Pediatric Chest

Question 1

4 main causes of respiratory distress in newborns

Answer 1

TTN, neonatal respiratory distress, meconium aspiration, nenatal pneumonia/sepsis

Question 2

What is bronchopulmonary dysplasia?

Answer 2

chronic lung disease of prematurity, after RDS that persists at 28 days of life or persistent need for O2 at 36 post conceptual weeks

Question 3

Imaging findings of TTN

Answer 3

pulmonary edema, fluid in minor fissure

Question 4

Imaging findings of RDS/hyaline membrane disease

Answer 4

hazy pulmonary opacities with air bronchograms, low lung volumes

Question 5

Imaging findings of pulmonary interstitial emphysema

Answer 5

RDS with barotrauma, small cysts with hyperinflated lungs; look for pneumomediastinum/pneumothorax

Question 6

Most common cause of chronic respiratory failure in pediatrics

Answer 6

bronchopulmonary dysplasia

Question 7

Imaging findings of BPD

Answer 7

coarse interstitial opacities and increased lung volumes

Question 8

Imaging findings of meconium aspiration

Answer 8

ropey, coarse interstitial opacities; pneumothoraces

Question 9

Congenital diaphgragmatic hernia, common side?

Answer 9

Left posterior defect diaphragm (Bochdaleck), pulmonary hypoplasia; right side less common, poorer prognosis, liver hypoplasia

Question 10

Imaging findings of CDH

Answer 10

herniation of bowel into thorax, rightward shift of mediastinum; bowel may initially be solid at birth/no air

Question 11

Associations of CDH

Answer 11

bowel malrotation, neural tube defects, congenital heart disease

Question 12

Brochopulmonary foregut malformations

Answer 12

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

Question 13

Cause of congenital lobar emphysema

Answer 13

lobar air trapping most commonly due to bronchomalacia; usually symptomatic in first 4 weeks/6 months when detected

Question 14

Most common lobe affected with CLE

Answer 14

LUL, then RML and RUL

Question 15

Imaging findings of CLE

Answer 15

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

Question 16

Treatment for CLE

Answer 16

lobectomy in symptomatic cases

Question 17

Patient presentation with CLE

Answer 17

neonatal respiratory distress, progressive; decreased breath sounds on affected side; hyperresonant hemithorax; diagnosed in first 6 mo

Question 18

Bronchial atresia

Answer 18

atresia of a subsgemental, segmental, or lobar bronchus; distal mucus impaction and hyperinflation

Question 19

Imaging findings bronchial atresia

Answer 19

ovoid/tubular mucocele and focal pulmonary hyperlucency

Question 20

Commonly affected region for bronchial atresia

Answer 20

LL; usually incidentally found in adults

Question 21

Finger in glove sign

Answer 21

tubular branching mass with hyperinflated distal lung; key for bronchial atresia

Question 22

CPAM/CCAM

Answer 22

congenital pulmonary airway malformation or congenital cystic adenomatoid malformation; hamartomous proliferation of termile bronchioles that communicate with bronchial tree

Question 23

Imaging findings CPAM

Answer 23

multiple cysts of variable size; air fluid levels in cysts and variable cyst wall thickness; fluid filled at birth, gradually aerate; 5 histopathological types

Question 24

Arterial supply of CPAM

Answer 24

pulmonary circulation; different than sequestration (systemic circulation)

Question 25

Classification system for CPAM

Answer 25

Stocker classification; 5 types; Type 0 (fatal) to Type 4; prognosis depends on size, not classification system

Question 26

CPAM treatment

Answer 26

dependent on symptoms, usually surgical resection;

Question 27

Pulmonary sequestration, functionality,d a9IQ65 blood supply and location, most common type

Answer 27

aberrant nonfunctional lung tissue with system blood supply from aorta, no connection to bronchial tree; commonly LLL and intralobar > extralobar

Question 28

Intralobar vs extralobar bronchopulmonary sequestration

Answer 28

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

Question 29

Scimitar syndrome, hypogenetic lung syndrome, pulmonary venolobar syndrome

Answer 29

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

Question 30

Imaging findings of scimitar syndrome

Answer 30

Commonly RLL; Scimitar vein on XR, hyperlucent and hypoplastic RLL; partial anomalous pulmonary venous return into infradiaphgragmatic IVC

Question 31

Types of small airway disease

Answer 31

bronchiolitis, BOS, BOOP, bronchiectasis

Question 32

Common cause of bronchieolitis

Answer 32

RSV; small airway obstruction by inflammation/necrotic debris

Question 33

XR findings of bronchiolitis

Answer 33

hyperexexpanded lungs (flattening of diaphragm) and increased peribronchial markings

Question 34

Bronchiolitis obliterans syndrome or constrictive bronchiolitis

Answer 34

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

Question 35

Imaging findings of BOS

Answer 35

CXR normal or with hyperinflation | CT: air trapping, mosaic perfusion, bronchiectasis and bronchial wall thickening

Question 36

Swyer James MacLeod Syndrome

Answer 36

unilateral small hyperlucent lung with volume loss; postinfectious BOS complication

Question 37

Typical trigger for Swyer James

Answer 37

adenovirus --> BOS --> SJ

Question 38

Cryptogenic organizing pneumonia, bronchiolitis (COP), previously Bronchiolitis obliterans organizing pneumonia (BOOP),

Answer 38

filling of bronchioles and alveoli with granulation tissue polyps

Question 39

Imaging findings of COP

Answer 39

multifocal migratory consolidations, GGO, nodules

Question 40

Atoll or reverse halo sign

Answer 40

central lucency surrounded by ground glass; organizing pneumonia finding

Question 41

Bronchiectasis

Answer 41

bronchial dilation, inflammatory

Question 42

Causes of bronchiectasis

Answer 42

CF, allergic bronchopulmonary aspergillosis, post infectious, tracheobronchomegaly (Mounier-Kuhn), aspiration, intralobar sequestration (recurrent infections)

Question 43

Signt ring sign

Answer 43

enlargement of bronchiole, which is larger than adjacent pulmonary artery

Question 44

Poland syndrome

Answer 44

AR of congenital absence of pec major. Associated with anomalies of hand, short metacarpals, syndactyl (joined fingers)

Question 45

Spinnaker sign/angelwing sign

Answer 45

thymus lifted off mediastinum by ectopic air

Question 46

Pediatric anterior mediastinal masses

Answer 46

thymus (rebound), lymphoma, germ cell tumor, thymoma

Question 47

Pediatric middle mediastinal mass

Answer 47

foregut duplication cyst, neurenteric cyst (vertebral anomalies), lymphadenopathy

Question 48

Pediatric posterior mediastinal masses

Answer 48

neurogeic tumors (neuroblastoma, ganglioneuroblastoma, ganglioneuroma)