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ROENTGENOGRAPHY
PEDIATRIC CARDIOLOGY
JULY 2014
SYSTEMIC APPROACH
LOCATION OF THE LIVER AND STOMACH GAS BUBBLE
the cardiac apex should be on the same side as the stomach or opposite the hepatic
shadow.
SKELETAL ASPECT OF CHEST X-RAY FILM
- Pectus excavatum may flatten the heart in the anteroposterior dimension and cause a
compensatory increase in its transverse diameter, creating the false impression of
cardiomegaly.
- Thoracic scoliosis and vertebral abnormalities are frequent in cardiac patients.
- Rib notching is a specific finding of coa in an older child (usually older than 5 years) and
is usually found between the fourth and eighth ribs.
Identification of the descending aorta along the left margin of the spine usually indicates
a left aortic arch; identification along the right margin of the spine indicates a right aortic
arch. right aortic arch is frequently associated with TOF or persistent truncus arteriosus.
2.
When the descending aorta is not directly visible, the position of the trachea and esophagus
may help locate the descending aorta. If the trachea and esophagus are located slightly to
the right of the midline, the aorta usually descends normally on the left (i.e., left aortic arch).
In the right aortic arch, the trachea and esophagus are shifted to the left.
3.
In a heavily exposed film, the precoarctation and postcoarctation dilatation of the aorta may
be seen as a figure of 3. this may be confirmed by a barium esophagogram with e-shaped
indentation.
UPPER MEDIASTINUM
1.
The thymus is prominent in healthy infants and may give a false impression of cardiomegaly.
It may give the classic sail sign.
2.
The thymus shrinks in cyanotic infants or infants under severe stress from CHF .
In TGA, the mediastinal shadow is narrow (narrow waist), partly because of the shrinkage of
the
thymus gland. Infants with digeorge syndrome have an absent thymic shadow and a high
incidence of aortic arch anomalies.
3.
A snowman figure (or figure-of-8 configuration) is seen in infants, who are usually older than
4 months, with anomalous pulmonary venous return draining into the svc through the left svc
(vertical vein) and the left innominate vein
PULMONARY PARENCHYMA