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What Does This X-ray Report Indicate?

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Posted on Fri, 30 Sep 2016
Question: Hi sir,
I am attaching a X-ray report of my son who is 2 years old.. He was admitted in the hospital today for troubled breathing and lot of chest congestion to which the doctor suspected
Pneumonitis and started antibiotic augmentin given through veins..can you please explain me the report as I don't understand the first 2-3 lines..is it something serious or is it because of the infection? Will it clear out after the course of antibiotics are over?? Can u please please explain me in detail about this? I'll be really glad ..awaiting your reply..
doctor
Answered by Dr. Vivek Chail (25 minutes later)
Brief Answer:
There is a doubtful shadow near the left upper birder of the heart

Detailed Answer:
Hi,
Thanks for writing in to us.

There is mild increased markings in both lungs which is from mild pneumonia.

There is a doubtful shadow seen on the chest xray near the left upper birder of the heart. This can be a normal structure or can be abnormal enlargement of lymph nodes. The baby is very small and sometimes due to positioning also such shadows can be seen.

To rule out abnormal findings, the doctor has suggested CT scan and is required then an echocardiography.

The lung infection is important to treat and augmenting in the veins will cure it. Lung infection in 2 years old baby requires immediate care.

The doubtful shadow might require detailed imaging to know if there is any thing abnormal or if it is a false shadow. If it is a lymph node then it can be from the infection.

Hope your query is answered.
Please do write back if you have any doubts.

Regards,
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail (5 minutes later)
Dear sir Echo cardiography was done when he was one month old..I am attaching the report ...its normal...does it need to get repeated again???

Apart from the above question my question to u is what can be the abnormal finding you are talking about? Kindly explain in detail..also would like to tell u his cbc shows high wbc count of 18000..normal range is 5000-15000..crp is negative..oxygen saturation is 98..bp is normal..pulse is 136
doctor
Answered by Dr. Vivek Chail (1 hour later)
Brief Answer:
Repeat echocardiography is required only if clinically indicated

Detailed Answer:
Hi Sir,
Thanks for writing back with an update.

The echocardiography done when baby was 22 days is normal. Therefore there is no serious congenital heart condition that can be suspected. If there is any clinical suspicion from the treating doctor then they can request another echocardiography.

Lymph nodes need to be ruled out. However there is a possibility that it is a false shadow which looks like blood vessels or lymph nodes. CT is a good technique if there is a significant doubt which requires clinical evaluation.

The WBC and pulse are increased due to lung infection. In children even small infection can cause increase in pulse and WBC significantly. Please monitor for fever and bring to the notice of your doctor if there is fever.

Hope your query is answered.
Please do write back if you have any doubts.

Regards,
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail (56 minutes later)
Hi sir,
Clinically he is ok and eating well..fever was never there...just cough is there which is noticable only wen he coughs..otherwise u cannot make out that he has cough...never had blue fingernails ..his hb is 13..doctor says the same thing might be positioning error while doing the xray..he was moving and crying alot and we had to hold him for the xray..one more thing i want to tell u..they say it could be a thalamus shadow? What is that? Ot could be a possibilty? Overall he is 60% better then yesterday....what are your views on whatever info i just gave u? Also if lymph nodes are there is it dangerous? Dont they enlarge with infection ??? Treatment for swollen lynph nodes is antibiotics?? Hope u reply to all my concerns i have posted in this question...thanx alot sir
doctor
Answered by Dr. Vivek Chail (55 minutes later)
Brief Answer:
My first suspicion is false shadow due to positioning

Detailed Answer:
Hi Sir,
Thanks for writing back.

My first suspicion is a false shadow due to positioning error and this is based on my experience with xray in children. It is difficult to get a proper normal chest xray in a baby when crying.

Thymus (thalamus is something in the brain) is a normal organ in the chest which is big in children and slowly becomes small in adults. This causes a triangular shadow in the chest xray and can me interpreted as a lesion.

If your baby is better and there is no worsening then it is a good sign and he had mild respiratory infection.

Lymph node enlargement can be due to many causes and they are part of the immune system. During illness the lymph nodes can enlarge and this can happen due to infections and non infectious conditions. Treatment of swollen lymph nodes is based on the cause and not always antibiotics since there are many conditions involving lymph nodes. If lymph nodes are due to infection caused by bacteria then it will respond to antibiotics.

Hope your query is answered.
Please do write back if you have any doubts.

Regards,
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Vivek Chail

Radiologist

Practicing since :2002

Answered : 6874 Questions

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What Does This X-ray Report Indicate?

Brief Answer: There is a doubtful shadow near the left upper birder of the heart Detailed Answer: Hi, Thanks for writing in to us. There is mild increased markings in both lungs which is from mild pneumonia. There is a doubtful shadow seen on the chest xray near the left upper birder of the heart. This can be a normal structure or can be abnormal enlargement of lymph nodes. The baby is very small and sometimes due to positioning also such shadows can be seen. To rule out abnormal findings, the doctor has suggested CT scan and is required then an echocardiography. The lung infection is important to treat and augmenting in the veins will cure it. Lung infection in 2 years old baby requires immediate care. The doubtful shadow might require detailed imaging to know if there is any thing abnormal or if it is a false shadow. If it is a lymph node then it can be from the infection. Hope your query is answered. Please do write back if you have any doubts. Regards,