Infection - to exclude pneumonia
Inhaled foreign body
most lodge in intrathoracic tracheobronchial tree.
Need films in full inspiration and expiration to demonstrate air trapping or collapse.
for air leak, haemothorax or wide mediastinum.
Rib views rarely indicated.
Pneumothorax - full inspiratory films adequate
Asthma/ Bronchiolitis - Consider only if:
SEVERE attack - not responding to standard therapy
possible air leak.
NB. Focal signs +/- fever are most likely due to mucus plug and viral illness rather than pneumonia.
Clinical cardiomegaly or heart failure.
Large thymic shadow is normal under the age of 2 years.
Normal cardio-thoracic ratio 0.5 ( infants up to 0.6 )
Heart murmurs - If careful examination suggests innocent murmur, no need for urgent CXR - but arrange appropriate follow up.
Hypertension - CXR is seldom useful.
Septic screen - CXR indicated unless clear focus elsewhere
Respiratory distress - to exclude congestive cardiac failure or cardiomegaly