Paediatric X rays

PAEDIATRIC X-RAYS

  • Presenters: Nitish Sadhasivam, Nivedha, Niveditha, Noorul Hudha, Padmaja

INTRODUCTION

  • X-rays create images by passing from the tube to the detector through the human body.

  • The attenuation of X-rays by body structures determines the image produced.

  • Structures with high density are radiopaque (bright), while those with lower density are radiolucent (dark).

  • Five main densities: Air, Fat, Water (soft tissue), Calcium, and Metal.

TYPES OF PAEDIATRIC X-RAYS

  • Chest X-ray: Most common for evaluating lungs, heart, aorta, ribs, and sternum.

  • Abdominal X-ray: Evaluates abdominal organs.

  • Skeletal X-ray: Detection of fractures, dislocations, and bone deformities.

INTERPRETING AN X-RAY

  • Verify child’s name, date, and age.

  • Note the view (AP, PA, Lateral) and whether the X-ray is plain or contrast.

  • Comment on visible structures (bones, joints, organs) and any pathology or deformities.

NORMAL PAEDIATRIC CHEST X-RAY

  • Key structures to identify: Trachea, bronchial bifurcation, right atrium, diaphragm, clavicle, scapula.

SYSTEMIC APPROACH TO INTERPRET A CHEST X-RAY: 'RIPE' APPROACH

  • R: Rotation

  • I: Inspiration

  • P: Picture

  • E: Exposure

RIPE - DETAILS

Rotation

  • Check alignment of spinous processes between medial ends of the clavicles.

Inspiration

  • In a normal CXR, 7 anterior ribs and 9 posterior ribs should be visible.

Picture

  • Ensure all key body parts are included.

Exposure

  • Vertebral and bronchovascular structures should be faintly visible through the heart.

  • Overexposed: Too dark; Underexposed: Too bright.

CRITERIA FOR GOOD LATERAL FILM

  • Adequate collimation, lung apices visualization, clear diaphragm outline, and sharp heart border.

USES OF PAEDIATRIC X-RAYS

  • Evaluate respiratory conditions (e.g., pneumonia, pleural effusion, TB).

  • Assess cardiac conditions (e.g., cardiomegaly, pericardial effusion).

  • Diagnose gastrointestinal conditions (e.g., duodenal atresia, intestinal obstruction).

  • Locate ingested foreign objects and diagnose skeletal disorders (e.g., fractures).

PNEUMONIA - CONSOLIDATION

X-ray Findings

  • Dense opacity in lobe, air bronchograms, haziness, no mediastinal shift.

MANAGEMENT

  • Hospitalization, IV fluids, oxygen administration, culture and sensitivity testing, appropriate antibiotic therapy.

PNEUMOTHORAX

  • Causes: Chest trauma or lung disease.

  • Management: Observation, needle aspiration, chest tube insertion.

MILIARY TUBERCULOSIS

  • X-ray appearance: Numerous small, rounded opacities in lung fields.

  • Management includes drug dosage tailored for pediatric TB.

BRONCHIECTASIS

  • Causes: Congenital disorders, cystic fibrosis.

  • Management includes controlling infections and potential surgical resection.

HYALINE MEMBRANE DISEASE

  • X-ray: Ground-glass appearance, air bronchograms.

  • Management: Surfactant therapy.

CARDIOVASCULAR SYSTEM

Cardiomegaly

  • Causes: Anemia, cardiomyopathy, congenital heart disease.

  • Management includes diuretics and beta blockers.

PERICARDIAL EFFUSION

  • Appearance: "Water bottle" or "money bag" sign.

  • Management: Pericardiocentesis, antibiotics, anti-inflammatory drugs.

TETRALOGY OF FALLOT

  • Key features: Pulmonary stenosis, ventricular septal defect, hypertrophy.

  • Management: Iron supplementation, beta blockers, definitive surgery.

FOREIGN BODY X-RAY CLINICAL FEATURES

  • Trachea: Cough, distress; Esophagus: Dysphagia; Stomach: Abdominal pain.

  • Management for removal varies based on location.

RICKETS

Clinical Features

  • Bowed legs, knock knees, rickety rosary, increased fractures.

Management

  • Vitamin D administration, calcium supplements, orthopedic treatment.

SCURVY

Clinical Features

  • Early changes: Irritability, swelling; Late changes: Gum bleeding, poor wound healing.

Management

  • Vitamin C administration.

OSTEOGENESIS IMPERFECTA

Features

  • Fragile bones, osteoporosis, multiple fractures.

Management

  • Bisphosphonates, pain management, rehabilitation.

ACHONDROPLASIA

Features

  • Short stature, macrocephaly, spinal stenosis.

Management

  • Growth hormone therapy, surgical interventions.