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