Radiological approach to a child with chest infection

Dr/Ahmed Bahnassy

Consultant Radiologist RMH

MBCHB-MD-FRCR

Scope of Radiology

• Diagnose infection…• Detection of Etiology…• Follow up for response to treatment.• Monitoring of complications.

I-Evaluation of infection

Etiology

• Organisms :• Viral(Adeno virus-Haemophylis Influenza –

Respiratory syncitial virus)• Bacterial (streptococcal-Staphylococcal-

Klebsiella)• Fungal(aspergillosis)• Tuberculous.• Mycoplasma.• Amebic.

Acute epiglottitis

Croup (church steeple sign)

Retropharyngeal cellulitis

Obstructive viral pneumonia –RSV (note air trapping )

TB presentations

Bacterial pneumonia

Cavitating pneumonia

Lung and liver cysts -Hydatid

II-Routes of infection

• Air borne.

• Septic embolization.

• Extension from neck.

• Extension from liver.

From upper floor

Danger Space

• Para-pharyngeal absces extending to the mediatimum

From lower floor

• Thoraco-hepatic amebiasis

III-Evaluation of Complications

• Empyema.

• Pulmonary abscess.

• Bronchopleural fistula.

• Septic embolization.

Empyema after staph pneumonia

Bronchopleral fistula after staph pneumonia

Pulmonary abscess

IV-Patient with recurrent/chronic pulmonary problems

Mechanism Causes

1. Aspiration CNS malformation-cerebral tumors-Tracheo-esophageal fistula-Reflux

2.Anomaly Congenital lobar emphysema-Sequestration-Tracheobronchial tree anomalies(tracheal bronchus-stenosis-atresia)-bronchogenic cyst.

3.Allergy. Astham- Loeffler pneumonia-allergic alveolitis

4.Systemic disease. Cystic fibrosis

5.Immunodeficiency. Prematurity-AIDS-Neutropenia

6.Physical agents. Foreign body-Drugs-radiation-Bronchopulmonary dysplasia

7.Neoplasm. Leukemia-Lymphoma-Histiocytosis

8.CVS Left to right shunt -PA stenosis-vascular ring

9.specific Infections. TB-Mycoplasma-Bronchiectasis

10.Miscellaneous Interstitial Pneumonia-Collagen vascular disease-Alveolar proteinosis-sarcoidosis.

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

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.

Figure 2. Axial CT images through the area of apparent

consolidation during the administration of IV contrast show a

mass with inhomogenous enhancement involving the medial

aspect of the right lower lobe. There are focal areas of low density

in keeping with necrotic regions within the mass. There are no air

bronchograms or cavitations within the mass. A vessel is clearly

seen to arise from the anterior aspect of the aorta (curved arrow;

top, A), running laterally to the right, to enter the mass

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

Chronic Granulomatous disease

Di-George syndrome

1ry immunodeficiency

• Immunodeficiency IGE

V-Pulmonary opacities..

But NOT infection