Appendix 1: Rules for Reading Pediatric X-Rays*

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1 Appendix 1: Rules for Reding Peditric X-Rys* Red the ABCS: A = domen, B = one, C = chest, S = soft tissue 1. On every chest film, red the dominl portion s you would red n dominl film. 2. Knowledge of ntomy is the key to correct rdiogrphic dignosis. 3. The irwy should e visile on ll norml chest films. 4. A mss must e seen in two plnes. 5. An esophgrm must e performed in ny child with unexplined respirtory disese. 6. In unilterl hyperexpnsion of the lungs, you must see how the ir moves. Air must move in nd out of ech lung. Medistinl position is criticl to this determintion. 7. The hert nd liver re trnsprent orgns. 9. The dominl exmintion should include minimum of three views: supine, prone, nd erect. 10. On every dominl exmintion, evlute the chest s if you were looking t chest film. 11. In ostruction of the lumen, there should e proximl distention. 12. Try to find the effects of the mss on djcent orgns on ech dominl film. Drw the mss, if necessry. 13. After the mss hs een defined, find the center of the lesion. Then consider ll structures, gross nd microscopic, ner the center of the lesion s possile sources of the mss. Think skin to skin. 14. When viewing n extremity, try to imgine the ppernce of the ptient. An excellent exmple is owed legs or knock knees. 15. The periosteum is normlly not seen. 8. Alwys review ll old films to properly ssess the new one. Sutle findings cn esily e missed when single previous exmintion is reviewed. * These rules were dopted from Joseph O. Reed, MD, chief of peditric imging t Children s Hospitl of Michign from 1957 through Throughout this text we include these fundmentl concepts, which were used dily in his teching sessions.

Appendix 2: Answers to Questions Chpter 3 Fig. 3.4. The ptient in is rotted to the left.

right. Note the opcity in the right lower chest field (rrow). The reverse is true in e e Fig. 3.8.

2 Appendix 2: Answers to Questions Chpter 3 Fig The ptient in is rotted to the left. The hert is pprecily in the left hemithorx, nd the left side of the chest is reltively elongted, s compred to the right. Note the opcity in the right lower chest field (rrow). The reverse is true in e e Fig The film is reversed (right to left) ccording to mrkers! p, pedicle; white rrows on nterior ris; lck rrows on vessels in se of lung. Rememer, the hert nd liver re trnsprent

262 Appendix 2: Answers to Questions Fig. 3.13. Cn you detect the normlity on this chest film? Did you look t the ones?

ptient. There is ctheter entering from the left side extending into the right trium for intrvenous therpy Fig. 3.14.

3 262 Appendix 2: Answers to Questions Fig Cn you detect the normlity on this chest film? Did you look t the ones? There is destructive process of the right humerus (drk spots with periostel rection) consistent with osteomyelitis in this sickle cell ptient. There is ctheter entering from the left side extending into the right trium for intrvenous therpy Fig A 9-yer-old with cough. Frontl chest film revels the hert nd lungs to e norml, ut there is something missing the clvicles. This ptient hs cleidocrnil puic dysostosis

Appendix 2: Answers to Questions 263 Fig. 3.15. A 17-yer-old oy with cough. On the frontl film () the hert is lrge.

On the lterl view (), the corticl end pltes of most of the thorcic vertere re depressed. This ptient hs sickle cell nemi, nd the depressed end pltes (rrows) re due to infrctions.

4 Appendix 2: Answers to Questions 263 Fig A 17-yer-old oy with cough. On the frontl film () the hert is lrge. See the sclerosis (white spots) in the right humerus (rrow) nd the norml vertere (T8, T9) (rrows), which hve decresed height in their midportion. On the lterl view (), the corticl end pltes of most of the thorcic vertere re depressed. This ptient hs sickle cell nemi, nd the depressed end pltes (rrows) re due to infrctions. These re clled H vertere (look like old Lincoln cin log toy pieces) nd re typicl of sickle cell disese Fig This 12-yer-old presented with cfé u lit spots nd scoliosis. Aside from the ovious right lrge medistinl mss superiorly there re rion-like irregulrities of the left fourth through sixth ris. The comintion of the medistinl mss, ri chnges, nd cfé u lit spots suggests dignosis of neurofiromtosis. The chest mss is either n nterior meningocele or neurofirom. The ris re wvy secondry to dystrophic one nd hypertrophied intercostl tissue in the sucostl groove. The film is photogrphed for one detil nd lung mrkings re lost in this exposure

264 Appendix 2: Answers to Questions Fig. 3.17. A 6-month-old infnt with fever.

Compre this to the norml left humerus Fig. 3.24. Airwy normlities Acute epiglottis. This is 3-yer-old with respirtory distress.

5 264 Appendix 2: Answers to Questions Fig A 6-month-old infnt with fever. The frontl chest film shows soft-tissue swelling of the right shoulder. This ptient hs osteomyelitis of the right humerus (rrow). Compre this to the norml left humerus Fig Airwy normlities Acute epiglottis. This is 3-yer-old with respirtory distress. The lterl chest is norml, ut the lterl neck shows n enlrged epiglottis nd ryepiglottic folds Lryngel ppillomtosis. This 12-yer-old hs multiple growths in the irwy. It is not lck like the hypophrynx ut rther mottled gry

Appendix 2: Answers to Questions 265 Fig. 3.33. In this 4-yer-old symptomtic girl, ulge ws noted t the junction of the right min-stem ronchus nd trche (rrow).

At ultrsonic exmintion, the intrheptic ven cv ws found to e tretic, leving just n infrrenl ven cv. The mss is the zygos vein, which returns lood from the domen to the hert.

6 Appendix 2: Answers to Questions 265 Fig In this 4-yer-old symptomtic girl, ulge ws noted t the junction of the right min-stem ronchus nd trche (rrow). It did not pulste, nor did it ffect the esophgus. It ws not seen on the lterl film. At ultrsonic exmintion, the intrheptic ven cv ws found to e tretic, leving just n infrrenl ven cv. The mss is the zygos vein, which returns lood from the domen to the hert. This condition is clled zygous continution of the inferior ven cv Fig A child with onset of cute respirtory distress. Frontl () nd lterl () films. Did you notice the white, liner density long the right hert order? The child spirted pin nd it ws removed endoscopiclly from the right min-stem ronchus

266 Appendix 2: Answers to Questions Fig. 3.51. A 6-yer-old with cough. Frontl exmintion () revels lrge density extending to the left prspinl line ehind the hert. The hert is no longer trnsprent.

7 266 Appendix 2: Answers to Questions Fig A 6-yer-old with cough. Frontl exmintion () revels lrge density extending to the left prspinl line ehind the hert. The hert is no longer trnsprent. The orders of the density re convex lterlly, suggesting n extrpleurl mss. On the lterl view () the mss is difficult to see. The verterl odies re whiter inferiorly thn they re superiorly, indicting the mss is in the posterior spect of the hemithorx. This ws gnglioneurolstom

Appendix 2: Answers to Questions 267 c Fig. 3.52. A child with wheezing. The frontl rdiogrph () shows the distl trche pushed to the left nd effced; the crin is not djcent to the right pedicles.

8 Appendix 2: Answers to Questions 267 c Fig A child with wheezing. The frontl rdiogrph () shows the distl trche pushed to the left nd effced; the crin is not djcent to the right pedicles. The lterl film () revels the irwy owed forwrd nd slightly nrrowed. The frontl view of rium swllow (c) shows the right nd left indenttions on the esophgus. The lterl view (d) revels ulge ehind the esophgus nd some nrrowing nd owing of the irwy. The ptient hs vsculr ring, specificlly doule ortic rch d

40 in. (91 102 cm). Since the child is supine, the vsculrity of the upper nd lower lungs is equl c Fig. 4.6.

9 268 Appendix 2: Answers to Questions Chpter 4 Questions p. 63: Mgnifiction of the chest occurs ecuse of the portle technique. There is n pprent lrge crdiomedistinl silhouette ecuse the tue-to-film distnce is only in. ( cm). Since the child is supine, the vsculrity of the upper nd lower lungs is equl c Fig Neonte with dominl distension This intuted premture infnt hs gs within the liver (portl venous gs) nd ir in the owel wll (pneumtosis), giving uly ppernce. See c for etter pprecition of these findings. The y hs necrotizing enterocolitis. Alwys follow the ABCS In nother neonte, there is free ir in the peritoneum. The olique white curved opcity extending from the diphrgm to the ottom of the film is the flciform ligment. It cn only e seen when there is ir on oth sides of this thin ligment (ttches to the peritoneum posteriorly etween loes of the liver nd inferiorly to the umilicus). Multiple lines including nsogstric tue re present c Portl venous gs nd pneumtosis in y with necrotizing enterocolitis. This is the sme y s in

Appendix 2: Answers to Questions 269, c, d e Fig. 4.23. Congenitl neontl nomlies Agenesis of the right lung. There is no crin, only left min-stem ronchus.

10 Appendix 2: Answers to Questions 269, c, d e Fig Congenitl neontl nomlies Agenesis of the right lung. There is no crin, only left min-stem ronchus. The medistinum hs shifted to the right Another child with genesis of the right lung. It is common tht verterl nd ri nomlies occur with this disorder c Eventrtion of the right hemidiphrgm. Note how this cts s mss nd shifts the medistinum to the left. When n eventrtion cretes mss effect, it is treted s diphrgmtic herni d, e Two neontes with congenitl left diphrgmtic hernis. Note the shift of the medistinum to the right

270 Appendix 2: Answers to Questions Chpter 5 c Fig. 5.21.

11 270 Appendix 2: Answers to Questions Chpter 5 c Fig An 8-yer-old with right epigstric pin Upper gstrointestinl series shows dilted second nd third duodenum with the contrst (white) eing squeezed nd stretched over n intrmurl duodenl hemtom CT scn of the sme child showing the lrge hemtom (gry) surrounded y contrst c A third imge of the CT slightly lower thn showing the contrst round the duodenl mss

Appendix 2: Answers to Questions 271 c Fig. 5.37. Wht normlities do you see? VCU in neonte with urinry trct infection.

These re clled ldder ers nd re of no clinicl significnce, c An excretory urogrm in 15-yer-old who ws in n utomoile ccident.

12 Appendix 2: Answers to Questions 271 c Fig Wht normlities do you see? VCU in neonte with urinry trct infection. A portion of the ldder wll hs hernited (lterlly) into ech ptent processus vginlis in the inguinl cnl. These re clled ldder ers nd re of no clinicl significnce, c An excretory urogrm in 15-yer-old who ws in n utomoile ccident. The upper trcts pper norml, ut the ldder is rised off the pelvic floor nd pushed to the left. There is ovious disruption of the left puic one. In c, retrogrde urethrogrm ws performed, nd the ctheter ws removed. There is contrst in the pelvis ecuse of disruption of the posterior urethr. Fint contrst lso in the left hip joint ove the crtilge indictes disruption of the ones of the cetulum s well

272 Appendix 2: Answers to Questions d c Fig. 5.41. Multiple norml excretory urogrms, Teenge femle with left flnk mss.

13 272 Appendix 2: Answers to Questions d c Fig Multiple norml excretory urogrms, Teenge femle with left flnk mss. On the 10-min film () the right kidney ppers norml, ut on the left there is lrge mss with liner opcities. These represent the prenchyml tuules eing pushed in verticl direction (prenchyml rims out more lucent, dilted, urine-filled collecting system).a coned-down view of this kidney () shows the rims to etter dvntge. This ptient hd ureteropelvic junction ostruction c A 5-min film in 10-yer-old girl with multiple urinry trct infections. The left kidney is considerly smller thn the right nd mesures less thn three verterl odies in height. The right kidney is lrger thn norml, mesuring just out five verterl odies in height. Note how close the left upper pole clyx comes to the spine! This indictes loss of polr renl prenchym d A child with fever. The excretory urogrm shows the lower pole clyces overlying the spine. This is horseshoe kidney, perhps unrelted to the fever

Appendix 2: Answers to Questions 273 c Fig. 5.57.

colon (liner lck streks long left lterl dominl cvity).

14 Appendix 2: Answers to Questions 273 c Fig Two neontes with dominl distention, There is extrluminl gs (pneumtosis intestinlis) in the descending colon (liner lck streks long left lterl dominl cvity). This is pneumtosis intestinlis or ir in the wll of the owel. In, one sees lck streks in the liver portl venous gs. This y hs necrotizing enterocolitis c Another infnt with extreme pneumtosis intestinlis nd portl venous gs

274 Appendix 2: Answers to Questions c Fig. 5.58. A 1-yer-old with dominl pin nd distention.

The erect film () shows multiple ir fluid levels. Does the y hve smll owel ostruction?

15 274 Appendix 2: Answers to Questions c Fig A 1-yer-old with dominl pin nd distention. Three views of the domen help us define the prolem The supine view shows dilted owel filled with ir in the centrl domen, c The erect film () shows multiple ir fluid levels. Does the y hve smll owel ostruction? The nswer is on the prone film (c), where ll the gs is seen to e in the colon nd rectum The ptient does not hve n intestinl ostruction. Use the prone film to move ir with the help of grvity

Appendix 2: Answers to Questions 275 c Fig. 5.59.

hs chrcteristics of owel (hypoechoic muscle nd hyperechoic lumen) nd is not compressile.

16 Appendix 2: Answers to Questions 275 c Fig Teenge oy with right lower qudrnt pin ppendicitis Longitudinl ultrsound scn shows lrge ellipticl structure which hs chrcteristics of owel (hypoechoic muscle nd hyperechoic lumen) nd is not compressile. It mesured lmost centimeter in dimeter Similr scn with color flow Doppler shows perfuse flow to the muscle c Trnsverse scn with Doppler confirms these findings. This ws n inflmed ppendix with ppendicitis

276 Appendix 2: Answers to Questions Fig. 5.60.

17 276 Appendix 2: Answers to Questions Fig A cystogrm on 3-yer-old with poor urinry strem posterior urethrl vlves Frontl film shows n irregulr treculted ldder with diverticulum lterlly Lterl film during the voiding phse shows dilttion of the posterior urethr nd norml nterior urethr. There is contrst in n irregulr configurtion posterior to the posterior urethr reflux into the prostte. The ldder is irregulrly contrcted. This ptient hs posterior urethrl vlves. It is most evident y the discrepncy etween the size of the nterior nd posterior urethr. On other imges, the ptient hd significnt vesicoureterl reflux

Appendix 2: Answers to Questions 277 Chpter 7, c d, e Fig. 7.46. Multiple one nd soft tissue normlities Ten-yer-old with left elow pin.

18 Appendix 2: Answers to Questions 277 Chpter 7, c d, e Fig Multiple one nd soft tissue normlities Ten-yer-old with left elow pin. The medil epicondyle is displced inferiorly due to frcture through the pophysel growth-plte. There is mrked soft tissue swelling. Sometimes sutle growth-plte injuries require comprison views of the other extremity. (Reproduced with permission from Yontn Rosen) Two-yer-old with knee pin. There is lytic lesion in the proximl tiil metphysis with n ill-defined zone of trnsition nd ssocited periostel rection. You should guess from these fetures tht this is n ggressive lesion; this ptient hs metsttic neurolstom c Teenger with heel pin. Benign one cyst of the clcneus. It is solitry lesion which hs cler zone of demrction, no periostel rection, nd single lucency, typicl of cyst. You thought this ws enign, didn t you? d Teenger with leg pin. The sclerosis t the posterior spect of the proximl tii diphysis is clue. A lucency cn e seen in the center, nd the differentil dignosis include infections such s chronic scess, osteoid osteom, nd heling frcture. This ws one scess e Eight-yer-old with right nkle pin. There is right nkle effusion. Did you notice the symmetric widening of the distnce etween the right distl tiil epiphysis nd the tlr dome? There is soft tissue swelling f Six-yer-old with swollen right nkle. This is clssic exmple of Chrcot (neuropthic) joint. The typicl findings, s seen in this cse, include incresed density of the ones, destructive chnges (s in the tlr dome), joint effusion, clcifiction, nd soft tissue swelling. Such joint pthology is seen in ptients with insensitivity to pin (e.g., from syringomyeli, dietes, or congenitl insensitivity to pin) g n see pp. 278, 279 f

19 278 Appendix 2: Answers to Questions g, h i k j Fig (continued). Legend see p. 279

Appendix 2: Answers to Questions 279 l, m n Fig. 5.46 (continued) g, h Neworn with swollen extremities. This infnt hs diphysitis nd metphysitis from congenitl syphilis.

20 Appendix 2: Answers to Questions 279 l, m n Fig (continued) g, h Neworn with swollen extremities. This infnt hs diphysitis nd metphysitis from congenitl syphilis. Notice the periostel rection long the shfts of oth femor, oth tiie, the rdius nd the uln. Also notice the ony erosions in the medil tiil metphyses (Wimerger s sign) s well s in the distl rdil nd ulnr metphyses i Ten-yer-old with ump on leg. Myositis ossificns. Did you see the soft tissue clcifiction t the lterl spect of the proximl tiil diphysis? There is lucent (lck) zone etween the tii nd the clcifiction, which is chrcteristic of myositis ossificns j Eight-month-old with symmetric glutel folds. Left hip developmentl dysplsi. The left femur is displced lterlly nd in contrst to the norml right hip, the femorl hed is not yet ossified. The left cetulr roof is normlly steep. The projected left femorl hed would e outside the cetulum k Seven-yer-old with left hip pin. Avsculr necrosis of the left cpitl femorl epiphysis. The hed is smll nd frgmented. This is Legg-Clvé-Perthes disese l Five-yer-old with right hip pin. Frog lterl view of the pelvis shows mild flttening nd liner suchondrl lucency in the right cpitl femorl epiphysis, consistent with erly vsculr necrosis of the right cpitl femorl epiphysis. Another cse of Legg-Clvé-Perthes disese m, n Teenger with left knee pin. Osteochondritis dissecns of the lterl spect of the medil femorl condyle (lucent re) with resulting detchment of ony frgment, which is now loose in the knee joint. The loose ody is seen just superior to the tiil spines on the frontl view nd over the nterior spect of the distl femur on the lterl view

280 Appendix 2: Answers to Questions Chpter 8 Fig. 8.21. Osteoid osteom. Compre the pedicles on this X-ry.

21 280 Appendix 2: Answers to Questions Chpter 8 Fig Osteoid osteom. Compre the pedicles on this X-ry. The left pedicle of L5 is dense compred to the right pedicle or to either pedicle of L4. This is common loction for n osteoid osteom, which is enign one lesion cusing pin

Appendix 2: Answers to Questions 281 c d Fig. 8.22.

22 Appendix 2: Answers to Questions 281 c d Fig Anormlities of the spine Py creful ttention to the hypotheticl verticl line long the posterior odies of the vertere, which revels tht C7, the lowest cervicl verter, is out of position. Look t the reltionship of the rticulting fcets. This is disloction of C7 c Are ll the verterl odies the sme height? C3 is wfer verter (verter pln). The joint spce is intct, ut the verterl ody is severely compressed. This is commonly found in eosinophilic grnulom of one d There is compression frcture of C5 nd C6. Trum is mjor cuse of verterl compression frctures nd wedging

282 Appendix 2: Answers to Questions c Fig. 8.25. Multiple ptients A 2-yer-old with ck pin. This is tuerculosis Pott s disese. Note the disc spce nrrowing of T10 12.

23 282 Appendix 2: Answers to Questions c Fig Multiple ptients A 2-yer-old with ck pin. This is tuerculosis Pott s disese. Note the disc spce nrrowing of T There re ilterl prspinl msses with wide prspinl lines A 9.5-yer-old with congenitl nomly.you should detect the sence of the spinous processes of L2 through the scrum. Did you notice tht the pedicles hve lost their convex inner mrgin? This ptient hd meningomyelocele t irth c, d One-month-old femle with history of dominl wll defects nd now thromocytopeni. On coronl (c) nd sgittl (d) imges, there re multiple lesions. These hve n echogenic (white) rim with isoechoic (gry) center. Some re mostly echogenic. These re multiple sites of leeding d

Appendix 2: Answers to Questions 283, c d Fig. 8.26. Multiple ptients, On enhnced rin window CT () there is n ellipticl enhncing (white) mss (convex towrd the rin) with norml spicules of the one.

24 Appendix 2: Answers to Questions 283, c d Fig Multiple ptients, On enhnced rin window CT () there is n ellipticl enhncing (white) mss (convex towrd the rin) with norml spicules of the one. Bone window () shows the one destruction of the right frontl one. This is n epidurl metstsis with one destruction secondry to neurolstom c e Teenge myelomeningocele ptient. The CT (c) shows shunt ctheter on the left nd mild dilttion of the right lterl ventricle. The flx is missing nd the interhemispheric fissure is dysrphic (ent). Wht is the lck centrl structure? It is lcker thn fluid nd represents ft congenitl lipom of the corpus cllosum. Sgittl (d) nd coronl (e) MR show the lipom (white) over the nterior corpus cllosum nd sence of the posterior corpus cllosum. e

284 Appendix 2: Answers to Questions Fig. 8.27.

Coronl () nd sgittl () imges of this neonte revel multiple cvities (lck holes) surrounding the ventricle.

25 284 Appendix 2: Answers to Questions Fig Ultrsound of premture (26 weeks gesttion) infnt t 4 weeks of ge. Coronl () nd sgittl () imges of this neonte revel multiple cvities (lck holes) surrounding the ventricle. This represents ischemic disese clled periventriculr leukomlci Fig A 14-yer-old with ck pin. Sgittl () nd coronl () T1-weighted imges show norml signl (gry) in the 5th lumr verterl ody. This represented Ewing s tumor

Appendix 2: Answers to Questions 285 Fig. 8.29. A 10-yer-old with wekness.

It is fluid collection clled syrinx. It thins the neurl tissues Fig. 8.30. One-month-old y with encephlopthy.

26 Appendix 2: Answers to Questions 285 Fig A 10-yer-old with wekness. Sgittl () nd xil () T2-weighted imges of the cervicl spine show lrge high signl lesion (S) within the spinl cord. It is fluid collection clled syrinx. It thins the neurl tissues Fig One-month-old y with encephlopthy. Axil diffusion weighted MR imges show high signl in the right temporl region. This region ws norml on T2-weighted sequences. This y hs stroke, nd diffusion imges re the most sensitive sequence

27 Suject Index Adomen CT 104, 105 f. 106 f., 107 MR 108, 108 f. plin film 3, 86, 88 93,133 ultrsound 96, 97 f. Adominl msses (see lso Pelvic msses) ge 154 f., 158. incidence 154 f. identifiction 153 imging y sign nd symptoms 162 f. most likely cuses 131 f. symptoms 162 work-up 134, 138 f. Adominl pin 87 f., 88 f., 137 Ascess( es ), ppendicel 95 f. Air in domen 86 f. intrperitonel, free 90 f. Airwy evlution 29 mgnifiction high-kilovoltge rdiogrphy 29, 34 f. norml view, lterl 30 f., 31 f. phontion 32 f. respirtion 32f. ALARA 13, 83 Anl-rectl mlformtions 145 Antomicl vrints 23 ctheters 66 f. clips 23 skin fold 23, 70 f. spinous process, nonfused 23 f. sutures 23 tues 24 f. Anemi, sickle cell osteomyelitis in 190, 262 f. verterl involvement 263 f. Angiogrphy 2, 254 f., 255, 255 f. Angioplsty, percutneous trnsluminl 209 Aortic Arch, doule 45 f., 46 f., 267 f. Appendicitis 137, 140, 140 f., 141 f., 253 f., 275 f. Appendicolith 91 f., 137 Arthritides f. Ascites 88 f. Atelectsis 68 f. Brium enem Bttered child syndrome 142 f., 182, 183, f., 228 f. Bldder 124, 125 f., 126 f., 127, 128 f. exstrophy 89 f. Blood vessels rteriogrphy 252 f., 254 f., 255 Seldinger method 255 venogrphy 252 Bone scess 279 f. Bone cyst(s) 195, 196 f., 279 f. Bone mrrow f. Bone tumors 179 f., Bones ABCs 179 ppositionl new one 182, 183 f. in childhood flt 170 mturtion 171 f., 174, 180, 182 ossifiction 170, 170 f., 175 periosteum 170, 180 Bowel ostruction 94 f., 115 with tresi 95 f. Brin cudte nucleus 223 f. computed tomogrphy f. corpus cllosum 223 f., 283 f. epidurl leeding 228 f. mgnetic resonnce 6 f., 223 f. 227 f. MRS 7 f., 234, 236 f. thlmus 223 f. ultrsound 214 f. Brin ventricles, enlrged 230 f. Clcifiction(s) 90, 155 in drenl glnd 155 f. in gllldder 91 f.

28 288 Suject Index in kidney 106 f. in peritoneum 91 f. in spleen, secondry to hemolytic nemi 91 f. Clvrium (see lso skull) 207 f., 211 superiostel leeding 212 f. tles 211, 212 f. Wter s view 209 f., 213 f. Crdic order, moguls(umps) 43, 44 f. Crdic silhouette, enlrged 41 f., 42 f. Crdiomegly 69 f. Cererl vessels rteriogrphy 236 MR ngiogrphy 225 f. 226 f. Chest rdiogrph expirtory 17 f. inspirtory 15 f. interprettion 64 lung volume 16 neontes, interprettion of, 63 64, 63 f., 64 f. norml 2 ptient position 16 f. rotted 16, 19 f., 20 f. Chonl tresi 30 f. Choledochl cyst 123 f. Circle of Willis 225 f., 226 f. Cleidocrnil dysostosis, clvicl normlities 262 f. Colitis (see Ulcertive colitis) 119 f. Colon 86 f. Computed tomogrphy 3 4 Constiption 142 Crniosynostosis (crniostenosis ) 230, 232 f., 233 f. Dextrocrdi 26 f. Duodenum 114 f., 115, 270 f. tresi 95 f. mlrottion 118 f. Er CT 219 f. 220 f. Elow, nursemid( supermrket) 182, 184 f. Emoliztion 256 Emphysem pulmonry interstitil 78 f. Endotrchel tue, misplced, respirtory distress in 64 f. Enterocolitis, necrotizing 268 f., 273 f. Epiglottitis 264f f. Esophgrm 47 f., 83 f., 112 f. Esophgus 43, 111 normlities 111, 113 ff. ostruction 65, 113 f. reltionship to trche 47 f. respirtory distress 24 f., 65 Ewing s srcom 195, 198 f., 284 f. Ft line, properitonel 88 f. Ft pds positive 183, 185 f. Femur 169 f. Fluoroscopy 2 Fontnelle(s) 207 nterior, ultrsound 213, 214 f. 215 f. closure 211 f. Foreign odies, ronchil 265 f. Frcture(s) nkle 176 f. ucket hndle 173 f. greenstick 173 f. Slter-Hrris 172 f., 176 f. skull stress 183, 185 f. tii 183, 185 f. Gllldder gllstones 26 f., 91 f. ultrsound 5f. Gnglioneurolstom 266 f. Gs owel pttern 90, 92 93, 92 f. owel size 93 Gstroesophgel reflux 133, 134 f., 135 Gstrointestinl leeding 142, 142 f. Hert oot-shped 69 enlrged 26 f., 42 f., 69 f. norml 41, 43 f. Hemtom rin 227 Hemturi 147 Hemophili, long ones squring 201 f. Herni, inguinl 94 f., 137 f. Hip symmetry 87, 88 f. dislocted 189, 190 f. ultrsound 178 f., 189, 190 f. Hirchsprung s disese 144 f. Hyline memrne disese 72, 77 f. ronchopulmonry dysplsi with 81 f. ground glss ppernce of X-ry in 73 f., 77 Hydronephrosis, in neworn 148 f. Hyperprthyroidism 194 f.

29 Suject Index 289 Ilel tresi, owel ostruction with 95 f. Ileum 115, 116 f. Imging modlities, comprison 9 f. Interventionl rdiogrphy 249 iopsies nd dringes 253 f., 257 f. gstrointestinl 255, 256 f. less invsive urinry system 255, 257 f. vsculr 252 f., 253, 254 f., 255, 256, 258 f. Intrcrnil imging, indictions 227 Intrcrnil pressure incresed 229, 231 f. suture spred 230 Towne s projection 208 f., 209 f. Intussusception 138 f., 139 f., 156 f. Jejunum 111, 114 f., 116 f. tresi 95 f. Joint(s) rthrogrphy 250 f. infections 88 f., f. neuropthic (Chrcot) 279 f. Joint spce 181 f., 182 Kidney computed tomogrphy 106 f. differentil dignosis 130 f. duplex 110 f. mgnetic resonnce 109, 109 f., 110 f. in neworn 148 f., 157 f. nucler exmintion , 129 f. ultrsound Knee, mgnetic resonnce 177 f. Led intoxiction 194, 195 f. Led lines 194 Legg-Clve-Perthes disese 193, 193 f., 279 f. Ligment of Treitz 111, 114 f., 118 f., 135 Lipom 283 f. Liver computed tomogrphy 124 f., 166 f. mgnetic resonnce 166 f., 167 f. rdionuclide scn 121, 122 f. ultrsound 97 f., 98 f., 167 f. Long one(s) 169 Lung(s) ntomy 44 f., 48 computed tomogrphy 48 f. collpse 51, f. hyperexpnsion 49 51, 50 f. msses volume 76 79, 82, 82 f. retined fetl fluid 74 f. Lymphom 160 f., 165 Mgnetic Resonnce 5, 6 f. Spectroscopy f. T1 5 Mlrottion 118 f. Meconium spirtion 75 f. Medistinl msses 56, 57 f., 58 pseudomsses 56 f., 71 f. Medistinum 30, 35 f. computed tomogrphy, norml 38 f. moguls 43, 44 f. mgnetic resonnce, norml f. Meningomyelocele 243 f., 245 f., 282 f. Metsttic mlignncy one 179 f. lung(s) 57 f. Neck msses 236, 238 Neonte(s) irwy 68, 68 f. ones 67, 202, 202 f. chest film, interprettion of 64, 66 lung normlities 72, 72 f., 269 f. medistinum respirtory distress 64 f., 70 f. Neurolstom 159 f., 164, 245 f. metsttic 279 f., 283 f. Neurofiromtosis 28 f., 263 f. Nucler Medicine (see Rdionuclide imging) Oritl cellulites 238 f. Osteochondrom 196 f. Osteogenesis imperfect 182, 183 f. Osteogenic srcom 195, 198 f. Osteoid osteom 195, 280 f. Osteomyelitis 180 f., f., 264 f. in immune deficient children 191 mgnetic resonnce 192 f. in neontes 191 in sickle cell nemi 190 Ovrin cysts 158 f. Pncres CT 105 f. ultrsound 98 f. Prnsl sinuses CT 221 f. 222 f., 225 f., 236 Pelvic mss(es) dermoid 156 f. ovrin cyst 158 f.

30 290 Suject Index pregnncy 156 f., 157, 168 rhdomyosrcom 161 f., 165, 168 Pelvis ultrsound 104 f. Periventriculr leukomlci 284 f. PICC line Plin films 1 Pleur, loclized thickening of 59 Pleurl effusions 59 f., 76 Pleurl empyem 59 f. Pneumomedistinum 79, 80 f. Pneumoni left lower loe 54 f. round 55f. streptococcl 55 f. Pneumothorx tension 77 f., 121 Polyp(s),of colon 120 f. Posterior urethrl vlves 125 f., 276 f. Pulmonry vsculrity 41 decresed 43 Pyloric stenosis f. rilrod trck sign 134, 136 f. ultrsound 135 f. Rdition dose 11 13, 83 Rdiologist s ABCs 60, 85 Rdiologist s circle 25, 85 Rdionuclide imging 2 PET 2 Spect 2 Rectl leeding 142 f. Rheumtoid rthritis, juvenile 201 f. Rickets 181 f., Rule(s) 259 No. 1 25, 64 No. 2 29, 30, 93 No.3 30 No. 4 41, 69 No. 5 43, 82, 111 No.6 51 No No No No No No No No No Slivry glnds, imging 249 silogrphy 251 f. Schmorl s node 243 f. Scoliosis 243 Sentinel loop 93 f. Sickle cell nemi (See Anemi, sickle cell) Sinusitis 236 f. 237f. (See lso Prnsl sinuses) Skull 207 f. 210 f. ony tles 211 sell turcic 230 views for projection 209 f., 213 f. Slipped cpitl femorl epiphysis 183, 186 ff. Soft tissue normlities 179 f. swelling with frcture 180 f. tumors 199 Spinl imging, indictions 243 Spine , 240 f., 285 f. hernition of nucleus pulposus , 243 f. mgnetic resonnce 241 f. 243 f. Spleen 89, 97 f. enlrgement 91 f., 153 f. Stenting 249, 255 Stomch 114 f., 115 Stridor 34 f. Suture(s), crnil 207, 210 spred 230, 231 f. Syphilis, congenitl 279 f. Tetrlogy of Fllot 35 f. Thymus glnd 36, 37 f. Tomogrphy, computed 4, 5 f. Hounsfield units 4 f. Tomogrphy, positron emission 2 3 Tomogrphy, single-photon emission computer 2 TORCH infections 234, 235 f. Trum computed tomogrphy 124 f., 141, 143 f., 186 f. mgnetic resonnce 186 in neworn 182, 183 f. tips 183 Tuerculosis, lung 48 f. Pott s disese 282 f. Tumor(s) (see lso specifics) rin 234 heptic 159, 165 f. rhdomyosrcom 161 f.

31 Suject Index 291 Ulcertive colitis 119 f. Ultrsound 4, 5, 5 f. 6 f. Ureteropelvic junction ostruction 157 f., 272 f. Urethr 126 f. Urinry trct cystogrm 125 f., 128 f. excretory urogrm 131 f. imging modlities 130 infection , 272 f. intrvenous urogrphy 132 f. nucler medicine 129 f. reflux 147 f. 110 f., 148 f., Vcuum phenomenon 181 f. Verter/vertere , 281 f. cervicl 240 f. pedicles 239 f. trnsverse process 239 f. Viscus, perforted, ir(gs)in 90 f. Vomiting Wilms tumor , 163 f. X-rys production 2 3, 21 22

3 Chest Examinations in Children

3 Chest Examinations in Children 3 Chest Exmintions in Children The chest film is the most frequently ordered peditric rdiogrphic exmintion. However, ecuse one looks t so mny chest rdiogrphs, fmilirity my crete flse sense of security