High-resolution CT of pediatric lung disease

https://doi.org/10.1016/S0033-8389(03)00111-8Get rights and content

Section snippets

INDICATIONS

The most common indications for pediatric HRCT are listed in Table 1. Virtually any time a child has a pulmonary parenchymal abnormality requiring CT, a relatively thin-slice technique should be used in combination with the edge-enhancing algorithm. For some conditions, such as metastatic disease, all of both lungs need to be imaged. For other conditions, such as an anomaly or localized mass, it may be possible to restrict the examination to the region of interest to limit radiation to the

Image Quality

Four components impact on the quality of HRCT images in children: (1) motion, (2) lung volume, (3) patient size, and (4) CT technical factors. Technique should be chosen after consideration of the first three factors. Although technique is the primary determinant of dose, it has the least impact on image quality.

Motion. The greatest impediment to obtaining high-quality CT studies in children is respiratory and gross body motion. In children who cannot follow instructions, typically those under

Electron Beam CT

Electron beam CT allows routine use of a 0.1-second scan time that is short enough to stop respiratory motion artifact. Drawbacks include spatial resolution inferior to that of helical scanners and the lack of widespread availability of EBCT.

Stop Ventilation Technique

HRCT in young children is limited both by patient motion and by an inability to obtain inspiratory and expiratory images. The stop ventilation technique uses conscious sedation and mask ventilation to provide motion-free images at inspiration and expiration.

Airways

Investigation of diseases of the pediatric airways is perhaps the most important use of HRCT because this group of diseases is so common in children. HRCT signs of diseases involving the airways are listed in Table 2. Diseases primarily affecting the bronchi are diagnosed by finding bronchial wall thickening or bronchiectasis. The abnormalities can range from subtle and equivocal to grossly obvious. Minimal bronchial wall thickening, whether caused by infection, infiltration, or edema, can be

DISORDERS ASSOCIATED WITH PULMONARY NODULES OR SMALL MASSES

Pulmonary nodules can be classified in a number of ways: by attenuation that may be ground-glass, soft tissue, calcific, or air-containing; by size; or by location (Table 7). It can be difficult to determine if a CT image showing too many dots is caused by multiple small nodules, vessels, or CLOs. Using a slightly thicker slice (3 to 5 mm) allows easier recognition of vessels. Nodules tend to be diffuse and CLOs tend to be localized, associated with bronchial wall thickening, and possess a

FATAL NEONATAL LUNG DISORDERS

Surfactant B deficiency has been identified as a cause of congenital pulmonary alveolar proteinosis.95 This condition presents at birth with radiographic findings similar to respiratory distress syndrome. The CT appearance in two cases was similar to that described in the adult form of alveolar proteinosis described previously with diffuse GGO and marked septal thickening (Fig. 17).61a This disease also is usually fatal unless lung transplantation is performed. A second rare neonatal condition

SUMMARY

High-resolution CT in children remains a technically challenging procedure, both to perform optimally and to interpret correctly. Although much remains to be learned about its optimal application, it is apparent that often confusing or nonspecific chest radiographs are clarified and a much clearer understanding is being gained about the diagnosis and evolution of both common and unusual pediatric lung diseases. As new therapies become available for these disorders, and CT becomes faster and

First page preview

First page preview
Click to open first page preview

References (90)

  • V Albafouille et al.

    CT scan patterns of pulmonary alveolar proteinosis in children

    Pediatr Radiol

    (1999)
  • MM Ambrosino et al.

    Application of thin-section low-dose chest CT (TSCT) in the management of pediatric AIDS

    Pediatr Radiol

    (1995)
  • SL Aquino et al.

    Tree-in-bud pattern: Frequency and significance on thin section CT

    J Comput Assist Tomogr

    (1996)
  • SL Aquino et al.

    High resolution inspiratory and expiratory CT in older children and adults with bronchopulmonary dysplasia

    AJR Am J Roentgenol

    (1999)
  • M Bhalla et al.

    Acute chest syndrome in sickle cell disease: CT evidence of microvascular occlusion

    Radiology

    (1993)
  • M Bhalla et al.

    Cystic fibrosis scoring system with thin section CT

    Radiology

    (1991)
  • MW Brauner et al.

    Pulmonary Langerhans' cell histiocytosis: Evolution of lesions on CT scan

    Radiology

    (1997)
  • AS Brody et al.

    High resolution computed tomography of the chest in children with cystic fibrosis: Support for use as an outcome surrogate

    Pediatr Radiol

    (1999)
  • AB Chang et al.

    Post-infectious bronchiolitis obliterans: Clinical, radiological and pulmonary function sequelae

    Pediatr Radiol

    (1998)
  • F Coakley et al.

    Detection of pulmonary metastases with pathological correlation: Effect of breathing on the accuracy of spiral CT

    Pediatr Radiol

    (1997)
  • L Coleman et al.

    Bronchiectasis in children

    J Thorac Imaging

    (1995)
  • B Connolly et al.

    CT appearance of pulmonary vasculitis in children

    AJR Am J Roentgenol

    (1996)
  • S Desena et al.

    Jugular thrombophlebitis complicating bacterial pharyngitis (Lemierre syndrome)

    Pediatr Radiol

    (1996)
    R Deterding et al.

    Persistent tachypnea of infancy

    Am J Respir Crit Care Med

    (1997)
  • B Dufour et al.

    High-resolution CT of the chest in four patients with pulmonary capillary hemangiomatosis or pulmonary venoocclusive disease

    AJR Am J Roentgenol

    (1900)
  • J Eglehoff et al.

    Safety and efficacy of sedation in children using a structured sedation program

    AJR Am J Roentgenol

    (1997)
  • N Fishback et al.

    Update on lymphoid interstitial pneumonitis

    Curr Opin Pulm Med

    (1996)
  • K Garg et al.

    Proliferative and constrictive bronchiolitis: Classification and radiologic features

    AJR Am J Roentgenol

    (1994)
  • NT Griscom

    Diseases of the trachea, bronchi and smaller airways

    Radiol Clin North Am

    (1993)
  • S Ha et al.

    Lung involvement in Langerhans' cell histiocytosis: Prevalence, clinical features and outcome

    Pediatrics

    (1992)
  • M Haliloglu et al.

    CT presentation of Wegener's granulomatosis in a child: Rapidly progressive changes of pulmonary nodules to cavities

    Eur J Radiol

    (2000)
  • TH Helbich et al.

    Cystic fibrosis: CT assessment of lung involvement in children and adults

    Radiology

    (1999)
  • TH Helbich et al.

    Evolution of CT findings in patients with cystic fibrosis

    AJR Am J Roentgenol

    (1999)
  • TH Helbich et al.

    Pulmonary alveolar microlithiasis in children: Radiographic and high-resolution CT findings

    AJR Am J Roentgenol

    (1997)
  • K Helton et al.

    Bronchiolitis obliterans-organizing pneumonia (BOOP) in children with malignant disease

    Pediatr Radiol

    (1992)
  • CJ Herold et al.

    Assessment of pulmonary airway reactivity with high resolution CT

    Radiology

    (1991)
  • WH Hoffman et al.

    Interstitial pulmonary edema in children and adolescents with diabetic ketoacidosis

    J Diabetes Complications

    (1998)
  • AA Jabra et al.

    Localized persistent pulmonary interstitial emphysema: CT findings with radiographic-pathologic correlation

    AJR Am J Roentgenol

    (1997)
  • EY Kang et al.

    Interlobular septal thickening: Patterns at high-resolution computed tomography

    J Thorac Imaging

    (1996)
  • I Karnack et al.

    Pulmonary lymphomatoid granulomatosis in a 4 year old

    J Pediatr Surg

    (1999)
  • AL Katzenstein et al.

    Chronic pneumonitis of infancy: A unique form of interstitial lung disease occurring in early childhood

    Am J Surg Pathol

    (1995)
  • CK Kim et al.

    Late abnormal findings on high-resolution computed tomography after mycoplasma pneumonia

    Pediatrics

    (2000)
  • WS Kim et al.

    Pulmonary tuberculosis in children: Evaluation with CT

    AJR Am J Roentgenol

    (1997)
  • B Kinane et al.

    Follicular bronchitis in the pediatric population

    Chest

    (1993)
  • J Kuhn

    Normal lung and anomalies

  • JP Kuhn

    High resolution CT of diffuse parenchymal disorders

  • Cited by (38)

    • Aspiration

      2019, Kendig's Disorders of the Respiratory Tract in Children, Ninth Edition
    • 76 - Aspiration

      2019, Kendig's Disorders of the Respiratory Tract in Children
    • Aspiration

      2012, Kendig and Chernick's Disorders of the Respiratory Tract in Children
    • Aspiration Lung Disease

      2009, Pediatric Clinics of North America
      Citation Excerpt :

      Plain chest radiographs and high-resolution computed thomography (HRCT) are commonly used in the evaluation of children suspected of aspiration. Although not diagnostic tests for aspiration, they are useful indicators of lung injury and may also document disease progression or resolution over time.26,27 On radiographs, CLA typically presents as hyperaeration, peribronchial thickening, subsegmental or segmental infiltrates, and atelectasis.

    • Chest

      2009, Pediatric Radiology, Third Edition
    View all citing articles on Scopus
    View full text