AIM: Brant: Ch 67: Pediatric Chest Flashcards
T/F: The younger the child, the larger the heart, the wider the chest relative to the height, and the less well-defined the lung markings, particularly the pulmonary vascularity.
True
In a newborn infant, the transverse cardiac diameter may be up to ____ of the transverse dimension of the chest measured between the inner rib margins.
a. 55%
b. 60%
c. 65%
d. 70%
b. 60%
T/F: The cardiothoracic ratio decreases as the child grows older, and should be less than 50%, with the heart appearing similar to an adult, by the first decade.
False
The cardiothoracic ratio decreases as the child grows older, and should be less than 50%, with the heart appearing similar to an adult, by the SECOND decade.
A guide for normal heart size is that a line drawn along the ____ on the lateral CXR should pass posterior to the heart.
a. Anterior tracheal wall
b. Posterior tracheal wall
c. Anterior esophageal wall
d. Posterior esophgeal wall
b. Posterior tracheal wall
While this is a useful guide, comparisons with cross-sectional imaging have shown that heart size on CXR does not correlate well with true chamber volumes.
The following are true regarding the pediatric heart, except:
a. An appearance suggesting a “boot-shaped heart” or “egg on a string” is probably more likely due to normal variation than to the malformation classically associated with that description.
b. The right margin of the left atrium is visible in one-third of normal children.
c. The ascending aorta is never prominent in normal children.
d. All of the above are true
d. All of the above are true
The thymus is proportionately largest at birth, but continues to grow, more slowly than the child, until ____, when it is reaches its maximum size.
a. Puberty
b. Adulthood
c. Age 30
d. Age 40
a. Puberty
Largest at birth
Maximum size at puberty
Name the sign
Thymic wave sign
Anterior rib end impressions cause a wavy edge laterally that is often better seen on shallow oblique views.
A ____ can often be seen on frontal view marking the transition between the inferior border of the thymus and the cardiac margin.
Thymic notch
In newborns the thymus can involute in response to physiologic stress within ____
a. 3 hours
b. 6 hours
c. 12 hours
d. 24 hours
b. 6 hours
The thymus can also grow following recovery from a period of stress, although this takes weeks or months. This “thymic rebound” is most often seen after the completion of chemotherapy, and can be seen in other situations of prolonged physiologic stress such as of multiple stage cardiac surgeries
True about thymus, except:
a. The thymus is proportionately largest at puberty
b. The thymus then atrophies after puberty, but can still be seen as well-defined anterior mediastinal soft tissue through young adulthood.
c. It widens the superior mediastinum, often obscures the aortic arch, and can extend along the right cardiac border to the diaphragm and simulate cardiomegaly.
d. On the lateral view, the thymus is denser anteriorly, and often along the minor fissure.
a. The thymus is proportionately largest at puberty
The thymus is proportionately largest at BIRTH
The following statements are true about pediatric lung volume, except:
a. Low lung volumes simulate cardiomegaly and pulmonary edema
b. Hyperinflation is the primary finding in asthma, and is much more common in bacterial than in viral pneumonia.
c. The 6th anterior rib should be the first to cross the diaphragm. An inspiration of less than 5 or more than 7 ribs is very likely to be abnormal.
d. An expiratory CXR to evaluate for air trapping, as would be seen with an obstructing foreign body, can be useful. In children who can’t follow instructions, bilateral decubitus radiographs are usually easier to obtain and interpret
b. Hyperinflation is the primary finding in asthma, and is much more common in bacterial than in viral pneumonia.
Hyperinflation is the primary finding in asthma, and is much more common in VIRAL than in bacterial pneumonia.
The following statements are true about pediatric trachea, except:
a. The trachea always buckles in the direction opposite to the location of the aortic arch.
b. A true midline trachea can be normal
c. An anterior impression at the level of the brachiocephalic (innominate) artery crossing is a common finding in children when it is mild
d. A focal right-sided impression on the trachea is almost always due to a right arch
b. A true midline trachea can be normal
A true midline trachea is abnormal, and a sign of a double aortic arch although this is rarely appreciated prospectively
The following findings are highly suggestive of neonatal surfactant deficiency, except:
a. Presence of pleural fluid
b. Diffuse ground-glass opacities
c. Low lung volumes
d. Granular, not hazy ground-glass opacities
a. Presence of pleural fluid
Presence of fluid suggests infection rather than NSD
Term newbord presenting with distress. On CXR, noted bilaterally symmetrical coarse linear and branching opacities with areas of atelectasis and inflammation alternating with areas of hyperinflation. Diagnosis?
a. Neonatal surfactant deficiency
b. Meconium aspiration pneumonia
c. Transient tachypnea of the newborn
d. Neonatal pneumonia
b. Meconium aspiration pneumonia
Term newborn presenting with distress. On CXR, noted linear opacities, central greater than peripheral, particularly radiating from the hila as well as pleural fluid. On follow-up after 72 hours, noted resolution of the infiltrates. Diagnosis?
a. Neonatal surfactant deficiency
b. Meconium aspiration pneumonia
c. Transient tachypnea of the newborn
d. Neonatal pneumonia
c. Transient tachypnea of the newborn
This is most common cause of lung abnormalities in older infants in the neonatal ICU.
a. Neonatal pneumonia
b. Bronchopulmonary dysplasia
c. Pulmonary hemorrhage
d. A and B
b. Bronchopulmonary dysplasia
Signs that you’re dealing with a skin fold, not a pneumothorax include the following, except:
a. Absence of the thin white pleural line at the interface between the central higher attenuation and the peripheral lower attenuation
b. Line that ends in the middle of the lung instead of extending to a pleural surface
c. “Pneumothorax” in a dependent portion of the lung, such as the lateral pleura adjacent to the upper lobe in a supine patient
d. Lucency adjacent to the cardiomediastinal silhouette with a sharply defined cardiac or diaphragmatic margin
d. Lucency adjacent to the cardiomediastinal silhouette with a sharply defined cardiac or diaphragmatic margin
Item D is a sign of pneumothorax
Items A-C pertain to a skin fold
The following statements are consistent with pulmonary interstitial emphysema, except:
a. One of small round and rod-like lucencies superimposed on a background of higher attenuation lung
b. Distribution involving the peripheral more than the central lung
c. Radiographic abnormality usually resolves quickly
d. Radiographic abnormality may persist for months
b. Distribution involving the peripheral more than the central lung
Rapid onset and a distribution involving the peripheral as much as the central lung
The following are true regarding acceptable placements of neonatal support equipement, except:
a. Umbilical arterial catheter: T6-T9 or Bottom of L3
b. Umbilical venous catheter: Right atrium
c. Venous ECMO catheter: Right atrium
d. Arterial ECMO catheter: Above the aortic arch
b. Umbilical venous catheter: Right atrium
Should be DIAPHRAGM (tip of the IVC)
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Single most important feature to identify on imaging in the context of congenital lung malformation:
a. Presence of mass effect
b. Areas of abnormal signal
c. Feeding vessel (artery) supplying the lesion
d. None of the above
c. Feeding vessel (artery) supplying the lesion
A feeding vessel identifies the lesion as a sequestration, or at least one containing histologic features of sequestration.
Most common congenital lung malformation
a. Congenital Pulmonary Airway Malformation
b. Sequestration
c. Foregut Duplication Cysts
d. Congenital Lobar Overinflation
a. Congenital Pulmonary Airway Malformation
The following statements are true about congenital pulmonary airway malformation, except:
a. Type 1 is the most common of all types, making up to 60% to 70% of all cases
b. Type 0 and 4 lesions are extremely rare
c. Type 3 has cystic components measuring <5 mm and are associated hydrops and a poor prognosis
d. AOTA are true
d. AOTA are true
Which of the following statements are true?
a. Intralobar sequestration does not aerate from collateral ventilation
b. Extralobar sequestration has its own pleura
c. Extralobar sequestration drains into a pulmonary vein
d. Both types are common in the lower lobes, right more than the left
b. Extralobar sequestration has its own pleura
a. False
b. True
c. False. It drains into azygos or hemiazygos vein or IVC
d. False. LEFT more than right
True about bronchogenic cysts, except:
a. Round, well-defined masses that can occur in mediastinum or in the lung, usually centrally
b. Communicate with the tracheobronchial tree and air within does not necessarily suggest infection
c. On CT, they are homogeneous in attenuation and commonly have greater than water level attenuation, thought to be due to highly proteinaceous mucus
d. Lined with respiratory epithelium and filled with fluid or mucus
b. Communicate with the tracheobronchial tree and air within does not necessarily suggest infection
Do not communicate with the tracheobronchial tree and air within one suggests infection
The following statements are true about Scimitar syndrome, except:
a. There is an abnormal drainage of a lobe to the IVC, hepatic vein, or left atrium
b. Affected lobe is small; often abnormal arterial supply from the aorta as well; which indicates a coexisting sequestration
c. Affects both the lung and pulmonary vascularity
d. It is also known as Hypogenetic Lung Syndrome
b. Affected lobe is small; often abnormal arterial supply from the aorta as well; which indicates a coexisting sequestration
This DOES NOT indicate a coexisting sequestration
Which of the following findings is characteristic of bronchia atresia?
a. Mucocele
b. Air trapping
c. Soft tissue nodule
d. All of the above
b. Air trapping
This is the only eparterial bronchus:
a. Right upper lobe bronchus
b. Bronchus intermedius
c. Left upper bronchus
d. Light lower lobe bronchus
a. Right upper lobe bronchus
Most important predictor of the infectious agent of pneumonia in children:
a. Age
b. APGAR score
c. Presence of pleural effusion
c. All of the above
a. Age
Most common etiologic agent of pneumonia in the first month of life
a. Group B streptococcus (GBS)
b. Gram-negative bacteria
c. Chlamydia trachomatis
d. A and B only
e. All of the above
d. A and B only
In the newborn period, maternal immunity provides protection from viral infection, while bacterial infection may be transmitted at birth from the mother, both factors increasing the likelihood of bacterial infection
- Few months to few years: Viral pneumonia predominate
- Older children: Bacterial pneumonia more common
Most common etiologic agent of pneumonia in the 1-3 months of life
a. Chlamydia trachomatis
b. Streptococcus pneumoniae
c. Staphylococcus pneumonia
d. Respiratory syncytial virus (RSV)
b. Streptococcus pneumoniae
In the newborn period, maternal immunity provides protection from viral infection, while bacterial infection may be transmitted at birth from the mother, both factors increasing the likelihood of bacterial infection
- Few months to few years: Viral pneumonia predominate
- Older children: Bacterial pneumonia more common
The following are findings seen in childhood TB until age puberty:
a. Pulmonary infiltates most often in the peripheral and in the mid or lower lung
b. Hilar/mediastinal LAD
c. Apicopleural thickening
d. A and B only
d. A and B only
Ghon complex: primary pulmonary focus of inflammatioin + hilar/mediastinal LAD
The most common lung mass in a child:
a. Round pneumonia
b. Granuloma
c. Metastases
d. Inflammatory myofibroblastic tumor (IMT)
a. Round pneumonia
Most common etiology of pulmonary infection in infants and young children, and the most common cause of bronchiolitis
a. Respiratory syncytial virus (RSV)
b. Mycoplasma pneumonia
c. S. pneumoniae
d. Mycobacterium tuberculosis
a. Respiratory syncytial virus (RSV)
Most common cause of pneumonia in children (primarily school age through adolescence), responsible for 40% or more of pediatric pneumonia
a. Respiratory syncytial virus (RSV)
b. Mycoplasma pneumonia
c. S. pneumoniae
d. Mycobacterium tuberculosis
b. Mycoplasma pneumonia
Most common cause of bacterial pneumonia in children after the neonatal period
a. Respiratory syncytial virus (RSV)
b. Mycoplasma pneumonia
c. S. pneumoniae
d. Mycobacterium tuberculosis
c. S. pneumoniae
Most common neoplasms in the pediatric chest
a. Pulmonary hamartoma
b. Pleuropulmonary blastoma (PPB)
c. Metastases
d. Inflammatory myofibroblastic tumor (IMT)
c. Metastases
Most common true lung mass in children
a. Pulmonary hamartoma
b. Pleuropulmonary blastoma (PPB)
c. Metastases
d. Inflammatory myofibroblastic tumor (IMT)
d. Inflammatory myofibroblastic tumor (IMT)
Most common primary benign neoplasm
a. Pulmonary hamartoma
b. Pleuropulmonary blastoma (PPB)
c. Metastases
d. Inflammatory myofibroblastic tumor (IMT)
a. Pulmonary hamartoma
Most common primary malignant pulmonary lesion
a. Pulmonary hamartoma
b. Pleuropulmonary blastoma (PPB)
c. Metastases
d. Inflammatory myofibroblastic tumor (IMT)
b. Pleuropulmonary blastoma (PPB)
