Imaging of the Lung in Children

Imaging methods X-Ray of the Lung (Anteroposterior, ) CT, HRCT MRI USG

Congenital developmental defects of the lungs Agenesis, aplasia, hypoplasia Tension pulmonary anomalies (pulmonary cyst, congenital lobar emphysema, cystic adenomatoid malformation) Pulmonary sequestration Anomalous origine of the bronchus Congenital diaphragmatic herniation

Agenesis, aplasia, hypoplasia Bilateral agenesis or aplasia is not compatible with life X ray, CT Agenesis missing pulmonary and bronchial tissue, blood vessels are missing (unilateral compatible with life) Aplasia the bronchus is present, without pulmonary parenchyma, without blood vessels Hypoplasia rudimentary bronchi are present, pulmonary parenchyma and pulmonary blood vessels (in congenital diaphragmatic hernia)

Agenesis, aplasia, hypoplasia of the lung Shading caused by movement of the mediastinum to the affected side Compensatory emphysema of the preserved lung The image is the same as lobar athelectasis

Tension pulmonary anomalies Pulmonary cyst Congenital lobar emphysema Cystic adenomatoid pulmonary malformation

Tension pulmonary anomalies-- pulmonary cyst Bronchogenic cyst Congenital anomaly resulting in the development of bronchi and lung, localized centrally, or in the periphery Communication with the bronchial tree is more common in peripheral cysts Localisation of cysts extra, - intrapulmonary X-ray, CT

Tension pulmonary anomalies-- pulmonary cyst Non-communicating sharply defined rounded lucency Communicating circular bounded, hydro-aeric levels The thin wall (unlike abscess)

Tension pulmonary abnormalitiescongenital lobar emphysema Valve like obstruction of the bronchus Postnataly resulting from increased airiness of one or more pulmonary lobes in normal lung tissue Bronchomalacy with the collapse of bronchus, external pressure on the bronchus (blood vessel), idiopathic The cause of the obstruction, mucosal fold, cartilage agenesis, fibrous band, anomalous blood vessel The most commonly affected bronchus for the left upper lobe, right, middle, and upper right lobe

Tension pulmonary anomalycongenital lobar emphysema The large volume of the affected lobe of the lung with higher transparency Mediastinal shifting to the opposite side Útlak přilehléčásti plíce Compression of adjacent parts of the lungs

Tension pulmonary anomaly-congenital cystic adenomatoid malformation (CCAM) Hamartogenic proliferation of the terminal bronchi Cystoid appearance may vary according to the content of the sputum in the cysts Multicystic mass of lung tissue, with the proliferation of bronchial structures, communicates with the normal tracheobronchial tree and only rarely has the anomalous vascular supply 3 types I. even simple or multiple cysts, II. multiple small cysts, III. solid lesions without the presence of cysts Prenatal MRI/USG, can regress

Tension pulmonary anomaly-congenital cystic adenomatoid malformation (CCAM) Enlargement of the affected part of the lungs, with mediastinal shifting Cystic lucency According to the quantity of the sputum in the cysts and the event. inflammatory complications and shading

Pulmonary sequestration Usually in the basal parts of the lung on the left Cystic or solid Cystic and solid mass of lung tissue, which does not have the normal communication with the tracheobronchial tree and is supplied of an arterial blood by anomaly arteries from the thoracic and abdominal aorta Intralobar x extralobar X-ray, USG, CT, MRI

Pulmonary sequestration Recurrent pulmonary inflammation

Anomalous bronchial origine Without signs X narrowing of the bronchi Obstructive emphysema, hypoventilation, inflammatory changes The upper lobe CT x endoscopy

The current indications for pulmonary resection in children: -Congenital Defects- 123 patients (33%) CPS CD 1984-1990 1991-2000 2001-2010 Bronchogenic cyst Lobar emphysema 23 16 16 10 11 11 Pulmonary sequestration 4 8 11 CPAM 2 2 19

Congenital diaphragmatic herniation The anomaly of the diaphragm, usually to the left The defect in the membranous part The lung on the affected side is hypoplastic Poor gas content in the area of the abdomen www.branicni-kyla.cz

Newborn pneumopaty (pneumopaty of immature newborns) Wet lungs The respiratory distress syndrome (RDS), Hyaline Membrane Dissease Bronchopulmonary dysplasia

Wet lung Late foetal fluid removal from the lungs When larger quantities of fluid - White lung In healthy children, cleansing the lungs from fetal fluids (normalisation of X-ray) within 48 hours after birth Complications - lead to other pneumopathy, hyalin membrane dissease

Hyaline Membrane Dissease, respiratory distress syndrome, RDS Diseases of immature infants with a birth weight below 1700 g The lack of antiatelect. factorsurfactant 2.-3. day after birth Granular shadows to the periphery, negative bronchogram 3 degrees

Bronchopulmonary dysplasia 14 days after the artificial pulmonary ventilation

Pulmonary fibrosiscystic fibrosis (CF) (pulmonary changes) Obstructive changes emphysema, athelectasis Recurrent inflammation of the lungs In the later stages - pulmonary fibrosis Bronchiectasia, emphysema, pneumothorax HRCT the image of the Signet Ring sign, air trapping

Chest CF The lung parenchyma lung HRCT A boy of 10 years CF-progression of bronchiectasy Helikální acquisitions in inhale = volume pro 3R AX view 1mm ST incr. 15mm

Chest CF The lung parenchyma lung HRCT Klasické sekvenční 1mm scany (Inc. 10-20mm) NÁDECH Klasické sekvenční 1mm scany (Inc. 10-20mm) VÝDECH

Hrudník Plicní parenchym HRCT plic The first examination for CF: NÁDECH : Helical (Spi) VÝDECH : Sekvenčně Control examination for CF: NÁDECH : Sekvenčně VÝDECH : Sekvenčně

Aspirations, foreign body Pre-school age As a general rule, valveobstructive emphysema on the affected side Athelectasis just an exceptionally A cough can lead to pneumomediastinum

CT of the Lung in children: inflammation

CT of the Lung in Children: inflammationpulmonary wedge resection CPS in Motol Inflammatory diseases-65 patients (17%), chronic atelectasis, pulmonary abscess, gangrene, inflammatory pseudotumor, bronchiectasy 1984-1990 16 patients 1991-2000 13 patients 2001-2010 36 patients

CT examination of lungs in children: tumors Primary Lung Tumors Benign Karcinoid 6 Hamartoma 2 Adenoma 1 Neuroepitelioma 1 Fibrous histiocytoma 1 Invasive fibroblastic tumor 1 Malignant Pneumoblastoma 3 Rabdomyosarkoma 2 Adenokarcinoma 1 Mukoepidermoid karcinoma 1 m.hodgkin (the main bronchus) 1

CT examination of lungs in children: tumors

Pneumotorax