CR Peds Chest

Question 1

• What is the most reliable predictor of postnatal survival in the setting of CDH?

Answer 1

• Absence of liver herniation.

Question 2

Which CPAM subtype is associated w/other abnormalities & has malignant potential?

Answer 2

• Type 1: most common type.
  
  • Has distinct, thin-walled cysts measuring 2-10cm each.

Question 3

• Where are foregut duplication cysts most commonly found?
• What cell type are they commonly lined with?

Answer 3

• Proximal small intestine.
• Gastric epithelium.

Question 4

1. DDx peds posterior mediastinal mass.
2. Which peds mass is classically located in the posterior mediastinum?

Answer 4

1. Neuroblastoma, Ewing sarcoma, Askin tumour, neuroenteric cysts, extramedullary hematopoiesis.
2. Neuroblastoma.

Question 5

1. What is the most common bug in the setting of round pneumonia?
2. Why is round pneumonia unusual after age 8?

Answer 5

1. Strep pneumonia.
2. B/c collateral airways tend to be well developed by this age.

Question 6

What % of aspirated FBs are opaque?

Answer 6

• <20%.

Question 7

• 10mth male w/Hx of a multilocular cystic nephroma. Dx of this primary lung lesion?

Answer 7

Dx: pleuropulmonary blastoma.

• Usually R-sided & pleural-based.
  
  • No chest wall invasion nor calcs.
  • Can be solid & huge or cystic.
• 10% have an associated multilocular cystic nephroma.
• Can look like CPAMs if they have a cystic component.
  
  • The cystic type is often in younger kids & is more benign.

Question 8

What are the top 3 DDx for a peds anterior mediastinal mass?

Answer 8

• Lymphoma: the most common anterior mass in kids.
• Thymoma
• Teratoma/germ cell tumour
• The fourth of the terrible Ts is thyroid carcinoma

Question 9

1. Which measurement is used to assess severity of sternal incursion in pectus excavatum?
2. Which procedure is used to correct it?

Answer 9

1. Haller index.
2. Nuss procedure: a concave bar is inserted substernally.

Question 10

Name the most common congenital venous anomaly of the chest.

Answer 10

Persistent L-sided SVC.

Question 11

Name the most common subtype of TEF.

Answer 11

• Proximal atresia, distal fistula.

Question 12

What is the next step for this pt who presents after an MVC where the car hit a tree?

Answer 12

• ACR supports use of chest CTA in combination w/CXR as 1st line investigation.

Question 13

Dx?

Answer 13

Pneumomediastinum.

• The continuous diagphragm sign.

Question 14

Dx in a 2-day-old, & name of sign?

Answer 14

Dx: pneumomediastinum.

• “Angel wing” sign: the thymus is large & its lobes are lifted up off the heart & surrounded by lucent gas.

Question 15

0-day-old pt w/prenatally diagnosed abnormality, Dx?

Answer 15

• Dx: congenital diaphragmatic hernia, as evidenced by the classic, upturned J-shaped enteric tube w/a mixed lucent & opaque filling in the chest & mediastinal displacement.

Question 16

In CDH, list the 4 most important prognostic factors.

Answer 16

• Liver herniation: the most important/grim.
• Pulmonary hypoplasia
• PHTN
• Congenital heart disease