the road to hrct evaluation of pediatric diffuse lung diseases.part 2
DESCRIPTION
part 2 of step by step evaluation of pediatric diffuse lung diseases.TRANSCRIPT
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The road to HRCT evaluation of
Dr/Ahmed Bahnassy
Consultant Radiologist
Riyadh Military Hospital
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Causes of chILD• Infectious • Aspiration
(GORD)• Environmental
(hypersensitivity pneumonitis)
• Drug-induced • Neoplastic
diseases (&LCH)
• Lymphoproliferative disorders (including HIV)
• Metabolic disorders
• Surfactant disorders
• Neurocutaneous syndromes
• Idiopathic pulm hemosidrosis
• Infectious • Aspiration
(GORD)• Environmental
(hypersensitivity pneumonitis)
• Drug-induced • Neoplastic
diseases (&LCH)
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Causes of chILD cont….
• Collagen vascular disease
• Pulmonary vasculitis syndromes
• Radiation-induced
• Amyloidosis• Graft-versus-
host disease
• ARDS (recovering phase)
• Hypereosinophilic syndromes
• Pulmonary veno-occlusive disease
• Sarcoidosis• With chronic
liver, kidney, bowel diseases
• Lymphoproliferative disorders (including HIV)
• Metabolic disorders• Surfactant disorders• Neurocutaneous
syndromes
• Idiopathic pulm hemosidrosis
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Causes of ILD
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Between Adults and ChILD
NSIP
ILD
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DIP
LIP
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Neuroendocrine cell hyperplasia of infancy (NEHI)
Ground Glass opacity primarily affecting the middle and lingular lobes
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NEHI
• Another typical example of right middle lobe ,and left lingular GGO.
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Surfactant Metabolism Dysfunction
• Surfactant is a complex mixture of phospholipids
and proteins (SP-A, -B, -C and -D)& ABCA3.
• ABCA3 an ATP-binding transporter Of lipids.
(chILD) due to ABCA3 gene mutations
Diffuse GG opacity with variableIntelobular septal thickening
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Nonspecific interstitial pneumonitis
Bilateral scattered middle zonal GGOBi basilar consolidations.Bronchial dilatation.
HRCT shows a mosaicperfusion pattern and multiple bilateral linear densities
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PIG..Pulmonary interstitial Glycogenosis
• GGO
• Interlobular septal thickening.
• Reticular changes.
• Posterior cysts.
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BOOP• Diffuse
nodules.
• Mild intralobular septal thickening.
• Patchy GGO.
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Hypersensitivity pneumonitis
• Ground Glass and nodular like opacities in lung bases.
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Eosinophilic pneumonia
• Reversed Halo sign
• Right peripheral mid-zonal GGO
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Pulmonary alveolar proteinosis
• GGO
• +
• Interlobular septal thickening
• =
• Crazy-paving pattern.
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Bronchopulmonary Dysplasia septal thickening,
parenchymal bands and multiple hyperlucent areas.
Repeated HRCT at the age of 2 years shows a mosaic pattern andsome residual parenchymal bands
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Parenchymal bands in BPD
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Bronchial asthma
Normal
Expiratory scan revealed severeAir trapping
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Hemosiderosis
ground-glass attenuation due to pulmonary hemorrhage
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Langerhans cell histiocytosis
thick- and thin-walled cysts;few micronodules also seen
pulmonary cystic lesions, some located subpleurally, andbilateral pneumothoraces
Bizarre shaped
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Lympngiomatosis
Prominent diffuse smooth septal thickening, bronchovascularbundles and ground-glass attenuation
Consider vascular/lymphatic cause
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Lesson learned
Most HRCT features are non-specific,
but when related to the clinical findings, they can suggest the proper diagnosis and obviate biopsy.
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A new classification system for pediatricinterstitial lung disease evolved out of the recognitionthat clinical setting is an important considerationin the diagnosis of pediatric ILD and thatcombined clinical, imaging, and pathological correlationis a more powerful diagnostic tool, thanany one single component.
This new pediatric interstitial lung disease classification system was validated for infants and very young children in a retrospective review of 186 lung biopsies done
between 1999 and 2004 with accompanying clinical histories and images from children under age 2 contributed by 11 pediatric institutions in North America.
Based on this new classification system, ChILD is classified into three main groups: (1) disorders of infancy; (2) other categories
(not specific to infancy); and (3)unclassifiable.
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