NeonatalChest

Hernandez, Ray X Hernandez, Ray X

tXRayInterpretation
XX--Ray Interpretation Ray Interpretation
Types of C TypesofC
PA Routine CXR taken at a PA RoutineCXRtakenata
APtogivebetterclarity
feet=truetosize).
AP Portablefilmstakenat
criticalorbedriddenpa
LATERAL To better assess t LATERAL Tobetterassesst
abnormalityseeninPA/APv
LATERALDECUBITUS Take
affectedsidetoassessfluid
OBLIQUE Allowsforvisual
lower lobes lowerlobes.
Hernandez, Ray X Hernandez, Ray X
hest Films hestFilms
a greater distance than agreaterdistancethan
yandlessmagnification(6
tacloserdistancefor
atients.
the position and degree of thepositionanddegree of
view.
nwiththepatientlyingonthe
withinthechest.
lizationofthemiddleand
XX--Ray Interpretation Ray Interpretation
Densities o Densitieso
AIR Densityofthelungs
FAT Not seen on CXR FAT NotseenonCXR.
Foundaroundsome
muscles
WATER Densityofthe
heart,muscles,blood.
METAL / BONE Density METAL/BONE Density
oftheribs(calcium)
Hernandez, Ray X Hernandez, Ray X
of Xrays ofX rays
XX--Ray Interpretation Ray Interpretation
Reviewing Film ReviewingFilm
Position Position
ObserveSoftTis
MediastinalStuc
HilarArea
Diaphragms
Bony Structures BonyStructures
DeterminingLan
Hernandez, Ray X Hernandez, Ray X
s Systematically sSystematically
ssues
ctures
ndmarks
XX--Ray Interpretation Ray Interpretation
Positio Positio
Lookforequal
distancefromspineto
lateral ribcage lateralribcage.
Claviclesnormallyrest
at 90 degree angle at90degreeangle.
Isthepatient
ROTATED! ROTATED!
Hernandez, Ray X Hernandez, Ray X
on on
XX--Ray Interpretation Ray Interpretation
Observe Sof ObserveSof
Xraypenetration
underexposed
d overexposed
Edema
S b t i Subcutaneousair
Hernandez, Ray X Hernandez, Ray X
ft Tissues ftTissues
XX--Ray Interpretation Ray Interpretation
Mediastinal S MediastinalS
Observecontour
Shiftfrommidline
Widening
Thymuspresent
Hernandez, Ray X Hernandez, Ray X
Structures Structures
XX--Ray Interpretation Ray Interpretation
Hilar A HilarA
Vascularity
Increasedmarkings
and butterfly shape andbutterflyshape
indicatepulmonary
congestion.
Hernandez, Ray X Hernandez, Ray X
rea rea
XX--Ray Interpretation Ray Interpretation
Diaphra Diaphra
Assesslunginflation
Clarityofcostophrenic
l angles
Positionof
hemidiaphra ms hemidiaphragms
Hernandez, Ray X Hernandez, Ray X
gms gms
XX--Ray Interpretation Ray Interpretation
Bony Stru BonyStru
Observeribsfor
fractures
Cl i l f f Claviclesforfractures
Vertebraeforscoliosis
Hernandez, Ray X Hernandez, Ray X
ctures ctures
XX--Ray Interpretation Ray Interpretation
Determining l Determiningl
b b h Countribstoptobottomth
countbackwardsbottomtot
NEVERassume12setsofrib
ETplacement usuallyT1 T2
NGtube
UAC
HighplacementT9 T10
L l L3 L4 LowplacementL3 L4
Hernandez, Ray X Hernandez, Ray X
andmarks andmarks
en
top.
bs!!
2.
XX--Ray Interpretation Ray Interpretation
Respiratory Distre Respiratory Distre
H li M H li M
Definition: Definition:
Hyaline Mem Hyaline Mem
Definition: Definition:
Surfactant Deficiency Surfactant Deficiency
th l i th l i the lung causing the lung causing
decreased lung decreased lung
li d li d compliance and compliance and
atelectasis atelectasis
Pathophysiology: Pathophysiology:
Commonly occurs in Commonly occurs in
Hernandez, Ray X Hernandez, Ray X
Commonly occurs in Commonly occurs in
premature infants. premature infants.
ess Syndrome (RDS) ess Syndrome (RDS)
b Di b Di mbrane Disease mbrane Disease
y of y of
nn
XX--Ray Interpretation Ray Interpretation
n n
Respiratory Distre Respiratory Distre
H li M H li M Hyaline Mem Hyaline Mem
Pathophysiolo Pathophysiolo
Commonly occu Commonly occu
in premature in premature
infants. infants.
Maternal diabete Maternal diabete Maternal diabete Maternal diabete
Stress that caus Stress that caus
acidosis acidosis
Hernandez, Ray X Hernandez, Ray X
acidosis acidosis
ess Syndrome (RDS) ess Syndrome (RDS)
b Di b Di mbrane Disease mbrane Disease
ogy: ogy:
urs urs
es es es es
ses ses
XX--Ray Interpretation Ray Interpretation
Respiratory Distre Respiratory Distre
H li M H li M
Symptoms Symptoms
Hyaline Mem Hyaline Mem
Symptoms Symptoms
Tachypnea Tachypnea
retractions retractions
grunting grunting g g g g
nasal flaring nasal flaring
cyanosis cyanosis cyanosis cyanosis
Hernandez, Ray X Hernandez, Ray X
ess Syndrome (RDS) ess Syndrome (RDS)
b Di b Di mbrane Disease mbrane Disease
XX--Ray Interpretation Ray Interpretation
Respiratory Distre RespiratoryDistre
f d f Surfactanctdeficiency
prematurity
deactivation deactivation
asphyxiainsult
Lowlungvolumes o u g o u es
Airbronchograms
Groundglassappearance
Hernandez, Ray X Hernandez, Ray X
ess Syndrome (RDS) essSyndrome(RDS)
XX--Ray Interpretation Ray Interpretation
Respiratory Distre Respiratory Distre
H li M H li M
Treatment Treatment
Hyaline Mem Hyaline Mem
Treatment Treatment
Oxygen therapy Oxygen therapy
Nasal CPAP Nasal CPAP Nasal CPAP Nasal CPAP
Mechanical ventilation Mechanical ventilation
High High frequency frequency ventilatio ventilatio High High frequency frequency ventilatio ventilatio
Surfactant replacemen Surfactant replacemen
therapy therapy therapy therapy
Exosurf 5cc/kg Exosurf 5cc/kg
Survanta 4cc/kg Survanta 4cc/kg
Hernandez, Ray X Hernandez, Ray X
gg
ess Syndrome (RDS) ess Syndrome (RDS)
b Di b Di mbrane Disease mbrane Disease
on on on on
t t
XX--Ray Interpretation Ray Interpretation
RDS RDS RDS RDS
Hernandez, Ray X Hernandez, Ray XXX--Ray Interpretation Ray Interpretation
TransientTachpnea
RR
Definition:
Retentionoflungw
distress.
Pathophysiology:
Commonly occurs in Commonlyoccursin
infants.
Cesareansection
Precipitousbirth
Sepsis
Hernandez, Ray X Hernandez, Ray X
oftheNewborn(TTN)
RDS II RDSII
watercausingrespiratory
n term or near term ntermornearterm
XX--Ray Interpretation Ray Interpretation
TransientTachpnea
RR
Poor pulmonary cleara Poorpulmonarycleara
IncreasedV/Qmismat
Poorsurfactantdistrib
Increased surface tens Increasedsurfacetens
Atelectasis
Hernandez, Ray X Hernandez, Ray X
aoftheNewborn(TTN)
RDS II RDSII
ance of fluid anceoffluid
tch
bution
sion sion
XX--Ray Interpretation Ray Interpretation
TransientTachpnea
RR
Diagnosis: Diagnosis:
Followssamesymptom
Tachypnea,nasalflaring
Xray Fluffyorstreaky
d ll l Symptomsgraduallycle
Hernandez, Ray X Hernandez, Ray X
oftheNewborn(TTN)
DS II DSII
msofRDS
g,retractions,andgrunting.
yinfiltrates.Fluidinthefissure.
h h earwithin2448hours.
XX--Ray Interpretation Ray Interpretation
Transient Tachypn TransientTachypn
Perihilarcongestion
Fluffyinfiltrates
Fluidinthetransverse
fissure
Mayhaveunderlying
RDS
Hernandez, Ray X Hernandez, Ray X
nea of the Newborn neaoftheNewborn
XX--Ray Interpretation Ray Interpretation
TransientTachpnea
RR
Treatment: Treatment:
Treathypoxia viahead
humidified) humidified)
CPAPtherapytotreatr
R/O th ibiliti R/Ootherpossibilitieso
(pnuemonia)
Hernandez, Ray X Hernandez, Ray X
aoftheNewborn(TTN)
RDS II RDSII
dhoodO2(warm/
efractoryhypoxemia.
f R i t Di t ofRespiratoryDistress
XX--Ray Interpretation Ray Interpretation
Transient Tachy Transient Tachy Transient Tachy Transient Tachy
Hernandez, Ray X Hernandez, Ray X
Day 1 Day 1
ypnea of the Newborn ypnea of the Newborn ypnea of the Newborn ypnea of the Newborn
XX--Ray Interpretation Ray Interpretation
Day 2 Day 2
RDS / T RDS/T
Hernandez, Ray X Hernandez, Ray X
TTN TTN
XX--Ray Interpretation Ray Interpretation
Group B Streptoc GroupBStreptoc
Septecemia,
respiratorydistress,
shock respiratory shock,respiratory
failure.
Within 24 hours if not Within24hoursifnot
treated
Can closely mimic RDS CancloselymimicRDS
course
Hernandez, Ray X Hernandez, Ray X
coccus Pneumonia coccusPneumonia
XX--Ray Interpretation Ray Interpretation
Diagraphragm Diagraphragm
Absenceof
hemidiaphragmto
fullyformed
Bowelinchest
Hypoplasticlung
Hernandez, Ray X Hernandez, Ray X
matic Hernia maticHernia
XX--Ray Interpretation Ray Interpretation
Bronchopulmo Bronchopulmo
Patchy,cysticchanges
Scarring
Barrelchest(Usual
somedegree)
Hernandez, Ray X Hernandez, Ray X
onary Dysplasia onaryDysplasia
lyto
XX--Ray Interpretation Ray Interpretation
BP BP
Hernandez, Ray X Hernandez, Ray X
PD PD
XX--Ray Interpretation Ray Interpretation
Meconium Aspirat MeconiumAspirat
Nonhomogeneous,
patchydensity(atelectasis
/ hyperaeration) /hyperaeration)
Oftenperihilar
congestivestreaking
Hernandez, Ray X Hernandez, Ray X
ion Syndrome (MAS) ionSyndrome(MAS)
XX--Ray Interpretation Ray Interpretation
PulmonaryInte y
Smallbubbledtrapp
gassurroundedby
collapsed alveoli collapsedalveoli
Gradesrangefrom
grade 1 to grade 3 P grade1tograde3P
Hernandez, Ray X Hernandez, Ray X
erstitialEmphysema p y
ped
IE IE
XX--Ray Interpretation Ray Interpretation