Pediatric Radiology for R a ngsit medical students

1. PediatricRadiologyforRangsitmedicalstudents WarangkanaRatanaprakarn, MD. NarongNithipanya, MD. BunyapunKarnjanalux QueenSirikitNationalInstituteofChildHealth

2. PEDIATRIC RADIOLOGY CHEST ABDOMEN BONE SKULL

3. RESPIRATORY DISTRESS IN NEWBORNPULMONARY CAUSES

4. NORMAL NEWBORN CHEST 1. AERATION : Right dome is at right posterior 8th rib 2. LUNG DENSITY : = Bowel gas 3. CARDIOTHYMIC SHADOW : Cardiothoracic ratio ~ 57 - 60% Thymus : Superoanterior mediastinal soft tissue 4. THORACIC CAGE : Rounded cephalic portion 5. POSITIONING : Aware of rotation ( miss to be mediastinal shift )

5. Normal chest

6. Normalchest

7. Normal thymus

8. Expiration film

9. Inspiration film

10. RESPIRATORY DISTRESS SYNDROME (RDS)or HYALINE MEMBRANE DISEASE Predisposing factor : Prematurity Pathophysiology : Deficiency of surfactant Alveolar atelectasis Interstitial edema Detachment of epith. & leakage of interstitial fluid into alveoli = hyaline membrane formation Increased distance between cap. endoth.& alveolar epith. Poor gas exchange

11. RDS : X-RAY FINDINGS • Hypoaeration ( right dome is at or above posterior 7th rib ) • Diffuse, bilateral fine granular or ground-glass opacity with air bronchogram • Onset 0-2 hours , definite change at 6 hours • Severity : Mild = little alveolar process Severe = obliteration of cardiac border • Pitfall : with positive pressure ventilation , pattern of hypoaeration may be absent • Complication : pulmonary hemorrhage, BPD, barotrauma ( PIE, pneumothorax & ~mediastinum )

16. TRANSIENT TRACHYPNIA OF THE NEWBORN ( TTN ) OR WET LUNG DISEASE Predisposing factor : prematurity , C/S , maternal DM Pathophysiology : Delayed resorption of normal fetal lung fluid from : - deficiency of thoracic squeeze ( C/S ) - hypoproteinemia ( premy ) - hypervolumia

17. TTN :X-RAY FINDINGS • Normal to mild hyperaeration • Bilateral alveolar infiltration in initial film --> increased vascular markings in later film • Pleural effusion • Borderlined heart size to mild cardiomegaly • Course : usually improve in 24 - 72 hr. by conservative Rx • DDx : aspiration of clear amniotic fluid , hypervolumic condition ( polycythemia , CHF, etc )

18. M term AGA 6 hrs old , dyspnea after birth

19. 48 hours later

20. BBA, term 6 hrs old , cyanosis

23. MECONIUM ASPIRATION SYNDROME (MAS) • Predisposing factor : post term , SGA • Pathophysiology : Severe hypoxia in utero Gasping suck meconium-stained amniotic fluid into tracheobronchial tree Bronchial obstruction Diffuse obstruction --> acute cor pulmonale --> death Success resuscitation --> subsegmental atelectasis & focal areas of emphysema

24. MAS : X-RAY FINDINGS • Hyperaeration • Asymmetrical & scattered coarse patchy opacity & focal irregular aeration ( atelectasis and/or consolidsation & emphysema ) • Common with alveolar blow out complication : pneumothorax, pneumomediastinum , PIE • DDx , congenital pneumonia , hemorrhage

25. Post-term, 43 wk GA, birth asphyxia & thick meconium-stained amniotic fluid

28. BAROTRAUMA • Pneumothorax • Pneumomediastinum • Pulmonary interstitial emphysema ( PIE ) • Pneumopericardium • Pneumoperitoneum • Subcutaneous emphysema

30. Pneumomediastinum

31. Pneumopericardium