part 2 of step by step evaluation of pediatric diffuse lung diseases.

1. The road to HRCT
evaluation of
Dr/Ahmed Bahnassy
Consultant Radiologist
Riyadh Military Hospital

2. Causes of chILD
• Infectious • Lymphoproliferat • Infectious
• Aspiration ive disorders • Aspiration (GORD)
(GORD) (including HIV) • Environmental
(hypersensitivity
• Environmental • Metabolic pneumonitis)
(hypersensitivi disorders • Drug-induced
ty • Surfactant • Neoplastic
pneumonitis) disorders diseases (&LCH)
• Drug-induced • Neurocutaneous
• Neoplastic syndromes
diseases • Idiopathic pulm
(&LCH)
hemosidrosis

3. Causes of chILD cont….
• ARDS
• Lymphoproliferative (recovering
disorders (including • Collagen phase)
vascular • Hypereosino
HIV)
disease philic
• Metabolic disorders syndromes
• Pulmonary • Pulmonary
• Surfactant disorders
vasculitis veno-
• Neurocutaneous syndromes occlusive
syndromes • Radiation- disease
• Idiopathic pulm induced • Sarcoidosis
hemosidrosis • Amyloidosis • With chronic
liver, kidney,
• Graft-versus- bowel
host disease diseases

4. Causes of ILD

7. ILD
Between Adults and ChILD
NSIP

8. DIP
LIP

10. Neuroendocrine cell hyperplasia
of infancy (NEHI)
Ground Glass opacity primarily affecting
the middle and lingular lobes

11. NEHI
• Another
typical
example of
right middle
lobe ,and left
lingular GGO.

12. Surfactant Metabolism Dysfunction
• Surfactant is a complex mixture of phospholipids
and proteins (SP-A, -B, -C and -D)& ABCA3.
• ABCA3 an ATP-binding transporter Of lipids.
Diffuse GG opacity with variable
Intelobular septal thickening
(chILD) due to ABCA3 gene mutations

13. Nonspecific interstitial
pneumonitis
Bilateral scattered middle zonal GGO
Bi basilar consolidations.
Bronchial dilatation.
HRCT shows a mosaic
perfusion pattern and multiple bilateral linear densities

14. PIG..Pulmonary interstitial
Glycogenosis
• GGO
• Interlobular septal
thickening.
• Reticular changes.
• Posterior cysts.

15. BOOP
• Diffuse
nodules.
• Mild
intralobular
septal
thickening.
• Patchy GGO.

16. Hypersensitivity pneumonitis
• Ground Glass
and nodular
like opacities
in lung bases.

17. Eosinophilic pneumonia
• Reversed Halo
sign
• Right peripheral
mid-zonal GGO

18. Pulmonary alveolar proteinosis
• GGO
• +
• Interlobular
septal
thickening
• =
• Crazy-paving
pattern.

19. Bronchopulmonary Dysplasia
septal thickening,
parenchymal bands and
multiple hyperlucent
areas.
Repeated HRCT at
the age of 2 years
shows a mosaic
pattern and
some residual
parenchymal bands

20. Parenchymal bands in BPD

21. Bronchial asthma
Normal
Expiratory scan
revealed severe
Air trapping

22. Hemosiderosis
ground-glass attenuation due to pulmonary hemorrhage

23. Langerhans cell histiocytosis
Bizarre
thick- and thin-walled cysts; shaped
few micronodules also seen
pulmonary cystic lesions, some located
subpleurally, and
bilateral pneumothoraces

24. Lympngiomatosis
Consider vascular/lymphatic cause
Prominent diffuse smooth septal thickening, bronchovascular
bundles and ground-glass attenuation

25. Lesson learned
Most HRCT features are non-specific,
but when related to the clinical findings,
they can suggest the proper diagnosis and
obviate biopsy.

26. A new classification system for pediatric
interstitial lung disease evolved out of the recognition
that clinical setting is an important consideration
in the diagnosis of pediatric ILD and that
combined clinical, imaging, and pathological correlation
is a more powerful diagnostic tool, than
any one single component.
This new pediatric interstitial lung disease classification
system was validated for infants and very young children
in a retrospective review of 186 lung biopsies done
between 1999 and 2004 with accompanying clinical
histories and images from children under age 2
contributed by 11 pediatric institutions in North
America.
Based on this new classification system, ChILD is classified into three main
groups: (1) disorders of infancy; (2) other categories
(not specific to infancy); and (3)unclassifiable.