Thieme: Directdiagnosis in Radiology -- Pediatric Imaging
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Lung Pathology: Embryologic Abnormalities
Chapter2C Lung Pathology: Embryologic Abnormalities Content and Objectives Pulmonary Sequestration 2C-3 Chest X-ray Findings in Arteriovenous Malformation of the Great Vein of Galen 2C-7 Situs Inversus Totalis 2C-10 Congenital Cystic Adenomatoid Malformation of the Lung 2C-14 VATER Association 2C-20 Extralobar Sequestration with Congenital Diaphragmatic Hernia: A Complicated Case Study 2C-24 Congenital Chylothorax: A Case Study 2C-37 Continuing Nursing Education Test CNE-1 Objectives: 1. Explain how the diagnosis of pulmonary sequestration is made. 2. Discuss the types of imaging studies used to diagnose AVM of the great vein of Galen. 3. Describe how imaging studies are used to treat AVM. 4. Explain how situs inversus totalis is diagnosed. 5. Discuss the differential diagnosis of congenital cystic adenomatoid malformation. (continued) Neonatal Radiology Basics Lung Pathology: Embryologic Abnormalities 2C-1 6. Describe the diagnosis work-up for VATER association. 7. Explain the three classifications of pulmonary sequestration. 8. Discuss the diagnostic procedures for congenital chylothorax. 2C-2 Lung Pathology: Embryologic Abnormalities Neonatal Radiology Basics Chapter2C Lung Pathology: Embryologic Abnormalities EDITOR Carol Trotter, PhD, RN, NNP-BC Pulmonary Sequestration pulmonary sequestrations is cited as the 1902 theory of Eppinger and Schauenstein.4 The two postulated an accessory he clinician frequently cares for infants who present foregut tracheobronchia budding distal to the normal buds, Twith respiratory distress and/or abnormal chest x-ray with caudal migration giving rise to the sequestered tissue. The findings of undetermined etiology. One of the essential com- type of sequestration, intralobar or extralobar, would depend ponents in the process of patient evaluation is consideration on the timing of the accessory foregut budding (Figure 2C-1). -
Extralobar Pulmonary Sequestration Infected with Mycobacterium Gordonae
Brief Communications Extralobar pulmonary sequestration infected with Mycobacterium gordonae Yukio Umeda, MD, PhD,a Yukihiro Matsuno, MD, PhD,a Matsuhisa Imaizumi, MD, PhD,a Yoshio Mori, MD, PhD,a Hitoshi Iwata, MD, PhD,b and Hiroshi Takiya, MD, PhD,a Gifu, Japan Pulmonary sequestration is a malformation composed of lung was found except around the left lower pulmonary dysplastic lung tissue without normal communication with vein. We diagnosed it as extralobar sequestration and the tracheobronchial tree and with an anomalous systemic planned a simple excision of the sequestrated lung. We di- arterial supply.1 Few cases of pulmonary sequestration in- vided the aberrant artery and drainage vein and excised the fected with tuberculous or nontuberculous mycobacterium sequestrated lung using a linear stapler. The postoperative have been reported.2-4 However, all of those reports were course was uneventful. of intralobar pulmonary sequestrations. In the present article, Histopathologic study revealed destruction of alveolar we describe the first case of extralobar sequestration infected and reconstruction of respiratory epithelium within its own with Mycobacterium gordonae. pleura. The alveolar spaces were filled by mucoid or mono- nuclear cells. Caseating epithelioid granulomas and Lan- ghans’ giant cells were also observed (Figure 2). The CLINICAL SUMMARY diagnosis was of an extralobar pulmonary sequestration in- In August of 2005, a 72-year-old woman was referred to fected with Mycobacterium. M. gordonae was identified the Gifu Prefectural General Medical Center for abnormal from the culture of preoperatively collected sputum and sur- shadow on chest x-ray. Contrast media-enhanced com- gical specimen by the DNA–DNA hybridization method. -
Recurrent Pneumonia (Recurrent Lower Respiratory Tract Infections)
Recurrent Pneumonia (Recurrent lower respiratory tract infections) Guideline developed by Gulnur Com, MD, and Jeanne Velasco, MD in collaboration with the ANGELS team. Last reviewed by Jeanne Velasco, MD, on May 15, 2017. Key Points A single episode of uncomplicated pneumonia in an otherwise healthy child does not require investigation. Recurrent pneumonia is not an uncommon presenting symptom in general pediatric practice and one of the most common reasons for referral to pediatric pulmonologists. Recurrent pneumonia is usually defined as ≥2 episodes of pneumonia in a year or ≥3 in life.1 Many children with recurrent pneumonia do not need a full diagnostic work up, either because pneumonia episodes are not frequent or severe enough or because eventually children become asymptomatic. Evaluation of children with recurrent pneumonias begins by taking a careful history, an examination while the child is sick, and confirmation that the child is truly experiencing recurrent pneumonia. The majority of recurrent pneumonia causes in children have predictable risk factors (e.g., psychomotor retardation with feeding problems). Extensive investigations may not identify an underlying cause in up to 30% of children with recurrent pneumonia.1 The initial step in evaluating a child with recurrent respiratory symptoms includes distinguishing between recurrent wheezing versus recurrent infections. Studies show that asthma is being over diagnosed in children with recurrent respiratory symptoms. Patients with atypical asthma that does not respond to therapy should be investigated further. The evaluation of children with recurrent pneumonia should not be focused only on the respiratory tract. 1 Investigation for other organ system involvement may help for ultimate diagnosis (e.g., cystic fibrosis). -
The Diseases of Airway-Tracheal Diverticulum: a Review of the Literature
Review Article The diseases of airway-tracheal diverticulum: a review of the literature Asli Tanrivermis Sayit, Muzaffer Elmali, Dilek Saglam, Cetin Celenk Department of Radiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey Contributions: (I) Conception and design: A Tanrivermis Sayit; (II) Administrative support: M Elmali, C Celenk; (III) Provision of study materials or patients: A Tanrivermis Sayit; (IV) Collection and assembly of data: A Tanrivermis Sayit, D Saglam; (V) Data analysis and interpretation: A Tanrivermis Sayit, M Elmali, C Celenk; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Asli Tanrivermis Sayit. Department of Radiology, Faculty of Medicine, Ondokuz Mayis University, 55139, Atakum/Samsun, Turkey. Email: [email protected]. Abstract: Tracheal diverticulum (DV) is a type of paratracheal air cyst (PTAC) that is often asymptomatic and usually detected incidentally by imaging methods. Tracheal DV are divided into two subgroups: congenital and acquired. Dysphagia, odynophagia, neck pain, hoarseness, hemoptysis, choking, and recurrent episodes of hiccups and burping can also be seen in symptomatic patients. Thin-section multidetector computed tomography (MDCT) is useful for diagnosis of tracheal diverticulum. The relationship between DV and tracheal lumen can be demonstrated by axial, coronal, and sagittal reformat multiplanar images. Bronchoscopy can also be used in diagnosis for tracheal DV. However, the connection between DV and tracheal lumen can not be shown easily with bronchoscopy. Conservative treatment is the preferred treatment in asymptomatic patients. Surgical or conservative treatment can be performed for symptomatic patients, depending on patient age and physical condition. Keywords: Trachea; diverticulum (DV); thorax; multidetector computed tomography; tracheal diseases; chronic obstructive pulmonary disease (CODP) Submitted Sep 17, 2016. -
PQI 15 Asthma in Younger Adults Admission Rate
AHRQ Quality Indicators™ (AHRQ QI™) ICD-10-CM/PCS Specification v2021 Prevention Quality Indicator 15 (PQI 15) Asthma in Younger Adults Admission Rate July 2021 Area-Level Indicator Type of Score: Rate Prepared by: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services www.qualityindicators.ahrq.gov DESCRIPTION Admissions for a principal diagnosis of asthma per 100,000 population, ages 18 to 39 years. Excludes admissions with an indication of cystic fibrosis or anomalies of the respiratory system, obstetric admissions, and transfers from other institutions. [NOTE: The software provides the rate per population. However, common practice reports the measure as per 100,000 population. The user must multiply the rate obtained from the software by 100,000 to report admissions per 100,000 population.] NUMERATOR Discharges, for patients ages 18 through 39 years, with a principal ICD-10-CM diagnosis code for asthma (ACSASTD*). [NOTE: Obstetric discharges are not included in the PQI rate for PQI 15, though the AHRQ QI™ does not explicitly exclude obstetric cases. By definition, discharges with a principal diagnosis of asthma exclude obstetric discharges, because the principal diagnosis for an obstetric discharge would identify it as obstetric, and no such diagnoses are included in the set of qualifying diagnoses.] July 2021 1 of 5 AHRQ QI™ ICD-10-CM/PCS Specification v2021 PQI 15 Asthma in Younger Adults Admission Rate www.qualityindicators.ahrq.gov NUMERATOR EXCLUSIONS Exclude cases: • with any listed ICD-10-CM -
Adult Outcome of Congenital Lower Respiratory Tract Malformations M S Zach, E Eber
500 Arch Dis Child: first published as 10.1136/adc.87.6.500 on 1 December 2002. Downloaded from PAEDIATRIC ORIGINS OF ADULT LUNG DISEASES Series editors: P Sly, S Stick Adult outcome of congenital lower respiratory tract malformations M S Zach, E Eber ............................................................................................................................. Arch Dis Child 2002;87:500–505 ongenital malformations of the lower respiratory tract relevant studies have shown absence of the normal peristaltic are usually diagnosed and managed in the newborn wave, atonia, and pooling of oesophageal contents.89 Cperiod, in infancy, or in childhood. To what extent The clinical course in the first years after repair of TOF is should the adult pulmonologist be experienced in this often characterised by a high incidence of chronic respiratory predominantly paediatric field? symptoms.910 The most typical of these is a brassy, seal-like There are three ways in which an adult physician may be cough that stems from the residual tracheomalacia. While this confronted with this spectrum of disorders. The most frequent “TOF cough” is both impressive and harmless per se, recurrent type of encounter will be a former paediatric patient, now bronchitis and pneumonitis are also frequently observed.711In reaching adulthood, with the history of a surgically treated rare cases, however, tracheomalacia can be severe enough to respiratory malformation; in some of these patients the early cause life threatening apnoeic spells.712 These respiratory loss of lung tissue raises questions of residual damage and symptoms tend to decrease in both frequency and severity compensatory growth. Secondly, there is an increasing with age, and most patients have few or no respiratory number of children in whom paediatric pulmonologists treat complaints by the time they reach adulthood.13 14 respiratory malformations expectantly; these patients eventu- The entire spectrum of residual respiratory morbidity after ally become adults with their malformation still in place. -
Obstructive Sleep Apnea Diagnosis and Treatment
Obstructive Sleep Apnea Diagnosis and Treatment Last Review Date: February 12, 2021 Number: MG.MM.ME.25qv2 Medical Guideline Disclaimer Property of EmblemHealth. All rights reserved. The treating physician or primary care provider must submit to EmblemHealth the clinical evidence that the patient meets the criteria for the treatment or surgical procedure. Without this documentation and information, EmblemHealth will not be able to properly review the request for prior authorization. The clinical review criteria expressed below reflects how EmblemHealth determines whether certain services or supplies are medically necessary. EmblemHealth established the clinical review criteria based upon a review of currently available clinical information (including clinical outcome studies in the peer reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). EmblemHealth expressly reserves the right to revise these conclusions as clinical information changes and welcomes further relevant information. Each benefit program defines which services are covered. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered and/or paid for by EmblemHealth, as some programs exclude coverage for services or supplies that EmblemHealth considers medically necessary. If there is a discrepancy between this guideline and a member's benefits program, the benefits program will govern. In addition, coverage may be mandated by applicable legal requirements of a state, the Federal Government or the Centers for Medicare & Medicaid Services (CMS) for Medicare and Medicaid members. -
XI. COMPLICATIONS of PREGNANCY, Childbffith and the PUERPERIUM 630 Hydatidiform Mole Trophoblastic Disease NOS Vesicular Mole Ex
XI. COMPLICATIONS OF PREGNANCY, CHILDBffiTH AND THE PUERPERIUM PREGNANCY WITH ABORTIVE OUTCOME (630-639) 630 Hydatidiform mole Trophoblastic disease NOS Vesicular mole Excludes: chorionepithelioma (181) 631 Other abnormal product of conception Blighted ovum Mole: NOS carneous fleshy Excludes: with mention of conditions in 630 (630) 632 Missed abortion Early fetal death with retention of dead fetus Retained products of conception, not following spontaneous or induced abortion or delivery Excludes: failed induced abortion (638) missed delivery (656.4) with abnormal product of conception (630, 631) 633 Ectopic pregnancy Includes: ruptured ectopic pregnancy 633.0 Abdominal pregnancy 633.1 Tubalpregnancy Fallopian pregnancy Rupture of (fallopian) tube due to pregnancy Tubal abortion 633.2 Ovarian pregnancy 633.8 Other ectopic pregnancy Pregnancy: Pregnancy: cervical intraligamentous combined mesometric cornual mural - 355- 356 TABULAR LIST 633.9 Unspecified The following fourth-digit subdivisions are for use with categories 634-638: .0 Complicated by genital tract and pelvic infection [any condition listed in 639.0] .1 Complicated by delayed or excessive haemorrhage [any condition listed in 639.1] .2 Complicated by damage to pelvic organs and tissues [any condi- tion listed in 639.2] .3 Complicated by renal failure [any condition listed in 639.3] .4 Complicated by metabolic disorder [any condition listed in 639.4] .5 Complicated by shock [any condition listed in 639.5] .6 Complicated by embolism [any condition listed in 639.6] .7 With other -
Paratracheal Air Cysts: Prevalence and Relevance to Pulmonary Emphysema and Bronchiectasis Using Thoracic Multidetector CT
Diagn Interv Radiol 2015; 21:42–46 CHEST IMAGING © Turkish Society of Radiology 2015 ORIGINAL ARTICLE Paratracheal air cysts: prevalence and relevance to pulmonary emphysema and bronchiectasis using thoracic multidetector CT Nurefsan Boyaci, Dilek Sen Dokumaci, Ekrem Karakas, Funda Yalcin, Ayse Gul Oney Kurnaz PURPOSE aratracheal air cysts (PTACs) are small collections of air adjacent to We aimed to determine the prevalence of paratracheal air the trachea at the level of the thoracic inlet (1). Pathological diag- cysts (PTACs) and the relationship of PTACs with emphysema nosis of PTACs in surgically confirmed cases includes tracheal di- and bronchiectasis through retrospective analysis of multide- P tector computed tomography (MDCT) findings. verticulum, lymphoepithelial cyst, and bronchogenic cyst (1–3). These cysts are covered with ciliary columnar epithelium and connected with METHODS MDCT findings of 1027 consecutive patients who underwent the trachea (4). The majority of PTACs are reported as tracheal divertic- routine thorax examination between January 2012 and Janu- ula in the literature, due to their connection with the trachea (2). The ary 2013 were evaluated retrospectively for the presence of thoracic inlet between the cartilage and muscle layers in right postero- PTACs. Localization of the PTACs, as well as their size, shape, and relationship with the trachea were examined. Presence lateral wall of the trachea is the most common location for PTACs. A of emphysema and bronchiectasis was recorded, and bron- relationship may be seen between an isolated PTAC and the trachea l chiectasis severity index was calculated when present. We randomly selected 80 patients who had no visible PTACs as lumen (5). -
The Respiratory System
Embryology18 Dr.Ban The respiratory system Respiratory system development is a highly coordinated and complex process it’s development is tightly associated with the digestive system from the beginning.The respiratory tract is divided anatomically into 2 main parts: A-upper respiratory tract, consisting of the nose, nasal cavity and the pharynx B-lower respiratory tract consisting of the larynx, trachea, bronchi and the lungs. The pharynx is the part of the throat behind the mouth and nasal cavity, and above the esophagus and larynx. In humans, the pharynx is part of the digestive system and the conducting zone of the respiratory system. The conducting zone which also includes the nostrils of the nose, the larynx, trachea, bronchi, and bronchioles filters, warms and moistens air and conducts it into the lungs). The human pharynx is divided into three sections: . nasopharynx . oropharynx . laryngopharynx 1 Embryology18 Dr.Ban The larynx The internal lining of the larynx originates from endoderm, but the cartilages and muscles originate from mesenchyme of the 4th and 6th pharyngeal arches. As a result of rapid proliferation of this mesenchyme, the laryngeal orifice changes in appearance from a sagital slit to a T-shaped opening. When the mesenchyme of the two arches transforms into the thyroid, cricoid and arytenoid cartilages the adult shape of the laryngeal orifice can be recognized. The laryngeal epithelium proliferates rapidly, resulting in a temporary occlusion of the lumen. Subsequently, vacuolization and recanalization produces a pair of lateral recesses, the laryngeal ventricles that are bounded by folds of tissue that differentiate into the false and true vocal cords. -
Perinatal/Neonatal Case Presentation
Perinatal/Neonatal Case Presentation Primary Unilateral Pulmonary Hypoplasia: Neonate through Early Childhood F Case Report, Radiographic Diagnosis and Review of the Literature Matthew E. Abrams, MD (Figure 1) and a retrosternal opacity on lateral view (Figure 2). Veda L. Ackerman, MD Serial radiographs failed to show improvement in the appearance William A. Engle, MD of the right hemithorax. However, the patient’s respiratory status normalized. Computed topography (CT) scan of the chest (Figure 3) at the infant’s referring hospital was interpreted as complete collapse of the right upper lobe versus a right upper lobe Unilateral pulmonary hypoplasia is a rare cause of respiratory distress in the chest mass. The infant was transferred to our institution at 9 days neonate. It is usually secondary to other causes such as diaphragmatic of life for further evaluation. At this time, the infant was symptom hernia. We present a case of a newborn with primary hypoplasia of the right free without tachypnea, cyanosis, or cough. The infant otherwise upper lobe who was later found to also have tracheobronchomalacia. We appeared normal without any dysmorphic features. Review of the describe the clinical course through early childhood. chest radiograph series and chest CT scan confirmed the diagnosis Journal of Perinatology (2004) 24, 667–670. doi:10.1038/sj.jp.7211156 of unilateral right upper lobe pulmonary hypoplasia without any evidence for a chest mass. A magnetic resonance image (MRI) of the chest (Figure 4) was consistent with hypoplasia of the right upper lobe. An assessment of pulmonary venous drainage was not possible secondary to technical problems. -
Bronchial Atresia
31 Bronchial Atresia Lirios Sacristán Bou and Francisco Peña Blas Hospital General de Tomelloso & Centro de Salud de Monforte del Cid España 1. Introduction Bronchial atresia is an interesting congenital abnormality because of its variable appearance and its semblance to certain acquired diseases. It is characterized by a branching mass formed by mucus that dilates the proximal bronchi to the atretic segment. The distal lung to atresia can develop normally but it shows a paucity of blood vessels and is hyperinflated due to unidirectional collateral air drift through intraalveolar pores of Kohn, bronchoalveolar channels of Lambert and interbronchiolar pores of Martin from the adjacent normal lung. These collateral communications act as a check-valve mechanism allowing the air to enter but not to leave the distal lung. More than 150 cases of bronchial atresia have been reported since 1953, when it was first described by Ramsay & Byron. The exact mechanism that ends in bronchial atresia is still unknown, but there are two hypotheses about the pathogenesis which have in common that they should occur before birth because the bronchial pattern to the site of stenosis is entirely normal. Many of the most relevant case reports and published series of cases are reviewed in this chapter to update our knowledge of bronchial atresia. They have been obtained as the result of a bibliographical research at Pubmed; ninety five articles were found using the Medical Subject Headings (MeSH) thesaurus descriptors congenital and bronchial atresia. 2. Pathogenesis Bronchial buds appear in the fifth week of gestation and then complete branching takes place in the sixteenth week.