Radiology – Integrated Training Initiative (R-ITI) | Paediatrics | Pathological Causes of Bilateral Hyperlucent Hemithoraces

Pathological Causes of Bilateral Hyperlucent Hemithoraces
Session Overview
Description
This session describes common causes of bilateral hyperlucent hemithoraces in children and through a series of examples explains how to investigate further to determine the most likely diagnosis.

Learning Objectives
By the end of this session you will be able to:

• Describe common causes of bilateral hyperlucency of the paediatric chest x-ray (CXR)
• Discuss an approach to radiological investigation
• List common types of vascular rings and explain their radiological appearances

Prerequisites
Before commencing this session you should:

• Have a basic understanding of paediatric chest pathology
• Recognise normal appearances of the paediatric CXR
• Have completed the session in Module 5 Paediatrics/Assessment of Bilateral Hyperlucent Hemithoraces (300-0447)

In the session in Module 5 Paediatrics/Assessment of Bilateral Hyperlucent Hemithoraces you considered how to assess a CXR for hyperlucency and briefly considered the influence of technique on radiographic appearance.

In this current session you will now consider the main pathological causes of hyperlucency in more detail:

• Hyperinflation of the lungs, which may be:

• Non-obstructive
• Obstructive

There are additionally many causes of generalised hyperinflation of the lungs in children, such as:

• Decreased pulmonary blood flow
• Free intrathoracic air

The session will give you information about all these points.

Non-obstructive hyperinflation

This is also referred to as physiological hyperinflation.

It can be caused by:

• Compensatory 'air hunger' e.g. in cases of acidosis and cyanotic congenital heart disease
• Mechanical ventilation