Pneumonia in children including sars
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Pneumonia in children including SARS. Winnie Chu. The Chinese University of Hong Kong Department of Diagnostic Radiology and Organ Imaging Prince of Wales Hospital. Role of imaging of pulmonary infection in children. Role of imaging in pneumonia. Confirmation/ exclusion

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Pneumonia in children including SARS

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Pneumonia in children including sars

Pneumonia in children including SARS

Winnie Chu

The Chinese University of Hong Kong

Department of Diagnostic Radiology and Organ Imaging

Prince of Wales Hospital


Role of imaging of pulmonary infection in children

Role of imaging of pulmonary infection in children


Role of imaging in pneumonia

Role of imaging in pneumonia

  • Confirmation/ exclusion

  • Underlying cause when failure to resolve or recur

  • Acute complications

  • Chronic sequelae

  • Characterization and prediction of infectious agent


Follow up cxr

Follow up CXR

  • Not a routine

  • Post-obstructive pneumonia secondary to CA is not a concern

  • reserved for:

    • persistent symptoms

    • recurrent symptoms

    • immunodeficiency


Persistent recurrent pneumonia

Persistent/ recurrent pneumonia

  • Developmental lung masses

    • sequestration

    • bronchogenic cyst

    • cystic adenomatoid malformation

  • reflux, aspiration, systemic disorders


  • Acute complications

    Acute complications

    • Parapneumonic effusion

    • cavitary necrosis

    • empyema

    • lung abscess

    • pneumothorax

    • purulent pericarditis


    Guiding management

    Guiding management

    • Placement of chest tubes

    • loculated collection


    Chronic sequelae

    Chronic sequelae

    • Parenchymal scarring

    • bronchial wall thickening

    • bronchiectasis

    • bronchiolitis obliterans

    • Swyer-James syndrome


    Typical pneumonia

    Typical pneumonia


    Sars severe acute respiratory syndrome

    SARSSevere Acute Respiratory Syndrome


    Risk in children

    Risk in children

    • household contact

    • healthcare setting contact


    Presenting symptoms of sars children

    120

    100

    80

    60

    Percentage

    40

    20

    0

    fever

    cough

    malaise

    myalgia

    headache

    dizziness

    dyspnoea

    sorethroat

    runny nose

    chills/ rigor

    febrile convulsion

    Presenting symptoms of SARS children


    Pneumonia in children including sars

    Upper zone

    Middle zone

    Lower zone

    Upper & lower

    Zonal distribution of air-space

    opacification


    Distribution of air space opacification on cxr

    focal

    multi-focal

    bilateral

    Distribution of air-space opacification on CXR


    Radiological change

    Radiological change

    • Worst CXR appearance


    Radiological changes

    Radiological changes

    • Complete resolution of CXR


    Role of hrct in sars

    Role of HRCT in SARS

    • Aid diagnosis in children with strong clinical suspicion of SARS but non-contributory CXR

    • Assessment of treatment response in prolonged course of the disease


    Pneumonia in children including sars

    Suspected paediatric SARS

    Moderately severe symptoms

    +

    High swinging fever

    Mild symptoms

    • Ribavirin i.v.

    • Hydrocortisone i.v./ prednisolone p.o.

    • Cefotaxime i.v.

    • Clarithromycin p.o.

    • Cefotaxime i.v.

    • Clarithromycin i.v.

    • Ribavarin i.v.

    Persistent fever,

    Clinical deterioration

    No improvement

    + Pulse Methylprednisolone i.v.

    + Prednisolone p.o.

    No improvement

    + Pulse Methylprednisolone i.v.


    Outcome

    Outcome

    • Discharge: 16

    • Observation: 1

    • Mortality : 0


    Conclusion

    Conclusion

    • Young children develop a milder form of the disease with a less aggressive clinical course and milder radiological changes


    Conclusion1

    Conclusion

    • Teenagers may simulate adult pattern, presenting with a more severe clinical disease and bizzare radiological finding


    Thank you

    THANK YOU


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