Knowledge Check: Evaluation of the Chest Radiograph in Children with Known or Suspected Heart Disease
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Question 1 of 10
1. Question
An 8 month old presents with cyanosis and a murmur is noted on exam. Based on his Chest X-Ray, which of the chambers of the heart appears to be most prominently enlarged?
Hint
Hint: 1:14. The most anterior chamber of the right the heart appears to be enlarged out of proportion to the rest of the chambers.
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Question 2 of 10
2. Question
A 14 yo girl presents with fever, arthralgia, shortness of breath and found to have acute rheumatic fever. On lateral Chest X-ray, there is displacement of the trachea by the posterior right heart border. This is indicative of enlargement of which of the following chambers?
Hint
Hint: 1:47. The right side of the heart is more anterior to the chest wall, while the left side of the heart is more posterior.
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Question 3 of 10
3. Question
An 8 year old presents wtih shortness of breath. How would you characterize his heart on Chest X-ray?
Hint
Hint: 2:35. The heart appears to be quite round from all the fluid that has accumulated in the pericardial space
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Question 4 of 10
4. Question
A 2 week old presents with cyanosis, respiratory distress and is noted to have a murmur on exam. What is his Chest X-Ray most consistent with?
Hint
Hint: 4:17. The pulmonary markings are markedly diminished. This patient has Tetralogy of Fallot and pulmonary stenosis.
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Question 5 of 10
5. Question
Size comparison of the following two structures on Chest X-Ray can be used to assess for Left to Right shunt?
Hint
Hint: 5:22. Left to Right shunt results in back-up of blood in the pulmonary vasculature, particularly the vessels going from the heart to the lungs.
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Question 6 of 10
6. Question
A 6 month old baby with a history of Glenn shunt repair had a venous catheter placed in the superior vena cava. In which of the following structures is the catheter terminating?
Hint
Hint:10:14. A Glenn procedure is a stent from the superior vena cava to the right pulmonary artery, as reflected by the increased vascularity on the right side of the lung.
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Question 7 of 10
7. Question
A 20 month old presented with stridor. Based on the Chest X-Ray, what is the most likely cause for his symptoms?
Hint
Hint: 12:42. The trachea typically lies to the right of the midline. In this Chest X-Ray, the trachea is displaced to the left by a structure that runs posteriorly to it.
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Question 8 of 10
8. Question
A 13 year old patient presents with hypertension and is noted to have notching of the inferior ribs on Chest X-Ray. This is most consistent with what conditions?
Hint
Hint: 14:15. Notching is caused by the pulsatility of the collaterals that are traveling under the ribs. Collaterals formed in order to ensure adequate blood supply past the narrowing of a major vessel.
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Question 9 of 10
9. Question
Which of the following pairs regarding situs is correct?
Hint
Hint: 15:34. In a Chest X-Ray of a normal anatomy, the heart appears mostly on the left side and the gastric bubble on the left side as well. Other variations include the heart and the abdominal viscera being on the same side but reversed or on opposite sides.
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Question 10 of 10
10. Question
On Chest X-Ray, pulmonary artery hypertension can lead to disproportionately small peripheral pulmonary vessels compared to the large pulmonary arteries. This is referred to as what?
Hint
Hint: 6:59. Pulmonary vasculature changes with time in pulmonary artery hypertension that is untreated. The central pulmonary artery is still enlarged, but the peripheral pulmonary vessels are diminished.
