Interpretación de la Radiografía de Tórax en Pediatría

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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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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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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Interpreting Pediatric

Chest X-Rays


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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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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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Children Are Different

Chest X-rays change with age Cooperation may be limited

The thymus can cause confusion


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Chest X-rays Change withAge


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Normal 3 Year Old


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Normal 12 Year Old


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12 year old

3 year old


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One View or Two?


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Foreign Body Aspiration


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Foreign Body Aspiration


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More Than 2 Views


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Lateral Decubitus X-rays


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Cooperation May Be Limited


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Inspiration

Expiration


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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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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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The Thymus


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The Normal Thymus

Infant Adolescent


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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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The Sail and Wave Signs


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Thymic Rebound


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Thymic Rebound

Child with Acute Leukemia

DuringTreatment

AfterTreatment


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Two Special Places to Look


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"Experience is a hard teacher

because she gives the testfirst, the lesson afterwards."

-- Vernon Saunders Law


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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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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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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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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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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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Thank You for Your

Attention

Alan Brody

[email protected]


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Interpretación de la Radiografía de Tórax en Pediatría

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