X-Rays

Friday, 7 January 2022 8:18 PM

PEDIATRICS VIVA-VOCE: X-RAY

-Dr.Ashray S Patel
Ph No: 9482141673
E-mail: patel1995ash@gmail.com

INTERPRETATION
NEONATOLOGY
RESPIRATORY SYSTEM
CVS
GIT
GENITOURINARY SYSTEM
BONE

BASICS OF X-RAY INTERPRETATION:

How to Systematically Interpret the X-ray film?

• Plain/Contrast X-ray
• Comment on which part of the
body X-ray is taken
• Name/Age/Sex/Date
• Side Marker
• View: AP/PA/Lateral/Oblique
• Exposure
• Centring of the Film
• Inspiratory/Expiratory Film
• Systematically Examine Each Part
of the X-ray
• Commenting on any Abnormality

AP vs PA View:

EXPOSURE: Under/Correct/Over Exposure

ROTATION:

• Both Medial ends of Clavicle should be equidistant

from midline, vertical drawn through the centre of
T1-T5 vertebral bodies.
• Rotation: medial end of one of the clavicle further
away from the vertical line.

INSPIRATORY/EXPIRATORY Film:

Systematically Examine each part of the X-ray:

INSIDE OUT APPROACH

• TRACHEA/CARINA/BRONCHUS
• SUPERIOR MEDIASTINUM

• AORTIC ARCH
• AORTIC KNUCKLE
• HILAR SHADOWS: MPA dividing into Right PA
and Left PA.
• Comment on the Cardia
• Diaphragm and below diaphragm
• Costo-Phrenic Angle
• Chest wall
• Compare Lung Zones

Commenting on any Abnormality:

• Unilateral/Bilateral
• Symmetric/Assymetric
• Focal/Diffuse
• Radiolucent/Opaque
• Focal/Diffuse

NEONATOLOGY

RESPIRATORY DISTRESS SYNDROME:

• Fine granular appearance

• Ground Glass Appearance
• White Out Lung
• Bilateral and Symmetrical
• Air Bronchograms extending Peripherally
• Stages:
1. Reticulogranular Pattern
2. Air Bronchograms
3. Decreased transperancy+Blurry Diaphragm
and Heart
4. Whiteout Lung

TRANSIENT TACHYPNEA OF NEWBORN:

• Hyperinflation of the lungs

• Interstitial edema: peri-hilar
streaks(Sunray Appearance)
• Prominent fissure of Right
upper Lobe.
• Rarely Cardiomegaly.

MECONIUM ASPIRATION SYNDROME:

• Bilateral, Diffuse,
Heterogeneous Fluffy
Opacities
• This is suggestive of patchy
areas of atelectasis and
emphysema from air
trapping.
• Hyperinflated
• Air leak

ESOPHAGEAL ATRESIA:

Tracheo-Esophageal Fistula Isolated Esophageal Atresia

CONGENITAL DIAPHRAGMATIC HERNIA:

• Ipsilateral Hemithorax contains

bowel loops filled with gas.
• Ispilateral lung is hypoplastic.
• Mediastinal Shift to opposite
side.

DUODENAL ATRESIA:

• Simultaneous distension
of stomach and first part
of duodenum.

RESPIRATORY SYSTEM:

ANATOMY:

INFECTIONS:

VIRAL SPECTRUM:

• Hyperinflated Lung Fields

• Flattening of diaphragm
• Translucent lung fields

• Parahilar Peribronchial Infiltrates

Streaky or Reticular Bilateral nodular, fluffy,

infiltrates radiating from patchy or rarely consolidave
hilar regions into the changes.
parenchyma

BACTERIAL:

LOCALIZATION IS USUALLY POSSIBLE

COLLAPSE:

• White Homogenous Opacity

• Compensatory over-inflation of
the adjacent lobes
• Trachea or mediastinal shift to
affected side
• Vessels are more spread out

• Luftsichel Sign: sickle shaped

air crescent noticed around
aortic knuckle due to
compensatory hyperinflation
of upper part of left lower
lobe.

PNEUMOTHORAX:

• Absent vascular
markings
• Increased size and
licence of the involved
hemithorax
• Shift of mediastinum to
opposite side
• Flattening of ipsilateral
diaphragm

PLEURAL EFFUSION:

• Blunting of Costco-phrenic
and Cardio-phrenic angle
• Opacification
• S shaped curve of Ellis
• Shift of mediastinum to the
opposite side

CARDIO-VASCULAR SYSTEM:
ANATOMY:

CARDIOMEGALY:
Cardio-Thoracic Ratio of more than:
• 0.6 in newborns and infants
• 0.5 in older children

RV ENLARGEMENT:

• Upturned Apex: apex is laterally

and upwardly displaced and
elevated from diaphragm
• D-TGA
• ASD with Eisenmenger Syndrome
• TAPVC
• ASD
• VSD with PAH

RIGHT ATRIAL ENLARGEMENT:

• A prominent convexity on right

side
• Right atrial shadow occupies
more than 2.5 interspaces
• Distance from midline to right
heart border will be more than
4cm.
• Severe PS, Ebstein’s Anamoly,
Tricuspid Atresia.

LEFT ATRIAL ENLARGEMENT:

• Straightening of left heart

border
• PDA
• VSD
• MR
• MITRAL STENOSIS

LEFT VENTRICULAR ENLARGEMENT:

• Apex is shifted down and

out
• Large VSD
• Significant MR, AR
• PDA, with large shunt

CONGENITAL HEART DISEASE:

1) TETRALOGY OF FALLOT:

• Boot shaped heart or

“Coeur en Sabot”
• Upturned apex without
Cardiomegaly
• Pulmonary Oligemia

2) TRANSPOSITION OF GREAT ARTERIES:

• EGG ON STRING
APPEARANCE
• RV apex/Right atrial
enlargement
• Increased pulmonary
vascularity

3) EBSTEIN’s ANAMOLY:

• Massive Cardiomegaly
• Huge RA
• Dilated RVOT
• BOX SHAPED HEART

4) TOTAL ANAMOLOUS PULMONARY VENOUS

CONNECTION:

• FIGURE OF 8 APPEARANCE/
SNOWMAN APPEARANCE

CARDIAC FAILURE: Pulmonary Edema

INTERSTITIAL STAGE:

• Reticular lines, followed by

increasing haziness and
generalised opacity of the
lungs.
• B Lines: small transverse lines
located in the costo-phrenic
sulci
• A Lines: longer lines running
outward from the hilar regions

ALVEOLAR STAGE:

• Nodular or diffuse
haziness
• Usually accumulates in the
parahilar regions sparing
apical region
• BUTTERFLY/BATWING
Appearance

GASTRO-INTESTINAL SYSTEM:
HYPERTROPHIC PYLORIC STENOSIS:

• Single Bubble Appearance

Sonography is diagnostic:
• Muscle thickness > 3mm
• Channel length > 15mm
• Diameter > 8mm

HIRSCHSPRUNG’s DISEASE:

• Distended bowel loops

throughout the abdomen

• Rectum is more dilated than

sigmoid normally.
• Rectum is narrow, sigmoid is
dilated.

PNEUMOPERITONIUM:

• Air under Diaphragm

• Intestinal Perforation

INTUSSUSCEPTION:

• Claw Sign

GENITOURINARY SYSTEM:
VESICOURETERAL REFLUX:

POSTERIOR URETHRAL VALVE:

BONE:
RICKETS:

• Generalized Osteopenia
• Cupping
• Fraying: irregular margins of the
metaphysis
• Splaying: widening of metaphysical
ends
• Bending of bones, lateral bowing

SCURVY:

• Pencil thin cortex

• Ground glass appearance of the
shaft
• Ring Epiphysis/Wimberger Sign
• White line of Frenkel
• Scorbutic Zone
• Pelken Spurs