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
The road to HRCT evaluation of
Dr/Ahmed Bahnassy
Consultant Radiologist
Riyadh Military Hospital
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)
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
Causes of ILD
Between Adults and ChILD
NSIP
ILD
DIP
LIP
Neuroendocrine cell hyperplasia of infancy (NEHI)
Ground Glass opacity primarily affecting the middle and lingular lobes
NEHI
• Another typical example of right middle lobe ,and left lingular GGO.
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
Nonspecific interstitial pneumonitis
Bilateral scattered middle zonal GGOBi basilar consolidations.Bronchial dilatation.
HRCT shows a mosaicperfusion pattern and multiple bilateral linear densities
PIG..Pulmonary interstitial Glycogenosis
• GGO
• Interlobular septal thickening.
• Reticular changes.
• Posterior cysts.
BOOP• Diffuse
nodules.
• Mild intralobular septal thickening.
• Patchy GGO.
Hypersensitivity pneumonitis
• Ground Glass and nodular like opacities in lung bases.
Eosinophilic pneumonia
• Reversed Halo sign
• Right peripheral mid-zonal GGO
Pulmonary alveolar proteinosis
• GGO
• +
• Interlobular septal thickening
• =
• Crazy-paving pattern.
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
Parenchymal bands in BPD
Bronchial asthma
Normal
Expiratory scan revealed severeAir trapping
Hemosiderosis
ground-glass attenuation due to pulmonary hemorrhage
Langerhans cell histiocytosis
thick- and thin-walled cysts;few micronodules also seen
pulmonary cystic lesions, some located subpleurally, andbilateral pneumothoraces
Bizarre shaped
Lympngiomatosis
Prominent diffuse smooth septal thickening, bronchovascularbundles and ground-glass attenuation
Consider vascular/lymphatic cause
Lesson learned
Most HRCT features are non-specific,
but when related to the clinical findings, they can suggest the proper diagnosis and obviate biopsy.
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.