Chest abnormalities are a common presenting pathology of the pediatric population. Imaging modalities such as chest X-rays X-rays X-rays are high-energy particles of electromagnetic radiation used in the medical field for the generation of anatomical images. X-rays are projected through the body of a patient and onto a film, and this technique is called conventional or projectional radiography. X-rays are the initial diagnostic test of choice used in urgent/emergent pediatric cases. Imaging modalities aid in differentiating the causes of respiratory distress in infants and finding the underlying infectious Infectious Febrile Infant, traumatic, or congenital Congenital Chorioretinitis disorder. Computed tomography (CT) is a useful adjunctive modality in the pediatric population when conventional radiography Conventional Radiography X-rays fails to adequately characterize pathology. Given the common occurrence with many cardiac Cardiac Total Anomalous Pulmonary Venous Return (TAPVR) or vascular anomalies, specific protocols are necessary to highlight potentially abnormal anatomical structures. Pediatric chest imaging is a multimodality process at most centers used to help answer clinical questions and adequately care for individuals.
Last updated: 10 May, 2022
Systematic approach:
Anteroposterior (AP) view:
Transient
tachypnea
Tachypnea
Increased respiratory rate.
Pulmonary Examination of the
newborn
Newborn
An infant during the first 28 days after birth.
Physical Examination of the Newborn (wet lung):
A:
Frontal
Frontal
The bone that forms the frontal aspect of the skull. Its flat part forms the forehead, articulating inferiorly with the nasal bone and the cheek bone on each side of the face.
Skull: Anatomy chest radiograph on day 1 at 6 hours showing a bilateral, diffuse, ground-glass appearance and fine granularity due to interstitial opacities. Note the left paraspinal lucency due to air within the distal
esophagus
Esophagus
The esophagus is a muscular tube-shaped organ of around 25 centimeters in length that connects the pharynx to the stomach. The organ extends from approximately the 6th cervical vertebra to the 11th thoracic vertebra and can be divided grossly into 3 parts: the cervical part, the thoracic part, and the abdominal part.
Esophagus: Anatomy.
B:
Frontal
Frontal
The bone that forms the frontal aspect of the skull. Its flat part forms the forehead, articulating inferiorly with the nasal bone and the cheek bone on each side of the face.
Skull: Anatomy chest radiograph of the same individual at 2 days of age showing decreased pulmonary parenchymal opacities (perihilar streaky markings remain).
Bilateral pneumothoraces in a neonate Neonate An infant during the first 28 days after birth. Physical Examination of the Newborn with meconium Meconium The thick green-to-black mucilaginous material found in the intestines of a full-term fetus. It consists of secretions of the intestinal glands; bile pigments; fatty acids; amniotic fluid; and intrauterine debris. It constitutes the first stools passed by a newborn. Prenatal and Postnatal Physiology of the Neonate aspiration
Image: “F0028” by Khan, A.N., Al AL Amyloidosis-Jahdali, H., Al AL Amyloidosis-Ghanem, S., Gouda, A. License: CC BY 2.0Chest radiograph of a 1-day-old boy born 29 weeks, 3 days of gestation with respiratory distress:
The radiograph demonstrates signs of infant respiratory distress syndrome in the form of generalized, fine granular opacities, which create
air bronchograms
Air Bronchograms
Imaging of the Lungs and Pleura.
The thorax is bell-shaped due to decreased lung volume.
Arterial and venous umbilical lines, a
nasogastric tube
Nasogastric tube
Malnutrition in children in resource-limited countries, and
electrocardiography
Electrocardiography
Recording of the moment-to-moment electromotive forces of the heart as projected onto various sites on the body’s surface, delineated as a scalar function of time. The recording is monitored by a tracing on slow moving chart paper or by observing it on a cardioscope, which is a cathode ray tube display.
Electrocardiogram (ECG)
electrodes
Electrodes
Electric conductors through which electric currents enter or leave a medium, whether it be an electrolytic solution, solid, molten mass, gas, or vacuum.
Electrocardiogram (ECG) are also present.
Lateral radiograph of the neck Neck The part of a human or animal body connecting the head to the rest of the body. Peritonsillar Abscess shows diffuse enlargement of the epiglottis Epiglottis A thin leaf-shaped cartilage that is covered with laryngeal mucosa and situated posterior to the root of the tongue and hyoid bone. During swallowing, the epiglottis folds back over the larynx inlet thus prevents foods from entering the airway. Larynx: Anatomy (the soft tissue Soft Tissue Soft Tissue Abscess area of increased density adjacent to the arrow tip) consistent with epiglottitis Epiglottitis Epiglottitis (or “supraglottitis”) is an inflammation of the epiglottis and adjacent supraglottic structures. The majority of cases are caused by bacterial infection. Symptoms are rapid in onset and severe. Epiglottitis
Image: “ Epiglottitis Epiglottitis Epiglottitis (or “supraglottitis”) is an inflammation of the epiglottis and adjacent supraglottic structures. The majority of cases are caused by bacterial infection. Symptoms are rapid in onset and severe. Epiglottitis” by Med Chaos. License: CC0 1.0Posteroanterior (PA) chest radiograph demonstrating subglottic stenosis Stenosis Hypoplastic Left Heart Syndrome (HLHS), also known as steeple sign, seen between the red arrows
Image: “fig1” by Patel, J.J., Kitchin, E., Pfeifer, K. License: CC BY 4.0A foreign body Foreign Body Foreign Body Aspiration in the right main bronchus
Image: “F1” by Hashemi, S.M., Kolahdouzan, M., et al AL Amyloidosis. License: CC BY 3.0A anteroposterior (AP) chest X-ray Chest X-ray X-ray visualization of the chest and organs of the thoracic cavity. It is not restricted to visualization of the lungs. Pulmonary Function Tests shows a radio-opaque foreign body Foreign Body Foreign Body Aspiration in the right main bronchus (arrow)
Image: “fig-001” by Adoga, A.A., Kokong, D.D., Ma’an, N.D. License: CC BY 3.0(a): A chest radiograph at admission shows complete collapse of the left lung with mediastinal shift to the left.
(b): A chest radiograph shows almost complete expansion of the left lung after
bronchoscopy
Bronchoscopy
Endoscopic examination, therapy or surgery of the bronchi.
Laryngomalacia and Tracheomalacia and removal of the
foreign body
Foreign Body
Foreign Body Aspiration.
Standard CT scanning Standard CT scanning Imaging of the Liver and Biliary Tract:
Normal chest CT (findings may be dependent on the individual’s age):
Multiple CT correlated findings:
Consistent with cystic Cystic Fibrocystic Change fibrosis Fibrosis Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. Bronchiolitis Obliterans, an axial Axial Computed Tomography (CT) CT scan through the level of the chest demonstrates bronchiectasis Bronchiectasis Bronchiectasis is a chronic disease of the airways that results from permanent bronchial distortion. This results from a continuous cycle of inflammation, bronchial damage and dilation, impaired clearance of secretions, and recurrent infections. Bronchiectasis with peribronchial wall thickening
Image: “F0001” by El-Azami-El-Idrissi, M., Lakhdar-Idrissi, M., et al AL Amyloidosis. License: CC BY 2.0A specific type of vascular anomaly involving partial or complete entrapment of the esophagus Esophagus The esophagus is a muscular tube-shaped organ of around 25 centimeters in length that connects the pharynx to the stomach. The organ extends from approximately the 6th cervical vertebra to the 11th thoracic vertebra and can be divided grossly into 3 parts: the cervical part, the thoracic part, and the abdominal part. Esophagus: Anatomy or trachea Trachea The trachea is a tubular structure that forms part of the lower respiratory tract. The trachea is continuous superiorly with the larynx and inferiorly becomes the bronchial tree within the lungs. The trachea consists of a support frame of semicircular, or C-shaped, rings made out of hyaline cartilage and reinforced by collagenous connective tissue. Trachea: Anatomy by a vessel:
Consistent with a pulmonary sling, an axial Axial Computed Tomography (CT) slice through the chest in the pulmonary artery Pulmonary artery The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. Lungs: Anatomy phase demonstrates an aberrant course of the left pulmonary artery Pulmonary artery The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. Lungs: Anatomy.
Image: “F0002” by Verma, S.K., Mahajan, V. License: CC BY 2.0An axial Axial Computed Tomography (CT) CT scan of the chest and abdomen demonstrates plate atelectasis Atelectasis Atelectasis is the partial or complete collapse of a part of the lung. Atelectasis is almost always a secondary phenomenon from conditions causing bronchial obstruction, external compression, surfactant deficiency, or scarring. Atelectasis in the right upper lobe, presumably a consequence of a longstanding anterior diaphragmatic Morgagni hernia Hernia Protrusion of tissue, structure, or part of an organ through the bone, muscular tissue, or the membrane by which it is normally contained. Hernia may involve tissues such as the abdominal wall or the respiratory diaphragm. Hernias may be internal, external, congenital, or acquired. Abdominal Hernias on the right side, which displaces the heart to the left.
Image: “F2” by Rashid, F., Chaparala, R., Ahmed, J., Iftikhar, S.Y. License: CC BY 2.0