1	THIS PRESENTATION WILL BE AVAILABLE ON OUR WEB SITE FOR THIRTY DAYS radiology.utmb.edu (go to main page, go to pediatric radiology)
2	ACUTE PULMONARY INFECTIONS IN CHILDREN; IMAGING AND PATHOPHYSIOLOGY Leonard E. Swischuk, M.D. The University of Texas Medical Branch Galveston, Texas
3	PULMONARY INFECTIONS Bacterial Viral Mycoplasma
4	CLINICAL PICTURES Bacterial pneumonia Toxic, septic Shallow breathing Viral bronchitis Respiratory distress Rapid breathing Bad gases Air trapping Usually not toxic Mycoplasma Mildly sick
5	FEVER High in bacterial pneumonia 39^o, 40^oC, 103-105^o F Low or high in viral infection Usually, but not always low Usually low with mycoplasma
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10	CLEAN BACTERIAL PNEUMONIA
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12	DIRTY VIRAL BRONCHITIS
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18	CONFUSING PATTERNS
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26	BACTERIAL INFECTIONS (Pathophysiology) Inhale organism Organism deep in alveoli Organism trapped Organism multiplies Purulent exudate Replaces air Consolidation
27	CONSOLIDATION Pleural based Empyemas common Smooth homogenous infiltrate Starts from the periphery Occasionally fluffy, nodular Occasionally round or mass-like No volume loss Exudate replaces air
28	CONSOLIDATION Pleural based Empyemas common Smooth homogenous infiltrate Starts from the periphery Occasionally fluffy, nodular Occasionally round or mass-like No volume loss Exudate replaces air
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36	NO VOLUME LOSS WHY ?
37	BECAUSE Exudate simply replaces air
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39	CONSOLIDATION Occasionally fluffy, nodular
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41	CONSOLIDATION Occasionally round or mass-like
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44	CONSOLIDATION Pleural based Empyemas common
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46	VIRAL INFECTIONS (Pathophysiology) Intracellular infections Begin in nasal passages and hypopharynx Descend into trachea and bronchi Tracheo-bronchitis
47	VIRAL TRACHEO-BRONCHITIS Peribronchial thickening Bilateral parahilar (central) infiltrates Radiate outward Symmetric Parahilar peribronchial (PHPB) Bilateral hilar adenopathy Overaeration (bronchospasm) Pleural effusion rare Fever variable, usually low
48	VIRAL TRACHEO-BRONCHITIS Peribronchial thickening Bilateral parahilar (central) infiltrates Radiate outward Symmetric Parahilar peribronchial (PHPB) Bilateral hilar adenopathy Overaeration (bronchospasm) Pleural effusion rare Fever variable, usually low
49	VIRAL TRACHEO-BRONCHITIS Bilateral, Central, Symmetric
50	WHAT DO WE CALL THIS ? PHPB
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54	RESULT DIRTY
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56	DIRTY VIRAL PATTERN (PHPB) SPECTRUM
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61	VARIATIONS AND PROBLEMS
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64	ATELECTASIS LOBAR SEGMENTAL MUCOUS PLUGS
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67	WHAT ARE WHISKERS
68	SEGMENTAL ATELECTASIS Streaky, linear Wedge-like Multiple
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73	LOBAR ATELECTASIS Volume loss Often multiple
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79	CLINICAL PICTURES Bacterial pneumonia Toxic, septic Shallow breathing Viral bronchitis Respiratory distress Rapid breathing Bad gases Air trapping Usually not toxic Mycoplasma Mildly sick
80	"Viral bronchitis" Viral bronchitis Respiratory distress Rapid breathing Bad gases Air trapping Usually not toxic
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82	VIRAL INFECTIONS (Other Patterns) CLEAR LUNGS RETICULO-NODULAR - HAZY / OPAQUE LUNGS - total bilateral - lower lobes bilateral - pseudoconsolidation or - interstital consolidation
83	CLEAR LUNGS
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86	VIRAL INTERSTITIAL INFECTION (Pneumonitis) Reticular nodular infiltrates Hazy / opaque lungs Both lungs totally involved Both lower lobes involved
87	RETICULO – NODULAR INFILTRATES
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91	HAZY / OPAQUE INFILTRATES
92	BILATERAL LOWER LOBES
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101	BILATERAL TOTAL
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104	PSEUDO CONSOLIDATION (Viral Consolidation) Interstitial inflammatory edema
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106	ENTIRE SPECTRUM Clear lungs to pseudoconsolidation
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110	VIRAL INFECTION WITH SUPERIMPOSED BACTERIAL CONSOLIDATION
111	VIRAL WITH SUPERIMPOSED BACTERIA Takes about a week PHPB baseline Superimposed pneumonia
112	CLINICAL PICTURES Bacterial pneumonia Toxic, septic Shallow breathing Viral bronchitis Respiratory distress Rapid breathing Bad gases Air trapping Usually not toxic Mycoplasma Mildly sick
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117	"MYCOPLASMA INFECTION" MYCOPLASMA INFECTION (Pathophysiology) Basicaly the same as viral
118	MYCOPLASMA INFECTIONS PHPB Diffuse parenchymal Reticulonodular Hazy Lobar (often one lobe) Pseudoconsolidation (opaque) Retriculonodular () Hazy () Ipsilateral hilar adenopathy Mimics TBc
119	MYCOPLASMA INFECTIONS Lobar (often one lobe) Pseudoconsolidation (uncommon) Retriculonodular (very common) Hazy (very common)
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131	MYCOPLASMA INFECTIONS Mimic TBC Ipsilateral hilar adenopathy
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135	REVIEW CASES PRIOR CASES
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137	BILATERAL LOWER LOBE HAZY INFILTRATES Virus best bet Occasionally mycoplasma Bacterial pneumonia – no
138	IF SINGLE LOBE - SWITCH TO MYCOPLASMA
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141	BILATERAL OPAQUE LOWER LOBES Viral pneumonitis best bet Occasionally mycoplasma Bacterial pneumonia – no Except in Sickle cell disease Acute chest syndrome
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144	SINGLE LOBE CONSOLIDATION Bacterial pneumonia best bet Occasionally mycoplasma Rarely viral
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146	BILATERAL TOTALLY OPACIFIED LUNGS Viral best bet Mycoplasma very rare Bacterial pneumonia basically doesn't happen
147	ATELECTASIS OR PNEUMONIA ? VOLUME LOSS OR NO VOLUME LOSS CLINICAL CORRELATION
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158	VIRAL, BACTERIAL OR MYCOPLASMA ? WHICH IS THE MOST LIKELY ?
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161	REMEMBER Bilateral Symmetric Central predominance
162	REMEMBER DIRTY
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164	CONCLUSION PATHOPHYSIOLOGY IMAGING CLINICAL CORRELATION
165	THIS PRESENTATION WILL BE AVAILABLE ON OUR WEB SITE FOR THIRTY DAYS radiology.utmb.edu (go to main page, go to pediatric radiology)