Pneumonia in children including SARS
Winnie Chu
The Chinese University of Hong Kong
Department of Diagnostic Radiology and Organ Imaging
Prince of Wales Hospital
Role of imaging in pneumonia• Confirmation/ exclusion
• Underlying cause when failure to resolve or
recur
• Acute complications
• Chronic sequelae
• Characterization and prediction of
infectious agent
Follow up CXR• Not a routine
• Post-obstructive pneumonia secondary to
CA is not a concern
• reserved for:
• persistent symptoms
• recurrent symptoms
• immunodeficiency
Persistent/ recurrent pneumonia• Developmental lung masses
• sequestration
• bronchogenic cyst
• cystic adenomatoid malformation
• reflux, aspiration, systemic disorders
Acute complications• Parapneumonic effusion
• cavitary necrosis
• empyema
• lung abscess
• pneumothorax
• purulent pericarditis
Chronic sequelae• Parenchymal scarring
• bronchial wall thickening
• bronchiectasis
• bronchiolitis obliterans
• Swyer-James syndrome
Presenting symptoms of SARS children
0
20
40
60
80
100
120
feve
r
coug
h
mya
lgia
chills
/ rigo
r
runn
y nos
e
dysp
noea
sore
thro
at
head
ache
dizzin
ess
mala
ise
febr
ile co
nvuls
ion
Per
cen
tag
e
Radiological change• Worst CXR appearance
Mean, SD RangeChild 5.5 +/- 1.6 4-8 daysTeenager 7+/- 3.3 3-12 days
Radiological changes• Complete resolution of CXR
Mean, SD RangeChild 13.8 +/- 4.6 9 -22 daysTeenager 17.4 +/- 7.7 8-30 days
Role of HRCT in SARS• Aid diagnosis in children with strong
clinical suspicion of SARS but non-
contributory CXR
• Assessment of treatment response in
prolonged course of the disease
i. Ribavirin i.v.ii. Hydrocortisone i.v./ prednisolone p.o.iii. Cefotaxime i.v.iv. Clarithromycin p.o.
Suspected paediatric SARS
Mild symptomsModerately severe symptoms
+High swinging fever
i. Cefotaxime i.v.ii. Clarithromycin i.v.iii. Ribavarin i.v.
No improvement Persistent fever,Clinical deterioration
+ Prednisolone p.o. + Pulse Methylprednisolone i.v.
No improvement
+ Pulse Methylprednisolone i.v.
Conclusion• Young children develop a milder form of
the disease with a less aggressive
clinical course and milder radiological
changes
Conclusion• Teenagers may simulate adult pattern,
presenting with a more severe clinical
disease and bizzare radiological finding