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PNEUMONIA IN PNEUMONIA IN CHILDRENCHILDREN

PNEUMONIA IN PNEUMONIA IN CHILDRENCHILDREN

Neonatal Neonatal Community acquiredCommunity acquired

ViralViralB t i lB t i lBacterialBacterialMycoplasmaMycoplasma

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N t lN t lNeonatal Neonatal pneumoniapneumonia

Neonatal pneumoniaNeonatal pneumonia

I f ti i fi t 4 k f lifI f ti i fi t 4 k f lifInfections in first 4 weeks of lifeInfections in first 4 weeks of lifeOften acquired from mother Often acquired from mother (transplacental or postamnionitis)(transplacental or postamnionitis)Frequently associated with sepsisFrequently associated with sepsisSi ifi t bidit & t litSi ifi t bidit & t litSignificant morbidity & mortalitySignificant morbidity & mortality

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Neonatal pneumoniaNeonatal pneumonia

BacterialBacterialBacterialBacterialGroup B Strep most commonGroup B Strep most commonOthers include Staph aureus & E coli, Others include Staph aureus & E coli, H flu, Listeria speciesH flu, Listeria species

ViralViralAdenovirus, influenza, parainfluenza, Adenovirus, influenza, parainfluenza, CMV, HSVCMV, HSV

Neonatal bacterial Neonatal bacterial pneumoniapneumonia

Intralobar fissures incompletely formedIntralobar fissures incompletely formedMultilobar consolidation or diffuse air Multilobar consolidation or diffuse air space diseasespace diseaseEarly lower lobe > upper lobeEarly lower lobe > upper lobeSolitary lobar consolidation uncommonSolitary lobar consolidation uncommon

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Neonatal bacterial Neonatal bacterial pneumoniapneumonia

Diffuse ground glass opacitiesDiffuse ground glass opacitiesMimics surfactant deficiency disease Mimics surfactant deficiency disease or pulmonary edemaor pulmonary edemaPneumonia/Sepsis r/o on all Pneumonia/Sepsis r/o on all newborns with respiratory distressnewborns with respiratory distress

C it i dC it i dCommunity acquired Community acquired pneumoniapneumonia

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Community Acquired Community Acquired PneumoniaPneumonia

Ability to differentiate viral from Ability to differentiate viral from bacterial debatablebacterial debatableBoth agents may coBoth agents may co--existexistMycoplasma can mimic bothMycoplasma can mimic bothE i l i f id ifi dE i l i f id ifi dEtiologic agent often not identifiedEtiologic agent often not identifiedGold standard often lackingGold standard often lacking

Community Acquired Community Acquired PneumoniaPneumonia

RadiographyRadiographyPrimary imaging examPrimary imaging examHigher predictive valueHigher predictive value

PA & LateralPA & LateralFull inspirationFull inspirationNo existing lung diseaseNo existing lung disease

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ViralViralViral Viral PneumoniaPneumonia

Viral PneumoniaViral Pneumonia

Most common agentMost common agentMost common agentMost common agentRSV most common organismRSV most common organismPrimarily < 5 yearsPrimarily < 5 yearsInflammation of respiratory mucosaInflammation of respiratory mucosaC t l b hi l & ib hi l dC t l b hi l & ib hi l dCentral bronchial & peribronchial edemaCentral bronchial & peribronchial edema

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Viral PneumoniaViral Pneumonia

R di hi fi diR di hi fi diRadiographic findingsRadiographic findingsParahilar, peribronchial opacitiesParahilar, peribronchial opacitiesHyperinflationHyperinflationAtelectasisAtelectasis

Parahilar opacitiesParahilar opacities

S t i lS t i lSymmetricalSymmetricalLinearLinearRadiate out from Radiate out from hilumhilum

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AtelectasisAtelectasis

Present in >50%Present in >50%SubsegmentalSubsegmental

Wedged shapedWedged shapedLinearLinearLL > ULLL > ULLL > ULLL > UL

HyperinflationHyperinflation

Flattened diaphragmFlattened diaphragmLateral > FrontalLateral > Frontal

Diaphragm below Diaphragm below 1010thth posterior ribposterior rib

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BronchiolitisBronchiolitis<6 months of age<6 months of ageGreater difficulty breathing due to Greater difficulty breathing due to smaller airwayssmaller airwaysWheezing, coughing, tachypneaWheezing, coughing, tachypneaSevere cases may require Severe cases may require hospitalizationhospitalization

Fatigue, cyanosis, respiratory failureFatigue, cyanosis, respiratory failure

BacterialBacterialBacterial Bacterial PneumoniaPneumonia

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Bacterial pneumoniaBacterial pneumonia

Inhalation of organisms into airspacesInhalation of organisms into airspacesInhalation of organisms into airspacesInhalation of organisms into airspacesDevelopment of alveolar exudate & edemaDevelopment of alveolar exudate & edemaMost common in preMost common in pre--school age childrenschool age childrenStrep pneumo, StaphStrep pneumo, Staph & & H. fluH. flu commoncommon

Bacterial pneumoniaBacterial pneumonia

RadiographyRadiographyRadiographyRadiographyLobar or segmental Lobar or segmental consolidationconsolidationSilhouette signSilhouette signAir bronchogramsAir bronchogramsPleural effusionPleural effusion

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Multilobar Multilobar PneumoniaPneumonia

>> 2 lobes2 lobesIncreased Increased morbidity & morbidity & prolonged prolonged coursecourse

Round PneumoniaRound PneumoniaYounger children (< 8 y)Younger children (< 8 y)g ( y)g ( y)

Lack well developed system of Lack well developed system of collateral ventilationcollateral ventilation

Early (1Early (1stst 1212--24 hours)24 hours)Alveolar exudate does not Alveolar exudate does not spread as quicklyspread as quicklyspread as quickly spread as quickly

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Bacterial pneumoniaBacterial pneumoniaComplicationsComplications

Parapneumonic effusionParapneumonic effusionEmpyemaEmpyemaLung necrosisLung necrosis

Parapneumonic effusionParapneumonic effusionCommonCommonTreatment Treatment optionsoptions

AntibioticsAntibioticsThoracentesisThoracentesisChest tube Chest tube FibrinolysisFibrinolysisVATSVATS

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Fluid vs EmpyemaFluid vs EmpyemaCT characteristics do not differentiateCT characteristics do not differentiateSimilar prevalence of Similar prevalence of pleural pleural enhancement, parietal pleural thickening, enhancement, parietal pleural thickening, extrapleural subcostal soft tissue extrapleural subcostal soft tissue thickeningthickening

D ll AJR 1997 169 179D ll AJR 1997 169 179 182182Donnelly. AJR 1997;169:179Donnelly. AJR 1997;169:179--182182

Bacterial pneumoniaBacterial pneumoniaRole of CTRole of CT

E l t h l li tiE l t h l li tiEvaluate parenchymal complicationsEvaluate parenchymal complicationsCavitary necrosis Cavitary necrosis Bronchopleural fistulaBronchopleural fistula

Define pleural complicationsDefine pleural complicationsPleural effusionPleural effusionPleural effusionPleural effusionEmpyemaEmpyema

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Cavitary necrosisCavitary necrosisAlso called necrotizing pneumoniaAlso called necrotizing pneumoniag pg pMost common w/ Most common w/ Strep pneumoniaStrep pneumoniaDecreased parenchymal enhancementDecreased parenchymal enhancementAir or fluid filled thinAir or fluid filled thin--walled cavitieswalled cavitiesFavorable outcome w/ medical mgmtFavorable outcome w/ medical mgmta o ab e ou co e / ed ca ga o ab e ou co e / ed ca g

Bacterial pneumoniaBacterial pneumoniaRole of USRole of US

Identify presence of pleural fluidIdentify presence of pleural fluidQuantify amount of pleural fluidQuantify amount of pleural fluidCharacterize appearance of fluidCharacterize appearance of fluid

Anechoic vs echogenic material, internal Anechoic vs echogenic material, internal echoes septationsechoes septationsechoes, septationsechoes, septations

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Low vs High Grade EffusionsLow vs High Grade Effusions

Low grade Low grade –– anechoic fluidanechoic fluidHigh grade High grade –– echogenic material, septationsechogenic material, septationsHospital stay reduced by 50% with surgical Hospital stay reduced by 50% with surgical intervention in high grade effusionsintervention in high grade effusionsLength of hospital stay not affected with surgical Length of hospital stay not affected with surgical intervention in low grade effusionsintervention in low grade effusionsintervention in low grade effusionsintervention in low grade effusions

Ramnath. Pediatrics 1998;101:68Ramnath. Pediatrics 1998;101:68

Mycoplasma pneumoniaMycoplasma pneumoniaUncommon < 5 yearsUncommon < 5 yearsyy30% of pneumonia in school age children30% of pneumonia in school age childrenInitial upper respiratory symptoms Initial upper respiratory symptoms progress to tracheobronchitisprogress to tracheobronchitisInflammation of respiratory mucosaInflammation of respiratory mucosaInflammation may extend to interstitiumInflammation may extend to interstitium

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Mycoplasma pneumoniaMycoplasma pneumoniaRadiographyRadiography

Parahilar peribronchial opacitiesParahilar peribronchial opacitiesLobar or segmental consolidationLobar or segmental consolidationFocal > diffuse reticular opacitiesFocal > diffuse reticular opacitiesAtelectasisAtelectasisPleural effusionsPleural effusionsPleural effusionsPleural effusionsLymphadenopathyLymphadenopathy

PNEUMONIA INPNEUMONIA INPNEUMONIA IN PNEUMONIA IN CHILDRENCHILDREN