hard to interpret in children
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Alan S. Brody September 8, 2005
Interpreting Pediatric ChestX-Rays
Chest X-rays look different in children Children have different diseases
There are special places to look whenreading a pediatric chest X-ray
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Alan S. Brody September 8, 2005
Children Are Different
Chest X-rays change with age Cooperation may be limited
The thymus can cause confusion
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Alan S. Brody September 8, 2005
Chest X-rays Change withAge
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Alan S. Brody September 8, 2005
Normal 3 Year Old
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Alan S. Brody September 8, 2005
Normal 12 Year Old
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Alan S. Brody September 8, 2005
12 year old
3 year old
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Alan S. Brody September 8, 2005
One View or Two?
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Alan S. Brody September 8, 2005
Foreign Body Aspiration
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Alan S. Brody September 8, 2005
Foreign Body Aspiration
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Alan S. Brody September 8, 2005
More Than 2 Views
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Alan S. Brody September 8, 2005
Lateral Decubitus X-rays
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Alan S. Brody September 8, 2005
Cooperation May Be Limited
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Inspiration
Expiration
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Alan S. Brody September 8, 2005
Heart Size
In newborns, can be a little more thanhalf the width of the chest
The lateral film is often more accuratethan the frontal film
A good breath is required to judge heart
size
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Lung Volume Affects theAppearance of the Heart
Expiration Inspiration
Heart Size Changes Much More
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Heart Size Changes Much MoreOn the Frontal than the Lateral
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? Large Heart ?
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Alan S. Brody September 8, 2005
Improving Interpretation ofChildrens Chest X-rays
Make a file of chest X-rays of normalchildren at different ages
Get 2 views of the chest
Repeat low volume or rotated X-rays
Someone who enjoys working with
children will get better X-rays
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Alan S. Brody September 8, 2005
The Thymus
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Alan S. Brody September 8, 2005
The Normal Thymus
Infant Adolescent
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Alan S. Brody September 8, 2005
The Thymus
Increases in size from birth to puberty,but the child grows more, so the thymusappears smaller in older children
Is highly variable in size andappearance
Can shrink within hours due to illness
May increase suddenly in size,especially after chemotherapy
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Alan S. Brody September 8, 2005
The Sail and Wave Signs
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Alan S. Brody September 8, 2005
Thymic Rebound
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Alan S. Brody September 8, 2005
Thymic Rebound
Child with Acute Leukemia
DuringTreatment
AfterTreatment
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Alan S. Brody September 8, 2005
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Alan S. Brody September 8, 2005
Two Special Places to Look
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Alan S. Brody September 8, 2005
"Experience is a hard teacher
because she gives the testfirst, the lesson afterwards."
-- Vernon Saunders Law
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Alan S. Brody September 8, 2005
A Test Five Children
One has a vascular abnormality
One is suffering
One has cancer
One has pneumonia
One is normal
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Infant with Noisy Breathing
8 Month Old with Tachypnea
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8 Month Old with Tachypnea
One Year Old with Lethargy
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One Year Old with Lethargy
Two Year Old with Cough
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Two Year Old with Cough
3 Year Old with A Palpable Mass
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3 Year Old with A Palpable Mass
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Alan S. Brody September 8, 2005
Diagnoses
Vascular ring caused by a double aorticarch
Rib fractures from child abuse
Paraspinous neuroblastoma
Round pneumonia
Bifid anterior rib
V l Ri
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Vascular Ring
V l Ri
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Vascular Ring
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Right Aortic Arch
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g t o t c c
Rib Fractures from Child Abuse
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15 Month Old
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Posterior Rib Fractures
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Neuroblastoma
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Neuroblastoma
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Density and Abnormal Rib
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Round Pneumonia
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Alan S. Brody September 8, 2005
Round Pneumonia Symptoms of pneumonia
Lower lobe location
Children 8 years old or younger
No evidence of chest wall abnormality
Pneumococcus
Another chest X-ray in 1 to 2 weeksshould show improvement
Bifid Right 4th Rib
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Alan S. Brody September 8, 2005
Bifid Rib Common anatomic abnormality
Frequently presents as an asymptomatic hardmass
Anterior chest wall masses with normal chestX-rays do not require further imaging
Donnelly et al. Radiology. 1997 Mar;202(3):829-31.
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Alan S. Brody September 8, 2005
Conclusion Pediatric chest X-rays are challenging
Reference images and high qualitystudies help with interpretation
Take an extra look at the ribs and thetrachea
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Alan S. Brody September 8, 2005
Thank You for Your
Attention
Alan Brody
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Alan S. Brody September 8, 2005