Knowledge Check: Introduction to Pediatric Chest Radiography

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Question 1 of 10

1. Question
A 2 month old boy had a Chest X-Ray to evaluate for rib fracture. The X-rays does not demonstrate any fractures, but is notable for a right sided mass in the right upper thorax. What does most commonly represent?
- lymph node concerning for leukemia
- right upper lobe consolidation concerning for pneumonia
- pulmonary vascular congestion concerning for heart failure
- thymic shadow
Hint

Hint: 1:10 and 11:05. The Chest X-Ray changes depending on the age of the child as certain structures involute with time.
Question 2 of 10

2. Question
How many ribs of inflation are noted in this Chest X-Ray obtained in a 14 month old boy with cough and wheezing?
- 3
- 5
- 7
- 9
Hint

Hint: 2:40. Hypoinflation of the lungs (9 ribs) can mimic pneumonia on Chest X-Ray. In a normal inflation, there should be about 9 ribs visible.
Question 3 of 10

3. Question
This 2 month old boy presents with fever, tachypnea and difficulty eating. Based on his Chest X-Ray. what is the most likely diagnosis?
- Normal thymus
- Congestive heart failure
- Pneumonia
- Atelectasis
Hint

Hint: 11:05. The opacification seen in the right upper lobe has a sharp border, we cannot see lung markings behind it, and the trachea is displaced the left of the child. This is consistent with an infiltrate.
Question 4 of 10

4. Question
How can atelectasis be differentiated from an infiltrate on Chest X-Ray?
- The trachea deviates towards the side of the atelectasis.
- The trachea deviates away from the side of the atelectasis.
- The lung parenchyma appears more lucent in areas of ateletasis.
- The diaphragm is flattened on the side of atelectasis.
Hint

12:09. Atelectasis is collapse of the lung parenchyma, so structures tend to move towards the side of atelectasis.
Question 5 of 10

5. Question
A 2 year old girl is brought to the hospital because of difficulty breathing. Chest X-Ray demonstartes assymetric lung fields. What is this most consistent with?
- Right sided pneumonia
- Left sided foreign body aspiration
- Pneumothorax
- Bronchiolitis
Hint

Hint: 3:12. The left lung is more lucent than the right lung. This results from air trapping and over-inflation of the lung.
Question 6 of 10

6. Question
A 5 year old boy is brought in with respiratory distress after trauma to the chest. What is the most likely diagnosis based on his on Chest X-Ray ?
- Left sided pleural effusion
- Cardiogenic shock
- Right sided pulmonary contusion
- Right sided pneumothorax
Hint

Hint: 3:54. Unlike adults, children tend to develop a pneumothorax medially and/or anteriorly to the lungs.
Question 7 of 10

7. Question
A 5 year girl presents with cough and fever. Her oxygen saturation on room air is 89%. Chest X-Ray is consistent with a “round” pneumonia. What is the exact location of the consolidation?
- Right middle lobe
- Right lower lobe
- Left middle lobe
- Left lower lobe
Hint

Hint: 4:53. The opacity is retrocardiac. The left side of the lung only has two lobes and a lingula.
Question 8 of 10

8. Question
A 16 year old has a Chest X-Ray as part of tuberculosis screening. There is no evidence of tuberculosis, however, the diagnosis of a right aortic arch is made. Which of the following lead this diagnosis?
- The trachea is deviated to the left of midline.
- The trachea is deviated to the right of midline.
- The cardiac silhouette is deviated to the left of midline.
- The cardiac silhouette is deviated to the right of midline.
Hint

Hint: 8:47. The aorta itself is located to the left of midline.
Question 9 of 10

9. Question
A 2 month old boy presents with cough. Chest X-Ray shows a large mass with scalloped borders. What is this consistent with?
- Aortic coarctation with rib notching.
- Anterior lymphadenopathy
- Hypetrophied left ventricle
- Normal thymic silhouette.
Hint

Hint: 10:03. The age of the child and the scalloping are clues that this is a normal finding in this patient.
Question 10 of 10

10. Question
A 9 month old girl was brought to the hospital for excessive crying. A Chest X-Ray is obtained. What is the location of the fractures?
- Anterior ribs
- Posterior ribs
- Vertebral body
- Spinous process
Hint

Hint: 14:41. Note the spinous processes and the relation of the rib fracture to the vertebral column.