Learning objectives
Pulmonary infectious diseases in immunocompromised children are caused by many etiological agents but the radiological manifestations are quite similar to each other.
Aim of this educational exhibit is to describe main radiological features of pulmonary infections encountered in a population of immunocompromised pediatric patients.
Background
Pneumonia is an infection of the lower respiratory tract.
The annual incidence of pneumonia in children younger than 5 years is about 34 to 40 cases per 1000,
and decreases to 7 cases per 1000 in adolescents 12 to 15 years of age [1] [2].
Childhood mortality from pneumonia in developed countries is low,
instead pneumonia represents the main cause of childhood mortality in developing countries [3].
However,
mortality from respiratory infections increases in immunocompromised pediatric patients.
In a paper by Zenginet al,
infections were...
Findings and procedure details
1.
Fungal infections
1.1.
Aspergillus fumigatus
The chest radiographic findings of diffuse infiltrates in children is different from those of adults and bilateral involvement and respiratory insufficiency are negative prognostic factors [8] [Fig. 1 - Fig. 2].
In invasive pulmonary aspergillosis there are many radiological findings including round pneumonic infiltrates,
peripheral wedge-shaped opacity and the characteristic “halo sign” around pneumonic infiltrates [9] [Fig. 3 - Fig. 4 - Fig. 5 - Fig. 6].
The “halo sign” is a zone of ground-glass opacity surrounding nodules or...
Conclusion
In immunocompromised children,
chest radiography could be limited in diagnostic accuracy.
A CT examination is often required in order to demonstrate the presence of parenchymal inflammatory disease.
Although radiological findings are similar for each etiological agent,
combining anamnesis and clinical features with various radiologic patterns could be important to reaching a correct diagnosis.
Some CT features - such as cavitation,
halo sign,
reverse halo sign and crazy paving - may be helpful for radiologists,
in order to provide a correct diagnosis.
References
[1] Murphy TF,
Henderson FW,
Clyde WA Jr,
et al.
Pneumonia: an eleven-year study in a pediatric practice.
Am J Epidemiol 1981; 113(1): 12–21.
[2] Jokinen C,
Heiskanen L,
Juvonen H,
et al.
Incidence of community-acquired pneumonia in the population of four municipalities in eastern Finland.
Am J Epidemiol 1993; 137(9): 977 – 88.
[3] Wardlaw T,
Salama P,
Johansson EW,
et al.
Pneumonia: the leading killer of children.
Lancet 2006; 368 (9541): 1048–50.
[4] Zengin E,
Sarper N,
Gelen SA,
Demirsoy U,
Karadoğan M,...