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Practical approach to the pediatric chest Xray

Practical approach to the pediatric chest Xray. Valoraction practica de la RX de torax. IX Congress of the Latin American Society of Pediatric Radiology Buenos Aires on September 7-9, 2005. Mutsuhisa Fujioka, M.D. Chairman, The Asian and Oceanic Society for Pediatric Radiology

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Practical approach to the pediatric chest Xray

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  1. Practical approach to the pediatric chest Xray Valoraction practica de la RX de torax IX Congress of the Latin American Society of Pediatric Radiology Buenos Aires on September 7-9, 2005 Mutsuhisa Fujioka, M.D. Chairman, The Asian and Oceanic Society for Pediatric Radiology Professor and Chairman, Department of Radiology, Dokkyo University School of Medicine

  2. http://www.aospr.org/

  3. Journal

  4. Editorial board members Managing Editors (Africa, Asia, Australasia, Europe, and elsewhere outside the Americas) Dr. S. Chapman The Birmingham Children’s Hospital NHS Trust Steelhouse Lane Birmingham B4 6NH United Kingdom steve.chapman@bch.wmids.uk (The Americas) Dr. T. L. Slovis Children’s Hospital c/o: CRCM 3901 Beaubien Boulevard Detroit, MI 48201, USA pedradeditor@med.wayne.edu Assistant Editors Dr. D. Frush Duke University Medical Center Div of Pediatric Radiology (Box 3808) 1905 McGovern Davison Children’s Hlth. Ctr. Durham, NC 27710, USA frush943@mc.duke.edu Dr. G. Sebag Department of Paediatric Radiology Hồpital Robert Debré 48, boulevard Sérurier 75935 Paris Cedex, France guy.sebag@rdp.ap-hop-paris.fr Honorary Editor Dr. W. E. Berdon Columbia Presbyterian Medical Center, Babies Hospital Dept of Radiology (3-318) 3959 Broadway New York, NY 10032-1590, USA Web2@columbia.edu Editorial Board Cardiovascular T. Chung, Houston J. A. Culham, Vancouver M. Oddone, Genoa S. Laurin, Lund C. Holmqvist, Lund Chest V. Donoghue, Dublin E. Effmann, Seattle M. Fujioka, Utsunomiya J. Lucaya, Barcelona B. Newman, Pittsburgh Education J. Reid, Cleveland J-N. Dacher, Rouen Experimental Design K. Applegate, Indianapolis Genetics – Molecular Imaging R. Lachman, Santa Monica W. McAlister – St. Louis General Paediatric Radiology S. Andronikou, Cape Town M. Argyropoulou, Ioannina P. Babyn, Toronto A. Daneman, Toronto H. Ducou Le Pointe, Paris F. Gudinchet, Lausanne I-O, Kim, Seoul H. Lederman, San Paulo P. Strouse, Ann Arbor G. Taylor, Boston R. Teele, Auckland Gastrointestinal G. Benz-Bohm, Cologne D. Bloom, Detroit D. Eggli, Hershey M. Hernanz-Schulman, Nashville K. McHugh, London D. Pariente, Bicetre C. Sivit, Cleveland Interventional P. Chait, Toronto P. Clapuyt, Brussels J. Donaldson, Chicago D. Roebuck, London R. Towbin, Philadelphia Musculoskeletal M. Azouz, Miami H. Carty, Liverpool C. Hall, London D. Jaramillo, Boston G. Kalifa, Paris M. Keller, Wilmington T. Laor, Cincinnati Neuroradiology C. Adamsbaum, Paris N. Boddaert, Paris F. Brunelle, Paris B. Koch, Cincinnati M. Nelson, Los Angeles C. Robson, Boston Y. Sato, Iowa City Oncology H. Brisse, Paris S. Kaste, Memphis J. Meyer, Wilmington C. Owens. London Perinatal C. Garel, Paris L. Garel, Montreal L. Guibaud, Lyon E. Simon, Philadelphia Technology M. Claudon, Nancy W. Huda, Syracuse T. Metens, Brussels W.K. Rorhschneider, Heidelberg K. White, Salt Lake City C. Willis, Houston P. Winkler, Stuttgart Uroradiology F. Avni, Brussels B. Coley, Columbus K. Darge, Wuerzburg R. Fotter, Graz U. Willi, Zurich M. Zerin, Detroit Book Reviews J. Haller, Teaneck M. Hassan, Paris Statistics, Information, Technology and Editing H. Fischer, Detroit W. Grever, Detroit R. Thomas, Detroit Manuscripts must be sent to the appropriate Managing editor only. Please ensure that the manuscript complies with the “Instructions to authors: at http://link.springer.de/link/service/journals/00247/instr.htm

  5. A practical approach to the pediatric chest radiograph Steps for reading 1.Detection 2.Differentiation

  6. What are we looking for? Change in size and shape of normal anatomical structures. Soft tissue, bones, heart, aorta, trachea, main bronchi, thymus, hili, esophagus, pleura, diaphragms, pulmonary arteries, veins, bronchial walls, gastric air bubble, liver, spleen

  7. What are we looking for? Abnormality(increased or decreased opacity) which should not be present in normal individual

  8. Increased lung opacity • ground-glass opacity(haziness) • consolidation • nodule or mass • linear, reticular or band like shadow • calcification

  9. Decreased lung opacity and cystic abnormalities • hyperlucency(air trapping or pneumothorax) • lung cyst or bulla • honeycomb • cavitary nodule or mass • cystic bronchiectasis

  10. Features of Lung Diseasein High Resolution CT Ground-Glass Opacity Consolidation Pulmonary Nodule Bronchiolar Disease and Tree-in-Bud Air Trapping Septal Thickening Parenchimal Bands Honeycombing Mosaic Perfusion Architectural Distortion Air-Filled Cystic Lung Lesions Dependent Increased Attenuation Emphysema Halo Sign Signet Ring Sign Crazy Paving Pattern

  11. The main role of HRCT is to differentiate fine pathological abnormality.

  12. Change in size and shape of normal anatomical structures can rather be easier to be detected by the findings of chest radiograph rather than those of CT.

  13. Therefore for adequate interpretation of pediatric chest radiographs, we should be aware of gross abnormal findings which might be overlooked by particular reasons.

  14. However it is very important to know what kind of abnormality is not demonstrable on usual chest radiograph but well demonstrated on CT or HRCT.

  15. Detection of abnormal findings Quiz 1 Any abnormality in the lung in a child with cough and fever ?

  16. Pneumonia and/or atelectasis at the left S8 Positive silhouette sign of the left hemidiaphragm

  17. Detection of Pneumonia using Silhouette sign 2yo Bilateral pneumonia: Lingula of the left upper lobe, right lower lobe

  18. Detection of Pneumonia using Silhouette sign Positive SS along left cardiac border 2yo Bilateral pneumonia: Lingula of the left upper lobe, right lower lobe

  19. Detection of Pneumonia using Silhouette sign Negative SS along right cardiac border 2yo Bilateral pneumonia: Lingula of the left upper lobe, right lower lobe

  20. How to detect abnormal findings silhouette sign silhouette out (Positive silhouette sign) Pneumonia and/or atelectasis of the lingula of the left upper lobe

  21. Subsegmental pneumonia of the S10of the left lower lobe Positive silhouette sign of the posterior portion of the left hemidiaphragm

  22. Detection of abnormal findings Quiz 2 Any abnormality in the central shadow in a child with habitual vomiting?

  23. Esophageal achalasia Esophageal achalasia

  24. Mediastinal interfaces and lines anterior junction line posterior junction line azygoesophageal line aortic-pulmonic window aortic pulmonary stripe left paraspinal line right paratracheal stripe posterior tracheal band（lateral） tracheo-esophageal stripe（lateral） aortic nipple How to detect abnormal finding

  25. azygoesophageal line left paraspinal line

  26. Yoon HK, et al: Mediastinal interfaces and lines in children: radiographic-CT correlation. Pediatr Radiol(2001)31:406-412 Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Two mediastinal lines, the anterior and posterior junction lines, are occasionally seen on normal plain radiographs. The descending aorta and SVC interfaces are commonly seen on normal chest radiographs; their absence may suggest mediastinal or pulmonary abnormalities. The azygoesophageal and left paraspinal interfaces are not commonly seen on normal chest radiographs.

  27. mediastinal reflection Abnormal shadow hidden by the central shadow or the diaphragmatic domes right paratracheal stripe

  28. Abnormality of the right paratracheal stripe tracheal bronchus atelectasis tracheal bronchus(pig bronchus)

  29. Abnormality of the right paratracheal stripe Double aortic arch Tracheal displacement

  30. azygos line, paraesophageal line

  31. cervicothoracic sign neuroblastoma

  32. posterior mediastinal line neuroblastoma

  33. ＡＬＬ　extramedullary infiltrates

  34. Tracheal displacement Tracheal displacement Bronchogenic cyst

  35. Tracheal displacement Tracheal displacement Bronchogenic cyst

  36. Tracheal displacement Tracheal displacement Bronchogenic cyst

  37. Pneumomediastinum from asthmatic attack

  38. Detection of abnormal findings Quiz 3 Any abnormality in the lung in a child with abdominal pain ?

  39. Right basilar pneumonia detection of basilar pneumonia on an abdominal radiograph

  40. Below the margin of the diaphragamatic domes How to detect abnormal finding

  41. Lesions hidden by the diaphragmatic domes Appendicitis ?

  42. Right basilar pneumonia diaphragm pneumonia Plain abdomen Ultrasonography

  43. Pulmonary metastasis of Wilms tumor ＣＴ

  44. infrapulmonary effusion Decubitus view Ultrasonography

  45. Detection of abnormal finding Quiz 4 Any nodule suggesting metasasis of Wilms tumor ?

  46. A pulmonary metastasis of Wilms tumor

  47. How to detect abnormal finding Atelectasis of Ｓ8of the left lower lobe

  48. Detection of abnormal findings Quiz 5 Any evidence of peanut aspiration ?

  49. Peanut aspiration Air trapping of the left lung due to check valve mechanism Expiratory phase Inspiratory phase

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