Chest imaging in children presents unique challenges due to varying requirements across age groups. For chest radiographs, achieving optimal images often involves careful positioning and immobilisation techniques. Anteroposterior projections are easier to obtain in younger children, while lateral decubitus radiographs are sometimes used when expiratory images are difficult to obtain and for free air exclusion. Chest CT protocols should be age-dependent to minimise radiation exposure and motion artefacts. MRI is primarily used in specialised centres to reduce radiation exposure, requiring specific expertise and sedation in younger children. Respiratory distress syndrome is a leading cause of morbidity in preterm neonates, diagnosed through characteristic radiographic findings and a history of prematurity. Bronchopulmonary dysplasia is the most common complication of extreme preterm birth and chronic oxygen therapy; imaging is used for predicting outcomes for the assessment of severe cases. Transient tachypnoea of the newborn and meconium aspiration syndrome are common in term infants, with specific imaging characteristics aiding in their differentiation. Congenital lung malformations present diagnostic and management challenges, with imaging playing a crucial role in diagnosis and surgical planning. Finally, imaging is essential in detecting complications from pneumonia in children, such as empyema and necrotic pneumonia, or in identifying foreign object aspiration.

Clinical relevance statement 

This review summarises current radiology practice of paediatric chest pathologies, aiding in the accurate diagnosis and management of neonatal and congenital pulmonary conditions and pneumonia complications, ultimately improving patient outcomes through precise imaging interpretation and targeted clinical intervention.

Key Points 

● Chest radiographs should be systematically assessed for pathology. 

● Ensure accurate differential diagnosis of neonatal lung diseases by collecting information on gestational age, method of delivery, presenting symptoms, ventilation type, and fetal ultrasound findings.

● Radiographs and ultrasound are initial diagnostic tools for paediatric pulmonary disease; CT should be reserved for complex cases. Referral to paediatric hospital should be considered when the use of chest MRI is indicated.

儿童胸部影像学检查因不同年龄段的需求差异而面临独特的挑战。对于胸部X线片，获取优质图像通常需要精心的体位摆放和固定技术。年幼儿童更易获取前后位投照图像，而当呼气相图像难以获取或需排除游离气体时，有时会采用侧卧位X线片。胸部CT检查方案应随年龄调整，以最大限度减少辐射暴露和运动伪影。磁共振成像主要在专科中心使用，以减少辐射暴露，年幼儿童检查时需要特定的专业技能和镇静处理。呼吸窘迫综合征是早产儿发病的主要原因，通过典型的影像学表现和早产史即可诊断。支气管肺发育不良是极早产和长期氧疗最常见的并发症；影像学可用于预测预后及评估重症病例。新生儿暂时性呼吸增快和胎粪吸入综合征在足月儿中常见，其特定的影像学特征有助于鉴别诊断。先天性肺畸形给诊断和管理带来挑战，影像学在诊断和手术规划中发挥关键作用。最后，影像学在发现儿童肺炎并发症（如脓胸、坏死性肺炎）或识别异物吸入方面至关重要。

临床相关性陈述

本综述总结了当前儿童胸部疾病的放射学实践，有助于新生儿及先天性肺部疾病、肺炎并发症的准确诊断和管理，最终通过精准的影像解读和针对性临床干预改善患者预后。

核心要点

● 胸部X线片应系统评估有无病变。

● 通过收集胎龄、分娩方式、临床表现、通气方式及胎儿超声检查结果等信息，确保新生儿肺部疾病的准确鉴别诊断。

● X线片和超声检查是儿童肺部疾病的初始诊断工具；CT应留用于复杂病例。当需要进行胸部MRI检查时，应考虑转诊至儿科医院。