‫بسم هللا الرحمن الرحيم‬

Pediatric Radiology
Postero-Anterior View
Normal cardio-thoracic ratio is 1:2 (50%)
 COMMENT ON NORMAL CHEST:
• Plain X-Rays chest post-anterior view .
• The patient is centralized.
• Normal bony structures.
• Central mediastinum.
• Normal cardio-thoracic ratio & cardiac
position .
• Both lung fields are clear with normal
hilar shadow.
• Both costopherenic recesses are clear
with normal cardio-pherenic angle.
NORMAL
Remember in each case:
1. Obtaining Clinical history.
2. Proper technique. i.e. Good exposure
3. Patient position i.e. centralized or
not?.
4. Orientation of the film , i.e. left or right
marked.
5. Recognition of film artifacts.
6. Systematic approach.
Comment:
• Plain X-rays chest P.A. view.
• Normal bony cage.
• Central mediastinum.
• Bilateral hyperinflation of both lungs.
• Non-homogenous opacity occupying
the middle lobe of the right lung.
• Diagnosis: mostly Rt. Middle lobe
pneumonia.
Right upper lobe pneumonia
Comment:
• Plain X-rays chest P.A. view.
• Traction of mediastinum towards the
Rt. Side, with narrowing of ipsilateral
ribs indicating volume loss.
• Non homogenous opacification filling
the Rt. Upper hemithorax.
• Compensatory hyperinflation of Lt.
lung.
• D/ mostly Rt. Upper lobe pneumonia.
 Trachea

Right upper lobe pneumonia

 Comment:
• Left basal opacification rising towards the
axilla.
• Oblitration of the Lt. costophrenic recess.
• Compensatory hyperinflation of Rt. Lung.
• Dignosis:
 Left sided pleural effusion, underlying
parenchymal lesion could not be excluded.
? SYNPNEUMONIC EMPYEMA
Right upper lobe pneumonia
Comment:
• Massive homogenous opacification of
the left hemithorax with obliteration of
the Lt. costo-phrenonic angle.
• Shifted mediastinum towards the
contrlateral (Rt.) side.
• Underlying pathology of Lt. lung could
not be excluded.
• D/ Left-sided massive pleural effusion.
• Homogenous opacification
oblitrarating the left costo-
phrenic angle.

• Air-fluid level on the left

side.

• Dignosis:
 Left-sided
Hydropneumothorax
 Rt. Lower lobe pneumonia.
Preserved Rt. Costophrenic recess.
It is NOT a case of pleural effusion.
Bilateral miliary shadows (highly suggestive of MILIARY T.B.)
Comment:
• Diffuse air occupying the left
hemithorax (Jet black , devoid of lung
markings).
• Underlying collapse of the Left lung.
• Mediastinal shift towards Rt. Side.
• A case of:
 Left-sided tension pneumothorax.
 Air-fluid level

Massive pleural effusion with

hydropneumothorax on the Lt. side.
 Herniation of the bowel into the left
hemithorax with contralteral mediastinal shift.
Dignosis: Congenital diaphragmatic hernia.
Congenital diaphragmatic hernia.
Congenital diaphragmatic hernia.
Ground glaas appearance.

Diminished lung volume

Air bronchogram.

(HYALINE MEMBRANE
DISEASE)…..

Versus congenital
pneumonia..
 COLLAPSED
LUNG

PNEUMOTHORAX
HYALINE MEMBRANE DISEASE
Right upper lobe large thin-walled pneumatocele
Rt. upper and middle lobe massive pneumonia
Comment:
• Jet black air with underlying lung
collapse of the Rt. Lung.
• Evident line of demarcation between air
and the collapsed lung.
• No significant mediastinal shift.

 Rt-sided pneumothorax.
Lt. sided pneumothorax
Rt. middle lobe pneumonia
Air-fluid level- HYDROPNEUMOTHORAX on Rt. side.
Comment:
• Bilateral nodular opacities with fluffy cotton
appearance infiltrating both lung fields.
• Ring shadow with well-delineated wall
occupying the right upper lobe. (lung
abscess).
• This picture is highly suggestive of
extensive bronchopneumonia
mostly in an immuno-compromised
subject.
Wavy sail appearance of normal thymus on right.
Left-sided Massive pleural effusion
 Rt. upper lobe pneumonia
Highly suggestive of aspiration pneumonia.
Bronchial asthma
Comment:
• Bilateral hyperinflation of both lungs ( jet black
lung fields) with increased volume .
• Flattened copulae of diaphragm .
• widened intercostal spaces .
• Vertical cardiac shadow .
• Features are highly suggestive of air trapping :
1.Bronchial asthma (acute attack)
2.Emphysema (older patients)
Bilateral hyperinflation (asthma)
with Rt upper lobar consolidation
Comment:
• Patchy or fluffy infiltrates of ill-defined
margins distributed throughout both lung
fields.
• Picture of bilateral extensive
bronchopneumonia
 ? Staphylococcal
 ? Fungal
 ? pneumocystis carinii
Rt. Pleural effusion with shifted mediastinum
Lung abscess in the Lt. upper lobe
Left-sided Pleural effusion
Bilateral extensive bronchopneumonic changes for
differential diagnosis
Right-sided Pleural effusion
Rt. upper lobe pneumonia
Left-sided massive pleural effusion
SKELETAL SYSTEM
• Plain X-ray wrist joint showing:

• Decreased bone density.

• Broadening, cupping and fraying of
distal ends of radius and ulna.
• Wide distance between distal ends of
radius and ulna & carpal & metacarpal
bones.

 DIAGNOSIS: ACTIVE RICKETS

ACTIVE RICKETS
ACTIVE RICKETS
ACTIVE RICKETS
Protruded maxilla, and characteristic SUN-RAYS appearance.
D/ chronic hemolytic anemia mostly beta-thalassemia major
HAIR STANDING ON AN END OR
SUN-RAYS APPEARANCE
RACHITIC ROSARIES
X-RAY ABDOMEN STANSDING
 MULTIPLE AIR-FLUID LEVELS.
MOSTLY LARGE BOWEL OBSTRUCTION
 DOUBLE-BUBBLE SIGN.
CHARACTERISTIC FOR DUODENAL ATRESISA.
AIR UNDER DIAPHRAGM
PERFORATED VISCUS
MULTIPLE AIR-FLUID LEVELS (gasless pelvis).
MOSTLY INTESTINAL OBSTRUCTION
MULTIPLE AIR-FLUID LEVELS (small and large bowel).
MOSTLY PARALYTIC ILEUS
AIR UNDER DIAPHRAGM
HEART
Normal cardio-thoracic ratio is 1:2 (50%)
 Cardiomegaly
Lobar pneumonia
Differential diagnosis of cardiomegaly

• Most important causes are:

 Pericardial effusion
 Dilated cardiomyopathy
 Rheumatic H.D. with multi-valvular affection
 Congestive heart failure.
COMMENT:
• Pulmonary oligemia.
• Small-sized heart with right ventricular
(supra-diaphragmatic apex).
• The left cardio-phrenic angle is acute.
• Heart is characteristically BOOT-
SHAPED. (Coeur en Sabot Sign).
• These findings are highly suggestive of
 TETRALOGY OF FALLOT
DIAGNOSIS:  Tetralogy of Fallot (TOF) - Coeur en Sabot Sign
Bilateral pulmonary venous congestion
Bilateral pulmonary edema
Huge Cardiomegaly.
The heart is flask-shaped and well-delineated.
Mostly pericardial effusion.
THANK YOU