DOCSLIB.ORG

CHEST RADIOLOGY Patterns and Differential Diagnoses This Page Intentionally Left Blank

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
CHEST RADIOLOGY Patterns and Differential Diagnoses This Page Intentionally Left Blank Any screen. Any time. Anywhere. Activate the eBook version of this title at no additional charge.rge. Expert Consult eBooks give you the power to browse and find content, view enhanced images, share notes and highlights—both online and offline. Unlock your eBook today. Visit Scan this QR code to redeem your 1 expertconsult.inkling.com/redeem eBook through your mobile device: 2 Scratch off your code 3 Type code into “Enter Code” box 4 Click “Redeem” 5 Log in or Sign up 6 Go to “My Library” It’s that easy! Place Peel Off Sticker Here For technical assistance: email [email protected] call 1-800-401-9962 (inside the US) call +1-314-447-8200 (outside the US) Use of the current edition of the electronic version of this book (eBook) is subject to the terms of the nontransferable, limited license granted on expertconsult.inkling.com. Access to the eBook is limited to the first individual who redeems the PIN, located on the inside cover of this book, at expertconsult.inkling.com and may not be transferred to another party by resale, lending, or other means. CHEST RADIOLOGY Patterns and Differential Diagnoses This page intentionally left blank Seventh Edition CHEST RADIOLOGY Patterns and Differential Diagnoses James C. Reed, MD Professor of Radiology University of Louisville Louisville, Kentucky 1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899 CHEST RADIOLOGY: PATTERNS AND DIFFERENTIAL DIAGNOSES ISBN: 978-0-323-49831-9 SEVENTH EDITION Copyright © 2018 by Elsevier, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the Publisher. Details on how to seek permis- sion, further information about the Publisher’s permissions policies, and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and expe- rience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods, they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to deter- mine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence, or otherwise or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Previous editions copyrighted 2011, 2003, 1997, 1991, 1987, 1981 by Mosby, Inc., an affiliate of Elsevier Inc. Library of Congress Cataloging-in-Publication Data Names: Reed, James C. (James Croft), 1942- author. Title: Chest radiology : patterns and differential diagnoses / James C. Reed. Description: Seventh edition. | Philadelphia, PA : Elsevier, [2018] | Previous editions have subtitle: Plain film patterns and differential diagnoses. | Includes bibliographical references and index. Identifiers: LCCN 2017043419 | ISBN 9780323498319 (hardcover : alk. paper) Subjects: | MESH: Radiography, Thoracic | Diagnosis, Differential | Respiratory Tract Diseases--diagnostic imaging Classification: LCC RC941 | NLM WF 975 | DDC 617.5/40757--dc23 LC record available at https://lccn.loc.gov/2017043419 Executive Content Strategist: Robin Carter Senior Content Development Specialist: Rae Robertson Publishing Services Manager: Catherine Albright Jackson Senior Project Manager: Doug Turner Designer: Maggie Reid Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 1 Thank you to my wife, Sharon, for the support and encouragement that have made it possible for this text to reach a seventh edition. This edition is dedicated to our grandchildren: Samantha, Hailey, Zachary, James III, Morgan, Connor, Madeline, and Andrew v This page intentionally left blank PREFACE Chest radiology is sometimes considered to be the static part of a radiology practice, but chest radiology has shared the benefits of the imaging revolution. The chest x-ray contains a lot of information that is compressed into one or two images compared with several hundred images in a complete chest computed tomography (CT) examination with axial, coronal, and sagittal images. Chest CT provides a better understanding of chest disease and has become an important part of chest radiology. CT has added new descriptive patterns to our lexicon, including ground glass opacities, ground glass nod- ules, mosaic perfusion, and crazy paving. Special CT protocols such as high-resolution CT and CT angiography have given us the ability to make more specific diagnoses. The impact of magnetic resonance imaging and ultrasound are more limited because of the air in the lungs, but they also have important thoracic applications. Continued medical progress and our collaborations with colleagues in medicine, surgery, and pathology have enhanced our understanding of chest diseases. By com- bining our new understanding of tumor biology with technical advancements, new imaging strategies such as low-dose CT screening for lung cancer have been developed. Over the course of seven editions of this text there have been many changes in chest radiology, but a patient with chest symptoms still almost always has a chest x-ray as a first examination. Evaluation of the chest x-ray continues to require accurate percep- tion of the abnormalities, recognition of the basic patterns, and development of a working differential diagnosis. James C. Reed, MD vii ACKNOWLEDGMENTS A special thank you to Mr. Danny McGrath for assistance with production of the new digital illustrations and Ms. Lisa Floore for technical assistance and advice on manu- script preparation. James C. Reed, MD viii CONTENTS PART 1 Chest Wall, Pleura, and Mediastinum 1 INTRODUCTION, 2 2 CHEST WALL LESIONS, 5 Questions, 6 Discussion, 7 Top 5 Diagnoses: Chest Wall Lesions, 19 Summary, 19 Answer Guide, 19 3 PLEURAL AND SUBPLEURAL OPACITIES, 21 Questions, 23 Discussion, 24 Top 5 Diagnoses: Pleural and Subpleural Opacities, 34 Summary, 34 Answer Guide, 35 4 PLEURAL EFFUSIONS, 36 Questions, 38 Discussion, 40 Top 5 Diagnoses: Pleural Effusions, 50 Summary, 50 Answer Guide, 51 5 PLEURAL THICKENING AND PLEURAL CALCIFICATION, 52 Questions, 53 Discussion, 54 Top 5 Diagnoses: Pleural Thickening and Pleural Calcification, 62 Summary, 62 Answer Guide, 62 6 ELEVATED DIAPHRAGM, 63 Questions, 63 Discussion, 64 Top 5 Diagnoses: Elevated Diaphragm, 68 Summary, 69 Answer Guide, 70 7 SHIFT OF THE MEDIASTINUM, 71 Questions, 72 Discussion, 73 ix x Contents Top 5 Diagnoses: Shift of the Mediastinum, 80 Summary, 80 Answer Guide, 81 8 WIDENING OF THE MEDIASTINUM, 82 Questions, 83 Discussion, 84 Top 5 Diagnoses: Widening of the Mediastinum, 95 Summary, 95 Answer Guide, 95 9 ANTERIOR MEDIASTINAL MASS, 96 Questions, 96 Discussion, 98 Top 5 Diagnoses: Anterior Mediastinal Mass, 107 Summary, 107 Answer Guide, 107 10 MIDDLE MEDIASTINAL MASS, 108 Questions, 110 Discussion, 112 Top 5 Diagnoses: Middle Mediastinal Mass, 126 Summary, 126 Answer Guide, 127 11 HILAR ENLARGEMENT, 128 Questions, 129 Discussion, 131 Top 5 Diagnoses: Hilar Enlargement, 144 Summary, 146 Answer Guide, 146 12 POSTERIOR MEDIASTINAL MASS, 147 Questions, 148 Discussion, 149 Top 5 Diagnoses: Posterior Mediastinal Mass, 162 Summary, 162 Answer Guide, 163 PART 2 Pulmonary Opacities 13 ATELECTASIS, 166 Questions, 167 Discussion, 169 Top 5 Diagnoses: Atelectasis, 184 Summary, 184 Answer Guide, 184 14 SEGMENTAL AND LOBAR CONSOLIDATIONS, 185 Questions, 185 Discussion, 187 Contents xi Top 5 Diagnoses: Segmental and Lobar Opacities, 195 Summary, 195 Answer Guide, 196 15 DIFFUSE AIR SPACE OPACITIES, 197 Questions, 198 Discussion, 201 Top 5 Diagnoses: Diffuse Air Space Opacities, 214 Summary, 215 Answer Guide, 215 16 MULTIFOCAL ILL-DEFINED OPACITIES, 216 Questions, 217 Discussion, 218 Top 5 Diagnoses: Multifocal Ill-Defined Opacities, 233 Summary, 233 Answer Guide, 234 17 DIFFUSE FINE NODULAR OPACITIES, 235 Questions, 236 Discussion, 237 Top 5 Diagnoses: Diffuse Fine Nodular Opacities, 245 Summary, 245 Answer Guide, 245 18 FINE RETICULAR OPACITIES, 246 Questions, 247 Discussion, 249 Top 5 Diagnoses: Fine Reticular Opacities, 257 Summary, 257 Answer Guide, 258 19 COARSE RETICULAR OPACITIES (HONEYCOMB LUNG), 259 Questions, 260 Discussion, 261 Top 5 Diagnoses: Coarse Reticular Opacities (Honeycomb
Load more

Recommended publications
  • Asphyxia Neonatorum
    CLINICAL REVIEW Asphyxia Neonatorum Raul C. Banagale, MD, and Steven M. Donn, MD Ann Arbor, Michigan Various biochemical and structural changes affecting the newborn’s well­ being develop as a result of perinatal asphyxia. Central nervous system ab­ normalities are frequent complications with high mortality and morbidity. Cardiac compromise may lead to dysrhythmias and cardiogenic shock. Coagulopathy in the form of disseminated intravascular coagulation or mas­ sive pulmonary hemorrhage are potentially lethal complications. Necrotizing enterocolitis, acute renal failure, and endocrine problems affecting fluid elec­ trolyte balance are likely to occur. Even the adrenal glands and pancreas are vulnerable to perinatal oxygen deprivation. The best form of management appears to be anticipation, early identification, and prevention of potential obstetrical-neonatal problems. Every effort should be made to carry out ef­ fective resuscitation measures on the depressed infant at the time of delivery. erinatal asphyxia produces a wide diversity of in­ molecules brought into the alveoli inadequately com­ Pjury in the newborn. Severe birth asphyxia, evi­ pensate for the uptake by the blood, causing decreases denced by Apgar scores of three or less at one minute, in alveolar oxygen pressure (P02), arterial P02 (Pa02) develops not only in the preterm but also in the term and arterial oxygen saturation. Correspondingly, arte­ and post-term infant. The knowledge encompassing rial carbon dioxide pressure (PaC02) rises because the the causes, detection, diagnosis, and management of insufficient ventilation cannot expel the volume of the clinical entities resulting from perinatal oxygen carbon dioxide that is added to the alveoli by the pul­ deprivation has been further enriched by investigators monary capillary blood.
    [Show full text]
  • Inflammatory Diseases of the Brain in Childhood
    Inflammatory Diseases of the Brain in Childhood Charles R. Fitz1 From the Children's National Medical Center, Washington, DC Pediatric inflammatory disease may resemble found that the frequency of congenital involve­ adult disease or show remarkable, unique char­ ment increases with each trimester, being 17%, acteristics. This paper summarizes the current 25%, and 65%. However, infection severity de­ imaging of pediatric diseases with emphasis on creases in each trimester. The true frequency of those that are the most different from adult ill­ early cases may have been underestimated in nesses. their study, because spontaneous abortions were not included in the retrospective analysis. Congenital Infections Intracranial calcification is the most notable radiologic sign. Basal ganglial, periventricular, Most intrauterine infections are acquired and peripheral locations are all common (Fig. 1). through the placenta, although transvaginal bac­ Large basal ganglial calcifications are related to terial infections may also occur. The TORCH early infection, as is hydrocephalus. The hydro­ eponym remains a good reminder for these enti­ cephalus is invariably secondary to aqueductal ties, identifying toxoplasmosis, others, rubella, stenosis (2), and often has a characteristically cytomegalic virus, and herpes simplex. A second marked expansion of the atria and occipital horns H for HlV or perhaps the words A (AIDS) TORCH (Fig. 2), probably partly due to associated tissue should now be used, as AIDS becomes the most loss. This is associated with increased periventric­ common maternally transmitted infection. ular calcification in the author's experience. Mi­ crocephaly is common, and encephalomalacia is seen occasionally (2). Hydrencephaly has also Toxoplasmosis been reported (3). This infection is passed to humans from cats, Because calcifications are common and fairly since the oocyst of the Toxoplasma gondii para­ characteristic, computed tomography (CT) is site is excreted in cat feces.
    [Show full text]
  • Acute Airway Obstruction, an Unusual Presentation of Vallecular Cyst
    Case Report Acute airway obstruction, an unusual presentation of vallecular cyst Address for correspondence: Sameer M Jahagirdar, P Karthikeyan1, Ravishankar M Dr. Sameer M Jahagirdar, Department of Anaesthesiology & Critical Care Medicine, and 1ENT, Mahatma Gandhi Medical College and A 14, Green Avenue Research Institute, Puducherry, India Apartment, Point Care Street, Mudaliyarpet, Puducherry ‑ 605 004, India. ABSTRACT E-mail: dr.sameerjahagirdar [email protected] A 18‑year‑old female presented to us with acute respiratory obstruction, unconsciousness, severe respiratory acidosis, and impending cardiac arrest. The emergency measures to secure the airway Access this article online included intubation with a 3.5-mm endotracheal tube and railroading of a 6.5-mm endotracheal Website: www.ijaweb.org tube over a suction catheter. Video laryngoscopy done after successful resuscitation showed an inflamed swollen epiglottis with a swelling in the left vallecular region, which proved to be a DOI: 10.4103/0019-5049.89896 vallecular cyst. Marsupialisation surgery was performed on the 8th post admission day and the Quick response code patient discharged on 10th day without any neurological deficit. Key words: Acute supraglottitis, airway management, vallecular cyst INTRODUCTION and heart rate 160/minute. The carotid, radial, and other peripheral pulses were not palpable. She had a diffuse Acute adult supraglottitis is an inflammatory disease swelling over the anterior aspect of her neck. Pulse of the epiglottis and adjacent structures. It can be oximetry showed oxygen saturation <50%. Oxygen rapidly fatal because of the potential for sudden by mask was started and an intravenous (IV) line was airway obstruction. Early recognition and prompt secured and 500 ml of Ringer’s lactate solution was airway management is of utmost importance to reduce given.
    [Show full text]
  • Research Article
    z Available online at http://www.journalcra.com INTERNATIONAL JOURNAL OF CURRENT RESEARCH International Journal of Current Research Vol. 11, Issue, 08, pp.6469-6472, August, 2019 DOI: https://doi.org/10.24941/ijcr.36052.08.2019 ISSN: 0975-833X RESEARCH ARTICLE PULMONARY HYDATID CYSTS IMAGING *Hayfaa Hashim Mohammed Specialist in Radiology and Imaging, Iraq ARTICLE INFO ABSTRACT Article History: Background and objective: Hydatid disease is a zoonosis that can involve almost any organ in the Received 16th May, 2019 human body. After the liver, the lungs are the most common site for hydatid disease in adults. Received in revised form Imaging plays a pivotal role in the diagnosis of the disease, as clinical features are often nonspecific. 19th June, 2019 The aim of this study is to present the common imaging finding of this disease in our locality. Accepted 11th July, 2019 Methods: In this study, we reviewed the imaging findings of twenty five patients with pulmonary Published online 31st August, 2019 hydatid cysts in Mosul teaching hospital over 3 years (Jan.1999-Dec.2002).The main objective was to study the imaging finding of this disease. Results: Twenty five patients were reported to have Key Word: pulmonary hydatid cysts by different imaging modalities. Seventeen patients where male and the main age was 39 years (6-72), fourteen patients were diagnosed by chest x ray. Conclusions: Pulmonary, Hydatid, Cyst, Radiography, Computed tomography. Hydatid disease is a manifestation of larval infestation by the echinococcustapeworm. In adults, the lungs are second-most common organ to be involved by hematogenous dissemination. *Corresponding author: Uncomplicated pulmonary hydatid cysts are most commonly diagnosed incidentally on imaging.
    [Show full text]
  • Chest Radiology: a Resident's Manual
    Chest Radiology: A Resident's Manual Bearbeitet von Johannes Kirchner 1. Auflage 2011. Buch. 300 S. Hardcover ISBN 978 3 13 153871 0 Format (B x L): 23 x 31 cm Weitere Fachgebiete > Medizin > Sonstige Medizinische Fachgebiete > Radiologie, Bildgebende Verfahren Zu Inhaltsverzeichnis schnell und portofrei erhältlich bei Die Online-Fachbuchhandlung beck-shop.de ist spezialisiert auf Fachbücher, insbesondere Recht, Steuern und Wirtschaft. Im Sortiment finden Sie alle Medien (Bücher, Zeitschriften, CDs, eBooks, etc.) aller Verlage. Ergänzt wird das Programm durch Services wie Neuerscheinungsdienst oder Zusammenstellungen von Büchern zu Sonderpreisen. Der Shop führt mehr als 8 Millionen Produkte. 1 Heart Failure Acute left heart failure is most commonly caused by a hyperten- " Compare pulmonary vessels that are equidistant to a central sive crisis. Radiographic signs on the plain chest radiograph ob- point in the respective hilum. tained with the patient standing include: " Compare the diameter of a random easily identifiable superior " Redistribution of pulmonary perfusion lobe artery (often the anterior segmental artery is most easily " Presence of interstitial patterns (Kerley lines, peribronchial identifiable) with the diameter of the corresponding ipsilateral cuffing) bronchus (Fig. 1.62). " Alveolar densities with indistinct vascular structures (ad- vanced stage) As the pulmonary artery and corresponding ipsilateral bronchus " Pleural effusions are normally of precisely equal diameter, a larger arterial diameter is indicative of redistribution of perfusion (Fig. 1.63). The diagnos- All of these signs are essentially attributable to increased fluid tic criteria of caudal-to-cranial redistribution cannot be evaluated content in the abnormally heavy “wet” lung. The fluid accumula- on radiographs obtained in the supine patient.
    [Show full text]
  • ABRUPTIO PLACENTA- 4 Vaginal Bleeding, ABDOMINAL PAIN, and Uterine Tenderness and the Absence of Hemorrhage
    ABRUPTIO PLACENTA- 4 vaginal bleeding, ABDOMINAL PAIN, and uterine tenderness and the absence of hemorrhage. DOES NOT rule out this Dx DDx: Placenta Previa, absence of bleeding RULES OUT PP. ****Risk factors: 1-HTN and PRE-ECLAMPSIA, 2-Placental abruption in previous pregnancy, 3-trauma, 4-short umbilical cord, 6-COCAINE abuse. AP MCC of DIC in pregnancy, which results from a release of activated thromboplastin from the decidual hematoma in to maternal circulation. ****Risk Factors: Smoking and Folate def. It can progress rapidly so careful monitoring is mandatory. Once dx is made, large-bore IV and Foley catheter. Pts with AP in LABOR -- managed aggressively to insure rapid vaginal delivery, this will remove the inciting cause of DIC and hemorrhage. ***If stable: Tocolysis with MgSO4 is considered, but remember Ritordin is C/I in pt with HTN. *** Once we dx the next step: Vaginal delivery with augmentation of labor if necessary. Now if mother and baby are not stable or if there is C/I à EMERGENT C-SECTION. If there is Dystocia (narrowing birth passage) then Forceps can be used. ABCD of HOMEOSTASIS 1-AIRWAY: An airway is needed for all unconscious pts *** ER = OROTRACHIAL INTUBATION (Best method) *** In the field = NEEDLE CRICOTHYOIDECTOMY *** Conscious pt = CHIN LIFT w/FACE MASK 2-BREATHING: Cervical spine injury should be analyzed but 1st step is to establish ABC. 3-CIRCULATION: Needs control of bleeding and restoring the BP. ***Most External Injuries -- PRESSURE is enough to stop bleeding ***Scalp Laceration -- SUTURING is needed. All pts with HYPOTENSION receives rapid infusion of isotonic fluid (e.g.
    [Show full text]
  • Chilaiditi's Sign and the Acute Abdomen
    ACS Case Reviews in Surgery Vol. 3, No. 2 Chilaiditi’s Sign and the Acute Abdomen AUTHORS: CORRESPONDENCE AUTHOR: AUTHOR AFFILIATION: Devecki K; Raygor D; Awad ZT; Puri R Ruchir Puri, MD, MS, FACS University of Florida College of Medicine, University of Florida College of Medicine Department of Surgery, Department of General Surgery Jacksonville, FL 32209 653 W. 8th Street Jacksonville, FL 32209 Phone: (904) 244-5502 E-mail: [email protected] Background Chilaiditi’s sign is a rare radiologic sign where the colon or small intestine is interposed between the liver and the diaphragm. Chilaiditi’s sign can be mistaken for pneumoperitoneum and can be alarming in the setting of an acute abdomen. Summary We present two cases of Chilaiditi’s sign resulting from vastly different pathologies. The first patient was a 67-year-old male who presented with right upper quadrant pain. He was found to have Chilaiditi’s sign on the upright chest X ray. A CT scan revealed a cecal bascule interposed between the liver and diaphragm with concomitant acute appendicitis. Diagnostic laparoscopy confirmed imaging findings, and he underwent an open right hemicolectomy. The second patient was a 59-year-old female who presented with acute onset of right-sided abdominal pain. An upright chest X ray revealed air under the right hemidiaphragm, and the CT scan demonstrated a large, right-sided Morgagni-type diaphragmatic hernia. She underwent an elective laparoscopic hernia repair, which confirmed the presence of an anteromedial diaphragmatic hernia containing small bowel, colon, and omentum. Conclusion Chilaiditi’s sign can be associated with an acute abdomen.
    [Show full text]
  • Essr Congress June 9 – 10, 2006 Bruges / Belgium
    EUROPEAN SOCIETY FOR MUSCULOSKELETAL RADIOLOGY ESSR CONGRESS JUNE 9 – 10, 2006 BRUGES / BELGIUM PROGRAM www.essr.org Welcome Dear Colleagues, On behalf of the ESSR and the local organising commitee it is a great pleas- ure for me to welcome You in Bruges, Belgium, to attend the 13th Annual Meeting of the European Society of Musculoskeletal Radiology from June 9 to 10, 2006. The ESSR 2006 Congress will present two days of scientific papers, poster exhibits, refresher courses and ultrasound workshops. The main topic of the educational courses of the 2006 congress will be “Knee”: 24 “state-of-the-art” lectures by distinguished speakers will present current knowledge and future trends in the anatomy, diagnosis and therapy of diseases which are encountered in this joint. Hands-on workshops in the musculoskeletal ultrasound at basic and master class levels will provide invaluable practical experience. Six other half day courses on “Bone marrow imaging”, “Whole body imag- ing”, “Paediatric imaging”, “Trauma imaging”, “Orthopaedic hardware” and “Postoperative imaging” are planned. The contributions of many people presenting papers or posters in all aspects of musculoskeletal imaging are appreciated. We hope you will enjoy the social programme the organizing committee has arranged. We invite you to explore and visit the beautiful area of Bruges. There are numerous places to visit in the old city of Bruges… I am confident that this congress will be both educational and enjoyable. We welcome all members of the ESSR, non-members, guests and companions to this wonderful experience and venue and we look forward to see you in Bruges.
    [Show full text]
  • Common Pediatric Pulmonary Issues
    Common Pediatric Pulmonary Issues Chris Woleben MD, FAAP Associate Dean, Student Affairs VCU School of Medicine Assistant Professor, Emergency Medicine and Pediatrics Objectives • Learn common causes of upper and lower airway disease in the pediatric population • Learn basic management skills for common pediatric pulmonary problems Upper Airway Disease • Extrathoracic structures • Pharynx, larynx, trachea • Stridor • Externally audible sound produced by turbulent flow through narrowed airway • Signifies partial airway obstruction • May be acute or chronic Remember Physics? Poiseuille’s Law Acute Stridor • Febrile • Laryngotracheitis (croup) • Retropharyngeal abscess • Epiglottitis • Bacterial tracheitis • Afebrile • Foreign body • Caustic or thermal airway injury • Angioedema Croup - Epidemiology • Usually 6 to 36 months old • Males > Females (3:2) • Fall / Winter predilection • Common causes: • Parainfluenza • RSV • Adenovirus • Influenza Croup - Pathophysiology • Begins with URI symptoms and fever • Infection spreads from nasopharynx to larynx and trachea • Subglottic mucosal swelling and secretions lead to narrowed airway • Development of barky, “seal-like” cough with inspiratory stridor • Symptoms worse at night Croup - Management • Keep child as calm as possible, usually sitting in parent’s lap • Humidified saline via nebulizer • Steroids (Dexamethasone 0.6 mg/kg) • Oral and IM route both acceptable • Racemic Epinephrine • <10kg: 0.25 mg via nebulizer • >10kg: 0.5 mg via nebulizer Croup – Management • Must observe for 4 hours after
    [Show full text]
  • Radiologic Assessment in the Pediatric Intensive Care Unit
    THE YALE JOURNAL OF BIOLOGY AND MEDICINE 57 (1984), 49-82 Radiologic Assessment in the Pediatric Intensive Care Unit RICHARD I. MARKOWITZ, M.D. Associate Professor, Departments of Diagnostic Radiology and Pediatrics, Yale University School of Medicine, New Haven, Connecticut Received May 31, 1983 The severely ill infant or child who requires admission to a pediatric intensive care unit (PICU) often presents with a complex set of problems necessitating multiple and frequent management decisions. Diagnostic imaging plays an important role, not only in the initial assessment of the patient's condition and establishing a diagnosis, but also in monitoring the patient's progress and the effects of interventional therapeutic measures. Bedside studies ob- tained using portable equipment are often limited but can provide much useful information when a careful and detailed approach is utilized in producing the radiograph and interpreting the examination. This article reviews some of the basic principles of radiographic interpreta- tion and details some of the diagnostic points which, when promptly recognized, can lead to a better understanding of the patient's condition and thus to improved patient care and manage- ment. While chest radiography is stressed, studies of other regions including the upper airway, abdomen, skull, and extremities are discussed. A brief consideration of the expanding role of new modality imaging (i.e., ultrasound, CT) is also included. Multiple illustrative examples of common and uncommon problems are shown. Radiologic evaluation forms an important part of the diagnostic assessment of pa- tients in the pediatric intensive care unit (PICU). Because of the precarious condi- tion of these patients, as well as the multiple tubes, lines, catheters, and monitoring devices to which they are attached, it is usually impossible or highly undesirable to transport these patients to other areas of the hospital for general radiographic studies.
    [Show full text]
  • Respiratory Distress in Pediatrics
    Hindsight is 20/20 Karen A. Santucci, M.D. Professor of Pediatrics Yale-New Haven Children’s Hospital October 9, 2014 Disclosure No Financial Relationships Personal Financial Disclosure Case 1 Toddler siblings are jumping on the couch Larger one lands on top of the smaller one, both landing on the tile floor The smaller child cries out and develops respiratory distress. 911 activated Vitals: RR 62, HR 168, afebrile, crying EMS is transports her to the nearest hospital Case Progression Upon arrival, oxygen saturation in 70’s and severe respiratory distress Supplemental oxygen not helping! Decreased breath sounds bilaterally! No reported tracheal deviation Difficult to ventilate and oxygenate! Bilateral chest tubes are placed! She’s Intubated! Still difficult to ventilate and oxygenate! Case Progression Differential Diagnoses? Differential Diagnoses? Pulmonary contusion? Traumatic pneumothorax? Hemothorax? Crush injury? Transection? Underlying problem????? -Asthma -Pneumonia -Cystic fibrosis Perplexing Case Pediatric Pearl If it doesn’t make sense, go back to the basics. What were they doing right before the fall? Something We Don’t See Everyday! or Do We???? What the Heck!! Epidemiology 92,166 cases reported to Poison Centers in 2003 Peak incidence 6 months to 3 years 600 children die annually Majority present to EDs 2003 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System Am J Emerg Med 2004; 22:335-404 Foreign Bodies Food Coins Toys Munchausen Syndrome by
    [Show full text]
  • People Behind Exclusive Eponyms of Radiologic Signs (Part I)
    Canadian Association of Radiologists Journal 60 (2009) 201e212 www.carjonline.org History / Histoire People Behind Exclusive Eponyms of Radiologic Signs (Part I) Zeev V. Maizlin, MDa,*, Peter L. Cooperberg, MDb, Jason J. Clement, MDb, Patrick M. Vos, MDb, Craig L. Coblentz, MDa aDepartment of Radiology, McMaster University Medical Centre, Hamilton, Ontario, Canada bDepartment of Radiology, St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada Introduction were picked up and cited to create the eponym. The initial citation, in fact, was the birth act for the eponym. Chrono- An eponym in medicine is the name of a disease or logically, most eponyms used in radiology today were a structure based on or derived from the name of a person. created in the first half of the 20th century. No eponyms seem Eponyms are frequently used in the fields of both radiology to be originating from articles published starting from the and clinical disciplines. They play an important role in late 1970s. proper reporting and communication. Use of eponyms There is an interesting trend in the spelling of eponyms provides an efficient, easy, and short way of describing signs and noticed by F. M. Hall [1]. Traditionally, eponyms were and syndromes. Eponyms also honor those who have valu- recorded as possessives, as if the sign or disease belonged to ably contributed to medicine. Eponyms are links to our the honored individual (eg, Rigler’s). Over the past few history. Historical knowledge about eponyms opens up to us decades, a trend, started by omitting the apostrophe the personality of the people who developed the modern (Riglers), resulted more recently in elimination of the science of medicine.
    [Show full text]