Neonatal Chest X-ray Findings
Neonatal Chest X-ray
Key Points
- Essential diagnostic tool in neonatal care
- Requires systematic approach for interpretation
- Understanding normal variants is crucial
- Radiation protection principles must be followed
- Serial examinations often necessary
Common Indications
- Respiratory
- Respiratory distress
- Assessment of RDS
- Pneumonia evaluation
- Air leak syndromes
- Cardiovascular
- Congenital heart disease
- Cardiomegaly
- Heart failure
- Line/Tube Placement
- ETT position
- UVC/UAC placement
- PICC line verification
Technical Aspects
Positioning
- Standard Views
- AP (anteroposterior) supine
- Lateral views when indicated
- Cross-table lateral for specific conditions
- Optimal Position
- Arms above head or along sides
- Body straight and symmetric
- Chin slightly elevated
Radiation Protection
- ALARA Principle
- Minimize exposure time
- Appropriate collimation
- Gonadal shielding
- Optimal technical factors
- Technical Parameters
- kVp: 60-65
- mAs: 1.5-2.0
- Focus-film distance: 100cm
Systematic Approach
Initial Assessment
- Technical Quality
- Proper rotation
- Adequate inspiration
- Penetration
- Patient identification
- Anatomical Coverage
- Cervicothoracic junction to T12/L1
- Complete chest wall laterally
- Symmetry assessment
Review Areas
- Soft Tissues
- Subcutaneous emphysema
- Chest wall thickness
- Breast shadows
- Bones
- Ribs (count and integrity)
- Clavicles
- Vertebrae
- Scapulae
- Airway
- Tracheal position
- Bronchial pattern
- Air bronchograms
- Lungs
- Density
- Symmetry
- Vascular markings
- Pleural spaces
- Heart & Mediastinum
- Cardiac size and shape
- Mediastinal width
- Thymus
- Diaphragm
- Position
- Contour
- Costophrenic angles
Normal Findings
Age-Specific Features
- Thymus
- Sail sign
- Notch sign
- Wave sign
- Normal variations
- Heart
- Cardiothoracic ratio ≤ 0.6
- Normal cardiac silhouette
- Left-sided apex
- Lung Fields
- 8-9 posterior ribs
- Symmetric vascular markings
- Clear costophrenic angles
Developmental Variations
- Prominent pulmonary interstitium
- Relative cardiomegaly
- Thymic size variations
- Ossification centers
Common Pathologies
Respiratory Conditions
- RDS
- Reticulogranular pattern
- Air bronchograms
- Ground glass appearance
- Decreased lung volumes
- TTN
- Perihilar streaking
- Fluid in fissures
- Normal/increased lung volumes
- MAS
- Patchy infiltrates
- Hyperinflation
- Air trapping
- Pneumothorax risk
Air Leak Syndromes
- Pneumothorax
- Deep sulcus sign
- Mediastinal shift
- Visible pleural line
- PIE
- Linear/cystic lucencies
- Perivascular distribution
- Asymmetric presentation
- Pneumomediastinum
- Thymic sail sign
- Continuous diaphragm sign
- Air around great vessels
Lines & Tubes Assessment
Endotracheal Tube
- Position
- T1-T2 level optimal
- Above carina
- Midline position
- Complications
- Right mainstem intubation
- Esophageal placement
- Too high/low position
Umbilical Lines
- UVC
- T8-T9 level (high)
- T10 (low position)
- Verify straight course
- UAC
- T6-T9 (high)
- L3-L4 (low)
- Check for curves/loops
Other Devices
- PICC Lines
- SVC junction ideal
- Verify no loops
- Check tip position
- Chest Tubes
- Anterior position
- All holes within pleural space
- Direction of tip
