Part 3 0 Standardised Interpretation of Paediatric AXR

Part 3. 0 Standardised Interpretation of Paediatric AXR Done in collaboration with: The Northern School of Radiology, UK County Durham and Darlington NHS Foundation Trust Authors: Dr. Alasdair Mackie MD Dr. Abdelrahman Omer MD Dr. Ramdas Senasi MD

Aim Ø Demonstrate a systematic approach in the interpretation of paediatric Abdominal X-rays using ABCDE method.

Test you skills

The answer is • Splenomegaly and right femoral head sclerotic abnormality. • How not to miss it • Systematic approach

Systematic approach Technique • A - Air • B - Bones and Bowel • C – Calcification and soft tissue. • D - Diaphragm • E - Extra body equipment

Child vs Adult Anatomy

Systematic approach ►Air: ►B ►C ►D ►E • Extra-luminal air – always pathological. • Intra-luminal air – it depends on the distribution

Gastric bubble Small bowel gas distribution centrally NO EXTRA)LUMINAL FREE GAS Gas in the rectum Large bowel gas peripheral

Systematic approach ►A ►Bone and Bowel: ►C Bones: ribs, pelvis, femur, ►D spine. ►E Bowel: Thorough look at the bowel dilatation from stomach to rectum

Spine Ribs Thin bowel wall Femur Pelvic bones

Systematic approach ►A ►B ►Calcifications and soft tissue ►Easy to miss especially soft tissue ►D because of poor contrast difference ►E ►E. g: Hepatosplenomegaly

Spleen Abnormal calcifications Liver Left Kidney Left psoas muscle line

Systematic approach ►A ►B ►C ►Diaphragm: ►Should be clear and crisp. ►E ►Not to miss lung bases or air under diaphragm

Lungs bases No air under diaphragm

Systematic approach ►A ►B ►C ►D ►Extras: ►Check for lines and tubing

Temperature probe Endotracheal tube Nasogastric tube Umbilical vein catheter Umbilical artery catheter

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Summary ØDemonstrated a systematic approach to paediatric AXR using ABCDE.

• Thank you for your attention. • Any questions?

References Ø Images obtained from following resources; Øhttps: //www. pinterest. com/pin/24192781120473 4854/ Øhttp: //www. pedrad. org/portals/5/events/2013/m arkowitz-abdradiograph. pdf ØRadiopaedia. org