Avoiding pitfalls in pediatric chest radiography

Pediatric chest radiography is a prime tool used for patients. However, it could be challenging to use with younger patients in many cases, ultimately resulting in potential mistakes.

Pediatric radiologists practicing in Seattle, published “Pediatric Chest Radiographs: Common and Less Common Errors,” in the American Journal of Roentgenology, which outlines the pitfalls of pediatric chest imaging and gives readers tips and tricks to avoid potential errors.

"Errors in interpretation may lead to inappropriate further imaging, incurring additional radiation exposure and cost, as well as psychologic effects on the patients and their families,” said co-author A. Luana Stanescu.

The study offered nine different cases from a 9-month-old girl who had a history of atrioventricular septal defect, to a 3-year-old boy who was in distress after tracheostomy tube placement.

The study of the young boy shows frontal and lateral chest radiograph images with a diffused narrowing of intrathoracic trachea and subtle anterior displacement of inferior trachea by soft-tissue density, interposed between trachea and esophagus, which were not described on the report.  

The authors teaching point states, “Assessment of the caliber and position of the trachea, as well as the laterality of the aortic arch, should be performed on every radiograph of the pediatric chest. These may be the first clues indicating the presence of a vascular anomaly. Attention to meticulous radiographic technique, including adequate inspiratory effort and positioning, is a crucial component of such evaluation.”

These case examples will not only aid pediatric and general radiologists from avoiding mistakes that could potentially be made, but it will also help them to render accurate interpretations.

“Having a thorough understanding of normal pediatric anatomy and developmental changes along with a good command of the entities unique to children is essential for the pediatric and general radiologist to avoid significant interpretive errors,” said Stanescu.

See the entire study here.