13
!"#$%&'%()'*+,-%&&.'+('*/%)+%,#+0'
12/.,'3%)+"4#%52.
S.
10/21/2013
20
!"#$%&'()$*+&,--#&$.//,0'1232'
!-#0'45*6'7849!
01
3
S.
K.
AO
SP
R
!"#$%&'"(&)*+),$-.*/*01)
2$34/&1)*+)5"-.3.(")
6%.(3")*+)7*(08/$)9(.:"%;.&1))
<$&)=$.>)?<@AB@C!)
1
10/21/2013
!"#$%&&'(")(*+,'#(-%."/0-%!+'!
S.
!"#$%&#'()"**+*
20
67"("0'(
S.
K.
AO
SP
R
/%0*'0$+*'#&#)
10*2#02*"1
13
,&*-'.
340*&%1&#)0+)0$")(2%5
01
3
!"#$%&#'()
*++,+-
2
S.
K.
AO
SP
R
20
13
S.
10/21/2013
A 3 year old boy with acute dyspnea 1 day
!"#$%&'($)("*+)$*,')-
Pneumothorax ?
Emphysema ?
Lung hypoplasia ?
Foreign body obstruction ?
01
3
‡
‡
‡
‡
3
10/21/2013
13
S.
8+0'0&+%
01
3
S.
K.
AO
SP
R
‡ Longer posterior ribs
20
‡ Symmetrical ribs and the medial
border of the clavicles
4
20
13
S.
10/21/2013
01
3
S.
K.
AO
SP
R
a 4 hour baby girl with meconium peritonitis
a 3 month old boy
Congenital lobar over-inflation of right lung
5
S.
K.
AO
SP
R
20
13
S.
10/21/2013
a 3 month old girl with wheezing
01
3
Right lung hypoplasia
6
13
S.
10/21/2013
01
3
S.
K.
AO
SP
R
20
A 2 year old boy
dyspnea for 2days
Left lateral decubitus
Right lateral decubitus
9":0);'&%)<*+%#$&'()+<10*2#0&+%
7
01
3
S.
K.
AO
SP
R
20
13
!"#$%&'()"*+(,-.%#/0%"'
S.
10/21/2013
The Journal of Laryngology and Otology
October 1990, Vol. 104, pp. 778-782
The Journal of Laryngology and Otology
October 1990, Vol. 104, pp. 778-782
8
01
3
S.
K.
AO
SP
R
20
13
S.
10/21/2013
The Journal of Laryngology and Otology
October 1990, Vol. 104, pp. 778-782
=++*)/%1>&*'0&+%
‡ Interstitial pneumonia
‡ Pulmonary edema
‡ Cardiomegaly
‡ Mediastinal mass!
9
20
13
S.
10/21/2013
01
3
S.
K.
AO
SP
R
Courtesy of Edward Y Lee
&KLOGUHQ¶V+RVSLWDO%RVWRQ
A 3 month old boy post operative CHD
worsening pulmonary edema ??
Curr Probl Diagn Radiol, May/June 1998
Tetralogy of Fallot ?
10
10/21/2013
‡ Round cardiac apex Î RVH
13
S.
9+*?+1&1
markings
20
‡ Prominent perihilar bronchovascular
01
3
S.
K.
AO
SP
R
‡ Horizontal or upturned anterior ribs
.//0102)3&*,31$%3&*40$5
‡ Assess cardiomegaly
‡ Determine location and confirm pulmonary
nodule on frontal view
‡ Clarify number & position of FB
‡ Evaluate LN and pulmonary hilum
11
01
3
S.
K.
AO
SP
R
13
20
S.
10/21/2013
12
S.
K.
AO
SP
R
20
13
S.
10/21/2013
Pulmonary AVM
01
3
.&+/'0-
13
10/21/2013
S.
,&*-'.1
20
13
‡ Tracheal buckling simulating
extrinsic compression by a mass
01
3
S.
K.
AO
SP
R
‡ Neck flexion simulating
retropharyngeal soft tissue
thickening
!
Tracheal buckling
14
13
S.
10/21/2013
*
20
Prevertebral soft tissue thickening?
01
3
S.
K.
AO
SP
R
*
Curr Probl Diagn Radiol, May/June 1998
a 1- year old girl with neck stiffness
*
*
Prevertebral soft tissue thickening?
15
13
S.
10/21/2013
20
,0.>&#'()>*"1"%0'0&+%)+:)@'-'1'7&)
*
*?&1"'1")&%).+2%5)&%:'%01)
01
3
S.
K.
AO
SP
R
Retropharyngeal fluid/abscess
()$*+&,--#&$./,'!0'-*'&:2';<-)='
>&?$/:'@7847A'4BC45BD4E9'
*
a 3 - year boy with snoring
16
10/21/2013
S.
9'0"*'()A"#7
‡ Over diagnosis of airway masses
13
‡ Prominent normal lymphoid tissue
20
‡ Significant enlargement ÍÎ airway
obliteration
S.
K.
AO
SP
R
‡ Considered immune deficiency > 6 months!
01
3
1%2+'2$,+'#&#)
32+4#24+"-
17
20
13
S.
10/21/2013
S.
K.
AO
SP
R
Mediastinal mass ?
!$.;21
‡ Most frequent pitfall
‡ Located in prevascular space
‡ Large at birth
‡ Less prominent in older children
01
3
‡ Never displace mediastinum
18
10/21/2013
‡ Unilateral / bilateral
‡ Wavy margin
01
3
S.
K.
AO
SP
R
‡ Thymic sail sign
20
‡ Cardio-thymic notch
13
S.
!$.;21
*
-'0"*)?"%1&0.
19
01
3
S.
K.
AO
SP
R
20
13
S.
10/21/2013
-'B.)1&5%
!$.;&#)1'&()1&5%
20
10/21/2013
S.
!$.;21
13
‡ Rebound thymic hyperplasia
‡ Ectopic location: posterior mediastinum/
20
retrocaval position
‡ Above sternum during respiration / crying
01
3
S.
K.
AO
SP
R
‡ US or CT or MRI
11/12/2009
A 7 year old boy
NHL stage II complete treatment
17/03/2010
19/7/2010
21
10/21/2013
01
3
S.
K.
AO
SP
R
20
13
S.
67"8'9*4:*;$/03910)3&*8399*<<
Courtesy of Edward Y Lee
&KLOGUHQ¶V+RVSLWDO%RVWRQ
2-month-old girl with fever and coughing
=291$%02%*;$/03910)3&*>?1$)902)
Courtesy of Edward Y Lee
&KLOGUHQ¶V+RVSLWDO%RVWRQ
Key Point!: contiguous with normal thymus
22
10/21/2013
01
3
S.
K.
AO
SP
R
20
13
S.
@$%A0(3&*>?1$)902)
Courtesy of Edward Y Lee
&KLOGUHQ¶V+RVSLWDO%RVWRQ
A+*;'()=2(;+%'*.)
C'1#2('*)60*2#02*"1
‡ Confluence of the pulmonary veins at
right paraspinal region
‡ Prominent normal MPA in adolescent
girls
‡ Post stenotic dilatation in PS
23
01
3
S.
K.
AO
SP
R
20
13
S.
10/21/2013
a 10 year old boy ± contacted TB
A+*;'()=2(;+%'*.)
C'1#2('*)60*2#02*"1
‡ Confluence of the pulmonary veins at
right paraspinal region
‡ Prominent normal MPA in adolescent
girls
‡ Post stenotic dilatation in PS
24
01
3
S.
K.
AO
SP
R
20
13
S.
10/21/2013
a - 18 year old girl ± check up
Ductus bump
A baby boy 2nd DOL
25
10/21/2013
S.
D2#021)E2;>
13
‡ Transient limited to newborn
‡ Distended PA and DA
20
‡ Prominent aortic knob
S.
K.
AO
SP
R
‡ The mostprominent on 2nd or 3rd DOL
01
3
*52+&%-&#)2,))
2$")64%7-
26
S.
K.
AO
SP
R
20
Pneumonia ?
13
S.
10/21/2013
Asymmetrical breast development
01
3
Neonatal incubator access port
27
13
S.
10/21/2013
01
3
S.
K.
AO
SP
R
20
Right pleural effusion ?
a 1- month old girl - TGA
Pneumothorax ?
28
10/21/2013
S.
67&%)F+(?
‡ Misinterpreted as pneumothorax
13
‡ Performed portable in ICU
20
‡ Pleural line ± distinct, curvilinear parallel
lateral chest wall
S.
K.
AO
SP
R
‡ Skin fold ± indistinct and random course
01
3
38"("2,%
29
/;;'02*")="?&'0*&#)67"("0+%
S.
10/21/2013
01
3
S.
K.
AO
SP
R
20
inexperienced observers !
13
‡ Simulating abnormalities to the
Mediastinal mass ?
30
60"*%'()G11&:&#'0&+%)H"%0"*1
S.
10/21/2013
13
‡ Not fused in infants and young children
20
‡ Slightly oblique
01
3
S.
K.
AO
SP
R
‡ Manubrial ossification center: mistaken
for a mediastinal massor foreign body!
a 8 month old girl
CHARGE association
31
01
3
S.
K.
AO
SP
R
20
13
S.
10/21/2013
/%#+;>("0")G11&:&#'0&+%
‡ Caudal ± Cranial posterior spinal fusion
‡ Thoracic posterior spinal elements 1st year
‡ Cervical spinal elements 2nd-3rd year
‡ Lack of clinical finding or pathologic
widening of spinal canal
32
01
3
S.
K.
AO
SP
R
20
13
S.
10/21/2013
Enlarged cervical spinal canal 6-12 months
33
01
3
S.
K.
AO
SP
R
20
OSTEOPETROSIS ?
13
S.
10/21/2013
Bone in bone appearance
OSTEOPETROSIS
34
‡ Younger than 2 months
S.
K.
AO
SP
R
20
‡ Will diminish with time
13
E+%")&%)E+%"),>>"'*'%#"
S.
10/21/2013
01
3
Axially oriented cleft??
35
10/21/2013
S.
C"*0"<*'()A+0#$
‡ Noted in lateral projection
13
‡ Young infants
20
‡ Anterior notch ± sinusoid blood space
‡ Posterior notch ± penetrating arteries
S.
K.
AO
SP
R
and veins
01
3
avulsion fracture??
36
10/21/2013
S.
='*0&'()G11&:#'0&+%
13
‡ Early ossified cartilaginous ring
01
3
S.
K.
AO
SP
R
‡ Mimic avulsion fracture
20
epiphysis at 12 years
Prominent
intertubercular
groove
37
=*+;&%"%0)/%0"*02<"*#2('*)
I*++B"
S.
10/21/2013
13
‡ Tendon of long head of biceps tendon
bony erosion
20
‡ Simulate periosteal reaction or focal
01
3
S.
K.
AO
SP
R
‡ Bilateral and symmetrical
38
10/21/2013
20
‡ Glenohumeral joint
13
‡ Immobilization
S.
J+&%0)C'#22;
S.
K.
AO
SP
R
‡ Intra-articular nitrogen gas
01
3
@2)-$)013&*B2)"*.)283&0$9
39
10/21/2013
S.
="#021)34#'B'02;
‡ Cardiomegaly
20
‡ Obscured right heart border
13
‡ Narrow AP dimension
‡ Relatively vertical orientation of
01
3
S.
K.
AO
SP
R
anterior ribs
A 9 year old girl
pectus excavatum
40
01
3
S.
K.
AO
SP
R
13
20
S.
10/21/2013
41
10/21/2013
S.
8&<1
13
‡ Bulbuous cartilaginous anterior rib ends
01
3
S.
K.
AO
SP
R
20
‡ Misleading calcified mass or expansile rib
!'7")K+;")=+&%01
‡ Technical factors, un-cooperative patients,
external factors
‡ Normal structures and immature skeleton
‡ Prevent misinterpretation
‡ Repeated radiographs, additional views or
other advanced imaging
42
S.
K.
AO
SP
R
20
13
S.
10/21/2013
01
3
!"#$%&'()&*(+&'()+&#,,-$,.($
43