Radiological approach to a child with chest infection


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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

  1. 1. Radiological approach to a child with chest infectionDr/AhmedBahnassy Consultant Radiologist RMHMBCHB-MD-FRCR
  2. 2. Scope of Radiology• Diagnose infection…• Detection of Etiology…• Follow up for response to treatment.• Monitoring of complications.
  3. 3. I-Evaluation of infection
  4. 4. Etiology• Organisms :• Viral(Adeno virus-Haemophylis Influenza – Respiratory syncitial virus)• Bacterial (streptococcal-Staphylococcal- Klebsiella)• Fungal(aspergillosis)• Tuberculous.• Mycoplasma.• Amebic.
  5. 5. Acute epiglottitis
  6. 6. Croup (church steeple sign)
  7. 7. Retropharyngeal cellulitis
  8. 8. Obstructive viral pneumonia –RSV (note air trapping )
  9. 9. TB presentations
  10. 10. Bacterial pneumonia
  11. 11. Cavitating pneumonia
  12. 12. Lung and liver cysts -Hydatid
  13. 13. II-Routes of infection• Air borne.• Septic embolization.• Extension from neck.• Extension from liver.
  14. 14. From upper floor
  15. 15. Danger Space
  16. 16. • Para- pharyngeal absces extending to the mediatimu m
  17. 17. From lower floor• Thoraco-hepatic amebiasis
  18. 18. III-Evaluation of Complications• Empyema.• Pulmonary abscess.• Bronchopleural fistula.• Septic embolization.
  19. 19. Empyema after staph pneumonia
  20. 20. Bronchopleral fistula after staph pneumonia
  21. 21. Pulmonary abscess
  22. 22. IV-Patient with recurrent/chronic pulmonary problemsMechanism Causes1. Aspiration CNS malformation-cerebral tumors-Tracheo- esophageal fistula-Reflux2.Anomaly Congenital lobar emphysema-Sequestration- Tracheobronchial tree anomalies(tracheal bronchus-stenosis-atresia)-bronchogenic cyst.3.Allergy. Astham- Loeffler pneumonia-allergic alveolitis4.Systemic disease. Cystic fibrosis5.Immunodeficiency. Prematurity-AIDS-Neutropenia6.Physical agents. Foreign body-Drugs-radiation-Bronchopulmonary dysplasia7.Neoplasm. Leukemia-Lymphoma-Histiocytosis8.CVS Left to right shunt -PA stenosis-vascular ring9.specific Infections. TB-Mycoplasma-Bronchiectasis10.Miscellaneous Interstitial Pneumonia-Collagen vascular disease- Alveolar proteinosis-sarcoidosis.
  23. 23. 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
  24. 24. 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.
  25. 25. Figure 2. Axial CT images through the area of apparentconsolidation during the administration of IV contrast show amass with inhomogenous enhancement involving the medialaspect of the right lower lobe. There are focal areas of low densityin keeping with necrotic regions within the mass. There are no airbronchograms or cavitations within the mass. A vessel is clearlyseen to arise from the anterior aspect of the aorta (curved arrow;top, A), running laterally to the right, to enter the mass
  26. 26. 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
  27. 27. Chronic Granulomatous disease
  28. 28. Di-George syndrome
  29. 29. 1ry immunodeficiency• Immunodefici ency IGE
  30. 30. V-Pulmonary opacities..But NOT infection