IMAGING OF PNEUMONIA IN CHILDREN

IMAGING OF PNEUMONIA IN CHILDREN is very important for very doctor to know .

  • Childhood pneumonias are commonly caused by:

– Mycoplasma, 30% àlower in age group < 3 years.

– Viral, 65% àhigher in age group < 3 years)

– Bacterial, 5%

Viral pneumonia:

Causes

  • respiratory syncytial virus (RSV), parainfluenza

Radiographic Patterns of Viral Pneumonia:

Pattern Frequency Description
Bronchiolitis:

Common o   Normal CXR

o   Overaeration is only diagnostic clue

o   Commonly due to RSV

Bronchiolitis+parahilar, peribronchial opacities:

Most Common o   Dirty parahilar regions caused by:

–         Peribronchial cuffing (inflammation)

–         Hilar adenopathy

Bronchiolitis+atelectasis:

Common o   Disordered pattern with:

–         Atelectasis

–         Areas of hyperaeration

–         Parahilar+peribronchial opacities

Reticulonodular interstitial:

Rare o   Interstitial pattern
Hazy lungs:

Rare o   Diffuse increase in density

Pearls:

  • All types of bronchiolitis & bronchitis cause air trapping (over-aeration) with flattening of hemi-diaphragms.
  • RSV, Mycoplasma, & parainfluenza virus : the most common agents that cause radiographic abnormalities (in 10 30% of infected children).
  • Any virus may result in any of the 5 different radiographic patterns.

Bacterial pneumonia:

  • The following 3 pathogens are the most common:

– Pneumococcus (ages 1 to 3)

– Staphylococcus aureus (infancy)

– Haemophilus influenzae (late infancy)

Radiographic Features:

Consolidation: o   Alveolar exudate

o   Segmental consolidation

o   Lobar consolidation

Other findings: o   Effusions

o   Pneumatocele

Complications: o   Pneumothorax

o   Bronchiectasis (reversible)

o   Swyer-James syndrome:

– Acquired pulmonary hypoplasia.

-Radiographically ch.ch by small, hyperlucent lungs + diminished vessels (focal emphysema).

o   Bronchiolitis obliterans

Round Pneumonia:

  • Usually age < 8 years
  • Pneumococcal pneumonia in early consolidative phase
  • Pneumonia appears round because of poorly developed collateral pathways (pores of Kohn & channels of Lambert).
  • With time the initially round pneumonia develops into a more typical consolidation.

Causes of recurrent Infections:

1-    Cystic fibrosis

2-    Recurrent aspirations

3-    Rare causes of recurrent infection:

o   Hypogammaglobulinemia (Bruton disease):  DDx clue : no adenoids or hilar LNs.

o   Hyperimmunoglobulinemia E (Buckley syndrome)

o   Kartagener syndrome.

o   Other immune-deficiencies

o   Bronchopulmonary foregut malformation

 

Aspiration pneumonia:

  • Results from inhalation of swallowed materials or gastric content.
  • Gastric acid damages capillaries causing acute pulmonary edema.
  • 2ry infection or acute respiratory distress syndrome (ARDS) may ensue.

Causes:

aspiration due to :

Swallowing dysfunction:

(most common cause)

o   Anoxic birth injury (common)

o   Coma,

o   Anesthesia.

Obstruction: o   Esophageal atresia or stenosis.

o   Esophageal obstruction.

o   Gastroesophageal reflux (GER),

o   Hiatus hernia.

o   Gastric or duodenal obstruction.

Fistula: o   Tracheoesophageal fistula (TEF)

Radiographic Features:

o   Recurrent pneumonias : distribution:

– Aspiration in supine position: upper lobes, superior segments of lower lobes.

– Aspiration in upright position : both lower lobes

o   Segmental and subsegmental atelectasis

o   Interstitial fibrosis

o   Inflammatory thickening of bronchial walls

Sickle cell anemia:

  • Pulmonary manifestations : are the leading cause of death:
  • Pneumonia, acute chest syndrome, & pulmonary fibrosis.
  • Children with acute chest syndrome may present with one or multiple foci of consolidation, fever, chest pain, or cough.

Causes:

  • Infection (higher incidence).
  • Fat emboli originating from infracting bone.
  • Pulmonary thrombosis.

Radiographic Findings

  • Consolidation
  • Pleural effusion
  • Fine reticular opacities (pulmonary fibrosis)
  • Large heart in severe anemia
  • H-shaped vertebral bodies
  • Osteonecrosis, bone infarct in visualized humeri

 

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