Lung- and airway emergencies
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1 Lung- and airway emergencies Charlotte de Lange,MD,PhD Pediatric Radiology unit, Oslo University Hospital, Norway 5th Nordic course - Emergency Radiology Oslo clange@ous-hf.no
2 How come pediatric lung/airway emergencies are so important and demand rapid treatment? More acute emergencies than adults!
3 Physiology, anatomy and pathology specific for children Smaller, flexible airways 75% collateral ventilation Large tongue 44% Increased metabolic rate Rapid hemodynamic/ respiratory decompensation!
4 Airway emergencies Upper Lower Traumatic Non-traumatic Non-traumatic lung and lower airway emergencies
5 Lung and airway emergencies in different age groups Age/ pathology Neonate (0-1 mth) Infant (1-23 mths) Preschool child (2-5 y) Child (6-12y) Adoles. (13-18y) Infection Viral bronchiolitis Virus Bacterial pneumonia Bacterial pneumonia Bacterial pneumonia Foreign body X 6mths-3y X 6mths-3y Tumor Teratoma Neuroblastoma Lymphoma Leukemia Histiocytosis Lymphoma Leukemia Histiocytosis Lymphoma Leukemia Congen. anomalies Heart/ lung/vasc./ tracheobron. anomalies Diaphr.hernia Heart/ lung/vasc. / tracheobron. anomalies Diaphr.hernia Airleaks x x x spont. de Lange C, Insights Imaging 2011
6 Clinical presentation Stridor, cough Wheezing Swallowing difficulty Respiratory distress Tachypnea Nasal flaring Intercostal retractions Hemoptysis Failure to thrive Fever, pain, sepsis or Asymptomatic!!
7 Imaging Chest x-ray Ultrasonography Computed tomography(ct) CT/HRCT, MDCT, CTA Magnetic resonance imaging (MRI), MRA en.wikipedia.org (PET-CT, Scintigraphy) ALARA principle (As Low As Reasonably Acheiveable)
8 Asthma cough at night / with exercise wheezing ~10-20% chest pain Chest x-ray if complications are suspected (air leaks/ infection)
9 Pulmonary infection and complications Virus > Bacteriae (airways) (alveoli) NB! Overlapping imaging findings
10 Girl 3 y Viral infection Boy 4 y Bacterial lobar pneumonia 30% of viral infections normal x-ray findings (Durand et al 2005)
11 Complications to infection: Parapneumonic effusion/ Empyema Boy 6 y - pneumonia left lower lobe and pleural effusion Chest x-ray US CT, iv C 2-12 % parapneumonic effusion -few need drainage (Bradley 2011, Elllis 2002) (Up to date guidelines, 2013)
12 Boy 13 y - ALL treatment with Asparginase, central venous line - slight chest pain US w doppler CE CT Pulmonary thrombo embolism Babyn P, Pediatr Radiol PTE in children Uderzo C Jclin Oncol % of ALL pat develpped PTE Goldenberg NA,NEJM Predictors for outcome of ped. PTE Victoria T Pediatr Radiol Evaluation for PTE in children with clinical suspicon
13 Air leaks
14 Pneumothoraxneonates and...
15 Adolescents Pneumothorax/ pneumomediastinum/ subcutaneous emphysema Chest x-ray, US (expiratory AP views) CT only in selected cases!
16 Masses Vascular malformations Fibromatosis Lymphoma/leukemia Neuroblastoma Teratoma
17 Vascular malformations Boy 8 months - rapidly growing tumor in the axilla CT Cor MRI Ax -STIR Lymphatic malformation
18 Boy 8 y Previous asthma - chest pain with increasing respiratory distress
19 Chest CT = acute imaging of airways T cell lymphoma/ leukemia Acute fatal outcome!
20 Congenital anomalies Heart Lung Vascular Tracheobronchial
21 Vascular rings chest x-ray upper GI series CTA/ MRA Boy 6 months - stridor Double aortic arch
22 Always look at the airways Boy 1 y - Viral inf. with severe breathing problems Tracheal deviation? Tracheo-bronchomalacia?
23 Bronchography/ CT VR 3D Tracheal bronchus with stenosis and malacia
24 Foreign body aspiration airway/oesophagus etc
25 Foreign body aspiration Girl 2 y - cough/ wheezing last 2 weeks Chest x-ray + fluoroscopy Medistinal shift Airtrapping of the ipsilateral side Diaphragmatic restricted motion Bronchoscopy - diagnosis/treatm.
26 Corpus alienum Girl 3 y. Cough for 9 mths before first x-ray
27
28
29 Summary Lung and airway emergencies in children -respiratory and swallowing difficulties Radiology is important for a rapid diagnosis Radiography - still first choice (US, CT, MRI) Always look at the airways clange@ous-hf.no
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