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Role of Computed Tomography in Pediatric Chest Conditions

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Abstract

CT is the preferred cross-sectional imaging modality for detailed evaluation of anatomy and pathology of the lung and tracheobronchial tree, and plays a complimentary role in the evaluation of certain chest wall, mediastinal, and cardiac abnormalities. The article provides an overview of indications and different types of CT chest, findings in common clinical conditions, and briefly touches upon the role of each team member in optimizing and thus reducing radiation dose.

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Contributions

AI, RVL and SMP: Manuscript preparation; SG: Manuscript plan, preparation, edition and will act as guarantor for this paper.

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Authors and Affiliations

  1. Department of Radiology, Christian Medical College, Vellore, 632004, Tamil Nadu, India

    Aparna Irodi, R. V. Leena & Sridhar Gibikote

  2. Department of Radiology, SSM Superspeciality Hospital, Hassan, Karnataka, India

    Shailesh M Prabhu

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  1. Aparna Irodi
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  2. R. V. Leena
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  3. Shailesh M Prabhu
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Correspondence to Sridhar Gibikote.

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Electronic supplementary material

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Supplementary Fig. S1

Endobronchial radioopaque foreign body. A 2-y-old boy with history of recurrent infection and empyema. CXR (a), non-contrast enhanced axial CT section in mediastinal window (b) and coronal CT section in lung window at the level of the carina, showing a metallic foreign body in distal left main bronchus (long arrow in b, single arrow in a,c) with collapse of left lung (*), left sided empyema with pleural thickening (multiple short thick arrows in b) and intercostal drain tube (thin double arrows in b,c) (JPEG 128 kb)

Supplementary Fig. S2

Intralobar sequestration. A 4-y-old boy with recurrent respiratory infections. Axial CT chest in lung (a) and mediastinal window (b) show abnormal cystic spaces and bronchiectatic changes in the right lung lower lobe (black arrows) which receives anomalous systemic arterial supply (double white arrows) from the descending thoracic aorta (long white arrow). (JPEG 76 kb)

Supplementary Fig. S3

Necrotising pseudomonas pneumonia. A 6-y-old with congenital neutropenia. Contrast enhanced axial CT section in mediastinal window (a) and lung window (b) showing a large consolidation in the right lower and upper lobes (black arrows in b) with non-enhancing necrotic areas (arrows in a). (JPEG 73 kb)

Supplementary Fig. S4

Tracheo-oesophageal fistula. Axial CT image in lung window through upper chest showing a tracheo-oesophageal fistula in a 10-y-old with recurrent chest infection. (JPEG 67 kb)

Supplementary Fig. S5

Miliary tuberculosis. Axial CT chest in lung window (a) with zoomed insert and chest radiograph (b) showing randomly distributed diffuse miliary (1–2 mm) nodules. (JPEG 107 kb)

Supplementary Fig. S6

Post primary tuberculosis. CT chest in lung window shows multiple thick walled cavities, some with air-fluid level and some with surrounding small nodules. (JPEG 115 kb)

Supplementary Fig. S7

Post primary tuberculosis. Non-conntrast CT chest in mediastinal window (a) shows pleural involvement with hydro-pneumothorax and diffuse pleural thickening suggestive of empyema. CT thorax in lung window at the level of carina in another patient (b) demonstrates branching opacities giving “ tree in bud” appearance suggestive of endobronchial spread. (JPEG 95 kb)

Supplementary Fig. S8

Fungal pneumonia (Invasive aspergillosis). A 12-y-old, post bone marrow transplant patient with neutropenia. Chest CTs in lung window shows a nodule with surrounding ground glass halo (curved white arrow in a). Smaller similar peripheral opacity is seen in left lung apex. HRCT obtained 1 wk after the previous CT (b) and when white cell counts recovered, shows “Air crescent “sign (white arrow). (JPEG 76 kb)

Supplementary Fig. S9

Ruptured bronchogenic cyst. Chest radiograph (a) shows increased lucency in upper and mid left hemithorax (arrow). Axial CT thorax in lung window (b) shows a large air filled cyst (arrow), proved to be a bronchogenic cyst on surgery. CPAM and ruptured hydatid cysts would be differentials. (JPEG 81 kb)

Supplementary Fig. S10

Obliterative bronchiolitis. Chest radiograph (a) shows increased lucency in left hemithorax with reduced vascular markings and small left hilum (curved arrow). Axial HRCT section (b) shows reduced attenuation of the left lung and patchy areas of right lung (arrows) with reduced caliber of vessels, mild bronchiectasis and bronchial wall thickening (double arrows) along with mild reduction in volume of affected segments. (JPEG 126 kb)

Supplementary Fig. S11

Bronchial atresia. Axial CT shows mucus impaction of the central bronchi(arrow heads) with distal parenchyma showing increased lucency and paucity of vessels suggestive of air trapping (curved arrows). (JPEG 97 kb)

Supplementary Fig. S12

Agnesis of left lung. Infant with fever and tachypnea. CXR (a) shows opaque left hemithorax (long arrow) with ipsilateral mediastinal shift and hyperinflation of contralateral lung (arrows). CT (b and c) show agenetic left lung (black arrow) with absent bronchus and left pulmonary artery (curved arrow in c). Also note multiple vertebral anomalies at upper thoracic level on CXR (curved arrow in a). (JPEG 69 kb)

Supplementary Fig. S13

Inflammatory myofibroblastic tumor. Axial contrast CT Chest image demonstrates a moderately enhancing soft tissue mass in the left lower lobe (arrow). (JPEG 62 kb)

Supplementary Fig. S14

Metastasis. Axial CT chest image in lung window demonstrates a nodular lesion (arrow) in the right lower lobe, in a patient with rhabdomyosarcoma of the temporal region. (JPEG 79 kb)

Supplementary Fig. S15

Rhabdomyosarcoma. Axial contrast enhanced CT Chest image demonstrates a large heterogeneous mass lesion in the right hemithorax displacing the mediastinum to the left (JPEG 66 kb)

Supplementary Fig. S16

Normal thymus. Axial contrast enhanced CT Chest images demonstrate normal thymus (arrows). (JPEG 60 kb)

Supplementary Fig. S17

Lymphoma. Chest radiograph (a) in a 11-y-old boy with lymphoma showing a mediastinal mass (arrows). Contrast enhanced CT chest shows discrete homogeneous nodal masses in anterior and middle mediastinum (arrows). (JPEG 92 kb)

Supplementary Fig. S18

Lymphatic malformation. Contrast enhanced axial CT images through the lower neck and upper chest shows a trans-spatial fluid density lesion extending from the neck to the thorax, insinuating between the subclavian vessels, causing mass effect on the mediastinal structures. (JPEG 89 kb)

Supplementary Fig. S19

Neuroblastoma. Contrast CT Chest axial image demonstrates a heterogenous right paraspinal mass (arrows) lesion showing necrotic areas (**). (JPEG 52 kb)

Supplementary Fig. S20

Neurofibromatosis. Note the scoliosis (long thin arrow) and ‘ribbon ribs’ (curved arrows), on the CXR (a). Contrast CT Chest axial images (b,c) demonstrate left paraspinal oval soft tissue lesion (arrow) with intraspinal extension and a similar lesion (double arrows) involving the left paraspinal muscles. (JPEG 91 kb)

Supplementary Fig. S21

Neurenteric cyst. Chest radiograph (a) shows mediastinal widening (arrows). Also note the segmentation anomalies in the spine (curved arrow). Contrast enhanced axial CT (b) shows a heterogeneous right posterior mediastinal mass (arrows) with some areas of fluid density (**). T2W coronal (c) and sagittal (d) MRI show a large lobulated elongated right posterior mediastinal mass extending from thoracic inlet to diaphragm (arrows in c). Vertebral anomalies with defect in vertebral body and intraspinal communication of the mediastinal cyst (curved arrow in d) and associated syrinx in the spinal cord (double arrows) are noted. (JPEG 102 kb)

Supplementary Fig. S22

PNET of chest wall. Contrast CT Chest axial image demonstrates a large heterogeneous anterior chest wall lesion showing rib destruction and large intrathoracic component. (JPEG 58 kb)

Supplementary Fig. S23

Pulmonary hypoplasia. A 7-y-old child with fever and cough. Chest radiograph (a) shows mediastinal shift to left (horizontal arrow). CT thorax in mediastinal and lung window (b) and (c) show small calibre left main bronchus and left pulmonary artery (oblique arrows). (JPEG 76 kb)

Supplementary Fig. S24

Bronchopulmonary dysplasia. A 3-wk-old prematurely born neonate. Chest radiograph (a) and CT thorax (b) show the typical bubbly lungs (arrows) due to multiple cysts intervening with thickened interlobular septa and linear opacities. Left sided pneumothorax is also seen. (JPEG 83 kb)

Supplementary Fig. S25

Chronic Eosinophilic pneumonia. 8 year old boy with multiple exacerbations of shortness of breath, peripheral and pulmonary eosinophilia. Frontal chest radiograph (a) and CT thorax (b) show bilateral peripheral consolidations (white arrows) in both lungs. (JPEG 104 kb)

Supplementary Fig. S26

Interstitial pneumonia in dermatomyositis. A 7-y-old girl with juvenile dermatomyositis - HRCT thorax shows extensive ground glass opacities, reticulation, architectural distortion bilaterally(thick white arrow) and right pneumothorax (thin white arrow). (JPEG 72 kb)

Supplementary Fig. S27

Follicular bronchiolitis in SLE. A 11-y-old girl with SLE, with biopsy proven bronchiolitis. HRCT section in lung window showing, multiple ground glass density centrilobular nodules scattered throughout both lungs (few shown by short white arrows). Pneumomediastinum (curved white arrows) and right pneumothorax (chevron) are also present (JPEG 104 kb)

Supplementary Fig. S28

Child with storage disorder (Niemann Pick disease). Axial HRCT in lung window showing ‘Crazy paving’ appearance with reticular opacities due to inter and intralobular septal thickening (few shown by small arrows) and associated ground glass opacities and consolidation (few shown by curved arrows). (JPEG 111 kb)

Supplementary Fig. S29

Histiocytosis. A 4-y-old child with recurrent pneumothorax. CXR (a) shows the pneumothorax and cystic lucencies and air space opacities in the lungs. Axial HRCT sections in lung window (b,c,d) show multiple irregular cysts (curved arrows) and bilateral pneumothorax (arrows). (JPEG 130 kb)

Supplementary Fig. S30

Pneumocystis carinii pneumonia. A 16-y-old boy with aplastic anemia, post bone marrow transplant. Axial HRCT thorax in lung window shows diffuse ground glass opacities (arrows) with a few interlobular septal thickening and few areas of sparing (curved black arrow). (JPEG 78 kb)

Supplementary Fig. S31

Idiopathic pulmonary arterial hypertension. A13-y-old girl with progressive breathlessness. Dilated main pulmonary artery (thick arrow), perivascular ground glass opacity (thin arrow), no cause for PAH was found. (JPEG 76 kb)

Supplementary Fig. S32

Morgagni hernia. CXR (a) shows a right paracardiac lesion with air lucencies within (arrows). Serial contrast CT sections (b) shows herniation of colonic loops (arrows) through the foramen of Morgagni, located close to xiphoid process (between the sternal and costal attachments of the diaphragm). (JPEG 113 kb)

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Irodi, A., Leena, R.V., Prabhu, S.M. et al. Role of Computed Tomography in Pediatric Chest Conditions. Indian J Pediatr 83, 675–690 (2016). https://doi.org/10.1007/s12098-015-1955-4

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  • DOI: https://doi.org/10.1007/s12098-015-1955-4

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