Download - Paediatric Chest
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PAEDIATRIC CHESIMAGIN THE YOUNG C
PRESENTER: D
FACILITATOR: Dr.
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Outin!
• Ra"iation #rot!$tion in $%i"r!n• &a'i$' o( $%!'t i)aging in #a!"iatri$'
• E*auation o( in!' an" tu+!'
• In(!$tion': +a$t!ria, *ira, T&
•Pn!u)ot%ora-, #!ura !u'ion
• In%a!" (or!ign +o"/
• A't%)a
• A$ut! C%!'t S/n"ro)!
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Ra"iation #rot!$tion
0u'ti1$ation 2 a*oi" unn!$$!'ar/ !-a)ination'O#ti)i3ation
A n!$!''ar/ !-#o'ur!' to ra"iation '%ou" +! 5!w A'
R!a'ona+! A$%i!*a+! 6ALARA #rin$i#!7
Gona"a #rot!$tion
Coi)ation a' a##ro#riat!
3
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• C%!'t Ra"iogra#%.R!)ain t%! +a'i' (or $%!'t !*auation.
U'ua/ 'u#in! AP in 89/r, PA in 9/r; Lat!ra
Di?$uti!' 2#oor in'#iration, )otion +ur, "i?$u#o'itioning, )agni1$ation o( ant!rior 'tru$tur!'6
Nor)a CTR 99>@B.
&!war! o( nor)a t%/)i$ '%a"ow.
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Nor)a C%!'t Ra"iogra#% goo" in'#iration
• L!'' t%an = o( t%! %!art +!ow t%! "o)!t%! %!)i"ia#%rag)'
• At !a't #o't!rior ri+' $!ar/ '!!n
• ant!rior ri+'
• Lung' '%ow goo" tran'u$!n$/.
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GOOD INSPIRATION EXPIRATION
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Rotat!" $%!'t ra"iogra#%'
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Rotat!" 1). Not! 't!rna o''i1$ation $!nt!r'
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Pa!"iatri$ $%!'t
•
A)o't $/in"ri$a in'%a#!
• Air +ron$%ogra)'$o))on/ '!!n
• Nor)a CTR a')u$% a' @9B 6"u!
to T%/)u'7
• Ri+' )or! %ori3onta
2 Dia#%rag) at @t% 2
t% Ant
ri+
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EVALUATION OF TUBES AND LINES
• NGT> ti# at t%! 'to)a$%• ETT>ti# '%ou" +! $)
a+o*! $arina or at T=!*!
• Pleural tubes- ti#
ant'u# 6#n!u)it%ora-7an" #o'tin( 6!u'ion7 i(#t 'u#in!.
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• Umbilical artery2iia$ art!r/> into a+"o)ina
aorta t%! ti# i"!a/ at T@> T 6%ig%7 or a$$!#ta+/L>L96ow7
Umbilical ei!>P> "u$tu'*!no'u'>IC>Rt atriu) 6ti#'%ou" +! at IC=RA
Jun$tion at t>t7
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INFECTIONS IN THE YOUNG CHILD• Pat%og!n' in$u"! +a$t!ria, *iru'!'6RS7,(ungi
an" )/$o+a$t!riu)
• M/$o#a')a i' $o))on in '$%oo>ag!"$%i"r!n6'!!n in B o( $%i"%oo" #n!u)onia7
• T%!'! in(!$tion' #r!'!nt a' ra"iogra#%i$ #att!rnt%at )a/ narrow t%! "i!r!ntia' o( $au'ati*!organi')'
• T%! ro! o( i)aging i' to $on1r) #r!'!n$!, !-t!nanato)i$a o$ation an" !*auat! #rogr!'' or$o)#i$ation'
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&ACTERIAL PNEUMONIA
Fo$a a*!oar $on'oi"ation
>)ain/ +/ 'tr!##!u)onia!,%a!)o#%iu'an" rar!/ )/$o#a')a
Muti#! #at$%/ a*!oaro#a$iti!'
>u'ua/ +/ 'ta#% ,(unga an"o##ortuni'ti$ in(!$tion'
CR>APLAT
>Ho)og!nou' o#a$it/Air +ron$%ogra)'
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>)ont% o" )a! wit% a %i'tor/ o( $oug%ing an" (!*!r.
L!(t u##!r o+! an" ingua $on'oi"ation.
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>/!ar o" )a! wit% (!*!r an" $oug%ing.
L!(t #o't!ro+a'a '!g)!nt $on'oi"ation
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Roun" #n!u)onia
•Cau'!" +/ 'tr!#to$o$$a#n!u)onia!
• U'ua/ $%i"r!n 8 /r'
• ! roun"!" o#a$iti!'i)uating a )a''
• Ma/ %a*! air +ron$%ogra)'• D"->tu)or, '!u!'trat!"
ung, +ron$%og!ni$ $/'t
• Foow u# CR i' a"*i$!".
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ROUND PNEUMONIA
• Lat. C%!'t Ra"iogra#%'
• A>roun" 'o(t ti''u! )a'' in'u#!rior '!g)!nt o( !(tow!r o+!.
• >w5' at!r, $o)#!t!r!'oution a(t!r anti+ioti$R-.
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IRAL PNEUMONIA
•IMAGING:>CR>in$r!a'!" #!ri+ron$%ia )ar5ing', %/#!rin
6%/#!ru$!n$/,att!ning o( "ia#%rag)', in$r!a'!$%!'t "ia)!t!r7, 'u+'!g)!nta at!!$ta'i' 6w!"'%a#!" o#a$it/ )o't $o))on in )i"=ow!r ung
CT>#ro)in!nt i>"!1n!" %ia ,#!ri+ron$%ia )ar5ra"iating into t%! ung, groun"> ga'' o#a$iti!' in$r!a'!" int!r'titia )ar5ing'
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IRAL PNEUMONIA
• CR>A. )i" in$r!a'!"
#!ri+ron$%ia )ar5ing' '/))!tri$ %/#!rination.
• CR> &. '!*!r! in$r!a'!"#!ri+ron$%i a )ar5ing',%/#!rina tion at!!$ta'i' in rt )i""! o+!'i%ou!tt> ing rt %!art+or"!r
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)ont%>o" wit% $oug%
P!ri+ron$%ia $u?ng, in$r!a'!" #!ri%iar 'tr!a5in!'', airtra##ing in *
#n!u)onia
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T%! i))un! $o)#ro)i'!" $%i"
•Pri)ar/ i))un! "!1$i!n$/ r!at!" to $ong!nitaa+nor)ait/ o( &=T $!'
• A ar! #ron! to in(!$tion' +/ !'' $o))on organ!.g #n!u)o$/'ti' $arinii
• Cini$a #i$tur! an" i)aging (!atur!' ar! "i*!r'!
!-#!$t!" #att!rn' to +i33ar! at/#i$a
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T%! i))un! $o)#ro)i'!"$%i"
• Miiar/ T&>1n! no"uarit/• PCP>wi"!'#r!a" a*!oar'%a"owing
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In%a!" For!ign &o"/
•Mo't F&' !nt!r t%! )or! *!rti$a/ ori!nt!" rt +r
• Co)#!t! airwa/ o+'tru$tion !a" to at!!$ta'i';o+'tru$tion !a" to o+'tru$ti*! !)#%/'!)a.
• Fi)' ta5!n in in'#iration !-#iration '%ow )!"'%i(t awa/ (ro) t%! o+'tru$ti*! !)#%/'!)a on
!-#iration
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In%a!" For!ign &o"/
• O+'tru$ti*! !)#%/'!)a (ro) F& in t )ain +ron$%u'
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A>INSPIRATORY FILM>RT SIDEHYPERLUCENT AND EPANDED&>EPIRATORY> RT SIDE AIR TRAPPINGC>NORMAL EPIRATORY FILM AFTERPEANUT REMOAL.
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T&
• Un"!r 9 *un!ra+!
• Po*!rt/,)autrition,o*!r$row"ing an"HI
• Can +! (o$a !'ion , %iara"!no#at%/6g%on (o$u'7 )iiar/,#!ura !u'ion
• Pri)ar/ )iiar/ )or! $o))onin /oung $%i"r!n
• '!$on"ar/>$a*itator/
• A "i!r!ntia in at/#i$a#n!u)onia>in HI
YRPARATRACHEAL LNLL PATCHY OPCITIESMILIARY PATTERN INLUNGS
•
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" #ear $l% &it' (eera!% SOB
• Primary TB withunilateral hilaradenopathy and
• secondary RMLcollapse.
• TB Ra%i$l$)icFi!%i!)s
• Nor)a
• Uniat!ra %iara"!no#at%/
• Ran5! $o)#!-
• Paratra$%!aa"!no#at%/
• Su+$arinaa"!no#at%/
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TOIC,META&OLIC
CR>Muti#! #at$%/ o#a$iti!' at t%!ow!r o+!'
Hydrocarbon Aspiration•
Hydrocarbons – furniture polish, gasoline,
• Aspirated due to low viscosity and surface
tension•
Severe chemical pneumonitis withdestruction of surfactant•
Radiographic abnormalities develop within
24hrs
• Pneumatoceles may develop
*+ ,$!t' $l% &it' resirat$
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*+ ,$!t' $l% &it' resirat$%istress18 month old status post hydrocarbon aspiration,
Showing central lower lobe alveolar opacities.
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A'#iration #n!u)onia
• A'#iration o( gut )at!ria in
GERD, TEF or NGT tu+! (!!"ing(or t%! 'i$5
• RNI )i5 '$an, %r PH)onitoring an" u##!r GI 'tu"i!'u'!" to "iagno'! GERD
• U##!r o+!>in(ant ,'u#in!
• Low!r o+!>o"!r ,u#rig%t
• CR>Para %iar #!ri+ron$%iao#a$iti!' r!'uting in a '%agg/$ar"ia$ +or"!r
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P!ura !u'ion9 /r o" wit% n!#%roti$ '/n"ro)
Pn!u)ot%ora-
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Pn!u)ot%ora-
• S#ontan!ou' !.g in(ant' on *!ntiator t%!r
• Trau)a
• D!$u+itu' CR wit% t%! 'i"! o( int!r!'t u#
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Ast'ma• Main ro! i' to !-$u"!:
•Pn!u)onia
• #n!u)ot%ora-
• I)aging (!atur!'• Nor)a $%!'t; )o't $o))on 1n"ing
• F!atur!' o( %/#!rination
• S!g)!nta or 'u+'!g)!nta at!!$ta'i' '!!na' #at$%/ o#a$iti!'
• P!ri+ron$%ia $u?ng
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/!ar o" a't%)ati$
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Acute .'est Sy!%r$me i! S. Y!ar o" wit% SO&
Acute chest syndrome with cardiomegaly, absence of splenic shadow, and gaclips indicating underlying sickle cell anemia. The bibasilar consolidations and
bilateral small pleural effusions suggest the diagnosis of acute chest syndrom
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R!(!r!n$!'
•
Graing!r Ai'on Diagno'ti$ Ra"ioog/ 9 t% E"ition
•
Da*i" Sutton T!-t+oo5 o( Ra"ioog/ an" I)aging E"ition
•
Pa!"iatri$ Ra"ioog/ &/ 0a$5 O. Ha!r; T%o)a' L. San" A#arna 0o'%i
• Pa!"iatri$ ra"ioog/ r" !"ition
• I)aging in #a!"iatri$ #u)onoog/ Ro+!rt $!*!an