Infant with respiratory distress

CXR of prominent thymus in inspiration and expiration — Inspiratory CXR AP (left) shows an enlarged mediastinal silhouette with a normal heart size while the pulmonary vascularity is normal and the lungs are clear. Expiratory CXR AP (right) shows an even more enlarged mediastinal silhouette with a now enlarged appearing heart.

The diagnosis was prominent thymus which appears even more prominent on expiration.

Infant with respiratory distress

CXR of a prominent thymus — CXR AP (left) shows a mass projecting over the right superior mediastinum and right superior heart. CXR lateral (right) shows the mass to be in the anterior mediastinum.

The diagnosis was prominent thymus.

Newborn with respiratory distress

Pediatric lordotic CXR — CXR AP is angled superiorly at greater than 90 degrees to the patient and therefore shows the apices of the lungs very clearly. The ribs have a different contour than would be expected on a normal CXR AP angled at 90 degrees to the patient. The heart size is normal, the pulmonary vascularity is not congested, and the lungs are clear.

The diagnosis was normal lordotic view of the chest.

Teenager with respiratory distress who has a history of vaping

CXR and CT of pediatric vaping associated lung disease — CXR PA (left) shows bilateral ground glass opacities that are more basilar than apical in nature, and which are more prominent on the left than on the right. Coronal (above right) and axial (below right) CT with contrast of the chest show diffuse bilateral ground glass opacities with a basilar predominance and some subpleural sparing.

The diagnosis was vaping associated lung disease.

Infant with chronic cough

CXR of pediatric mycoplasma pneumonia — CXR AP shows bilateral mild central airway thickening, interstitial infiltrates and lung hyperexpansion.

The diagnosis was mycoplasma pneumonia.

School ager with respiratory distress

CXR of pediatric bronchogenic cyst — CXR PA (left) shows a round soft tissue mass projecting just to the left of the spine that on CXR lateral (right) localizes to the middle mediastinum.

The diagnosis was bronchogenic cyst.

Female teenager who 2 weeks ago developed a fever and erythema around the nipple of the breast and now has drainage of fluid from the nipple

US of pediatric breast abscess — Transverse (above) and sagittal (below) color doppler US of the breast show a poorly defined retroareolar mass that has a hyperemic thick wall with a multiloculated hypoechoic center. The surrounding subcutaneous fat is hyperechoic.

The diagnosis was mastitis evolving into a breast abscess.

Infant with persistent cough

CXR of pediatric bacterial pneumonia in the lingula — CXR AP (left) shows an opacity in the lingula that is obscuring the left heart border (silhouette sign) which on the CXR lateral (right) projects over the heart.

The diagnosis was bacterial pneumonia in the lingula.

Toddler with fever and cough

CXR of pediatric viral pneumonia with subsegmental atelectasis — CXR AP (left) and lateral (right) shows thickened central airways and bilateral lung hyperexpansion causing flattening of the diaphragm. There is an opacity in the medial aspect of the right middle lobe causing the right heart border to be obscured (silhouette sign).

The diagnosis was viral pneumonia with subsegmental atelectasis in the medial aspect of the right middle lobe.

Preschooler with cough and fever

CXR of bacterial pneumonia of the right middle lobe — CXR PA (left) shows an opacity in the lower right lung that is obscuring the right heart border (silhouette sign) which on the lateral radiograph (right) projects over the heart.

The diagnosis was bacterial pneumonia of the right middle lobe.

School ager with cough and fever

CXR of adenovirus pneumonia with bacterial superinfection — Initial CXR PA (left) shows central airway thickening and bilateral lung hyperinflation resulting in flattening of the diaphragm. CXR PA obtained 3 days later (right) shows new dense opacities obscuring the left and right heart borders (silhouette sign).

The diagnosis was initially adenovirus pneumonia which was later complicated by bacterial superinfection.

School ager with cough and fever for 2 weeks

CXR of bacterial pneumonia in the lingula — CXR PA (left) shows an opacity in the lateral aspect of the left lung that on the lateral (right) projects over the heart.

The diagnosis was bacterial pneumonia / round pneumonia in the lingula.

Infant with respiratory distress

CXR of viral pneumonia — CXR PA (left) and lateral (right) shows thickening of the airways centrally and hyperexpansion of the lungs bilaterally leading to flattening of the diaphragm.

The diagnosis was viral pneumonia.

School ager with fever and worsening cough

CXR of bacterial pneumonia in the lateral aspect of the right middle lobe — CXR PA (left) shows an opacity in the lateral aspect of the right middle lobe which on the CXR lateral (right) projects over the heart.

The diagnosis was bacterial pneumonia in the lateral aspect of the right middle lobe.

Infant with cough who is hypoxemic

CXR of respiratory syncytial virus pneumonia — CXR AP shows central airway thickening and bilateral lung hyperinflation causing flattening of the diaphragm. There is also a small right apical pneumonthorax.

The diagnosis was respiratory syncytial virus pneumonia.

Toddler with hypoxia

CXR of bacterial pneumonia in the lingula — CXR PA (left) shows a faint opacity in the lingula lateral to the heart while CXR lateral (right) shows the opacity to be located over the heart.

The diagnosis was bacterial pneumonia in the lingula.

Toddler with respiratory distress

CXR of respiratory syncytial virus pneumonia and superinfection with community acquired bacterial pneumonia — CXR PA (left) shows central airway thickening and mild lung hyperinflation with a dense opacity in the right upper lobe and a dense opacity in the left lower lobe which is obscuring the left hemidiaphragm (silhouette sign). The lateral radiograph (right) shows dense opacities over the upper spine and over the lower spine (spine sign).

The diagnosis was respiratory syncytial virus pneumonia and superinfection with community acquired bacterial pneumonia.

School ager with fever and vomiting

CXR of bacterial pneumonia of the left lower lobe — CXR PA (left) shows a dense opacity overlying the heart and obscuring the medial aspect of the left hemidiaphragm (silhouette sign) while the lateral radiograph (right) shows dense opacity over the lower aspect of the spine (spine sign).

The diagnosis was bacterial pneumonia in the posterior left lower lobe.

Toddler whose parents both have chronic coughs

CXR of pulmonary tuberculosis — CXR AP shows bilateral hilar adenopathy, right greater than left, and a faint right lower lobe infiltrate.

The diagnosis was tuberculosis pneumonia.

Teenager with a productive cough and fever

CXR of right upper lobe bacterial pneumonia — CXR PA (left) shows a dense opacity in the right upper lobe which is located superiorly on the CXR lateral (right).

The diagnosis was right upper lobe bacterial pneumonia.

School ager with cough and fever

CXR of left lower lobe bacterial pneumonia — CXR PA (left) shows a faint opacity in the left lower lung that is obscuring the left hemidiaphragm (silhouette sign) and this opacity is seen just anterior to the lower spine on the lateral radiograph (right).

The diagnosis was bacterial pneumonia in the left lower lobe.

School ager with cough and shortness of breath

CXR of right middle lobe bacterial pneumonia — CXR PA (left) shows dense opacity throughout the right middle lobe which is obscuring the right heart border (silhouette sign). CXR lateral (right) shows the opacity located over the heart.

The diagnosis was right middle lobe bacterial pneumonia.

School ager with fever and cough for 1 week

CXR of bacterial pneumonia in the lingula — CXR PA (left) shows an opacity in the lingula that is obscuring the left heart border (silhouette sign) which on the CXR lateral (right) is seen to be projecting over the heart.

The diagnosis was lingular bacterial pneumonia.

School ager with fever and left chest pain

CXR of bacterial pneumonia in left lower lobe — CXR PA (left) shows a dense opacity over the heart obscuring the medial aspect of the left hemidiaphragm (silhouette sign) while the CXR lateral (right) shows the opacity is located posteriorly over the lower thoracic spine (spine sign).

The diagnosis was bacterial pneumonia in the posterior aspect of the left lower lobe.

Preschooler with cough and fever

CXR of bacterial pneumonia of the left lower lobe — CXR PA (left) shows a retrocardiac opacity which on the CXR lateral (right) is seen to be located over the lower spine resulting in a spine sign.

The diagnosis was bacterial pneumonia in the posterior left lower lobe.