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Viewing the pediatric chest and lungs, whether by radiographic
or bronchoscopic means, is often central in the evaluation of these
patients. Although the chest x-ray has a venerable place in history,
radiologic technologies now available include computerized tomography
(CT), chest ultrasound, magnetic resonance imaging (MRI), and nuclear
medicine. These novel methods allow better evaluation of the respiratory tract
both anatomically and physiologically. The rigid bronchoscope has been
available since the early part of the twentieth century, but advances
in fiberoptics now allow for safer bronchoscopic studies in pediatric
patients. These newer technologies improve the evaluation of the
infant or child with pulmonary complaints. This section will deal
with the various radiographic and nuclear medicine imaging techniques
as well as with rigid and flexible bronchoscopic evaluation of the
airways. Other diagnostic techniques such as pulmonary function
testing are described in Chapter 503.
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Imaging has long been important in the evaluation, diagnosis,
management and follow-up of pediatric chest diseases; and it contributes
greatly to our understanding of the pathophysiology of many entities.
The chest is no exception to the increased sophistication and complexity
of imaging techniques, with a myriad of available options involving
a bewildering array of modalities and choices. This section will
provide an overview of these options and their advantages, disadvantages,
and most appropriate use in the pediatric population.
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Children are often unwilling or unable to cooperate with the
maneuvers required to produce high quality imaging. Optimal studies
are most often the product of experienced personnel who work with
children in friendly surroundings with appropriate distraction,
immobilization, analgesic, and sedation techniques.
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Although plain film radiography remains the mainstay for chest
imaging, cross-sectional techniques provide remarkably detailed
images with versatile multiplanar and 3D reconstruction capabilities,
sophisticated angiographic and Doppler techniques, and functional
imaging even at the molecular level. It has become increasingly
important to tailor the imaging studies to the specific clinical
questions and concerns or limitations of individual patients. Imaging
is no longer “one size fits all” and close collaboration
between radiology and clinical colleagues is not just desirable
but essential in making the most appropriate choices and providing
the best patient care.1-12
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Chest Radiographs and
Chest Fluoroscopy
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Plain radiographs of frontal and lateral views of the chest remain the
mainstay of screening imaging of a child with a suspected chest abnormality.
Digital imaging systems are now widely available. These radiographs
usually include portions of the upper airway, larynx, trachea, and
central bronchi as well as the mediastinal structures, heart, lungs,
and bony and soft tissue chest wall. Evaluation of a chest radiograph
should include an overview of the following:
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1. Patient history and specific reason for the current
radiograph
2. Quality of the study: patient positioning, inspiratory effort, motion,
or presence of artifacts (eg, jewelry)
3. Overall pulmonary aeration and symmetry, position, and patency
of the airway
4. Presence and location of any tubes, lines, ...