The road to HRCT  evaluation of  Dr/Ahmed Bahnassy Consultant Radiologist Riyadh Military Hospital
Causes of chILD• Infectious        • Lymphoproliferat   • Infectious• Aspiration          ive disorders      • Aspiration ...
Causes of chILD                cont….                                         • ARDS• Lymphoproliferative                 ...
Causes of ILD
ILD      Between Adults and ChILD               NSIP
DIP LIP
Neuroendocrine cell hyperplasia      of infancy (NEHI)                 Ground Glass opacity primarily affecting           ...
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)& ABC...
Nonspecific interstitial            pneumonitisBilateral scattered middle zonal GGOBi basilar consolidations.Bronchial dil...
PIG..Pulmonary interstitial          Glycogenosis• GGO• Interlobular septal  thickening.• Reticular changes.• Posterior cy...
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 ye...
Parenchymal bands in BPD
Bronchial asthmaNormal             Expiratory scan             revealed severe             Air trapping
Hemosiderosisground-glass attenuation due to pulmonary hemorrhage
Langerhans cell histiocytosis                                                                         Bizarre             ...
Lympngiomatosis                             Consider vascular/lymphatic causeProminent diffuse smooth septal thickening, b...
Lesson learnedMost HRCT features are non-specific,but when related to the clinical findings,they can suggest the proper di...
A new classification system for pediatricinterstitial lung disease evolved out of the recognitionthat clinical setting is ...
The road to HRCT evaluation of pediatric diffuse lung diseases.part 2
The road to HRCT evaluation of pediatric diffuse lung diseases.part 2
The road to HRCT evaluation of pediatric diffuse lung diseases.part 2
The road to HRCT evaluation of pediatric diffuse lung diseases.part 2
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.

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

  1. 1. The road to HRCT evaluation of Dr/Ahmed Bahnassy Consultant Radiologist Riyadh Military Hospital
  2. 2. 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
  3. 3. 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
  4. 4. Causes of ILD
  5. 5. ILD Between Adults and ChILD NSIP
  6. 6. DIP LIP
  7. 7. Neuroendocrine cell hyperplasia of infancy (NEHI) Ground Glass opacity primarily affecting the middle and lingular lobes
  8. 8. NEHI• Another typical example of right middle lobe ,and left lingular GGO.
  9. 9. 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
  10. 10. Nonspecific interstitial pneumonitisBilateral scattered middle zonal GGOBi basilar consolidations.Bronchial dilatation. HRCT shows a mosaic perfusion pattern and multiple bilateral linear densities
  11. 11. PIG..Pulmonary interstitial Glycogenosis• GGO• Interlobular septal thickening.• Reticular changes.• Posterior cysts.
  12. 12. BOOP• Diffuse nodules.• Mild intralobular septal thickening.• Patchy GGO.
  13. 13. Hypersensitivity pneumonitis• Ground Glass and nodular like opacities in lung bases.
  14. 14. Eosinophilic pneumonia• Reversed Halo sign• Right peripheral mid-zonal GGO
  15. 15. Pulmonary alveolar proteinosis• GGO• +• Interlobular septal thickening• =• Crazy-paving pattern.
  16. 16. Bronchopulmonary Dysplasiaseptal thickening,parenchymal bands andmultiple hyperlucentareas.Repeated HRCT atthe age of 2 yearsshows a mosaicpattern andsome residualparenchymal bands
  17. 17. Parenchymal bands in BPD
  18. 18. Bronchial asthmaNormal Expiratory scan revealed severe Air trapping
  19. 19. Hemosiderosisground-glass attenuation due to pulmonary hemorrhage
  20. 20. Langerhans cell histiocytosis Bizarre thick- and thin-walled cysts; shaped few micronodules also seenpulmonary cystic lesions, some locatedsubpleurally, andbilateral pneumothoraces
  21. 21. Lympngiomatosis Consider vascular/lymphatic causeProminent diffuse smooth septal thickening, bronchovascularbundles and ground-glass attenuation
  22. 22. Lesson learnedMost HRCT features are non-specific,but when related to the clinical findings,they can suggest the proper diagnosis andobviate biopsy.
  23. 23. 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.

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