Paediatric X-rays

How to describe an X-ray?

1. Is it a plain/ contrast radiograph?

2. Antero-posterior view or Postero-anterior view?

Chest X-rays are usually taken in P-A view.
Abdominal X-rays are usually taken in A-P view.

3. What region is it?

Chest showing the neck and upper abdomen/
Abdomen showing the lower part of the chest

4. Is the X-ray centralized or is there rotation?

The sternal ends of both the clavicles should be equidistant from the midline or vertebral bodies.

5. Is the X-ray adequately exposed?

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In an adequately exposed X-ray, the spinous processes of the vertebrae are visible up to the 5
thoracic vertebrae and not below.

6. Is the skeleton mature?

Look if the epiphysis are fused.

Describe the X-ray from within outwards or out to in (as given below):

1. Soft tissue: Subcutaneous emphysema?

2. Bony cage: Fractures?
3. Trachea: Position and outline
4. Cardiac shadow: Shape, size and displacement
5. Diaphtagm: Outline, size, discplacement
6. Costo-phrenic and cardio-phrenic angles
7. Lungs: Localised/ Generalised abnormality? Which zone?
8. Artefacts (NG tube, chest leads etc.)

5 degrees of opacities on an X-ray:

Most opaque (white) to most lucent (black):

Metal > Bone or calcification > Soft tissue or Fluid > Fat > Air

(We weren’t allowed to take pictures. Here are X-rays of the conditions!)
 Bilateral consolidation

Heterogenous opacity seen in left and right middle and

lower zones.

Presence of air-bronchograms.

Air bronchogram refers to the phenomenon of air-filled

bronchi (dark) being made visible by the opacification of
surrounding alveoli (grey/white)

Cavitatory Lesion

Defined opacity. Wall is thick.

DDx: Lung Abscess.

Lung cyst.

Diaphragmatic Hernia

Bowel loops present in the place of the left lung.

Shift of the mediastinum to the right.

Right lung is hypoplastic.

Immediate treatment: Decompress with NG tube.

(NO BAG AND MASK VENTILATION)

 White-out Lung
Ground glass appearance seen in respiratory distress
syndrome.

Pleural Effusion
Left sided pleural effusion. Mediastinum shift present.

The Right C-P angle is obliterated.

Homogenous opacity in the left middle and lower zones.

No air-bronchograms (so not pneumonia).

The level is concave with maximum height towards the axilla.

(If the level is flat, it is a hydropneumothorax.)

Mediastinal Mass

In a newborn, it can be due to the thymus.

 Pneumoperitoneum

Gas under the diaphragm.

Omphalocele

Cardiomegaly

Steps:

a) Draw a vertical line passing through the midline/

spinous processes.
b) Draw a perpendicular from the point of
maximum convexity from the right border of the heart.
(AB)
c) Draw a perpendicular from the pint of maximum
convexity from the left border of the heart. (CD)
d) Draw a horizontal line joining the farthest points
on the lungs. (PQ)
 e) Add AB and CD.
f) If AB + CD is greater than 60 % (in children) of PQ, then cardiomegaly is present.

AP vs PA view (They probably won’t test this!)