Purpose

We aimed to demonstrate the consequences of rotation on neonatal chest radiographs and how it affects diagnosis. In addition, we demonstrate methods for determining the presence and direction of rotation.

Background

Patient rotation is common in chest X-rays of neonates. Rotation is present in over half of chest X-rays from the ICU, contributed to by unwillingness of technologists to reposition new-borns for fear of dislodging lines and tubes.

There are six main effects of rotation on supine paediatric chest X-rays: 1) unilateral hyperlucency of the side that the patient is rotated towards; 2) the side ‘up’ appears larger; 3) apparent deviation of the cardiomediastinal shadow in the direction that the chest is rotated towards; 4) apparent cardiomegaly; 5) distorted cardio-mediastinal configuration; and 6) reversed position of the tips of the umbilical artery and vein catheters with rotation to the left. These effects can cause diagnostic errors due to misinterpretation, including air-trapping, atelectasis, cardiomegaly, and pleural effusions, or disease may be masked. We demonstrate the methods of evaluating rotation with examples, including a 3D model of the bony thorax as a guide. In addition, multiple examples of the effects of rotation are provided including examples where disease was misinterpreted, underestimated or masked.

Conclusion

Rotation is often unavoidable in neonatal chest X-rays, especially in the ICU. It is therefore important for physicians to recognise rotation and its effects, and to be aware that it can mimic or mask disease.

中文翻译：

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患者旋转胸部 X 光检查以及儿科放射学中误判的后果

目的

我们的目的是证明旋转对新生儿胸片的影响及其对诊断的影响。此外，我们还演示了确定旋转的存在和方向的方法。

背景

患者旋转在新生儿胸部 X 光检查中很常见。ICU 一半以上的胸部 X 光检查中都存在旋转，这是由于技术人员担心管线和管子移动而不愿意重新调整新生儿的位置。

旋转对仰卧儿科胸部X线检查有六种主要影响：1）患者旋转一侧的单侧过度透明；2）“向上”的一面显得更大；3）心纵隔阴影向胸部旋转方向明显偏离；4）明显的心脏肥大；5）心纵隔结构扭曲；6) 反转脐动脉和静脉导管尖端的位置并向左旋转。这些影响可能会因误解而导致诊断错误，包括空气滞留、肺不张、心脏扩大和胸腔积液，或者疾病可能被掩盖。我们通过示例演示了评估旋转的方法，包括作为指导的骨胸部 3D 模型。此外，还提供了轮换影响的多个例子，包括疾病被误解、低估或掩盖的例子。

结论

在新生儿胸部 X 光检查中，旋转通常是不可避免的，尤其是在 ICU 中。因此，医生必须认识到轮换及其影响，并意识到它可以模仿或掩盖疾病。