Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed
When interpreting a chest x-ray in a child, the entire film should be examined, not just the chest. Use of the "ABC" approach ensures that all areas of the film are systematically examined.
A - Abdomen, check for: bowel gas pattern suggesting ileus or obstruction, free intraperitoneal air, abnormal calcification, abdominal situs, diaphragm position.
B - Bone, check for: fractures, lytic or blastic lesions, metabolic bone diseases.
C - Chest, check for: midline trachea and mediastinum, abnormal mediastinal and cardiac contours, position of the aortic arch, pleural effusions, pulmonary vascularity, pneumomediastinum, pneumothorax, pneumopericardium, infiltrates, atelectasis.
In older infants and children, a good inspiratory chest film is one in which the relationship of the 6th anterior rib ends intersect the domes of the diaphragm.
Haller JO, Slovis TL: Introduction to radiology in clinical pediatrics. Yearbook Medical Publishers (Chicago) 1984.
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