PEDIATRIC CHEST RADIOLOGY o delivery without proper preparation

- radiologic findings:
Anatomy o hazy patchy alveolar infiltrates
- Meconium Aspiration Pneumonia
Neonatal Chest o type of neonatal pneumonia
o globular heart o thick meconium: may be aspirated,
o RV>LV (3rd trimester: relative hypoxic lodge in dependent areas
environment thickening of tunica media upper lobes
physiologic pulmonary hypertension RV hilar area (superior basal segment
enlargement rounding of cardiac apex of lower lobe)
o apparent hyperlucency (smaller hilar o pathologic air-bronchogram
structures & blood vessels) o severe dyspnea
o larger AP diameter - complications:
o thymus gland enlarged (regress starting age o bronchopulmonary dysplasia
2) due to fibrosis
bubbly lung
Older Children
may be due to assisted ventilation
o no rounding of apex
o RV<LV
Barotrauma
o correction of physiologic pulmonary - excessive ventilation (usually assisted
hypertension ventilation)
- pneumothorax
pathologic air-bronchogram branching o air hyperlucency without vascular
linear radiolucent area (tertiary airways) markings
1. hyaline membrane disease o visceral pleural line seen
2. consolidation
- pneumomediastinum
sail sign physiologic enlargement of thymus
o air in mediastinal space
gland
thymus notch demarcates thymus and heart
Pneumomediastinum
- if thymus gland still present
Normal Enlarged Thymus (vs Pathologic
o displacement of thymus upward (angel
Mass)
- normal thymus regress starting 2 years wing sign)
- will not displace or distort trachea and o in anterior pneumothorax, displacement
esophagus (thymus only goes around) of thymus medially(pseudosnowman)
- merges inconspicuously with heart
(same density with heart) Anterior pneuothorax: emergency
Pneumomediastinum: not emergency
main pulmonary artery segment - where
hilar vessels are confluent Air embolism
- may be massive and make entire heart
Transient Tachypnea of Newborn hyperlucent
- usually in preterm delivered by cesarian
section (CS) Pneumonia
- excess pulmonary fluid 1. interstitial
- CS: no squeezing effect unlike NSD 2. alveolar
- Radiologic findings: 3. mixed
o engorged lymphatics: linear 4. lobar
densities from hilar segment
o hyperaeration (hyperlucency) Interstitial pneumonia
- viral (ex. Measles)
o depression/flattening of
- interstitial infiltrates (linear densities)
hemidiaphragm
- accompanied by air-trapping
o increase AP diameter
- flattening of hemidiaphragm
- all of these will clear within 48 hours - resolves in 10-14 days
Hyaline Membrane Disease Alveolar pneumonia
- persistent collapse of alveoli - homogenous opacification of a lobe
- common among premature - bacterial (ex. Pneumococci)
- surfactant deficiency - (+) pathologic air-bronchogram
- Radiologic findings:
o underaeration/opacification (collapse of Opacification of a Lobe
alveoli) - 4 differential diagnoses
o pathologic air-bronchogram 1. Consolidation
o ground glass appearance o trachea midline
- radio: depends on phase of respiration 2. Lobulated pleural effusion
- during inspiration: ground glass o contralateral tracheal shift
appearance collapse alveoli + patent o minor fissure bulging
airways (downwards)
- during expiration: (-) ground glass; (+) 3. Mass
white-out sign homogenous appearance o contralateral tracheal shift
due to already collapsed alveoli + collapse
o minor fissure bulging
of previously dilated airways
(downwards)
o (+) rib erosion
Neonatal Pneumonia
- crackles, dyspnea 4. Atelectasis
- predisposing maternal factors: o Ipsilateral tracheal shift
o premature rupture of membrane o (-) air bronchogram pattern
o urinary tract infection
o upper respiratory tract infection Bronchopneumonia
- usually S. aureus
- complications:
o pneumatocele
check-valve obstruction (alveoli)
o abscess
thick walled
air-fluid level
o empyema
massive effusion
contralateral mediastinal shift

Mixed Intestitial & Alveolar Pneumonia

- usually starts as viral pneumonia then
becomes bacterial
- viral pneumonia: clears within 2 weeks
- suspect when patients condition worsens
- may be complicated by brain abscess

Atelectasis
- Direct sign
o Fissural displacement
o Lobar atelectasis
- Indirect sign
o Ipsilateral shift
o Narrowing of intercostal spaces
o Elevation of diaphragm (ipsilateral)
o Compensatory emphysema in
contralateral side

Focal Areas of Radiolucency (holes in

lungs)
1. Congenital lobar emphysema
o hyperaerated lung
o displacement of lung
o depressed or flattened diaphragm
2. Pneumothorax
3. Diaphragmatic hernia (Traumatic)
o thick-walled radiolucency
o dyspneic, shock
o be careful in thoracostomy (peritonitis)

Cystic Adenomatoid Malformation

- Type 1 50% large cystic >1cm
- Type 2 40% multiple small <1cm
- Type 3 10% solid-looking

Primary TB
- 4 features
o Ghons lesion (primary lesion)
o Regional lymphadenopathy
o Lymphangitis
o Pleural effusion or thickening
- Differentials for enlarged hilar lymph node
o Sarcoidosis
o Leukemia
o Lymphoma
o PTB
o Histoplasmosis
- Ghons lesion
o early: hazy
o late: becomes calcified
o months-years (calcification)
- Pleural effusion
o homogenous opacification of
hemithorax
o curved upper border (Demaceus?
sign)
- comfortably dyspneic primary PTB
o even if already large abscess
(tuberculous)
- Right Middle Lobe sign
o obliteration of right cardiac border
o compression of lungs due to enlarged
LN
- cutaneous TB
o subcutaneous nodule (calcified on chest
x-ray)