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Michael P. D'Alessandro, M.D.
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When interpreting a chest x-ray in the neonate, the entire film should be examined, and 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 calcifications, abdominal situs, and diaphragm position.
B - Bone - check for: fractures, lytic or blastic lesions, and 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, and 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. This may be difficult to evaluate in the neonate where proper positioning is difficult.
Haller JO, Slovis TL: Introduction to radiology in clinical pediatrics. Yearbook Medical Publishers (Chicago) 1984.
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