CHEST X-RAY interpretation in paediatrics.

Assalamualaikum & good day everyone!!!

1. note the personal details of the patient.
- is it the right person?
- right age?
- what about the date?
- is it compatible to the history?

2.how about the positioning of the X-ray?
- is it AP or PA view?
- it does makes a difference where AP view will give larger view of the heart, where in actual condition, there is no cardiomegaly.
- to determine whether there is cardiomegaly, look at the cardiothoracic ratio:
- it is acceptable if the cardiac shadow is < 60%- less than 1 year
                                                              <50%- more than 1 year

3.comment on the quality of the film.
- is it a good quality film?
- seen by:- a) good penetration
                     can you see the intervertebral spaces?
                 b) is it centered?
                     look at the trachea, is there any deviation form the midline
                     also look at the medial part of the clavicle whether it is symmetrical for both sides.
                 c) any rotation?
                     seen by the outline of theX-ray
                     (this is my clue: see whether u can see the head turned to any side)
                     and of course if there is deviation of the trachea from the midline.
                  
- in case of rotation,u will realize that the vascular marking is remarkably visible only at one side, as when then X-ray is taken, that side is focussed more than the other side (as u see, children do move when the X ray was taken), but it does not mean, perihilar haziness is more prominent on one side of the heart only.

4. is the X-ray showes hyperinflation?
- count the posterior ribs
- if it is more than 7, it shows hyperinflated lung in case of: e.g: acute bronchiolitis, Asthma.

5.any area of consolidation?
- assess the lung by a lobe at a time.
- focus more on the periphery rather than mentioning perihilar haziness as it may only indicate the vascular marking

6. comment on any other features such as gas in bowel, or any other abnormal features seen.
- e.g: in situs inversus, liver can be noted to be on the left side, and of course, the heart (left ventricle located on the right side)

7. check for mediastinum (the outflow of heart aka the blood vessels at the top)
- wide: in newborn (before 6 months, the thymus can make the mediastinum looks wider)
- narrower in case of transposition of Great Arteries.

8. in case of dilated bowels, gas can be seen in the bowels..

ok, that's all for today, tomorrow, i will be coming back with example of X-ray and how to interpret it....

thanx...

roger and out!!!