Clinico-Radiologic CorrelationNormal Pediatric Chest Xray

Geronimo, Geronimo, Geronimo, Go

January 6, 2011

Points to remember...

• PROJECTION: • Supine AP– Tube to film distance = 3feet– Heart size and mediastinal width will be

exaggerated by both the supine position and the AP projection

• PA view– 2 years and above

Points to remember...

• PHASE OF RESPIRATION

Inspiration: Diaphragms 5th – 7th anterior rib

Expiration: will exaggerate the heart size and bronchovascular

markings

Points to remember...

• SYMMETRY: – check the symmetry of the ribs and the distance of

the medial borders of the clavicles from the spinous process of the vertebrae

• AGE: variability– Normal Anatomy corresponding to age

Points to remember...

• PROJECTION: • Supine AP– Tube to film distance = 3 feet– Heart size and mediastinal width will be

exaggerated by both the supine position and the AP projection

• PA view– 2 years and above

Points to remember...

• PHASE OF RESPIRATION

Inspiration: Diaphragms 5th – 7th anterior rib

Expiration: will exaggerate the heart size and bronchovascular

markings

Points to remember...

• SYMMETRY: – check the symmetry of the ribs and the distance of

the medial borders of the clavicles from the spinous process of the vertebrae

• AGE: variability– Normal Anatomy corresponding to age

ABC

• A – Abdomen– Bowel gas pattern suggesting ileus or obstruction,

free air, abnormal calcification, abdominal situs.• B – Bone– Fractures, lytic or blastic lesions, metabolic bone

diseases.• C – Chest– Midline trachea and mediastinum, abnormal

mediastinal and cardiac contours, position of the aortic arch and pulamonary pathologies

Newborn

• Globular configuration of the heart– Prominent RV rounding of the apex– Thickening of the tunica and increase pulmonary resistance

physiologic pulmonary HPN • Hyperaerated lung (Radiolucent)

– Thin chest wall– Smaller pulmonary vessels and hilar structures

• Air Bronchogram– NORMAL: trachea, R&L mainstem bronchi and 2° airways– PATHOLOGIC: Hyaline membrane disease and Consolidation

Newborn

• THYMUS GLAND “Sail’s Line”

Normal

Same density with the heart

Trachea and esophagus not

distorted

Regresses by 2 years old

3-4 years old

• Apex 5th LICS• >6th LICS = LVE• Anterior rib = vertical• Posterior rib = horizontal• CT ratio 0.65