Pediatric Chest Flashcards
4 main causes of respiratory distress in newborns
TTN, neonatal respiratory distress, meconium aspiration, nenatal pneumonia/sepsis
What is bronchopulmonary dysplasia?
chronic lung disease of prematurity, after RDS that persists at 28 days of life or persistent need for O2 at 36 post conceptual weeks
Imaging findings of TTN
pulmonary edema, fluid in minor fissure
Imaging findings of RDS/hyaline membrane disease
hazy pulmonary opacities with air bronchograms, low lung volumes
Imaging findings of pulmonary interstitial emphysema
RDS with barotrauma, small cysts with hyperinflated lungs; look for pneumomediastinum/pneumothorax
Most common cause of chronic respiratory failure in pediatrics
bronchopulmonary dysplasia
Imaging findings of BPD
coarse interstitial opacities and increased lung volumes
Imaging findings of meconium aspiration
ropey, coarse interstitial opacities; pneumothoraces
Congenital diaphgragmatic hernia, common side?
Left posterior defect diaphragm (Bochdaleck), pulmonary hypoplasia; right side less common, poorer prognosis, liver hypoplasia
Imaging findings of CDH
herniation of bowel into thorax, rightward shift of mediastinum; bowel may initially be solid at birth/no air
Associations of CDH
bowel malrotation, neural tube defects, congenital heart disease
Brochopulmonary foregut malformations
Anomalous budding of the foregut and tracheobronchial tree (affects vasculature/pulmonary parenchyma); Major types include: congenital lobar emphysema/overinflation, bronchial atresia, bronchogenic cyst, CPAM, sequestration, scimitar syndrome, AVM
Cause of congenital lobar emphysema
lobar air trapping most commonly due to bronchomalacia; usually symptomatic in first 4 weeks/6 months when detected
Most common lobe affected with CLE
LUL, then RML and RUL
Imaging findings of CLE
preinatal: CLE fluid filled –> lucent then with lobar hyperexpansion causes mass effect on structures
Differentiate from pneumothorax as a chest tube will only make it worse
Treatment for CLE
lobectomy in symptomatic cases
Patient presentation with CLE
neonatal respiratory distress, progressive; decreased breath sounds on affected side; hyperresonant hemithorax; diagnosed in first 6 mo
Bronchial atresia
atresia of a subsgemental, segmental, or lobar bronchus; distal mucus impaction and hyperinflation
Imaging findings bronchial atresia
ovoid/tubular mucocele and focal pulmonary hyperlucency
Commonly affected region for bronchial atresia
LL; usually incidentally found in adults
Finger in glove sign
tubular branching mass with hyperinflated distal lung; key for bronchial atresia
CPAM/CCAM
congenital pulmonary airway malformation or congenital cystic adenomatoid malformation; hamartomous proliferation of termile bronchioles that communicate with bronchial tree
Imaging findings CPAM
multiple cysts of variable size; air fluid levels in cysts and variable cyst wall thickness; fluid filled at birth, gradually aerate; 5 histopathological types
Arterial supply of CPAM
pulmonary circulation; different than sequestration (systemic circulation)
Classification system for CPAM
Stocker classification; 5 types; Type 0 (fatal) to Type 4; prognosis depends on size, not classification system
CPAM treatment
dependent on symptoms, usually surgical resection;
Pulmonary sequestration, functionality,d a9IQ65 blood supply and location, most common type
aberrant nonfunctional lung tissue with system blood supply from aorta, no connection to bronchial tree; commonly LLL and intralobar > extralobar
Intralobar vs extralobar bronchopulmonary sequestration
Intralobar more common; inside plura with pulmonary venous drainage
Extralobar: separate pleural investment with systemic venous drainage; can mimic adrenal mass if below the diaphragm
Scimitar syndrome, hypogenetic lung syndrome, pulmonary venolobar syndrome
partially anomalous pulmonary venous return from RLL pulmonary veins into right atrium/IVC vs TAPVR in which all four pulmonary veins return blood to right atrium
Imaging findings of scimitar syndrome
Commonly RLL; Scimitar vein on XR, hyperlucent and hypoplastic RLL; partial anomalous pulmonary venous return into infradiaphgragmatic IVC
Types of small airway disease
bronchiolitis, BOS, BOOP, bronchiectasis
Common cause of bronchieolitis
RSV; small airway obstruction by inflammation/necrotic debris
XR findings of bronchiolitis
hyperexexpanded lungs (flattening of diaphragm) and increased peribronchial markings
Bronchiolitis obliterans syndrome or constrictive bronchiolitis
small airway obstruction with submucosal and peribonchial fibrosis with luminal stenosis/occlusions; may be post-transplant, postinfectious, or due to toxin/drug exposure; associated with IBD, RA, Swyer James syndrome
Imaging findings of BOS
CXR normal or with hyperinflation
CT: air trapping, mosaic perfusion, bronchiectasis and bronchial wall thickening
Swyer James MacLeod Syndrome
unilateral small hyperlucent lung with volume loss; postinfectious BOS complication
Typical trigger for Swyer James
adenovirus –> BOS –> SJ
Cryptogenic organizing pneumonia, bronchiolitis (COP), previously Bronchiolitis obliterans organizing pneumonia (BOOP),
filling of bronchioles and alveoli with granulation tissue polyps
Imaging findings of COP
multifocal migratory consolidations, GGO, nodules
Atoll or reverse halo sign
central lucency surrounded by ground glass; organizing pneumonia finding
Bronchiectasis
bronchial dilation, inflammatory
Causes of bronchiectasis
CF, allergic bronchopulmonary aspergillosis, post infectious, tracheobronchomegaly (Mounier-Kuhn), aspiration, intralobar sequestration (recurrent infections)
Signt ring sign
enlargement of bronchiole, which is larger than adjacent pulmonary artery
Poland syndrome
AR of congenital absence of pec major. Associated with anomalies of hand, short metacarpals, syndactyl (joined fingers)
Spinnaker sign/angelwing sign
thymus lifted off mediastinum by ectopic air
Pediatric anterior mediastinal masses
thymus (rebound), lymphoma, germ cell tumor, thymoma
Pediatric middle mediastinal mass
foregut duplication cyst, neurenteric cyst (vertebral anomalies), lymphadenopathy
Pediatric posterior mediastinal masses
neurogeic tumors (neuroblastoma, ganglioneuroblastoma, ganglioneuroma)
