Pneumonia in children including SARS Winnie Chu The Chinese University of Hong Kong Department of...
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Transcript of Pneumonia in children including SARS Winnie Chu The Chinese University of Hong Kong Department of...
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• Confirmation/ exclusion
• Underlying cause when failure to resolve or
recur
• Acute complications
• Chronic sequelae
• Characterization and prediction of
infectious agent
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• Developmental lung masses
• sequestration
• bronchogenic cyst
• cystic adenomatoid malformation
• reflux, aspiration, systemic disorders
Acute complications• Parapneumonic effusion
• cavitary necrosis
• empyema
• lung abscess
• pneumothorax
• purulent pericarditis
Chronic sequelae• Parenchymal scarring
• bronchial wall thickening
• bronchiectasis
• bronchiolitis obliterans
• Swyer-James syndrome
Presenting symptoms of SARS children
0
20
40
60
80
100
120
feve
r
coug
h
mya
lgia
chills
/ rigo
r
runn
y nos
e
dysp
noea
sore
thro
at
head
ache
dizzin
ess
mala
ise
febr
ile co
nvuls
ion
Per
cen
tag
e
Radiological change• Worst CXR appearance
Mean, SD RangeChild 5.5 +/- 1.6 4-8 daysTeenager 7+/- 3.3 3-12 days
Radiological changes• Complete resolution of CXR
Mean, SD RangeChild 13.8 +/- 4.6 9 -22 daysTeenager 17.4 +/- 7.7 8-30 days
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
i. Ribavirin i.v.ii. Hydrocortisone i.v./ prednisolone p.o.iii. Cefotaxime i.v.iv. Clarithromycin p.o.
Suspected paediatric SARS
Mild symptomsModerately severe symptoms
+High swinging fever
i. Cefotaxime i.v.ii. Clarithromycin i.v.iii. Ribavarin i.v.
No improvement Persistent fever,Clinical deterioration
+ Prednisolone p.o. + Pulse Methylprednisolone i.v.
No improvement
+ Pulse Methylprednisolone i.v.
Conclusion• Young children develop a milder form of
the disease with a less aggressive
clinical course and milder radiological
changes
Conclusion• Teenagers may simulate adult pattern,
presenting with a more severe clinical
disease and bizzare radiological finding