The road to HRCT evaluation of pediatric diffuse lung diseases.part 2
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The road to HRCT evaluation of pediatric diffuse lung diseases.part 2

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part 2 of step by step evaluation of pediatric diffuse lung diseases.

part 2 of step by step evaluation of pediatric diffuse lung diseases.

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The road to HRCT evaluation of pediatric diffuse lung diseases.part 2 The road to HRCT evaluation of pediatric diffuse lung diseases.part 2 Presentation Transcript

  • The road to HRCT evaluation of Dr/Ahmed Bahnassy Consultant Radiologist Riyadh Military Hospital
  • Causes of chILD• Infectious • Lymphoproliferat • Infectious• Aspiration ive disorders • Aspiration (GORD) (GORD) (including HIV) • Environmental (hypersensitivity• Environmental • Metabolic pneumonitis) (hypersensitivi disorders • Drug-induced ty • Surfactant • Neoplastic pneumonitis) disorders diseases (&LCH)• Drug-induced • Neurocutaneous• Neoplastic syndromes diseases • Idiopathic pulm (&LCH) hemosidrosis
  • Causes of chILD cont…. • ARDS• Lymphoproliferative (recovering disorders (including • Collagen phase) vascular • Hypereosino HIV) disease philic• Metabolic disorders syndromes • Pulmonary • Pulmonary• Surfactant disorders vasculitis veno-• Neurocutaneous syndromes occlusive syndromes • Radiation- disease• Idiopathic pulm induced • Sarcoidosis hemosidrosis • Amyloidosis • With chronic liver, kidney, • Graft-versus- bowel host disease diseases
  • Causes of ILD
  • ILD Between Adults and ChILD NSIP
  • DIP LIP
  • Neuroendocrine cell hyperplasia of infancy (NEHI) Ground Glass opacity primarily affecting the middle and lingular lobes
  • NEHI• Another typical example of right middle lobe ,and left lingular GGO.
  • Surfactant Metabolism Dysfunction• Surfactant is a complex mixture of phospholipidsand proteins (SP-A, -B, -C and -D)& ABCA3.• ABCA3 an ATP-binding transporter Of lipids. Diffuse GG opacity with variable Intelobular septal thickening (chILD) due to ABCA3 gene mutations
  • Nonspecific interstitial pneumonitisBilateral scattered middle zonal GGOBi basilar consolidations.Bronchial dilatation. HRCT shows a mosaic perfusion pattern and multiple bilateral linear densities
  • PIG..Pulmonary interstitial Glycogenosis• GGO• Interlobular septal thickening.• Reticular changes.• Posterior cysts.
  • BOOP• Diffuse nodules.• Mild intralobular septal thickening.• Patchy GGO.
  • Hypersensitivity pneumonitis• Ground Glass and nodular like opacities in lung bases.
  • Eosinophilic pneumonia• Reversed Halo sign• Right peripheral mid-zonal GGO
  • Pulmonary alveolar proteinosis• GGO• +• Interlobular septal thickening• =• Crazy-paving pattern.
  • Bronchopulmonary Dysplasiaseptal thickening,parenchymal bands andmultiple hyperlucentareas.Repeated HRCT atthe age of 2 yearsshows a mosaicpattern andsome residualparenchymal bands
  • Parenchymal bands in BPD
  • Bronchial asthmaNormal Expiratory scan revealed severe Air trapping
  • Hemosiderosisground-glass attenuation due to pulmonary hemorrhage
  • Langerhans cell histiocytosis Bizarre thick- and thin-walled cysts; shaped few micronodules also seenpulmonary cystic lesions, some locatedsubpleurally, andbilateral pneumothoraces
  • Lympngiomatosis Consider vascular/lymphatic causeProminent diffuse smooth septal thickening, bronchovascularbundles and ground-glass attenuation
  • Lesson learnedMost HRCT features are non-specific,but when related to the clinical findings,they can suggest the proper diagnosis andobviate biopsy.
  • A new classification system for pediatricinterstitial lung disease evolved out of the recognitionthat clinical setting is an important considerationin the diagnosis of pediatric ILD and thatcombined clinical, imaging, and pathological correlationis a more powerful diagnostic tool, thanany one single component. This new pediatric interstitial lung disease classification system was validated for infants and very young children in a retrospective review of 186 lung biopsies done between 1999 and 2004 with accompanying clinical histories and images from children under age 2 contributed by 11 pediatric institutions in North America. Based on this new classification system, ChILD is classified into three main groups: (1) disorders of infancy; (2) other categories (not specific to infancy); and (3)unclassifiable.