IAP Textbook of Pediatric Radiology TM Ananda Kesavan, S Venkateswaran
Page numbers followed by f refer to figure and t refer to table.
Abdomen 149f, 174, 180f
conventional X-ray of 143
examination of 179
gasless 143, 153f
plain X-ray of 157f
Abdominal distension 180f
Abdominal pain 3
bottom of 41f
multiple 190f
rounded pus-filled 41f
Accessory ossicles 98
Acetabulum 141
Achalasia cardia 152, 153f
Achondroplasia 103, 103f
Acro-osteolysis 112f
Addison's disease 54
Adenopathy 11f
Adenovirus infection 24
Adrenogenital syndrome 122
Air bronchogram 175f
Allergic pneumonitis 55
Alveolar stage 44
Amyoplasia 142
Aneurysmal bone cyst 129f
Annular pancreas 144, 145
Anomalous left coronary artery 86
Anomaly, intermediate 149f
Anorectal malformations 148
Anorexia nervosa 54
Aorta, arching of 77
Aortic knob 7
Aortic knuckle, prominent 77f
Aortic regurgitation 94
Aortic stenosis 80, 85, 85f
Aortopulmonary window 92
Apert's syndrome 140
Arthrogryposis multiplex 142f
Ascites 148, 149f
Asphyxiating thoracic dysplasia 104, 104f
Aspiration problems 52
Asthma 46, 49f
Asthmatic chest 46, 47f
typical baseline 46
Asthmatic pneumomediastinum 47f, 48f
Atelectasis 13, 33
mimicking pneumonia 12, 12f, 46
plate-like 34f
segmental 34
Atrial enlargement 75
left 76, 81, 84
right 75, 76f, 81, 84, 85, 87, 88f, 92
Atrial septal defect 80, 81, 82f, 84, 92
large 82
moderate 81
small 81
Atrioventricular septal defect 80, 82
Atrium appendage, left 72f
Avascular necrosis 133
Bacterial organisms 124
Bacterial pneumonia 69
Bacterial spectrum 15
Barium enema 3, 147, 147f
X-ray 153
Barium filling cystic lesion 152f
Barium meal 145f, 151f
study 144
normal 145f
Barium small bowel 3
Barium study 151f, 181f, 201f
for digestive tract 3
Barium swallow 3
Battered baby syndrome 138f
Biatrial enlargement 77f
Bivalvular rheumatic heart disease 95f
capacity 165
diverticulae 171
diverticulum 171f
Blount's disease 136, 137f
Body positions 3
Bone 174
age, estimation of 99
density 206f
increased 188f, 206f
rickets with decreased 202f
disease 97
infection of 122
long 103105
neoplasia of 128
thickness of 98
tumors 128
benign 128
malignant 128, 131
within bone appearance 111f
Brodie's abscess 124
Bronchial fracture 61
Bronchiolitis 10, 11, 11f, 12f, 54f, 69
Bronchogenic cyst, large infected 56f
Bulbar urethra, proximal part of 170f
appearance 44
vertebra 141f
Caffey's disease 138f
diagnosis of 138
Calcaneum, bone cyst in 128f
Callus, multiple fractures with 111f
Cardiac malposition 73, 91, 92
Cardiac silhouette
posterior aspect of 10f
right 21f, 57f
huge 201f
marked 74f
mild 74f
moderate 74f
Cardiomyopathy, dilated 95, 200f
Cardiovascular system 70
Caries spine 126f, 127f
Carpenter's syndrome 140
Cartilage 108
cells, hypertrophied 115
Catastrophic injuries 61
Cerebrocostomandibular syndrome 109, 109f, 110f
Cervical 141
rib 193f
right-sided 193f
Chest 174
air trappings in 41
bell-shaped 105f
bowel loops in 150f
film, value of lateral 17
image, positive 16
lateral decubitus view of 4
masses 55
normal 9
overdistended 47f
posteroanterior view 6f
problems, miscellaneous 52
radiograph 4
indications 4
projections 4
radiography 3
pediatric 4
traumas 59
wall, loculated effusion in lateral 30
X-ray 6, 7, 70, 72
Child abuse 136
Chondrodysplasia punctata 106, 106f, 115
Chondroectodermal dysplasia 104, 115
Chromosomal diseases 101
Clavicle, absence of 197f
Claw sign in intussusception 153f
Cleidocranial dysplasia 107, 108f
Coarctation of aorta 85, 86, 86f, 201f
infant with 86
Cobra head appearance 164, 164f
Codman's triangle 132
Coeur en sabot appearance 87
Cold abscess 127f
Collapsed right middle lobe 37f
Colonic aganglionosis, total 183
Colonic atresia 182, 182f
Compensatory emphysema 14, 15f, 35f, 48
Compressor nudae muscle 167f
Computer-aided detection 64
Congenital abnormalities 139
Constrictive pericarditis 96f
Contralateral compensatory emphysema 48f
Contrast enema 182f
Conventional radiology, role of 155
Coryza 13
Costophrenic sulcus, posterior 23f
Cough 13
Coxa magna deformity 135
Craniostenosis 139, 140f
Cri Du Chat syndrome 102
Crookes tubes 1
Crouzon syndrome 140
Cushing's syndrome 122
Cyamella 98
Cyanotic congenital heart disease 87
Cyanotic Ebstein's anomaly 89
abdominopelvic 153, 153f
bronchial 198f
bronchogenic 56f
leptomeningeal 99, 99f
Cystic mass 55
Cystourethrogram, normal voiding 166f
Cytotoxic drugs 55f
Decubitus position 4
Dense bones 112f
Dense hazy infiltrate, bilateral 54f
Desquamative interstitial pneumonias 24
Dextrocardia 72, 93f, 200f
no true 92
true 93
with situs
inversus 73f
solitus 72f
Dextroposed heart 73f, 92
Dextroposition 72
Diaphragm 7
eventration of 151, 152f, 178, 179f, 194f, 200f
flattened 68
left, eventration of 179f
right 19f
Diaphragmatic hernia
congenital 92, 149, 178, 178f
delayed 55
Diaphragmatic leaflet
localization of 10f
right 19f, 23
Diaphragmatic sign, continuous 42f
Diaphyseal dysplasia 109
Diaphyseal fractures 137
Diaphysis 97
Diaphysitis 127
Digital chest radiography 64
Digital radiography
advantages of 64
disadvantages of 65
Discoid atelectasis
multiple 35f
segmental 35f
vertical 35f
Double bubble
shadow 197f
sign 144f, 180, 180f
Down's syndrome 102, 102f, 144
Drooping lily
appearance 152f
sign 162
Dudley's skull 2
Duodenal atresia 144, 180, 181f, 197f
Duodenal bulb 145f
Duodenal diaphragm 144, 145
Duodenal obstruction 144
Duodenal stenosis 180, 180f
Duodenal web 144
Duplex kidney 162, 163f
diagnosis of 162
Dysostosis multiplex group 112
Dysphagia 3
Dysplasia, suspected 115
Ebstein's anomaly 89, 89f, 90f
child with 89
significant 89
Ectodermal dysplasia 109, 115
Ectopic kidney, uncrossed 161
Ectopic ureter 163
Effusion 26
Egg on side appearance 89f
Ehlers-Danlos syndrome 172
Eisenmenger complex 92t
Eisenmenger syndrome 92, 92f
Elbow lateral 101f
Elevated diaphragm 5f
Ellis-van Creveld syndrome 104, 105f
Emphysema 14, 39
surgical 190f
Empyema 24
large loculated 30f
Enchondroma 129
disease hypothyroidism, bone in 121
disorders 102
Endotracheal tube 4, 173
placement 173f
Engelmann's disease 109, 109f
Enterocolitis, necrotizing 154f, 184
Eosinophilic granuloma 138, 203f
Epiglottitis 67
Epiphyseal dysgenesis 121
Epiphysis 97
Erosive esophagitis 186
Erythromycin 199f
Esophageal atresia 177, 177f
pure 152, 153f
Esophageal stricture formation 186
Esophagus, dilated 153f
Etched heart border 174
Ewing's tumor 132, 133f
Exostoses, multiple 129f
Exostosis 128
from fibula 129f
Fallot's tetralogy 200f
Familial short stature 102
Felson's silhouette sign 16, 18
left 137f
radiograph of 205f
Fever 13
Fibrous dysplasia 130, 131f
involving tibia 131f
Fifth cervical vertebra, destruction of 203f
Figure of 8 appearance 91f
bulging of 189f
effusion, vertical 27f
opacification, vertical 26
Flattened vertebrae 114f
Floating teeth appearance 139f
Fluoroscopy 2
Fluorosis 120
Focal pneumonia 23f
Foreign body 52f
aspiration 195f
disguised 51f
endotracheal opaque 39
expiratory film 50f
inspiratory film 50f
mimicking pneumonia 51
producing right lower lobe atelectasis 51f
with pneumomediastinum 52
depressed 99, 99f
growing 99f
Free air, presence of 179
Free fluid, presence of 180
Freiberg’ disease 135
Friedlander's pneumonia 24
Friedreich's disease 136
Fungal infections 24
Gastric outlet obstruction 143
Gastric scintiscan 186
Gastrocnemius muscle 98
Gastroesophageal reflux
disease 185, 186, 186f
secondary 186
Gastrointestinal system 143
Genitourinary system 155
Giant cell tumor 131
Giant cyst meconium peritonitis 146
Globular heart 75f
Glomerular filtration rate 158
Glomerulonephritis, acute 45f
Gracile ribs, thin 110f
Great arteries
L-transposition of 91
transposition of 88, 88f, 89f
Great vessels 76
Growth hormone deficiency 102
Gutter effusion
mediastinal 28
paraspinal 28
Haemophilus influenzae 25
type B 24
Hair hypoplasia 108
Hair-on-end appearance 204f
Hands 103, 105
modeling defect 115
Harlequin appearance 140
Healing fracture 116f
Healing rickets 117f
Heart 7
boot-shaped 200f
borders of 71, 72f, 174
acquired 70
congenital 70
elongated small 49, 49f
globular enlargement of 95f
hiding pneumonia behind right 21, 21f, 22f
left side of 21f
location of 72
size of 73
normal 74f
Hematogenous 126
Hematoma 62f
Hematuria 162
Hemivertebrae 141, 141f
Hemolytic anemia 204f
Hemoptysis 55
Hernia, diaphragmatic 56f, 150, 150f, 188, 188f, 197f
Hiatus hernia 151, 151f
Hila 7
Hilar adenopathy 12, 13f, 32f34f
Hilar region, prominent 13f
Hilum 7
developmental dysplasia of 141, 142f
dislocation 125f
Hirschsprung's disease 147, 148f, 154, 183, 184f
barium enema in 148f
short segment 183
Histiocytosis 138, 139f, 204f, 205f
Horseshoe kidney 161, 162f
Human immunodeficiency viruses infection 194f
Humerus epiphysis, widening of 202f
Humerus, osteolytic lesion of 205f
Hurler's syndrome 112, 113f
Hyaline membrane disease 174, 175, 175f, 196f
differential diagnosis of 196
Hydrocarbon pneumonia 53f, 54f
Hydronephrotic kidney, left 160f
Hydropneumothorax 198f
Hydrothorax 25
Hydroureteronephrosis 160f
Hyperparathyroidism 122
Hyperphosphatemia 121
Hyperpituitarism 122
Hyperthyroidism 121
Hypertrophic cardiomyopathy 94
Hypervitaminosis 119
Hypochondroplasia 103
Hypognathia 109f
Hypoparathyroidism 121, 205f
Hypophosphatasia 117, 118f
infant with severe 118f
Hypopituitarism 122
Hypoplastic left
heart syndrome 80, 86
lung 190f
Hypoplastic lower ilium 113f
Hypoplastic nails 115
Hypothyroidism 121f
older child with 121f
Ileal atresia 146, 180, 181f
Illnesses and injuries, diagnosis of 1
Image evaluation 4
Infantile cortical hyperostosis 138
Infantile hypertrophic pyloric stenosis 143
Inspiratory film 47, 48
Inspissated milk syndrome 154
Intensive care units 64
Interlobar fissure effusion, small 28f
Interstitial pneumonia, bilateral 194f
Interstitial pneumonitis 12
Interstitial stage 44
Intravenous pyelogram, normal 159f
Intravenous urography 155, 157, 160f, 161f
Intussusception 152
Jejunal atresia 145, 146f
Jeune's disease 104
infection of 122
tuberculosis of 125
Kartagener's syndrome 93f, 200
disorders, congenital 159
ectopic 161
right 161f
malrotated 161
normal left 161f
Klippel-Feil abnormality 140
Kohler's disease 135
Lamellar pleural effusion 199f
Larynx, foreign body in 192f
Lateral chest
film 16, 17f
wall 26
Lazy bladder syndrome 172
Left diaphragmatic leaflet 19f
hiding pneumonia behind 23
silhouette sign 18
Left hilum, hiding pneumonia behind 22, 22f
Left lower lobe 15f
atelectasis 38
pneumonia 19f
Left ureter, dilatation of 164f
Leukemic bone deposits 133, 133f
Levocardia 93, 94f
Ligament, anterior longitudinal 126
Lingular atelectasis 38f
Lingular lobe consolidation, left 69
Lipoid aspiration
chronic 53
pneumonia 54f
Lipoid pneumonitis 24
hiding pneumonia behind 23
right sided 200f
Lobar atelectasis 35
Lobar emphysema 39
congenital 40f, 194f
Loculated effusion 30, 31f
Loculated pleural effusion 29, 30f
Low anomaly 148f
Lower airway, foreign bodies in 49
Lower limb bones 124
Lower lobe
behind heart, right 14f
collapse of left 198f
collapsed 40f
Lower lobe atelectasis 37
right 37, 38f, 51
Lower lobe pneumonia 34f
behind heart, hiding left 21
hiding left 21f
right 22f
superior segment 34f
Lumbar spine 141
Lung 8, 55, 71
abscesses 192f
left 37
total 34, 35f
casting abnormal shadows, normal 57
density 8
hyperaerated hyperlucent 11f
hyperinflated 53
right 190f
hyperinflation 68
opacity, bilateral 175f
right 35f
vascularity 78f
volume, assess 8
white washed 90f
with microcardia, overaerated 53
Lymph nodes 7
Lymphoid interstitial pneumonia 194, 194f
Lymphoma, expanding mass of 56f
Main pulmonary artery 85f
segment 72f
Malrotated kidney, left-sided 161f
Malrotation 144, 146f
Mass 7
rapidly expanding 56f
Massive empyema 25, 26f
Massive pleural effusion 27, 28f
Massive pneumothorax 61
Meconium aspiration syndrome 176, 176f
Meconium ileus 146, 147f, 182, 183f
Meconium peritonitis 147f, 182, 183f
Mediastinal effusion 28, 29f
Mediastinal mass 60f
differential diagnosis of 192
large 56
posterior 34f
Mediastinum 152f
widened superior 63f
Megacystis 172, 172f
Megacystis-megaureter 172f
Melorheostosis 112
Mesocardia 73f
Mesomelic dysplasias 115
Metabolic disease 97
Metacarpal sign 101
Metadiaphyseal fracture 137f
in humerus 137f
in radius 137f
Metal poisoning, heavy 119, 119f, 120f
Metaphyseal chondrodysplasia 108, 108f
Metaphyseal dysplasia 109
Metaphysis 97
Metastatic neuroblastoma 133
Metatarsals, fourth and fifth 205f
Metatropic dysplasia 106
hands 107f
pelvis 107f
platyspondyly 107f
Microcolon 146
Micturating cystourethrogram 165
Middle lobe
collapse, right 36
silhouette sign, right 18f, 19, 20f
Middle lobe atelectasis 37
right 32f, 37, 37f
Miliary mottling, differential diagnosis of 189
Miliary tuberculosis 189f
Mimicking hydropneumothorax 150f
Mitral regurgitation 93, 94f
severe 95f
Mitral stenosis 80, 93, 94f
Morgagni hernia 150, 151f
Morquio's disease 113, 114f
tapering 114f
Mucolipidosis 114
type 2 114f
Mucopolysaccharidoses 112, 113f, 114f
pelvis 113f
Mucus plug 49f
dislodging 13f
Multiple vertebrae, compression of 134f
Muscle sign 123f
Mycoplasma pneumoniae 24, 198
Necrotizing entercolitis, presence of 180
Neonatal chest, normal 175
Neonatology 173
Neurofibromatosis 130
Neurogenic bladder 170, 171f
Newborn chest radiograph 81
Nonaccidental injury 136
Nondilated distal ureter 168f
Nondilated pelvicalyceal system 168f
Non-Hodgkin's lymphoma 187
Nonhomogeneous opacity 188
Noninvasive tests 1
Nonossifying fibroma 129f
Noonan's syndrome 102
Obstructive emphysema 1315, 15f, 33f, 40f, 47, 48f
Ollier's disease 130
Oncogenic rickets 117
Osgood-Schlatter disease 135
Osteoblastoma 130
Osteoblasts 97
Osteochondroma 128
Osteochondroses 134
Osteoclastoma 131
Osteoclasts 97
Osteofibrous dysplasia 130
Osteogenesis imperfecta 109, 110f, 111f
Osteogenic sarcoma 132f
Osteoid osteoma 130, 130f
Osteolytic lesion 204f, 205f
acute 123, 123f, 125f
chronic 123, 124f
type of subacute 124
Osteopetrorickets 206, 206f
Osteopetrosis 110, 188f, 206f
dense bones 111f
hands 111f
severe 208f
Osteosarcoma 131
angiogram in 132f
Panner's disease 135
Paraduodenal hernia, malrotation with 182, 182f
Parahilar pulmonary congestion 44f
Paramediastinal pneumatocele, traumatic lung with 62f
Pararenal inflammation 156
Paraspinal soft tissue shadow 127f
Paratracheal adenopathy 31
unilateral 32f
Parenchymal pneumonitis 10
Patella center, knees lateral for 101f
Patent ductus arteriosus 80, 83, 83f, 84, 92
moderate 83
small 83
Pathologic gastroesophageal reflux 186
Pelken's spur 119, 119f
Pelvic bones 102
Pelvicalyceal system, normal 159f
Pelvis 103105, 105f, 107
Pelviureteric junction obstruction 162, 164f
Peribronchial inflammation 13f
Pericardial effusion 95, 95f
Periosteal arteries 124
Periosteal cloaking 114f
Perthes disease 134, 135f
Pleura 8
Pleural effusion
lateral decubitus for 4
mimicking lobar pneumonia 29f
simple 25
Pleural fluid 24, 63f
collections, types of 24
Pneumatocele 40, 41f
large 190f
multiple 190f
Pneumatosis intestinalis 154
gas 184
carinii pneumonia 24
jiroveci 194
Pneumomediastinal air outlining aorta 47f
Pneumomediastinum 42, 42f, 174
complicating asthma 47
Pneumonia 10, 16, 43, 51f, 52, 175f, 191f
hiding 20
right apical 16f
lobe 22f
lower 199f
miscellaneous 24
pleural effusion with 28
subtle 16
superior segment 23f
uncomplicated 191f
with pleural effusion 29f
Pneumonitis 12, 43f
Pneumopericardium 42, 152, 152f, 174, 185, 185f
Pneumoperitoneum, neonatal 185
Pneumothorax 42, 55, 174, 190f
right 174f
tension 68
Poland syndrome 195f
Porous bones 111f
Post-traumatic pneumatocele, large 63f
Profunda femoris 134
Profuse neovascularity 132f
Proximal bulbar urethra 167f
Proximal ileal atresia 146f
Prune belly syndrome 172
Pseudofocal pneumonia 19, 20f
Pseudohypoparathyroidism 121
Pseudopneumonia sign 59f
Pseudopseudohypoparathyroidism 121
Pulmonary abscess 40, 41f
Pulmonary alveolar edema 46f
Pulmonary artery 47f, 86, 86f
dilated 78f
hypertension 91f, 95f
left 77, 78f, 85f
less prominent right 85f
prominent 49, 49f
right 77
descending 77, 78f
upper 77
Pulmonary aspiration 186
Pulmonary blood flow 79f, 80, 81, 84, 87
Pulmonary circulation, assessment of 7
Pulmonary congestion 43, 44f
Pulmonary contusion 60, 61, 61f
Pulmonary edema 43, 45f, 46f, 80, 174
acute 80f, 94f
alveolar stage 46
interstitial stage 45
stages of 44
Pulmonary hematoma 62f
Pulmonary hematomas 60
Pulmonary hemosiderosis 55
Pulmonary hypoplasia 176, 177f
Pulmonary ligament, interior 63f
Pulmonary oligemia 78, 78f, 85f, 90f
Pulmonary parenchymal injuries 60
Pulmonary plethora 78, 79, 79f
Pulmonary sequestration 67
Pulmonary stenosis 80, 84, 84f, 85, 89f
mild-moderate 84
severe 84, 85f, 85t
Pulmonary tuberculosis 24, 189
primary 31, 33f
Pulmonary vascularity 77
prominent 82f
reduced 89
Pulmonary venous
congestion 80f
hypertension 7981, 84, 94f
mild 94f
Pulmonary vessels 7
Pyknodysostosis 111, 112f
Pyloric atresia 143
barium meal contrast of 144f
plain X-ray of 143f
Pyloric canal, length of 144
Pyloric membrane 143
Pyomyositis 128
Pyopneumothorax 25, 26f
Radiation hazards 2
Radius, fracture of 202f
Renal agenesis 159
left 207f
Renal and bladder calculi 157f
Renal diseases, pediatric 155
Renal ectopia, crossed fused 161, 162f
Renal inflammation 156
Renal osteodystrophy 120
Renal rickets 120f
Respiratory cases 187
Respiratory disease, chronic 186
Respiratory distress, clinically 56
Respiratory system 5, 61
Respiratory tract infection
lower 10
recurrent 187
Retrocaval ureter 164f
Rheumatic heart diseases 93
Rheumatoid arthritis, juvenile 206f
bifid anterior end of 140, 140f
fractures 137
multiple 137
notching, causes of 201
posterior part of 110f
Rib polydactyly syndrome
Majewski type short 106f
short 105, 105f, 115
Rickets 115, 116f
chest X-ray in 117f
features of 202f
Rickety rosary 116
Right atrium, prominent 199f
Right clavicle, fracture of 204f
Right hilum, hiding pneumonia behind 22
Right ventricle
apex 75f
double outlet 90
Rim sign 163
Röntgen's discovery 1
Röntgen's great objections 1
Röntgen's rays 1
Rubella 128
Ryle's tube 150, 150f
Sacral agenesis 207f
Sacrococcygeal teratoma 170
Sail sign 57
Salter-Harris fractures 98
Scheuermann's disease 136
Sclerosing osteitis 124
Sclerotic border, thin 139f
Scurvy 118, 119f
Septic arthritis 125
left hip 125f
of knee 125f
Sever's disease 134, 135
diagnosis of 135
Shadow on shadow appearance 76f
Shaggy heart 12
appearance 13f
left-to-right 81
post-tricuspid 81t
pretricuspid 81t
Silhouette sign 18f, 19f
positive 18, 19f
Silver beaten appearance 206f
Simple bladder diverticulum 171f
Sinding Larsen disease 135
congestion 13
venosus atrial septal defect 82
Situs inversus 93, 93f, 94f
Skeletal dysplasias 102
Skeletal manifestations 114
predominate 138
Skeletal maturity 101
Skeletal metastasis 133
Skeletal pathology, diagnosis of 97
Skeletal tuberculosis 126
Skeleton, growing 98
Skull 103105
fractures 138
osteolytic lesion of 205f
Sloping metaphysis 105f
Soft tissues 8
Spina bifida 157f
Spina ventosa 126f
Spinal deformities 157f
Spinal dysraphism 170
Spinal tuberculosis 126
Spine 103105, 113f
Sprengel deformity 140, 141f
Square ilium 103f
Staghorn calculi 156
empyema 25, 25f, 30f
infection 26f
pneumonia 41f
aureus 24, 25
empyema, clues for 24
Status asthmaticus, common in 49
Stippled epiphysis 106f
bubble, single large 143f
dilated 145f
Streptococcus pneumoniae 24, 25
Subcutaneous emphysema, bilateral 191f
Subpulmonic effusion 30, 31f
Subtle early infiltrate 16, 17f
Subtle effusion 26
Subtle focal pneumonia 23f
Subtle interlobar fissure opacification 27
Subtle pleural effusion 26, 27f
Symphalangism 208f
Syphilis 127
metaphysitis of 127f
Systematic interpretation 6
Systemic disease 127
Tachypnea 13
Technical error 57f
Teratoma 56f
Tetralogy of Fallot 80, 85, 87, 87f
Thalassemia 208f
Thanatophoric dysplasia 103, 104f, 115
Thermal injury-induced bronchiolitis 40f
Thiemann's disease 136
Thin-walled cavity 62f
Thoracic cage 60
Thorax 104, 105
Throat, foreign body in 193f
Thymic lobe, large right 59f
Thymoma 7
Thymus 7, 71, 91f
blending of 58
gland, normal 57, 59f
large 192f
normal 58f, 59f
notch sign, normal 58f
prominent 175
sail sign 58f
of normal 58f
Tibia 129f, 137f
cortex of 129f
osteoclastoma of 131f
osteolytic lesion of left 204f
physiological bowing of 136f
radiograph of 205f
Tissue damage, risk of 2
Torus fracture 99f
Total anomalous pulmonary vein 80, 90f, 91f
connection 71, 90
Trachea, foreign body in 195f
Tracheobronchial inflammation 10
atresia 197f
fistula 143
Transient tachypnea 175, 176f
Traumatic aneurysm 63f
Traumatic pneumatocele 60, 61, 63f
Traumatic pneumoperitoneum 43f
Tricuspid atresia 87, 88, 89f, 199f
Tropical pyomyositis 128
Truncus arteriosus 92
Tuberculosis 32f
pleural effusion 191f
adenopathy 33f
osteomyelitis 125
pneumonias 24
Turner's syndrome 101, 102f
Umbilical arterial line 173
Umbilical venous catheter 174
Unexplained origin, weight loss of 3
Unilateral hilar 31
adenopathy 33f
Unilateral lung opacity, differential diagnosis of 192
Upper lobe
atypical right 36f
left 37, 38f, 39f
right 27f, 35, 36f, 37f, 53, 53f
collapse, atypical right 36
emphysema, congenital left 39
hyperlucent left 40f
left 38f
pneumonia, right 189f
right 59f
zone 193f
Upper medial tibia, punched out defect in 127f
Ureterocele 163, 165f
simple 164f
abnormalities of 167
anterior 165, 169f
posterior 168
Urethral abnormalities, anterior 168
Urethral diverticulum 170f
Urethral stone 167f
Urethral valve
anterior 168, 170f
posterior 167, 169f171f
Urinary bladder, abnormalities of 170
Urinary tract
calculi 156
infection 162, 172f
Urolithiasis 156, 158
Urological disorders, congenital 159
Varicella 24
Vena cava
inferior 71
superior 71
Ventricular septal defect 80, 82, 83f, 84, 89f, 92
Vertebra plana 139f
Vertebral abnormalities 140
Vesicoureteral reflux 155, 166, 169f
grades of 168f
Vesicoureteric junction, left 157f
Viral alveolar
pneumonia 14f
pneumonitis 14f
Viral croup 67
Viral interstitial
pneumonia 13f
pneumonitis, hazy lungs of 14f
Viral lower respiratory tract infection 12, 12f, 32f
Viral parahilar infiltrate 13f
mimicking hilar adenopathy 32f
peribronchial 11f
Viral spectrum 10
C 118
D 115, 120
deficiency 97, 115117
dependent rickets 117
resistant rickets 117
treatment with 203f
D3 115
Voiding cystourethrogram 155, 165, 167f, 168f, 172f
Vomiting, unexplained 3
Wet lung 175
White metaphyseal bands 119f
Wilson's disease 120
Wimberger sign 127f
Würzburg's physical-medical society 1
X-ray 1, 2
benefits of 2
chest reading 81t
dangers of 2
general 70
in infants 71
in morgagni hernia 151f
interesting bone 202
neonatal chest 173
normal chest 5, 15
risks of 2
testing 2
types of 2
barium 3
Chapter Notes

Save Clear

X-ray Imaging in ChildrenCHAPTER 1

Mona D Shastri
Radio imaging examinations are noninvasive tests that produce images of inside patient's body and provide valuable information to help diagnosis of illnesses and injuries.
The ray of hope for radiological investigation has first appeared on November 8, 1895, when physicist Professor Conrad Wilhelm RÖntgen (1845–1923) stumbled on X-rays while experimenting with Lenard tubes and Crookes tubes and began studying them. He wrote an initial report “ON A NEW KIND OF RAY: A PRELIMINARY COMMUNICATION” and on December 28, 1895 submitted it to Würzburg's Physical-Medical Society journal. This was the first paper written on X-rays. Röntgen referred to the radiation as “X”, to indicate that it was an unknown type of radiation. The name stuck, although (over Röntgen's great objections) many of his colleagues suggested calling them Röntgen rays. They are still referred to as such in many languages, including German, Hungarian, Danish, Polish, Swedish, Finnish, Estonian, Russian, Japanese, Dutch, Georgian, Hebrew, and Norwegian. Röntgen received the first Nobel Prize in Physics for his discovery.
X-rays are electromagnetic energy waves that act similarly to light rays, but at wave lengths approximately 1,000 times shorter than those of light. Röntgen holed up in his laboratory and conducted a series of experiments to better understand his discovery. He learned that X-rays penetrate human flesh but not higher-density substances such as bone or lead and that they can be photographed. He discovered their medical use when he made a picture of his wife's hand on a photographic plate formed due to X-rays. The photograph of his wife's hand was the first photograph of a human body part using X-rays. When she saw the picture, she said “I have seen my death”. Röntgen immediately noticed X-rays could have medical applications. Along with his 28 December Physical-Medical Society submission he sent a letter to physicians he knew around Europe (January 1, 1896). The first use of X-rays under clinical conditions was by John Hall-Edwards in Birmingham, England on 11 January 1896, when he radiographed a needle stuck in the hand of an associate. On February 14, 1896 Hall-Edwards was also the first to use X-rays in a surgical operation.
Röntgen's discovery was labeled as medical miracle and X-rays soon became an important diagnostic tool in medicine, allowing doctors to see inside the human body for the first time without surgery. In 1897, X-rays were first used on a military battlefield, during the Balkan War, to find bullets and broken bones inside patients.2
What is X-ray?
  • X-rays are a form of electromagnetic waves that can penetrate through the body and the images appear in shades of black and white, depending on the type of tissue the X-rays pass through.
  • Bones absorb more radiation and appear white on X-rays.
  • Muscle or fat absorbs less, and appears in shades of gray on X-ray film.
  • Air absorbs little of the X-rays, so the lungs appear black on an X-ray film.
Conventional Plain X-rays
The most common of X-rays and is the cheapest modality of radiological investigation.
Computed Tomography (CT) Scans
Computer-based three-dimensional X-ray images are processed to create detailed pictures (scans) of cross-sections of the body.
It is X-rays and a fluorescent screen to study moving or real-time structures in the body. When it is combined with swallowed or injected contrast agents the digestive processes or blood flow can be viewed. Clogged arteries can be opened by internally threaded contrast injected guided catheter using a fluoroscopy called cardiac angioplasty. Epidural injections or joint aspirations can be precisely done with the help of fluoroscopy.
Radiation Hazards
When X-ray was first introduced, scientists were quick to realize the benefits of X-rays, but slower to comprehend the harmful effects of radiation. Initially, it was believed X-rays passed through flesh as harmlessly as light. However, within several years, researchers began to report cases of burns and skin damage after exposure to X-rays, and in 1904, Thomas Edison's assistant, Clarence Dally, who had worked extensively with X-rays, died of skin cancer. With the widespread experimentation with X-rays after their discovery in 1895 by scientists, physicians, and inventors came many stories of burns, hair loss, and worse in technical journals of the time. In February 1896, Professor John Daniel and Dr William Lofland Dudley of Vanderbilt University reported hair loss after Dr Dudley was X-rayed. A child who had been shot in the head was brought to the Vanderbilt laboratory in 1896. Daniel reported that 21 days after taking a picture of Dudley's skull (with an exposure time of 1 hour), he noticed a bald spot of 2 inches (5.1 cm) in diameter on the part of his head nearest the X-ray tube.
In August 1896 Dr HD Hawks, a graduate of Columbia College, suffered severe hand and chest burns from an X-ray demonstration. Elihu Thomson deliberately exposed a finger to an X-ray tube over a period of time and suffered pain, swelling, and blistering. Dally's death caused some scientists to begin taking the risks of radiation more seriously, but they still were not fully understood.
Though the risk of tissue damage due to X-ray radiation is relatively small, it may increase with cumulative repeated multiple X-ray exposure over one's life time. The risk of developing cancer, cataracts, and skin burns are likely to occur with cumulative exposure. Radiation does have some risks to consider, but it is also important to remember X-rays can help detect disease or injury at early stages so the ailment can be treated appropriately. Sometimes X-ray testing can be lifesaving.3
Types of Barium X-rays
  • Barium swallow
  • Barium small bowel follow through
  • Barium enema.
Barium Swallow
A barium swallow is to examine the back of the throat, esophagus, and stomach. With a barium swallow, the patient is asked to drink barium-containing chalky liquid. The indications for barium swallow include:
  • Dysphagia
  • Abdominal pain
  • Unusual bloating
  • Unexplained vomiting
  • Weight loss of unexplained origin.
The barium coats the walls of the esophagus and stomach, which is then visible on X-rays. The test is effective in locating strictures, ulcers, hiatal hernias, erosions in the esophagus or stomach, muscle disorders such as achalasia, and other abnormalities such as esophageal cancer.
Barium Small Bowel Follow Through
Barium studies may also be used to look further down into the digestive tract. In a barium small bowel follow through the patient is observed as the barium passes beyond the stomach into the small intestine, and eventually makes its way to colon. In the procedure, the patient is often turned side to side to best visualize the small bowel or small intestine. A barium small bowel follow through may be done to help diagnose tumors of the small bowel, a small bowel obstruction, or inflammatory diseases of the small intestine such as Crohn's disease.
  • Pain abdomen
  • Rectal bleeding
  • Unexplained vomiting
  • Abnormal bowel movements
  • Chronic diarrhea or constipation
  • Dysphagia
  • Unexplained weight loss
  • Unusual bloating
  • To locate anatomical abnormalities.
Barium Enema
It is modality of choice for detecting pathology of large bowel and ano rectal region. It is mainly used for Hirschsprung disease to detect length of aganglionic segment. Before the availability of ultrasound scanning it was modality to diagnose and treat large bowel (Colo-colic) intussusception. Pre-procedure bowel preparation is not required
  • Anterior: Toward the front of the body
  • Posterior: Toward the back of the body
  • Superior: Toward the top of the body
  • Inferior: Toward the bottom of the body
  • Medial: Toward the midline
  • Lateral: Away from the midline.
Body Positions
  • Erect: Standing or sitting
  • Decubitus: Lying down
  • Supine: Lying on back
  • Prone: Lying face-down
  • Lateral decubitus: Lying on one side
    • Right lateral: Right side touches the cassette
    • Left lateral: Left side touches the cassette.
Views in Chest Radiography
  • Posteroanterior (PA)
  • Anteroposterior (AP) erect
  • Supine
  • Lateral
  • Cross table lateral.
The chest radiograph is the most commonly requested radiographic examinations in the assessment of the pediatric patient.
  • Respiratory distress
  • Cardiac disease
  • Bronchiolitis
  • Pneumonia
  • Pulmonary tuberculosis
  • Pneumothorax
  • Trauma
  • Foreign bodies
  • Line placement location (e.g. Endotracheal tube).
Regular Projections
  • PA erect
  • AP erect
  • AP supine
Special Projections
  • Lateral view and cross table lateral view
  • To highlight pathology in the mediastinum, costophrenic recess and localize lesions.
Tips for Pediatric Chest Radiography
The challenges in acquiring radiographs in children are:
  • Difficulty in achieving inspiration
  • Likelihood of motion blurring
  • Wide range of tissue densities
  • Need to minimize radiation dose.
To overcome these:
  • Attention diversion with toys, games, and/or conversation
  • Immobilization with blankets and velcro straps
  • Child-appropriate language.
Decubitus position: A position used in producing a radiograph of the chest or abdomen of a patient who is lying down, with the central ray horizontal.
The patient may be:
  • Prone (ventral decubitus)
  • Supine (dorsal decubitus)
  • Left or right side (left or right lateral decubitus).
  • Lateral decubitus view of the chest: To demonstrate small pleural effusions, pneumothorax, and inhaled foreign bodies.
Image Evaluation
  • Side marking should be clearly labeled.
  • In an ideal chest X-ray, lung fields should be visible from the apices down to the lateral costophrenic angles
  • No superimposition of chin over any structures
  • No superimposition of the scapulae borders on the lung fields
  • Sternoclavicular joints at equidistance
  • Clavicle should be in the same horizontal plane
  • A minimum of nine posterior ribs should be visualized above the diaphragm
  • Ribs and thoracic cage are seen only faintly over the heart
  • Clearly visible vascular markings of the lungs.
Lateral Decubitus for Pleural Effusions
The fluid in the chest gets layered when the patient lies on the suspected side and can be viewed by chest X-ray in the lateral decubitus position is more sensitive and can detect as little as 50 mL of fluid. At least 300 mL of fluid must be present before upright chest X-rays can detect a pleural effusion.