charlotte de lange,md,phd pediatric radiology unit, oslo...
TRANSCRIPT
![Page 1: Charlotte de Lange,MD,PhD Pediatric Radiology unit, Oslo ...h24-files.s3.amazonaws.com/110213/692953-cvqpg.pdf · Pediatric Radiology unit, Oslo University Hospital, Norway 5th Nordic](https://reader030.vdocuments.us/reader030/viewer/2022040221/5e39b4b143b3c316d472645e/html5/thumbnails/1.jpg)
Lung- and airway emergencies
Charlotte de Lange,MD,PhD
Pediatric Radiology unit,
Oslo University Hospital, Norway
5th Nordic course - Emergency Radiology
Oslo 18-21.5.2015 [email protected]
![Page 2: Charlotte de Lange,MD,PhD Pediatric Radiology unit, Oslo ...h24-files.s3.amazonaws.com/110213/692953-cvqpg.pdf · Pediatric Radiology unit, Oslo University Hospital, Norway 5th Nordic](https://reader030.vdocuments.us/reader030/viewer/2022040221/5e39b4b143b3c316d472645e/html5/thumbnails/2.jpg)
How come pediatric lung/airway
emergencies are so important
and demand rapid treatment?
www.consultant360.com
More acute emergencies than adults!
![Page 3: Charlotte de Lange,MD,PhD Pediatric Radiology unit, Oslo ...h24-files.s3.amazonaws.com/110213/692953-cvqpg.pdf · Pediatric Radiology unit, Oslo University Hospital, Norway 5th Nordic](https://reader030.vdocuments.us/reader030/viewer/2022040221/5e39b4b143b3c316d472645e/html5/thumbnails/3.jpg)
Physiology, anatomy and pathology
specific for children
Smaller, flexible airways
collateral ventilation
Large tongue
Increased metabolic rate
Rapid hemodynamic/ respiratory decompensation!
75%
44%
![Page 4: Charlotte de Lange,MD,PhD Pediatric Radiology unit, Oslo ...h24-files.s3.amazonaws.com/110213/692953-cvqpg.pdf · Pediatric Radiology unit, Oslo University Hospital, Norway 5th Nordic](https://reader030.vdocuments.us/reader030/viewer/2022040221/5e39b4b143b3c316d472645e/html5/thumbnails/4.jpg)
Airway emergencies
Upper
Lower
Traumatic
Non-traumatic
Non-traumatic
lung and lower airway emergencies
![Page 5: Charlotte de Lange,MD,PhD Pediatric Radiology unit, Oslo ...h24-files.s3.amazonaws.com/110213/692953-cvqpg.pdf · Pediatric Radiology unit, Oslo University Hospital, Norway 5th Nordic](https://reader030.vdocuments.us/reader030/viewer/2022040221/5e39b4b143b3c316d472645e/html5/thumbnails/5.jpg)
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
Neuro-
blastoma
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
![Page 6: Charlotte de Lange,MD,PhD Pediatric Radiology unit, Oslo ...h24-files.s3.amazonaws.com/110213/692953-cvqpg.pdf · Pediatric Radiology unit, Oslo University Hospital, Norway 5th Nordic](https://reader030.vdocuments.us/reader030/viewer/2022040221/5e39b4b143b3c316d472645e/html5/thumbnails/6.jpg)
Clinical presentation
Stridor, cough
Wheezing
Swallowing difficulty
Respiratory distress
Tachypnea
Nasal flaring
Intercostal retractions
Hemoptysis
Failure to thrive
Fever, pain, sepsis
or
Asymptomatic!!
![Page 7: Charlotte de Lange,MD,PhD Pediatric Radiology unit, Oslo ...h24-files.s3.amazonaws.com/110213/692953-cvqpg.pdf · Pediatric Radiology unit, Oslo University Hospital, Norway 5th Nordic](https://reader030.vdocuments.us/reader030/viewer/2022040221/5e39b4b143b3c316d472645e/html5/thumbnails/7.jpg)
Chest x-ray
Ultrasonography
Computed tomography(CT)
CT/HRCT, MDCT, CTA
Magnetic resonance imaging (MRI), MRA
(PET-CT, Scintigraphy)
ALARA principle (As Low As Reasonably Acheiveable)
Imaging
en.wikipedia.org
![Page 8: Charlotte de Lange,MD,PhD Pediatric Radiology unit, Oslo ...h24-files.s3.amazonaws.com/110213/692953-cvqpg.pdf · Pediatric Radiology unit, Oslo University Hospital, Norway 5th Nordic](https://reader030.vdocuments.us/reader030/viewer/2022040221/5e39b4b143b3c316d472645e/html5/thumbnails/8.jpg)
cough
at night / with exercise
wheezing
~10-20% chest pain
Chest x-ray if complications are suspected
(air leaks/ infection)
Asthma
![Page 9: Charlotte de Lange,MD,PhD Pediatric Radiology unit, Oslo ...h24-files.s3.amazonaws.com/110213/692953-cvqpg.pdf · Pediatric Radiology unit, Oslo University Hospital, Norway 5th Nordic](https://reader030.vdocuments.us/reader030/viewer/2022040221/5e39b4b143b3c316d472645e/html5/thumbnails/9.jpg)
Pulmonary infection and
complications
Virus > Bacteriae
(airways) (alveoli)
NB! Overlapping imaging findings
![Page 10: Charlotte de Lange,MD,PhD Pediatric Radiology unit, Oslo ...h24-files.s3.amazonaws.com/110213/692953-cvqpg.pdf · Pediatric Radiology unit, Oslo University Hospital, Norway 5th Nordic](https://reader030.vdocuments.us/reader030/viewer/2022040221/5e39b4b143b3c316d472645e/html5/thumbnails/10.jpg)
Girl 3 y Boy 4 y
Viral infection Bacterial lobar pneumonia
30% of viral infections – normal x-ray findings (Durand et al 2005)
![Page 11: Charlotte de Lange,MD,PhD Pediatric Radiology unit, Oslo ...h24-files.s3.amazonaws.com/110213/692953-cvqpg.pdf · Pediatric Radiology unit, Oslo University Hospital, Norway 5th Nordic](https://reader030.vdocuments.us/reader030/viewer/2022040221/5e39b4b143b3c316d472645e/html5/thumbnails/11.jpg)
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)
![Page 12: Charlotte de Lange,MD,PhD Pediatric Radiology unit, Oslo ...h24-files.s3.amazonaws.com/110213/692953-cvqpg.pdf · Pediatric Radiology unit, Oslo University Hospital, Norway 5th Nordic](https://reader030.vdocuments.us/reader030/viewer/2022040221/5e39b4b143b3c316d472645e/html5/thumbnails/12.jpg)
Boy 13 y - ALL treatment with Asparginase,
central venous line - slight chest pain
CE CTUS w doppler
Pulmonary thrombo embolismBabyn P , Pediatr Radiol 2005 - PTE in children
Uderzo C Jclin Oncol 1995 - 2.9% of ALL pat develpped PTE
Goldenberg NA,NEJM 2005 - Predictors for outcome of ped. PTE
Victoria T Pediatr Radiol 2009- Evaluation for PTE in children with clinical suspicon
![Page 13: Charlotte de Lange,MD,PhD Pediatric Radiology unit, Oslo ...h24-files.s3.amazonaws.com/110213/692953-cvqpg.pdf · Pediatric Radiology unit, Oslo University Hospital, Norway 5th Nordic](https://reader030.vdocuments.us/reader030/viewer/2022040221/5e39b4b143b3c316d472645e/html5/thumbnails/13.jpg)
Air leaks
![Page 14: Charlotte de Lange,MD,PhD Pediatric Radiology unit, Oslo ...h24-files.s3.amazonaws.com/110213/692953-cvqpg.pdf · Pediatric Radiology unit, Oslo University Hospital, Norway 5th Nordic](https://reader030.vdocuments.us/reader030/viewer/2022040221/5e39b4b143b3c316d472645e/html5/thumbnails/14.jpg)
Pneumothorax-
neonates and ...
![Page 15: Charlotte de Lange,MD,PhD Pediatric Radiology unit, Oslo ...h24-files.s3.amazonaws.com/110213/692953-cvqpg.pdf · Pediatric Radiology unit, Oslo University Hospital, Norway 5th Nordic](https://reader030.vdocuments.us/reader030/viewer/2022040221/5e39b4b143b3c316d472645e/html5/thumbnails/15.jpg)
Adolescents
Pneumothorax/ pneumomediastinum/
subcutaneous emphysema
Chest x-ray, US
(expiratory AP views)
CT only in selected cases!
![Page 16: Charlotte de Lange,MD,PhD Pediatric Radiology unit, Oslo ...h24-files.s3.amazonaws.com/110213/692953-cvqpg.pdf · Pediatric Radiology unit, Oslo University Hospital, Norway 5th Nordic](https://reader030.vdocuments.us/reader030/viewer/2022040221/5e39b4b143b3c316d472645e/html5/thumbnails/16.jpg)
Masses
Vascular malformations
Fibromatosis
Lymphoma/leukemia
Neuroblastoma
Teratoma
![Page 17: Charlotte de Lange,MD,PhD Pediatric Radiology unit, Oslo ...h24-files.s3.amazonaws.com/110213/692953-cvqpg.pdf · Pediatric Radiology unit, Oslo University Hospital, Norway 5th Nordic](https://reader030.vdocuments.us/reader030/viewer/2022040221/5e39b4b143b3c316d472645e/html5/thumbnails/17.jpg)
Vascular malformations Boy 8 months - rapidly growing tumor in the axilla
Lymphatic
malformation
CT
Cor
MRI Ax -STIR
![Page 18: Charlotte de Lange,MD,PhD Pediatric Radiology unit, Oslo ...h24-files.s3.amazonaws.com/110213/692953-cvqpg.pdf · Pediatric Radiology unit, Oslo University Hospital, Norway 5th Nordic](https://reader030.vdocuments.us/reader030/viewer/2022040221/5e39b4b143b3c316d472645e/html5/thumbnails/18.jpg)
Boy 8 y – Previous asthma - chest pain
with increasing respiratory distress
![Page 19: Charlotte de Lange,MD,PhD Pediatric Radiology unit, Oslo ...h24-files.s3.amazonaws.com/110213/692953-cvqpg.pdf · Pediatric Radiology unit, Oslo University Hospital, Norway 5th Nordic](https://reader030.vdocuments.us/reader030/viewer/2022040221/5e39b4b143b3c316d472645e/html5/thumbnails/19.jpg)
Chest CT = acute imaging of airways
T cell lymphoma/ leukemia
Acute fatal outcome!
![Page 20: Charlotte de Lange,MD,PhD Pediatric Radiology unit, Oslo ...h24-files.s3.amazonaws.com/110213/692953-cvqpg.pdf · Pediatric Radiology unit, Oslo University Hospital, Norway 5th Nordic](https://reader030.vdocuments.us/reader030/viewer/2022040221/5e39b4b143b3c316d472645e/html5/thumbnails/20.jpg)
Congenital anomalies
Heart
Lung
Vascular
Tracheobronchial
![Page 21: Charlotte de Lange,MD,PhD Pediatric Radiology unit, Oslo ...h24-files.s3.amazonaws.com/110213/692953-cvqpg.pdf · Pediatric Radiology unit, Oslo University Hospital, Norway 5th Nordic](https://reader030.vdocuments.us/reader030/viewer/2022040221/5e39b4b143b3c316d472645e/html5/thumbnails/21.jpg)
Vascular ringschest x-ray
upper GI series
CTA/ MRA
Boy 6 months - stridor
Double aortic arch
![Page 22: Charlotte de Lange,MD,PhD Pediatric Radiology unit, Oslo ...h24-files.s3.amazonaws.com/110213/692953-cvqpg.pdf · Pediatric Radiology unit, Oslo University Hospital, Norway 5th Nordic](https://reader030.vdocuments.us/reader030/viewer/2022040221/5e39b4b143b3c316d472645e/html5/thumbnails/22.jpg)
“Always look at the airways”
Boy 1 y - Viral inf. with severe breathing problems
Tracheal deviation? Tracheo-bronchomalacia?
![Page 23: Charlotte de Lange,MD,PhD Pediatric Radiology unit, Oslo ...h24-files.s3.amazonaws.com/110213/692953-cvqpg.pdf · Pediatric Radiology unit, Oslo University Hospital, Norway 5th Nordic](https://reader030.vdocuments.us/reader030/viewer/2022040221/5e39b4b143b3c316d472645e/html5/thumbnails/23.jpg)
Bronchography/
CT – VR 3DTracheal bronchus with
stenosis and malacia
![Page 24: Charlotte de Lange,MD,PhD Pediatric Radiology unit, Oslo ...h24-files.s3.amazonaws.com/110213/692953-cvqpg.pdf · Pediatric Radiology unit, Oslo University Hospital, Norway 5th Nordic](https://reader030.vdocuments.us/reader030/viewer/2022040221/5e39b4b143b3c316d472645e/html5/thumbnails/24.jpg)
Foreign body aspiration airway/oesophagus etc
![Page 25: Charlotte de Lange,MD,PhD Pediatric Radiology unit, Oslo ...h24-files.s3.amazonaws.com/110213/692953-cvqpg.pdf · Pediatric Radiology unit, Oslo University Hospital, Norway 5th Nordic](https://reader030.vdocuments.us/reader030/viewer/2022040221/5e39b4b143b3c316d472645e/html5/thumbnails/25.jpg)
Foreign body aspirationGirl 2 y -
cough/ wheezing last 2 weeks
Chest x-ray + fluoroscopy
Medistinal shift
Airtrapping of the ipsilateral side
Diaphragmatic restricted motion
Bronchoscopy - diagnosis/treatm.
![Page 26: Charlotte de Lange,MD,PhD Pediatric Radiology unit, Oslo ...h24-files.s3.amazonaws.com/110213/692953-cvqpg.pdf · Pediatric Radiology unit, Oslo University Hospital, Norway 5th Nordic](https://reader030.vdocuments.us/reader030/viewer/2022040221/5e39b4b143b3c316d472645e/html5/thumbnails/26.jpg)
Girl 3 y. Cough for 9 mths
before first x-ray
Corpus alienum
![Page 27: Charlotte de Lange,MD,PhD Pediatric Radiology unit, Oslo ...h24-files.s3.amazonaws.com/110213/692953-cvqpg.pdf · Pediatric Radiology unit, Oslo University Hospital, Norway 5th Nordic](https://reader030.vdocuments.us/reader030/viewer/2022040221/5e39b4b143b3c316d472645e/html5/thumbnails/27.jpg)
![Page 28: Charlotte de Lange,MD,PhD Pediatric Radiology unit, Oslo ...h24-files.s3.amazonaws.com/110213/692953-cvqpg.pdf · Pediatric Radiology unit, Oslo University Hospital, Norway 5th Nordic](https://reader030.vdocuments.us/reader030/viewer/2022040221/5e39b4b143b3c316d472645e/html5/thumbnails/28.jpg)
![Page 29: Charlotte de Lange,MD,PhD Pediatric Radiology unit, Oslo ...h24-files.s3.amazonaws.com/110213/692953-cvqpg.pdf · Pediatric Radiology unit, Oslo University Hospital, Norway 5th Nordic](https://reader030.vdocuments.us/reader030/viewer/2022040221/5e39b4b143b3c316d472645e/html5/thumbnails/29.jpg)
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”