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This is a problem based radiological approach to the pediatric patient with chest infection.
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Radiological approach to a child with chest infection
Dr/Ahmed Bahnassy
Consultant Radiologist RMH
MBCHB-MD-FRCR
Scope of Radiology
• Diagnose infection…• Detection of Etiology…• Follow up for response to treatment.• Monitoring of complications.
I-Evaluation of infection
Etiology
• Organisms :• Viral(Adeno virus-Haemophylis Influenza –
Respiratory syncitial virus)• Bacterial (streptococcal-Staphylococcal-
Klebsiella)• Fungal(aspergillosis)• Tuberculous.• Mycoplasma.• Amebic.
Acute epiglottitis
Croup (church steeple sign)
Retropharyngeal cellulitis
Obstructive viral pneumonia –RSV (note air trapping )
TB presentations
Bacterial pneumonia
Cavitating pneumonia
Lung and liver cysts -Hydatid
II-Routes of infection
• Air borne.
• Septic embolization.
• Extension from neck.
• Extension from liver.
From upper floor
Danger Space
• Para-pharyngeal absces extending to the mediatimum
From lower floor
• Thoraco-hepatic amebiasis
III-Evaluation of Complications
• Empyema.
• Pulmonary abscess.
• Bronchopleural fistula.
• Septic embolization.
Empyema after staph pneumonia
Bronchopleral fistula after staph pneumonia
Pulmonary abscess
IV-Patient with recurrent/chronic pulmonary problems
Mechanism Causes
1. Aspiration CNS malformation-cerebral tumors-Tracheo-esophageal fistula-Reflux
2.Anomaly Congenital lobar emphysema-Sequestration-Tracheobronchial tree anomalies(tracheal bronchus-stenosis-atresia)-bronchogenic cyst.
3.Allergy. Astham- Loeffler pneumonia-allergic alveolitis
4.Systemic disease. Cystic fibrosis
5.Immunodeficiency. Prematurity-AIDS-Neutropenia
6.Physical agents. Foreign body-Drugs-radiation-Bronchopulmonary dysplasia
7.Neoplasm. Leukemia-Lymphoma-Histiocytosis
8.CVS Left to right shunt -PA stenosis-vascular ring
9.specific Infections. TB-Mycoplasma-Bronchiectasis
10.Miscellaneous Interstitial Pneumonia-Collagen vascular disease-Alveolar proteinosis-sarcoidosis.
Role of Radiology • The role of radiology is 3 folds :• 1 .Evaluate the present X-ray.• The presence and distribution of opacities,• Pleural involvement ,Lymph nodal swellings ,pulmonary vascularity ,soft
tissue involvement , bony structures .• 2.Review of previous films.• Are the lesion stable in the same location (Sequestration ?)• Are they present always in upper lobe (aspiration ? )• Are they changing in location (Immunodeficiency ?)• 3.Perform esophagogram.• Reflux of gastric contents.• Abnormal peristalsis.• Compression of esophagus by a mass ,vascular ring.• Tracheo-esophageal fistula.• Hiatal Hernia
Recurrent right basal consolidation
• Posteroanterior (top, A) and lateral (bottom, B) chest
• radiographs demonstrate an area of ill-defined consolidation
• involving the medial segment of the right lower lobe.
Figure 2. Axial CT images through the area of apparent
consolidation during the administration of IV contrast show a
mass with inhomogenous enhancement involving the medial
aspect of the right lower lobe. There are focal areas of low density
in keeping with necrotic regions within the mass. There are no air
bronchograms or cavitations within the mass. A vessel is clearly
seen to arise from the anterior aspect of the aorta (curved arrow;
top, A), running laterally to the right, to enter the mass
Bronchopulmonary sequestration
• Three-dimensional reconstruction of the descending
• aorta further demonstrates the entire route of the anomalous
• vessel arising off the anterior aspect of the aorta and then passing
• inferiorly and to the right to supply the sequestrated segment
Chronic Granulomatous disease
Di-George syndrome
1ry immunodeficiency
• Immunodeficiency IGE
V-Pulmonary opacities..
But NOT infection