Clinico-Radiologic Correlation Normal Pediatric Chest Xray 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 5 th – 7 th 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 5 th – 7 th 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”

3-4 years old Apex 5 th LICS >6 th LICS = LVE Anterior rib = vertical Posterior rib = horizontal CT ratio 0.65