الله بسمالرحيم الرحمن

Pediatric Radiology

Postero-Anterior View

Normal cardio-thoracic ratio is 1:2 (50%)

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 fields are clear with normal hilar shadow.

• Both costopherenic recesses are clear with normal cardio-pherenic angle.

NORMAL

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 film , i.e. left or right marked.

5. Recognition of film artifacts.

6. Systematic approach.

Comment:

• Plain X-rays chest P.A. view.

• Normal bony cage.

• Central mediastinum.

• Bilateral hyperinflation of both lungs.

• Non-homogenous opacity occupying the middle lobe of the right lung.

• Diagnosis: mostly Rt. Middle lobe pneumonia.

Right upper lobe pneumonia

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 opacification filling the Rt. Upper hemithorax.

• Compensatory hyperinflation of Lt. lung.

• D/ mostly Rt. Upper lobe pneumonia.

Right upper lobe pneumonia

Trachea

Comment:

• Left basal opacification rising towards the axilla.

• Oblitration of the Lt. costophrenic recess.

• Compensatory hyperinflation of Rt. Lung.

• Dignosis:Left sided pleural effusion, underlying

parenchymal lesion could not be excluded.

? SYNPNEUMONIC EMPYEMA

Right upper lobe pneumonia

Comment:

• Massive homogenous opacification of the left hemithorax with obliteration of the Lt. costo-phrenonic angle.

• Shifted mediastinum towards the contrlateral (Rt.) side.

• Underlying pathology of Lt. lung could not be excluded.

• D/ Left-sided massive pleural effusion.

• Homogenous opacification oblitrarating the left costo- phrenic angle.

• Air-fluid level on the left side.

• Dignosis:Left-sided

Hydropneumothorax

Rt. Lower lobe pneumonia.Preserved Rt. Costophrenic recess.It is NOT a case of pleural effusion.

Bilateral miliary shadows (highly suggestive of MILIARY T.B.)

Comment:

• Diffuse air occupying the left hemithorax (Jet black , devoid of lung markings).

• Underlying collapse of the Left lung.

• Mediastinal shift towards Rt. Side.

• A case of:Left-sided tension pneumothorax.

Massive pleural effusion with hydropneumothorax on the Lt. side.

Air-fluid level

Herniation of the bowel into the left hemithorax with contralteral mediastinal shift.

Dignosis: Congenital diaphragmatic hernia.

Congenital diaphragmatic hernia.

Congenital diaphragmatic hernia.

Ground glaas appearance.

Diminished lung volume

Air bronchogram.

(HYALINE MEMBRANE DISEASE)…..

Versus congenital pneumonia..

PNEUMOTHORAX

COLLAPSED LUNG

HYALINE MEMBRANE DISEASE

Right upper lobe large thin-walled pneumatocele

Rt. upper and middle lobe massive pneumonia

Comment:

• Jet black air with underlying lung collapse of the Rt. Lung.

• Evident line of demarcation between air and the collapsed lung.

• No significant mediastinal shift.

Rt-sided pneumothorax.

Lt. sided pneumothorax

Rt. middle lobe pneumonia

Air-fluid level- HYDROPNEUMOTHORAX on Rt. side.

Comment:

• Bilateral nodular opacities with fluffy cotton appearance infiltrating both lung fields.

• Ring shadow with well-delineated wall occupying the right upper lobe. (lung abscess).

• This picture is highly suggestive of extensive bronchopneumonia mostly in an immuno-compromised subject.

Wavy sail appearance of normal thymus on right.

Left-sided Massive pleural effusion

Rt. upper lobe pneumoniaHighly suggestive of aspiration pneumonia.

Bronchial asthma

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)

Bilateral hyperinflation (asthma) with Rt upper lobar consolidation

Comment:

• Patchy or fluffy infiltrates of ill-defined margins distributed throughout both lung fields.

• Picture of bilateral extensive bronchopneumonia

? Staphylococcal? Fungal? pneumocystis carinii

Rt. Pleural effusion with shifted mediastinum

Lung abscess in the Lt. upper lobe

Left-sided Pleural effusion

Bilateral extensive bronchopneumonic changes for differential diagnosis

Right-sided Pleural effusion

Rt. upper lobe pneumonia

Left-sided massive pleural effusion

SKELETAL SYSTEM

• Plain X-ray wrist joint showing:

• Decreased bone density.

• Broadening, cupping and fraying of distal ends of radius and ulna.

• Wide distance between distal ends of radius and ulna & carpal & metacarpal bones.

DIAGNOSIS: ACTIVE RICKETS

ACTIVE RICKETS

ACTIVE RICKETS

ACTIVE RICKETS

Protruded maxilla, and characteristic SUN-RAYS appearance. D/ chronic hemolytic anemia mostly beta-thalassemia major

HAIR STANDING ON AN END OR SUN-RAYS APPEARANCE

RACHITIC ROSARIES

X-RAY ABDOMEN STANSDING

MULTIPLE AIR-FLUID LEVELS.MOSTLY LARGE BOWEL OBSTRUCTION

DOUBLE-BUBBLE SIGN. CHARACTERISTIC FOR DUODENAL ATRESISA.

AIR UNDER DIAPHRAGMPERFORATED VISCUS

MULTIPLE AIR-FLUID LEVELS (gasless pelvis).MOSTLY INTESTINAL OBSTRUCTION

MULTIPLE AIR-FLUID LEVELS (small and large bowel).MOSTLY PARALYTIC ILEUS

AIR UNDER DIAPHRAGM

HEART

Normal cardio-thoracic ratio is 1:2 (50%)

CardiomegalyLobar pneumonia

Differential diagnosis of cardiomegaly

• Most important causes are:

Pericardial effusion Dilated cardiomyopathy Rheumatic H.D. with multi-valvular affection Congestive heart failure.

COMMENT:

• Pulmonary oligemia.

• Small-sized heart with right ventricular (supra-diaphragmatic apex).

• The left cardio-phrenic angle is acute.

• Heart is characteristically BOOT-SHAPED. (Coeur en Sabot Sign).

• These findings are highly suggestive ofTETRALOGY OF FALLOT

DIAGNOSIS:  Tetralogy of Fallot (TOF) - Coeur en Sabot Sign

Bilateral pulmonary venous congestion

Bilateral pulmonary edema

Huge Cardiomegaly.The heart is flask-shaped and well-delineated.Mostly pericardial effusion.

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