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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

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 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
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
slide14
Upper zone

Middle zone

Lower zone

Upper & lower

Zonal distribution of air-space

opacification

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
slide20
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
ad