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Transcription

1 !"#$%&'%()'*+,-%&&.'+('*/%)+%,#+0' 12/.,'3%)+"4#%52.!"#$%&'()$*+&,--#&$.//,0'1232'!-#0'45 *6 '7849!!"#$%&'"(&)*+),$-.*/*01) 2$34/&1)*+)5"-.3.(") 6%.(3")*+)7*(08/$)9(.:"%;.&1)) 1

2 ,&*-'. /%0*'0$+*'#&#) 10*2#02*"1!"#$%&&'(")(*+,'#(-%."/0-%!+'! 340*&%1&#)0+)0$")(2%5!"#$%&#'() *++,+-!"#$%&#'()"**+* 67"("0'( 2

3 A 3 year old boy with acute dyspnea 1 day!"#$%&'($)("*+)$*,')- Pneumothorax? Emphysema? Lung hypoplasia? Foreign body obstruction? 3

4 8+0'0&+% Symmetrical ribs and the medial border of the clavicles Longer posterior ribs 4

5 a 4 hour baby girl with meconium peritonitis a 3 month old boy Congenital lobar over-inflation of right lung 5

6 a 3 month old girl with wheezing Right lung hypoplasia 6

7 Left lateral decubitus 9":0);'&%)<*+%#$&'()+<10*2#0&+% A 2 year old boy dyspnea for 2days Right lateral decubitus 7

8 !"#$%&'()"*+(,-.%#/0%"' 8

9 =++*)/%1>&*'0&+% Interstitial pneumonia Pulmonary edema Cardiomegaly Mediastinal mass! 9

10 A 3 month old boy post operative CHD worsening pulmonary edema?? Curr Probl Diagn Radiol, May/June 1998 Tetralogy of Fallot? Courtesy of Edward Y Lee 10

11 Round cardiac apex RVH Prominent perihilar bronchovascular markings 9+*?+1&1 Horizontal or upturned anterior ribs.//0102)3&*,31$%3&*40$5 Assess cardiomegaly Determine location and confirm pulmonary nodule on frontal view Clarify number & position of FB Evaluate LN and pulmonary hilum 11

12 12

13 Pulmonary AVM.&+/'0-13

14 ,&*-'.1 Tracheal buckling simulating extrinsic compression by a mass Neck flexion simulating retropharyngeal soft tissue thickening! Tracheal buckling 14

15 Prevertebral soft tissue thickening? * * Curr Probl Diagn Radiol, May/June 1998 a 1- year old girl with neck stiffness * * Prevertebral soft tissue thickening? 15

16 * * Retropharyngeal fluid/abscess * ()$*+&,--#&$./,'!0'-*'&:2';<-)=' >&?$/:'@7847A'4BC45BD4E9' a 3 - year boy with snoring 16

17 9'0"*'()A"#7 Prominent normal lymphoid tissue Over diagnosis of airway masses Significant enlargement airway obliteration Considered immune deficiency > 6 months! 1%2+'2$,+'#&#) 32+4#24+"- 17

18 Mediastinal mass? Most frequent pitfall Located in prevascular space Large at birth!$.;21 Less prominent in older children Never displace mediastinum 18

19 !$.;21 Unilateral / bilateral Wavy margin Cardio-thymic notch Thymic sail sign * -'0"*)?"%1&0. 19

20 -'B.)1&5%!$.;&#)1'&()1&5% 20

21 Rebound thymic hyperplasia Ectopic location: posterior mediastinum/ retrocaval position Above sternum during respiration / crying US or CT or MRI!$.;21 11/12/2009 A 7 year old boy NHL stage II complete treatment 17/03/ /7/

22 67"8'9*4:*;$/03910)3&*8399*<< 2-month-old girl with fever and coughing Courtesy of Edward Y Lee =291$%02%*;$/03910)3&*>?1$)902) Courtesy of Edward Y Lee Key Point!: contiguous with normal thymus 22

23 @$%A0(3&*>?1$)902) Courtesy of Edward Y Lee Confluence of the pulmonary veins at right paraspinal region Prominent normal MPA in adolescent girls A+*;'()=2(;+%'*.) C'1#2('*)60*2#02*"1 Post stenotic dilatation in PS 23

24 a 10 year old boy contacted TB A+*;'()=2(;+%'*.) C'1#2('*)60*2#02*"1 Confluence of the pulmonary veins at right paraspinal region Prominent normal MPA in adolescent girls Post stenotic dilatation in PS 24

25 a - 18 year old girl check up Ductus bump A baby boy 2 nd DOL 25

26 D2#021)E2;> Transient limited to newborn Prominent aortic knob Distended PA and DA The most prominent on 2 nd or 3 rd DOL *52+&%-&#)2,)) 2$")64%7-26

27 Pneumonia? Asymmetrical breast development Neonatal incubator access port 27

28 Right pleural effusion? a 1- month old girl - TGA Pneumothorax? 28

29 67&%)F+(? Performed portable in ICU Misinterpreted as pneumothorax Pleural line distinct, curvilinear parallel lateral chest wall Skin fold indistinct and random course 38"("2,% 29

30 /;;'02*")="?&'0*&#)67"("0+% Simulating abnormalities to the inexperienced observers! Mediastinal mass? 30

31 60"*%'()G11&:&#'0&+%)H"%0"*1 Not fused in infants and young children Slightly oblique Manubrial ossification center: mistaken for a mediastinal mass or foreign body! a 8 month old girl CHARGE association 31

32 /%#+;>("0")G11&:&#'0&+% Caudal Cranial posterior spinal fusion Thoracic posterior spinal elements 1 st year Cervical spinal elements 2 nd -3 rd year Lack of clinical finding or pathologic widening of spinal canal 32

33 Enlarged cervical spinal canal 6-12 months 33

34 OSTEOPETROSIS? Bone in bone appearance OSTEOPETROSIS 34

35 E+%")&%)E+%"),>>"'*'%#" Younger than 2 months Will diminish with time Axially oriented cleft?? 35

36 Young infants Noted in lateral projection Anterior notch sinusoid blood space Posterior notch penetrating arteries and veins avulsion fracture?? C"*0"<*'()A+0#$ 36

37 ='*0&'()G11&:#'0&+% Early ossified cartilaginous ring epiphysis at 12 years Mimic avulsion fracture Prominent intertubercular groove 37

38 =*+;&%"%0)/%0"*02<"*#2('*) I*++B" Tendon of long head of biceps tendon Simulate periosteal reaction or focal bony erosion Bilateral and symmetrical 38

39 J+&%0)C'#22; Immobilization Glenohumeral joint Intra-articular nitrogen 39

40 ="#021)34#'B'02; Narrow AP dimension Cardiomegaly Obscured right heart border Relatively vertical orientation of anterior ribs A 9 year old girl pectus excavatum 40

41 41

42 8&<1 Bulbuous cartilaginous anterior rib ends Misleading calcified mass or expansile rib!'7")k+;")=+&%01 Technical factors, un-cooperative patients, external factors Normal structures and immature skeleton Prevent misinterpretation Repeated radiographs, additional views or other advanced imaging 42

43 !"#$%&'()&*(+&'()+&#,,-$,.($ 43