6 mos-3 yrs
Barky Cough
Steeple sign
Parainfluenza Virus
Barky Cough
Steeple sign
Parainfluenza Virus
Croup
3.5 yrs (also teens)
Stridor
Thumb Print Sign
Hæmophilus Influenzae
Next Step: PORTABLE XR
Trivia: asphyxiation from aryepiglotic folds
Stridor
Thumb Print Sign
Hæmophilus Influenzae
Next Step: PORTABLE XR
Trivia: asphyxiation from aryepiglotic folds
Epiglottitis
6-10 years
Linear soft tissue filling defect (membrane) in the airway
Next Step: CT. Check mediastinum
Staph Aureus
Linear soft tissue filling defect (membrane) in the airway
Next Step: CT. Check mediastinum
Staph Aureus
Exudative Tracheitis
6 mos-12 mos
Massive retropharyngeal soft tissue thickening
Be careful of pseudo thickening from oblique
Next Step: extension lateral XR
CT: Midline low density
CT fakeout: Suppurative node (just medial to carotid)
Massive retropharyngeal soft tissue thickening
Be careful of pseudo thickening from oblique
Next Step: extension lateral XR
CT: Midline low density
CT fakeout: Suppurative node (just medial to carotid)
Retropharyngeal Cellulitis and Abscess
Most common soft tissue mass in trachea
Unilateral (usually Left)
50% assoc w/ cutaneous hemangioma
7% have PHACES syndrome
Fakeout: croup: (let infectious hx guide)
Unilateral (usually Left)
50% assoc w/ cutaneous hemangioma
7% have PHACES syndrome
Fakeout: croup: (let infectious hx guide)
Subglottic Hemangioma
Croup vs Subglottic hemangioma
Symmetry (shouldering)
Infectious history
Symmetry (shouldering)
Infectious history
Frontal Peds Airway Radiograph
Epiglottitis
Retropharyngeal Abscess- Too wide >6mm @ C2 or >22mm =@C6 Next step CT
Tonsilitis- Not seen till 3-6 months too big when encroach airway
Exudative Tracheitis- Linear Filling Defect Staph
Retropharyngeal Abscess- Too wide >6mm @ C2 or >22mm =@C6 Next step CT
Tonsilitis- Not seen till 3-6 months too big when encroach airway
Exudative Tracheitis- Linear Filling Defect Staph
Lateral Peds Airway Radiograph
Post Term Delivery
Ropy Appearance of asymmetric lung densities
HypERinflation from air trapping
Atelectasis
20%-40% have PTX
Ropy Appearance of asymmetric lung densities
HypERinflation from air trapping
Atelectasis
20%-40% have PTX
Meconium Aspiration
C-Section (no vaginal squeeze)
DM mother or “Maternal Sedation”
Start 6hrs
Peak- 1 day
Finish- After 3days
Normal to increased volume
Coarse interstitial markings
Fluid in the fissures
DM mother or “Maternal Sedation”
Start 6hrs
Peak- 1 day
Finish- After 3days
Normal to increased volume
Coarse interstitial markings
Fluid in the fissures
TTN (Transient Tachypnea of the Newborn)
Premature
Most common cause of death in premies
Low volumes
Bilateral Granular opacities
NO PLEURAL EFFUSIONS
Most common cause of death in premies
Low volumes
Bilateral Granular opacities
NO PLEURAL EFFUSIONS
Surfactant-Deficient Disease
Hyaline Membrane Disease
RDS
Hyaline Membrane Disease
RDS
Improved lung volume
Granular opacities clear centrally
Increased risk of pulmonary hemorrhage
Increased risk of PDA
Fakeout- PIE (ventilation)
Granular opacities clear centrally
Increased risk of pulmonary hemorrhage
Increased risk of PDA
Fakeout- PIE (ventilation)
Surfactant Replacement Therapy
Patchy asymmetric perihylar
FULL TERM, but looks like Surfactant deficiency
FULL TERM, but looks like Surfactant deficiency
Neonatal PNA (not beta haem strep)
Most Common newborn PNA
Exiting Dirty Vag
More often premature
Exiting Dirty Vag
More often premature
LOW volume
Granular appearance (same as SDD)
YES EFFUSION
Beta Haemolytic Strep PNA
Meconium Aspiration
Buzzword: Post Term Baby
Trans Tachy Newborn
Buzzword: C-Section
Trans Tachy Newborn
Buzzword: Maternal Sedation
SDD/RDS/Hyaline membrane disease
Buzzword: Premature
SDD- NO EFFUSION
B-Haem Strep – Effusion
B-Haem Strep – Effusion
Buzzword: Granular opacity newborn
Meconium
TTN
Neonatal PNA (non beta)
TTN
Neonatal PNA (non beta)
Gamesmanship: High lung volume Newborn
FIRST WEEK
PEEP related alveolar injury
LINEAR LUCENCIES
warning for PTX
Treat by placing affected side down and change vent settings
Fakeout:
-Surfactant replacement
-Bronchopulmonary Dysplasia (over 2 weeks old)
PEEP related alveolar injury
LINEAR LUCENCIES
warning for PTX
Treat by placing affected side down and change vent settings
Fakeout:
-Surfactant replacement
-Bronchopulmonary Dysplasia (over 2 weeks old)
Pulmonary Interstitial Emphysema (PIE)
Premature
Long vent course
over 2 weeks old
BAND LIKE OPACITIES
hazy lungs turn into bubble lucencies
Long vent course
over 2 weeks old
BAND LIKE OPACITIES
hazy lungs turn into bubble lucencies
Bronchopulmonary Dysplasia (BPD)
PIE Pulmonary interstitial Emphysema
Buzzword: Linear Lucencies lung
BPD Bronchopulmonary Dysplasia
Buzzword: Band like opacities lung
Congenital
Primary- no real questions
Secondary:
1. Decreased hemithoracic volume
-diaphragmatic hernia
-Neuroblastoma
-sequestration
2. Decreased Vascular supply
3. Decreased fluid (potter’s sequence)
Primary- no real questions
Secondary:
1. Decreased hemithoracic volume
-diaphragmatic hernia
-Neuroblastoma
-sequestration
2. Decreased Vascular supply
3. Decreased fluid (potter’s sequence)
Pulmonary Hypoplasia
2 Flavors:
Intralobular- Common- 75%
Adult or adolescent RECURRENT PNA
LLL most common
Intralobular- Common- 75%
Adult or adolescent RECURRENT PNA
LLL most common
Extralobular Less common 25%
presents in INFANCY with respiratory compromise
associated congenital cystic adenomatoid malformation
congenital diaphragmatic hernia
vertebral anomalies
congenital heart disease
Pulmonary hypOplasia
Rarely infected
Rarely-patent channel to stomach or esophagus
Bronchopulmonary sequestration
INTRALOBULAR Bronchopulmonary sequestiration
Gamesmanship: Recurrent PNA same place Adolescent-adult
Surfactant Deficiency Disease – NO EFFUSION
Beta Hæm Strep PNA – EFFUSION
Beta Hæm Strep PNA – EFFUSION
Gamesmanship: Low lung volume Newborn
Typically incidental
Solitary and unilocular
NO AIRWAY COMMUNICATION
– worry about infection if there is gas
Solitary and unilocular
NO AIRWAY COMMUNICATION
– worry about infection if there is gas
Bronchogenic Cysts
Decrease in 3rd trimester
No lobar preference
Airway communication
Tx: USA cut them out
Small risk of pleuropulmonary blastoma, rhabdomyosarcoma
If there’s an arterial feeder FAKEOUT sequestration
No lobar preference
Airway communication
Tx: USA cut them out
Small risk of pleuropulmonary blastoma, rhabdomyosarcoma
If there’s an arterial feeder FAKEOUT sequestration
Congenital Cystic Adenomatoid Malformation
CCAM
CCAM
Newborn Lucent hyper inflated lobe
LUL 40%
Lobectomy
LUL 40%
Lobectomy
CXR series:
Lobar opacity slow to clear
Eventually clears
Lucency lobar tension PTX
Congenital Lobar Emphysema
CLE
CLE
Most Common Bochdalek
B-BACK Posterior and left
IF on right- GBS PNA
Mortality rate related to degree of pulm HypOplasia
Most have congenital heart disease
Almost all are malrotated
B-BACK Posterior and left
IF on right- GBS PNA
Mortality rate related to degree of pulm HypOplasia
Most have congenital heart disease
Almost all are malrotated
Congenital Diaphragmatic Hernia
Congenital Diaphragmatic Hernia
Gamesmanship: NG curving into chest
Congenital Lobar emphysema
also Congenial cystic adenomatiod malformation can be anywhere
Gamesmanship: LUL lucent lesion peds DDX
Sequestration first
Congenital diaphragmatic hernia second
Gamesmanship: LLL lucent lesion Peds DDX
B. Extralobar Sequestration
Newborn, LLL and congenital heart disease:
A. Intralob Sequestration
B. Extralob Sequestration
C. Congenital Lobar Emphysema
A. Intralob Sequestration
B. Extralob Sequestration
C. Congenital Lobar Emphysema