Pediatric Chest X- Ray Interpretation


Associate Professor of Radiology TUMS


The availability of many imaging modalities require problem- oriented decisions to determine which teqniques should be used or omitted in any given clinical situation.For example PA or AP ,lateral CXR , lateral decubitus, lordotic view, .... versus directly doing CT scan! Radiation exposure, delay in both diagnosis and therapy and cost must be minimized. One must be aware of what is done to pediatric patient (risk)  versus what is done for the child (benefit). To minimize risks and maximize benefits from any imaging examination, the procedure must be tailored to the specific clinical problem. For chest interpretation, an ordered approach is important for systematic analysis of all anatomic regions of chest .Understanding normal anatomy is necessary in order to recognize and evaluate abnormalities. Patient, s demographic data and film marker must be checked before any work! The CXR should be evaluated first for technique  including  position, rotation, penetration, degree of inspiration  and motion.Systematic approach include careful evaluation of abdomen and neck especially for presence and position of any tubes or catheters.The chest wall, mediastnum, diaphragm and pleura are sequentially analyzed.A careful survey of the spinal and paraspinal regions is crucial.Finally the trachea, main bronchi, segmental bronchi, heart, pulmonary vessels, and pulmonary parenchyma are assessed, and any abnormalities are noted.  Normal variations including variety of thymic gland and some pathologic pediatric cases especially chest emergencies are reviewed in this lecture.