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Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed
The anterior arc of a rib on a normally aligned film should be directed downward, below the normally horizontal posterior rib. If the x-ray tube is angled cephalad or if the infant is not lying flat, a lordotic film is obtained. This results in the anterior arc of the rib projecting cephalad above the posterior rib. In severe lordotic distortion the ribs can appear dysplastic, the lung volumes decreased, the cardiac silhouette may have an elevated apex and appear enlarged, and the central portions of the diaphragm may appear elevated, simulating a diaphragmatic hernia. A normal appearing lateral view taken at the same time of the frontal view will confirm the lordotic nature of the frontal film.
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