Article

Contemporary perspectives on pediatric diffuse lung disease.

Department of Pediatric Radiology, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin Street, Houston, TX 77030, USA.
Radiologic Clinics of North America (Impact Factor: 1.83). 09/2011; 49(5):847-68. DOI: 10.1016/j.rcl.2011.06.004
Source: PubMed

ABSTRACT It is much more challenging in children than in adults to obtain computed tomography images of the lung parenchyma at optimal lung volumes without motion artifact. Some of the more common forms of diffuse lung disease in adults rarely occur in children, and several forms of diffuse lung disease are unique to children. Recognition of these differences has led to the development of a new classification scheme for pediatric diffuse lung disease. Knowledge of this classification and recognition of characteristic imaging findings of specific disorders will lead to accurate diagnosis and guide appropriate treatment of children with diffuse lung disease.

0 Bookmarks
 · 
101 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Radiation-induced lung disease is a known complication of therapeutic lung irradiation, but the features have not been well described in children. We report the clinical, radiologic and histologic features of interstitial lung disease (ILD) in a 4-year-old child who had previously received lung irradiation as part of successful treatment for metastatic Wilms tumor. Her radiologic abnormalities and clinical symptoms developed in an indolent manner. Clinical improvement gradually occurred with corticosteroid therapy. However, the observed radiologic progression from interstitial and reticulonodular opacities to diffuse cystic lung disease, with subsequent improvement, is striking and has not been previously described in children.
    Pediatric Radiology 12/2014; DOI:10.1007/s00247-014-3223-6 · 1.65 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The incidental detection of small lung nodules in children is a vexing consequence of an increased reliance on CT. We present an algorithm for the management of lung nodules detected on CT in children, based on the presence or absence of symptoms, the presence or absence of elements in the clinical history that might explain these nodules, and the imaging characteristics of the nodules (such as attenuation measurements within the nodule). We provide suggestions on how to perform a thoughtfully directed and focused search for clinically occult extrathoracic disease processes (including malignant disease) that may present as an incidentally detected lung nodule on CT. This algorithm emphasizes that because of the lack of definitive information on the natural history of small solid nodules that are truly detected incidentally, their clinical management is highly dependent on the caregivers’ individual risk tolerance. In addition, we present strategies to reduce the prevalence of these incidental findings, by preventing unnecessary chest CT scans or inadvertent inclusion of portions of the lungs in scans of adjacent body parts. Application of these guidelines provides pediatric radiologists with an important opportunity to practice patient-centered and evidence-based medicine.
    Pediatric Radiology 02/2015; DOI:10.1007/s00247-014-3267-7 · 1.65 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: No guidelines are in place for the follow-up and management of incidentally detected pulmonary nodules on CT in the pediatric population. The Fleischner guidelines, which were developed for the older adult population, do not apply to children. This review summarizes the evidence collected by the Society for Pediatric Radiology (SPR) Thoracic Imaging Committee in its attempt to develop pediatric-specific guidelines. Small pulmonary opacities can be characterized as linear or as ground-glass or solid nodules. Linear opacities and ground-glass nodules are extremely unlikely to represent an early primary or metastatic malignancy in a child. In our review, we found a virtual absence of reported cases of a primary pulmonary malignancy presenting as an incidentally detected small lung nodule on CT in a healthy immune-competent child. Because of the lack of definitive information on the clinical significance of incidentally detected small solid lung nodules on CT in children, the management of those that do not have the typical characteristics of an intrapulmonary lymph node should be dictated by the clinical history as to possible exposure to infectious agents, the presence of an occult immunodeficiency, the much higher likelihood that the nodule represents a metastasis than a primary lung tumor, and ultimately the individual preference of the child’s caregiver. Nodules appearing in children with a history of immune deficiency, malignancy or congenital pulmonary airway malformation should not be considered incidental, and their workup should be dictated by the natural history of these underlying conditions.
    Pediatric Radiology 02/2015; DOI:10.1007/s00247-014-3269-5 · 1.65 Impact Factor