X-rays in Children - Lecture Flashcards
(25 cards)
Cardiomegaly in x-ray in children
- If over 55% of cardiothoracic space
Size of thymus on x-ray
- Biggest at 2yrs old
- Can continue to grow ito adolescence
- If small - screen for DiGeorge
- Usually occupies R upper lobe - sail sign - if large
What can consolidation be on CXR?
- Could be infection, collapse of lung, effusion
- If treat with physio and improvement - suggests collapse
Appear very similar in children
When to Xray neonate for resp distress?
- Usually wait 4 hrs if well - can just be TTN
Lower lobe vs middle lobe differentiating in CXR
- If diaphragm obliterated - lower lobe
- If cardiac border gone - middle lobe
R lung has 3 lobes
What is shown here?
- Congenital lobar emphysema
- Appears as hyperinflated lung on one side
- Shifts structures away from inflation
- Presents with poor feeding and rapid breathing, failure to thrive
- Requires surgery later on
What is shown here?
- Congenital cystic adenomatoid malformation
- Non cancerous mass located in 1 part of lung
- Need surgery if large cyst, failure to thrive or repeated infections
What is this?
- Congenital diaphragmatic hernia
- Oxygenate poorly
- Need resus at birth
- Affects alveolar growth in utero - outcome is poor
What are the tubes shown in image?
Umbilical line - arterial and venous
What are the lines shown here?
ECMO lines
* Can do venous or venous and arterial
* If just venous - rest for lungs - used for meconium aspiration, quick recovery
* If both - lung and cardiac rest
Two common types of diaphragmatic hernia
- Posterior lateral - most common (foramen of bochdalek) - always causes problem
- Foramen of morgagni hernia is a lot less severe
If occurs early - causes more harm, impairs more growth. If later causes less harm = different outcomes
Consequences of CDH
- Pulmonary hypoplasia
- Pulmonary hypertension
What can cause raised hemidiaphragm?
- Diaphragm paresis/paralysis
Can occur post cardiac surgery
Would see paradoxical breathing - breathing in causes inward movement of chest
OR
* Eventration - muscle replaced by fibrous tissue
Eventration shown
What is choanal atresia?
What is shown here?
Oesophageal atresia +/- tracheooesophageal fistula
* Stomach filled with gas if fistula
* Coiling of NG due to atresia
* Need surgery to fix - TPN/PEG in meantime
* Cannot be sent home - need regular suction to remove saliva (otherwise this will pool and aspirate)
Need to put firm tube in instead
Which type is most common of tracheooesophageal fistula?
Type C - fistula betweem stomach and trachea
How can VSD present in neonates?
- Hepatomegaly - sign of HF on children
- VSD murmur may not present until 6-8 weeks of life
- Centile dropping, breathless while feeding but not cyanotic
How does bronchiolitis appear on CXR?
- RUL consolidation
- Probably due to mucus pluggling
- Should consider pneumonia if fever too
What can cause rpt CXR to show consolidation in same place with infection symptoms? In someone with neurological conditions
- Aspiration pneumonia
- Affects same area each time
- Persistent
When to intervene with ingested foreign bodies - which circumstances?
Button batteries
Multiple magnets
What do hypotonic children not show when in resp distress?
Do not show recessions/tracheal tug
Raised RR is enough to intervene
Harrington rods for scoliosis
Duchenne muscular dystrophy
- Delay in motor milestones
- Gower - use arms up body to stand from squat position
- Calf hypertrophy - muscles replaced with fibrous tissue
- Raised ALT
What is this and how does it typically present?
- Trisomy 21
- Bilious vomitting
- Polyhydramnios
- Double bubble sign on x-ray