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Pneumonia in children including SARS

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

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Pneumonia in children including SARS

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  1. Pneumonia in children including SARS Winnie Chu The Chinese University of Hong Kong Department of Diagnostic Radiology and Organ Imaging Prince of Wales Hospital

  2. Role of imaging of pulmonary infection in children

  3. 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

  4. Follow up CXR • Not a routine • Post-obstructive pneumonia secondary to CA is not a concern • reserved for: • persistent symptoms • recurrent symptoms • immunodeficiency

  5. Persistent/ recurrent pneumonia • Developmental lung masses • sequestration • bronchogenic cyst • cystic adenomatoid malformation • reflux, aspiration, systemic disorders

  6. Acute complications • Parapneumonic effusion • cavitary necrosis • empyema • lung abscess • pneumothorax • purulent pericarditis

  7. Guiding management • Placement of chest tubes • loculated collection

  8. Chronic sequelae • Parenchymal scarring • bronchial wall thickening • bronchiectasis • bronchiolitis obliterans • Swyer-James syndrome

  9. Typical pneumonia

  10. SARSSevere Acute Respiratory Syndrome

  11. Risk in children • household contact • healthcare setting contact

  12. 120 100 80 60 Percentage 40 20 0 fever cough malaise myalgia headache dizziness dyspnoea sorethroat runny nose chills/ rigor febrile convulsion Presenting symptoms of SARS children

  13. Upper zone Middle zone Lower zone Upper & lower Zonal distribution of air-space opacification

  14. focal multi-focal bilateral Distribution of air-space opacification on CXR

  15. Radiological change • Worst CXR appearance

  16. Radiological changes • Complete resolution of CXR

  17. 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

  18. Suspected paediatric SARS Moderately severe symptoms + High swinging fever Mild symptoms • Ribavirin i.v. • Hydrocortisone i.v./ prednisolone p.o. • Cefotaxime i.v. • Clarithromycin p.o. • Cefotaxime i.v. • Clarithromycin i.v. • Ribavarin i.v. Persistent fever, Clinical deterioration No improvement + Pulse Methylprednisolone i.v. + Prednisolone p.o. No improvement + Pulse Methylprednisolone i.v.

  19. Outcome • Discharge: 16 • Observation: 1 • Mortality : 0

  20. Conclusion • Young children develop a milder form of the disease with a less aggressive clinical course and milder radiological changes

  21. Conclusion • Teenagers may simulate adult pattern, presenting with a more severe clinical disease and bizzare radiological finding

  22. THANK YOU

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