Chest X-ray child
The basic principles about the chest X-ray examination of a child.
Checklist
In evaluating a chest x-ray in children, many of the same assessment criteria apply as those described in the module Chest X-ray :
- Technique: how was the x-ray taken? (PA or AP) Is everything visible? Rotation? Good inspiration when the x-ray was taken?
- Artificial lines (if present): position of drains/deep venous catheters/endotracheal tube/nasogastric tube/duodenal feeding tube/umbilical venous and artery catheters?
- Mediastinum: is the thymic volume proportionate to the patient’s age? (the thymus can be visible up until approximately 5 years of age). Variations in thymic shape (thymic notch sign, thymic sail sign)? Pneumomediastinum?
- Lung hila: are the hila well defined? Can everything be explained by blood vessels?
- Lungs: symmetrical pulmonary vascular markings? Accentuated pulmonary vascular markings? (coarse or fine?) Normal tapering to the periphery? Bronchial wall thickening? Consolidations? Atelectasis?
- Heart: are the cardiac outlines well defined? Can you see through the heart well?
- Pleura: pleural effusion? pleural enlargement? pneumothorax?
- Subdiaphragmal: dilated intestines? In preterm and full-term infants, the interpedicular distance of L2 is the distance applied for the maximum diameter of the intestines (small and large intestine). This will not be discussed further during this module.
- Soft tissues: subcutaneous emphysema? Are there (obscuring) abnormalities, e.g. of the skin?
- Bone: ribs intact? Anomalies? Bone lesions?
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Text
drs. A. van der Plas (MSK radiologist Maastricht UMC+)
Dr. I. Altmann-Scheider (fellow pediatric radiologist, Wilhelmina Kinderziekenhuis/Prinses Maxima Centrum)
Dr. A. Brandts (pediatric radiologist)
With special thanks to:
drs. M. Tijssen (Pediatric radiologist, Maastricht UMC+)
Illustrations
drs. A. van der Plas (MSK radiologist Maastricht UMC+)
Sources:
- Imaging acute airway obstruction in infants and children, Darras et al., Radiographics2015.
- Werkboek kinderradiologie, Lameer-Engel en Martijn et al., Stichting Bevordering Kinderradiologie 2003.
- Pediatric imaging, The fundamentals, L.F. Donelly,2009
- Evaluation of Umbilical Catheter and Tube Placement in Premature Infants, Lakshmana Das Narlaetal., Radiographics1991.
- Interstitial Lung Diseases in children made easier…Well, Almost. T.R. Semple et al., Radiographics2017.
21/05/2020
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