chest x-ray diagnosis of tb in children - a crash...
TRANSCRIPT
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Chest X-ray Diagnosis of TB in Children - a crash course
Savvas Andronikou
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How this works! Pay attention!
A] This is a quiz of children’s X-rays
– Only 3 possible responses for each
– You have 30 seconds per patient
– Record your answers 1 - 15
B] This is followed by a short training
C] Once ‘educated’ you attempt the same radiographs, recording your ‘new’ answers
D] Expert interpretation follows
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Answer options:
A = TB
= enough features to treat for TB B = INCONCLUSIVE = Abnormal BUT inseparable from
other infection C = NORMAL = no abnormality is seen
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A] Quiz:
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1.
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Case 10
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11.
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14.
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15.
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Your training is about to begin
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AP radiograph
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Diagnosis of TB in children =
identify lymphadenopathy
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Lymphadenopathy on AP: Hilum should be a hippo’s open mouth Nodes = a cauliflower in the mouth
Right hilar lymphadenopathy Right hilar lymphadenopathy
Left hilar lymphadenopathy Calcified lymphadenopathy
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Airways are a up-side-down tree Lymphadenopathy = ‘compressed air-way branches’
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Lateral radiograph
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Lymphadenopathy on Lateral
• Normal structures (=horseshoe)
• Diverging vessels (=tentacles)
• Lymphadenopathy (=‘doughnut’)
R main pulm art
L main pulm art Top Aortic arch
Lateral: doughnut replaces the horse-shoe and tentacles
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Midsagital: subcarinal nodes
Far para-sagital: Left hilar nodes
What makes the doughnut?
Subcarinal and left hilar lymphadenopathy
And there is the doughnut………
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Doughnuts and other foods
No mass behind bronchus intermedius
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Inconclusive pneumonia? Be Sherlock Holmes and uncover TB
Air space and airway Air space, cavity and airway
Air space expansile and airway Air space, effusion and airway Milliary nodules
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Go get them tiger! Grrr!
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B] Quiz again:
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Case 10
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15.
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D] ‘Expert’ answers:
He looks like an idiot!
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1. TB = A
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2. Normal = C
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3. TB = A
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4. Inconclusive = B
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5. Inconclusive = B
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6. Normal = C
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7.TB = A
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8. TB = A
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9. Normal = C
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10. TB = A
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11. Normal = C
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12. TB = A
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13. TB = A
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14. Normal = C
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15. TB = A
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Can you go it alone?