Neonatal chest x ray reading
-
Upload
dr-shahzad -
Category
Health & Medicine
-
view
2.435 -
download
6
description
Transcript of Neonatal chest x ray reading
![Page 1: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/1.jpg)
DR MUHAMMAD SHAHZADCHILDREN COMPLEX
MULTAN
![Page 2: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/2.jpg)
Neonatal chest x-ray reading
![Page 3: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/3.jpg)
In spite of recent modalities like USG, CT
SCAN, MRI, conventional radiography
is cornerstone of imaging…
![Page 4: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/4.jpg)
Chest should be straight so that both
hemi thorax can be visualized equally
![Page 5: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/5.jpg)
Film should be technically satisfactory…
![Page 6: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/6.jpg)
Mediastinum in neonate has much
variability and mainly consist of heart
and thymus…..
Thymus can fill the whole of upper
mediastinum or is prominent on right
side or left……..
![Page 7: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/7.jpg)
Apart from viewing pulmonary, cardiac,
and pleural pathology, neonatal x-ray
is used to demonstrate the position of
various lines and tubes……
![Page 8: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/8.jpg)
Endotracheal intubation
A. Preferred location is halfway between the thoracic inlet and
carina
B. If ett is too low, it will enter into right main bronchus
C. Chest film may show asymmetric aeration with both
hyperinflation and atelactasis
D. If tube extends below carina and does not match tracheal air
column, suspect esophageal intubation
E. Ett placed too high has tip above clavicle , x-ray film may
show diffuse atelactasis
![Page 9: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/9.jpg)
Nasogastric tube
Tip should be in mid stomach
![Page 10: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/10.jpg)
Umblical vein catheterization
At junction of inferior vena cava and right atrium
Degree and position of patient rotation affect how the UVC appears positioned on radiograph……..
![Page 11: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/11.jpg)
Umbilical artery catheterization
Cochrane review states that high catheters should be used exclusively
Recent analysis showed a decreased risk of vascular complications and no increased risk of hypertension, necrotizing enterocolitis, IVH or hematuria….
Low catheters are associated with increased risk of vasospasms………..
![Page 12: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/12.jpg)
Radiographic pearls
PULMONARY DISEASES
A. RDS a fine, diffuse reticulogranular pattern is seen secondary to microatelectasis of alveoli. The chest radiograghs reveals radiolucent areas known as air bronchograms, produced by air in major airways and contrasted with the opacified alveoli
![Page 13: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/13.jpg)
B. MECONIUM ASPIRATION SYNDROME
Bilateral, patchy, coarse infiltrates and hyperinflation of lungs are present. there is also an increased incidence of pneumothorax…
![Page 14: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/14.jpg)
C. PNEUMONIA
Diffuse alveolar or interstitial disease that is usually asymmetric and localized.
group b streptococcal pneumonia can appear similar to respiratory distress syndrome (rds).pneumatoceles ( air – filled lung cysts ) can occur with staphylococcal pneumonia.
Pleural effusions or empyema may occur with any bacterial pneumonia…
![Page 15: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/15.jpg)
![Page 16: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/16.jpg)
Extensive bilateral (right greater than left) streaky interstitial pulmonary opacities with airspace opacification at the right base. Features are non-specific.
![Page 17: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/17.jpg)
![Page 18: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/18.jpg)
48 hours later, there has been an improvement in appearances with reduction in the degree of basal opacification.
![Page 19: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/19.jpg)
D. TRANSIENT TACHYPNEA OF NEWBORN
Hyper aeration with symmetric peri hilar interstitial infiltrates are typical.
Pleural fluid may occur as well, appear as widening of pleural space or as prominence of the minor fissure
![Page 20: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/20.jpg)
![Page 21: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/21.jpg)
Bilateral extensive interstitial and alveolar opacities that are predominantly perihilar.
![Page 22: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/22.jpg)
Nasal oxygen is being delivered. The patient is rotated. Interstitial copacity in all areas both lungs with thickening of horizontal fissure. Note sternal ossification centres projected over right lung. No effusions or pneumothorax.
![Page 23: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/23.jpg)
![Page 24: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/24.jpg)
E. BRONCHOPULMONARY DYSPLASIA
Now more commonly referred to as chronic lung disease….
Radiographic appearance is highly variable, from a fine, hazy appearance of the lungs to mildly coarsened lung markings to a coarse, cystic lung pattern..
Typically occurring in ventilated premature neonates.
Cld minimally requires a 7-10 days to develop
![Page 25: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/25.jpg)
![Page 26: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/26.jpg)
Bronchopulmonary Dysplasia. The lungs are usually overaerated, in this case the left more than the right. There are diffuse rope-like densities separated in some areas by zones of hyperlucency. The densities are coalescent in many areas. The heart borders are completely obliterated
![Page 27: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/27.jpg)
F. AIR LEAKY SYNDROMES
1. Pneumopericardiumair surrounds the heart, including the inferior border..cardiac tamponade may result..
2. Pneumomediastinuma. AP viewhyperlucent rim of air is present lateral to the cardiac border and beneath the thymus, displacing the thymus superiorly away from the cardiac silhouette (“angel wing sign” )b. lateral viewan air collection is seen either substernally (anterior pneumomediastinum ) or in the retrocardiac area ( posterior pneumomediastinum)
![Page 28: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/28.jpg)
3. Pneumothoraxlung is typically displaced away from the lateral chest wall by a radiolucent zone of air…Adjacent lung may be collapsed with larger pneumothoracessmall pneumothorax may be very difficult to identify with only a subtle zone of air peripherally, a diffusely hyperlucent hemithorax, unusually sharply defined cardiothymic margins or a combination of these…
![Page 29: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/29.jpg)
4. Tension pneumothorax
diaphragm on affected side is depressedmediastinum is shifted to contralateral hemithorax.collapse of ipsilateral lobes is evident…
![Page 30: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/30.jpg)
5. Pulmonary interstitial emphysema
single or multiple circular radiolucencies
with well-demarcated walls are seen in a
localized or diffuse pattern..the volume of
the involved portion of the lung is usually
increased.
PIE usually occurs in ventilated preemies
with RDS within initial few days of life…..
![Page 31: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/31.jpg)
G. ATELECTASIS
A decrease in lung volume or collapse of part or all of a lung is apparent, appearing as areas of increased opacity. the mediastinum may be shifted toward the side of collapse. Compensatory hyperinflation of the opposite lung may be present.1. MICROATELECTASIS
non obstructed atelectasis associated with rds..
![Page 32: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/32.jpg)
2. GENERALIZED ATELECTASISdiffuse increase in opacity
(“whiteout”) of lungs is visible on the chest film. It may be seen in severe rds, airway obstruction, if the endotracheal tube is not in the trachea, and hypoventilation…
3. LOBAR ATELECTASIS Atelectasis of one lobe Most common site is right upper
lobe Right minor fissure is usually
elevated Often occur after extubation
![Page 33: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/33.jpg)
H . Pulmonary hypoplasia
small lung volumes and a bell shaped thorax are seen . The lungs usually appear radiolucent
![Page 34: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/34.jpg)
I . Pulmonary oedema
lungs appear diffusely hazy with an area of greatest density around the hilum of each lung. Heart size is usually increased…
![Page 35: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/35.jpg)
Cardiac diseases
Cardiothoracic ratio, which normally should be less than 0.6 is the width of the base of the heart divided by the width of the lower thorax
An index more than 0.6 indicate cardiomegaly
Pulmonary vascularity is increased if the diameter of descending branch of right pulmonary artery exceeds that of trachea…
![Page 36: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/36.jpg)
A . Cardiac dextroversion.
• Cardiac apex is on right side..• Aortic arch and stomach bubble
areOn left side..
• Incidence of congenital heart disease is very high, more than 90 %.
![Page 37: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/37.jpg)
B . CONGESTIVE HEART FAILURE
cardiomegaly, pulmonary venous congestion ( engorgement and increased diameter of the pulmonary veins ), diffuse opacification of perihilar region and pleural effusion are seen..
![Page 38: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/38.jpg)
C . Patent ductus arteriosus
Cardiomegaly,, pulmonary edema, ductal haze ( pulmonary edema with a patent ductus arteriosus ), and increased pulmonary vascular markings are evident …
![Page 39: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/39.jpg)
D . Ventricular septal defect
Cardiomegaly, an increase in pulmonary vascular density, enlargement of the left ventricle and left atrium, and enlargement of the main pulmonary artery
![Page 40: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/40.jpg)
E . Coarctation of aorta
1. preductal coarctation generalized Cardiomegaly with
normal pulmonary vascularity is seen.
2. postductal coarctationenlarged left ventricle and left
atrium and a dilating ascending aorta are present
![Page 41: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/41.jpg)
F . Tetrology of fallot
heart is boot shapednormal left atrium and left ventricle is associated with an enlarged, hypertrophied right ventricle and a small or absent main pulmonary artery. There is decreased pulmonary vascularity. A right aortic arch occur in approx 25% of patients
![Page 42: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/42.jpg)
G . TRANSP0SITION OF GREAT ARTERIES
Cardiomegaly, enlarged right atrium and right ventricle, narrow mediastinum and increase pulmonary vascular markings
But in most cases, chest film appears normal.
![Page 43: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/43.jpg)
H . TOTAL ANOMALOUS PULMONARY VENOUS RETURN
Pulmonary venous marking are increased…
Cardiomegaly is minimal or absent..Congestive heart failure and pulmonary
edema may be present…esp with type 3 TAPVR ( subdiaphragmatic )
![Page 44: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/44.jpg)
I . Hypoplastic left heart syndrome
chest film may be normal at firstmay show cardiomegaly and pulmonary congestion and enlargement of right atrium and ventricle…
![Page 45: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/45.jpg)
J . Tricuspid atresia
Heart size is usually normal or small, the main pulmonary artery is concave and pulmonary vascularity is decreased
![Page 46: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/46.jpg)
Truncus arteriosus
cardiomegaly, increased pulmonary vascularity , and enlargement of left atrium.a right aortic arch occur in 30% of patients….
![Page 47: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/47.jpg)
I . ATRIAL SEPTAL DEFECT
• varying degrees of enlargement of right atrium and ventricle is
seen• aorta and left ventricle is small• pulmonary artery is large• increased pulmonary vascularity is
evident
![Page 48: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/48.jpg)
M . Ebstein anomaly
Gross cardiomegaly and decreased pulmonary vascularity are apparent
Right heart border is prominent as a result of right atrial enlargement
![Page 49: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/49.jpg)
N . Valvular pulmonic stenosis
Heart size and pulmonary blood flow is usually normal unless the stenosis is severe.
Dilatation of main pulmonary artery is main chest film finding
![Page 50: Neonatal chest x ray reading](https://reader035.fdocuments.us/reader035/viewer/2022062418/554b1eecb4c9055d098b52be/html5/thumbnails/50.jpg)
thanks