sherman alter, m.d. elizabeth h. ey, m.d. mark warren, d.o. jeffrey pence, m.d

Current Management of Complicated Pneumonia

in ChildrenSherman Alter, M.D.Elizabeth H. Ey, M.D.Mark Warren, D.O.Jeffrey Pence, M.D.

Updates on:Infectious DiseaseDiagnostic ImagingInterventional RadiologySurgical Options

Diagnostic Imaging of Complicated Pneumonia

in Children

Elizabeth H. Ey, M.D.Medical ImagingDayton Children’s Medical Center

Chest Imaging Options•Chest radiography•Fluoroscopy•Ultrasound•Computerized Tomography•Magnetic Resonance Imaging•Radionuclide lung scan

Chest Imaging Options•Chest radiography• Portable or in department• Vertical or horizontal beam• Low radiation dose• No sedation• No preparation• Inexpensive

Chest Imaging Options•Fluoroscopy• Dynamic observation• Trachea• Diaphragm• Catheter, wire, tube placement

Chest Imaging Options•Ultrasound• Department or bedside• Most useful for evaluation of pleural fluid• Simple versus complex fluid

• Consolidated lung• Assess blood flow• No radiation• No sedation

Chest Imaging Options•Computerized Tomography (CT)• High resolution, soft tissue contrast• Multiplanar and 3D reconstructions• IV contrast usually needed• Sedation may be needed• NPO guidelines

• May need pre authorization• Radiation dose

Chest Imaging Options•Magnetic Resonance Imaging• Soft tissue contrast• Spine, spinal cord, masses, malformations

• Cardiovascular imaging• Often requires sedation• Sometimes requires contrast• No ionizing radiation• May need pre authorization

Chest Imaging Options•Radionuclide chest imaging• Perfusion imaging• Quantify blood flow to each lung• Demonstrate areas of diminished perfusion

• Ventilation imaging• Aerosol

• No portable studies

Pneumonia•Lung infection - inhaled, hematogenous•Alveolus fills with fluid and inflammatory cells•Bacterial pneumonia typically unilateral • Segmental• Lobar

Pneumonia

One Day Later

Parapneumonic effusion

•Abnormal accumulation of fluid in pleural space secondary to adjacent pulmonary infection

Parapneumonic effusion

•Simple, transudative effusion•Fibrinopurulent exudate (empyema)

Simple effusionAP Supine Right Decubitus

When not to perform decubitus

Simple or Transudative effusion

Ultrasound

Simple effusion after drain

Fibrinopurulent effusion Empyema

UltrasoundFibrinopurulent effusion

CT Chest with Contrast

Complicated Pneumonia

•Cavitating or necrotizing pneumonia•Pneumatocele•Lung abscess•Bronchopleural fistula

Cavitating Pneumonia•Severe inflammation in lung parenchyma•Thrombotic occlusion of alveolar capillaries •Ischemia with eventual necrosis and cavitation

Complicated Pneumonia

CT Chest with Contrast

May 5 June 17

Complicated pneumoniaUnderlying Lesion

•Congenital malformation• CCAM• Sequestration• Bronchial obstruction• Congenital• Acquired (foreign body)

• Tumor

Chest Dec 12

Chest Dec 23

Chest US

Chest CT

Chest Dec 25

Chest Feb 11

Chest March 3

Chest Post Op

Chest 12-23

Right Decubitus

CT Chest +C

Chest CT +C

Interventional Radiology

Mark Warren, D.O.

Questions?