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

• 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

Guiding management• Placement of chest tubes

• loculated collection

Chronic sequelae• Parenchymal scarring

• bronchial wall thickening

• bronchiectasis

• bronchiolitis obliterans

• Swyer-James syndrome

Typical pneumonia

SARSSevere Acute Respiratory Syndrome

Risk in children• household contact• healthcare setting contact

Presenting symptoms of SARS children

0

20

40

60

80

100

120

feve

r

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mya

lgia

chills

/ rigo

r

runn

y nos

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dysp

noea

sore

thro

at

head

ache

dizzin

ess

mala

ise

febr

ile co

nvuls

ion

Per

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tag

e

Zonal distribution of air-space opacification

Upper zone

Middle zone

Lower zone

Upper & lower

Distribution of air-space opacification on CXR

focal

multi-focal

bilateral

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.

Outcome• Discharge: 16

• Observation: 1

• Mortality : 0

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

THANK YOU