paediatric chest

8/17/2019 Paediatric Chest

1/36

PAEDIATRIC CHESIMAGIN THE YOUNG C

PRESENTER: D

FACILITATOR: Dr.


2/36

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)!


3/36

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


4/36

• 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.


5/36

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$!n$/.


6/36

GOOD INSPIRATION EXPIRATION


7/36

Rotat!" $%!'t ra"iogra#%'


8/36

Rotat!" 1). Not! 't!rna o''i1$ation $!nt!r'


9/36

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+


10/36

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!.


11/36

• 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


12/36

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'


13/36

&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)'


14/36

>)ont% o" )a! wit% a %i'tor/ o( $oug%ing an" (!*!r.

L!(t u##!r o+! an" ingua $on'oi"ation.


15/36

>/!ar o" )a! wit% (!*!r an" $oug%ing.

L!(t #o't!ro+a'a '!g)!nt $on'oi"ation


16/36

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$!".


17/36

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-.


18/36

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'


19/36

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


20/36

)ont%>o" wit% $oug%

P!ri+ron$%ia $u?ng, in$r!a'!" #!ri%iar 'tr!a5in!'', airtra##ing in *

#n!u)onia


21/36

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


22/36

T%! i))un! $o)#ro)i'!"$%i"

• Miiar/ T&>1n! no"uarit/• PCP>wi"!'#r!a" a*!oar'%a"owing


23/36

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


24/36

In%a!" For!ign &o"/

• O+'tru$ti*! !)#%/'!)a (ro) F& in t )ain +ron$%u'


25/36

A>INSPIRATORY FILM>RT SIDEHYPERLUCENT AND EPANDED&>EPIRATORY> RT SIDE AIR TRAPPINGC>NORMAL EPIRATORY FILM AFTERPEANUT REMOAL.


26/36

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

•


27/36

" #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%/


28/36

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' $l% &it' resirat$


29/36

*+ ,$!t' $l% &it' resirat$%istress18 month old status post hydrocarbon aspiration,

Showing central lower lobe alveolar opacities.


30/36

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


31/36

P!ura !u'ion9 /r o" wit% n!#%roti$ '/n"ro)

Pn!u)ot%ora-


32/36

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#


33/36

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


34/36

/!ar o" a't%)ati$


35/36

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


36/36

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

paediatric chest

Documents