Pediatric Chest X Ray Examination

dr. Herman P. L. Wungouw, Sp.Rad

Bagian Radiologi FK Undana

 PEDIATRIC CXR EXAMINATION
Should include :
 Technique of the exam 
> Positioning
> Proper exposure
> The degree of inspiration
 Normal variant and Position of all tubes and
lines
Normal Chest x ray
 Normal Chest –X ray

Good Inspiration
 Less than 1/3 of the heart is projected below
the hemidiaphragm;
 The diaphragm is rounded, and the sixth or
seventh anterior rib (ar) intersects the
diaphragm
 The lungs are air filled (black).
 Symmetrically positioned
 Errect  air-luid level in the stomach
POOR INSPIRATION

 The heart may appear enlarged

 The vessels may coalesce to give an opacity in
the bases and hila
 Lack of aerated lung.

Hyperexpansion of the lungs  increase in lung

volume or air trapping.
 Normal Chest -X ray

Non rotation
 Comparative anterior ribs equidistant from the
pedicles (p), symmetrically positioned
 The carina approximates the right pedicles
 No difference in aeration between the two sides
 Erect  air–fuid level in the stomach
 Technical Factor
 The degree of inspiration : lung volume

 The position of the patient: extent of rotation and

posture of the patient

 How the film was obtained

 Adequacy of the exposure

Expiratory chest No posterior air space behind heart
Hyperexpanded chest radiograph
The entire heart is projected above the diaphragm
The hemidiaphragms are flatened,the lungs are quite black
The hemidiaphragms are obliquely oriented
There is a large air space (a) both behind and in front of
the heart.
The Rotated Chest
A. Supine  Upper-lobe vessels are equal in size to those of the lower
lobe
B. Erect  The upper lobe vessels, not seen ,the lower lobe vessels are
easily seen
How the Film was obtained

 Posterior–anterior(PA) projection  the

heart is closer to the film and is less
magnified.
 Anterior–posterior (AP) projection  The
heart is farther to the film the magnified
heart and great vessels  cardiomegaly
magnification distance of the X-ray tube from the film
Adequacy Exposure

 Can see the detailed spine and pedicle

through the heart and the pulmonary
vessels in the peripheral lung.
 See the spine but not the pulmonary
vessels, the film is too dark
(overexposed).
Normal Variants and Positions
of Tubes
Normal variants

 Thymus
 Normal skin fold  differentiated from
pneumothorax
 Non Fusion of spinous proscess -->
ussually 3-5 years
 Sternal ossification centre
Thymus
Nonfusion of spinous
process.
Sternal ossification centers
Multiple rounded bony structures projecting
over the heart in the right hemithorax (arrows).
Interpretation of Chest x-ray
 Abdominal
 Airway
 Mediastinum
 Diaphragm
 Lungs and pleural space
 Bones and soft tissue
 Dextrocardia
 Abdominal situs inversus
 Great vessels  VCS ,arch aorta
 A right-sided aortic arch  congenital heart
disease
 Pulmonal vascularity  not be visible in the
peripheral third of the lung, if seen 
suggests increased pulmonary blood flow.
 Non-visualization of pulmonary vessels more
centrally  reduced pulmonary blood flow.
 Lymph node normal  not seen
 Enlargement of the hilar shadows  hilar
gland lymphadenopathy
 Lung : Start at the top and compare the R and
L
 elevation diaphragma loss of lung volume,
paralysis, eventration, congenital.
 A flattened diaphragm  overinflation or
loculated subpulmonary pneumothorax
 Loss of clarity of the diaphragm  pulmonary
collapse or consolidation.
 Arms, shoulders, ribs, sternum and
mandible,cervical, thoracic and lumbar
vertebrae.
 Fractures,congenital abnormalities, bone
destruction, or other
 Soft tissues  neck, thorax, and abdomen to
detect any swelling, foreign body, calcifications.