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Interpretation of Chest Radiographs in Infants with Cough and Fever¹

¹ From the Department of Radiology, Children's Hospital, Boston, 300 Longwood Ave, Boston, MA 02115. Received July 22, 2004; revision requested September 22; revision received November 10; accepted December 10. Address correspondence to R.T.B. (e-mail: robert.bramson{at}childrens.harvard.edu).

View larger version (27K): [in a new window]   Figure 1. Diagram shows gas exchange that occurs in the respiratory bronchiole and alveolar sac. In the lung periphery there may be as many as 25 generations of airways before the respiratory bronchiole is reached or as few as 10 (near the hila), depending on where the count is performed. Inset shows how a distal bronchiole may become narrowed with edema and mucus during inflammation.

View larger version (70K): [in a new window]   Figure 2a. (a) Diagram shows that during normal inspiration and expiration, there is dilation and collapse of the airways. This is most obvious in distal airways. Collapse in infant airways is greater than that in adult airways because cartilaginous soft tissues supporting the airways are more compliant in children. This is illustrated on (b) a lateral chest radiograph of an infant obtained near the end of normal expiration. The trachea (arrows) collapses to a much smaller diameter during normal expiration.

View larger version (92K): [in a new window]   Figure 2b. (a) Diagram shows that during normal inspiration and expiration, there is dilation and collapse of the airways. This is most obvious in distal airways. Collapse in infant airways is greater than that in adult airways because cartilaginous soft tissues supporting the airways are more compliant in children. This is illustrated on (b) a lateral chest radiograph of an infant obtained near the end of normal expiration. The trachea (arrows) collapses to a much smaller diameter during normal expiration.

View larger version (20K): [in a new window]   Figure 3. Graph depicts lung volumes at inspiration and expiration. Line on the left shows lung volume at expiration (A) and inspiration (B), as well as maximum expiration (C) and inspiration (D) during normal quiet respiratory cycles. The line on the right shows that when peripheral small-airways resistance is high (a, b), then residual volume (RV) is increased. This is the air trapping depicted on radiographs of infants with small-airways disease. c = Maximum expiration, d = maximum inspiration, ERV = expiratory reserve volume, IRV = inspiratory reserve volume, TLC = total lung capacity, TV = tidal volume, VC = vital capacity. (Reprinted, with permission, from reference 7.)

View larger version (138K): [in a new window]   Figure 4a. (a) Anteroposterior radiograph of normal chest in a 4-month-old child referred because of a possible fractured clavicle. (b) Lateral radiograph in the same infant shows rounded configuration of the diaphragm (arrows).

View larger version (134K): [in a new window]   Figure 4b. (a) Anteroposterior radiograph of normal chest in a 4-month-old child referred because of a possible fractured clavicle. (b) Lateral radiograph in the same infant shows rounded configuration of the diaphragm (arrows).

View larger version (76K): [in a new window]   Figure 5. Diagram shows that during viral infection, airways secrete increased amounts of mucus and become edematous, particularly in smaller peripheral airways. This narrows the airways, and that narrowing is accentuated during attempts at expiration.

View larger version (113K): [in a new window]   Figure 6a. (a) Anteroposterior radiograph shows hyperinflated lungs with suggestion that peribronchial markings are too prominent. (b) Lateral radiograph shows flat slope to the diaphragm, with none of the rounded configuration seen in Figure 4b. The diaphragm now has a straight-line slope rather than a rounded configuration.

View larger version (109K): [in a new window]   Figure 6b. (a) Anteroposterior radiograph shows hyperinflated lungs with suggestion that peribronchial markings are too prominent. (b) Lateral radiograph shows flat slope to the diaphragm, with none of the rounded configuration seen in Figure 4b. The diaphragm now has a straight-line slope rather than a rounded configuration.

View larger version (114K): [in a new window]   Figure 7a. (a) Anteroposterior radiograph of infant chest shows hyperinflated appearance characteristic of infant inflammatory airways disease. Hemidiaphragm domes are projected at level of the seventh anterior rib or lower. (b) Lateral radiograph of hyperinflated chest shows diaphragm has a straight (not domed) slope.

View larger version (110K): [in a new window]   Figure 7b. (a) Anteroposterior radiograph of infant chest shows hyperinflated appearance characteristic of infant inflammatory airways disease. Hemidiaphragm domes are projected at level of the seventh anterior rib or lower. (b) Lateral radiograph of hyperinflated chest shows diaphragm has a straight (not domed) slope.

View larger version (124K): [in a new window]   Figure 8a. Respiratory syncytial virus infection in a child. (a) Anteroposterior radiograph shows prominent peribronchial markings. (b) Patches of atelectasis (arrow) are best seen on lateral projection of the hyperinflated lungs. Scattered patches of atelectasis tend to follow peribronchial and perivascular structures in a child with respiratory syncytial virus infection.

View larger version (132K): [in a new window]   Figure 8b. Respiratory syncytial virus infection in a child. (a) Anteroposterior radiograph shows prominent peribronchial markings. (b) Patches of atelectasis (arrow) are best seen on lateral projection of the hyperinflated lungs. Scattered patches of atelectasis tend to follow peribronchial and perivascular structures in a child with respiratory syncytial virus infection.

View larger version (149K): [in a new window]   Figure 9. Anteroposterior chest radiograph displays round pneumonia (arrow). Child had a fever of 104°F (40°C), abdominal pain, and a cough.