Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.
J Med Imaging Radiat Sci. 2020 Dec;51(4):624-628. doi: 10.1016/j.jmir.2020.07.001. Epub 2020 Jul 16.
INTRODUCTION/BACKGROUND: Arm malposition in neonatal ICU radiographs may result in overlap of the arm soft tissues and chest wall giving the appearance of lamellar effusions. We aimed to determine the frequency of arm malposition on portable neonatal/infant intensive care unit (N/IICU) chest radiographs and the proportion of these mimicking lamellar effusions.
We evaluated a subgroup of supine portable chest radiographs performed at the N/IICU. Two reviewers, at a tertiary pediatric hospital located in the USA, evaluated each radiograph in consensus and classified arm position for either side independently as (1) acceptable: arm abducted and separated from the chest and (2) compromised: arm down and in contact with chest soft tissue. The compromised cases were evaluated regarding any overlap between soft tissues of the arm and chest of sufficient degree to mimic a lamellar effusion.
We reviewed 300 radiographs performed at the N/IICU (600 hemithoraces). The mean age was 1.8 ± 1.8 months. Of 600 hemithoraces, 233 (39%) showed arms down and in contact with the chest. In seven (1%) cases, the arm position was compromised and mimicked a lamellar effusion. We identified 32 (5%) true lamellar effusions in the whole sample; in 14 of the 32 cases with lamellar effusion, the radiographs were performed with the arms down.
Portable chest radiographs performed in the N/IICU without proper arm abduction represent a potential for misinterpretation of chest radiographs. Although the prevalence of mimickers of lamellar effusion is only around 1%, the prevalence of arms down on a portable chest radiograph is considerably high (39%).
简介/背景：新生儿重症监护病房（NICU）的手臂位置不当可能导致手臂软组织与胸壁重叠，使外观类似于板层积液。我们旨在确定在便携式新生儿/婴儿重症监护病房（N/IICU）胸部 X 光片中手臂位置不当的频率，以及这些假象模仿板层积液的比例。
我们评估了美国一家三级儿科医院 N/IICU 进行的仰卧位便携式胸部 X 光片的一个子组。两名评审员在共识的基础上，独立评估每张 X 光片，并将手臂位置分类为（1）可接受：手臂外展并与胸部分开；（2）受影响：手臂放下并与胸部软组织接触。对于受影响的病例，评估手臂软组织与胸部之间的重叠程度是否足以模拟板层积液。
我们回顾了 N/IICU 进行的 300 张 X 光片（600 个半胸腔）。平均年龄为 1.8±1.8 个月。在 600 个半胸腔中，有 233 个（39%）显示手臂放下并与胸部接触。在 7 个（1%）病例中，手臂位置受影响并模拟了板层积液。在整个样本中，我们发现了 32 个（5%）真正的板层积液；在 32 个有板层积液的病例中，有 14 个的 X 光片是手臂放下时拍摄的。
在 NICU 中不适当的手臂外展进行的便携式胸部 X 光片可能会导致对胸部 X 光片的错误解读。尽管模仿板层积液的假象的患病率仅为 1%左右，但便携式胸部 X 光片中手臂放下的患病率相当高（39%）。
