High-Resolution CT of the Lung in Children: Technique, Indications, Anatomy, and Features of Lung Disease

  • Javier Lucaya
  • Ana Coma
Part of the Medical Radiology book series (MEDRAD)


High-resolution computed tomography (HRCT) of the chest provides lung images with excellent anatomic detail. HRCT is a valuable technique to gain information on the pattern and anatomical distribution of lung disease, determine the response to therapy, and guide clinical management. Enormous advances in technology in recent years now enable high-quality volumetric CT examinations to be performed at progressively lower radiation doses. Routine use of low-dose techniques is mandatory in pediatric patients to minimize the potential side effects of ionizing radiation exposure. In this chapter, the HRCT features of the normal and abnormal lungs are reviewed and the differential diagnosis of the most common abnormal HRCT patterns is provided. Noncontiguous HRCT with 1 mm slices at 10 or 20 mm intervals remains the technique of choice in the evaluation of many pediatric lung conditions.


Bronchopulmonary Dysplasia Bronchiolitis Obliterans Mosaic Pattern Small Airway Disease Interlobular Septum 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Ambrosino NM, Genieser NB, Roche KJ et al (1994) Feasibility of high-resolution, low-dose chest CT in the evaluation of the pediatric chest. Pediatr Radiol 24:6–10PubMedCrossRefGoogle Scholar
  2. Aquino SL, Gamsu G, Webb WR et al (1996) Tree-in-bud pattern: frequency and significance on thin section CT. J Comput Assist Tomogr 20:594–599PubMedCrossRefGoogle Scholar
  3. Aquino SL, Schechter MS, Chiles C et al (1999) High-resolution inspiratory and expiratory CT in older children and adults with bronchopulmonary dysplasia. AJR Am J Roentgenol 173:963–967PubMedCrossRefGoogle Scholar
  4. Arakawa H, Webb WR (1998) Air-trapping on expiratory high-resolution CT scans in the absence of inspiratory scan abnormalities. AJR Am J Roentgenol 170:1012–1018CrossRefGoogle Scholar
  5. Aukland SM, Halvorsen T, Fosse KR et al (2006) High resolution CT of the chest in children and young adults who were born prematurely: findings in a population- based study. Am J Roentgenol 187:1012–1018CrossRefGoogle Scholar
  6. Bonelli FS, Hartman TE, Swensen SJ et al (1998) Accuracy of high-resolution CT in diagnosing lung diseases. AJR Am J Roentgenol 170:1507–1512PubMedCrossRefGoogle Scholar
  7. Brody AS (2005) Imaging considerations: interstitial lung disease in children. Radiol Clin North Am 43:391–403PubMedCrossRefGoogle Scholar
  8. Brody AS, Crotty EJ (2006) Neuroendocrine cell hyperplasia of infancy (NEHI). Pediatr Radiol 36:1328PubMedCrossRefGoogle Scholar
  9. Callahan MJ (2011) CT dose reduction in practice. Pediatr Radiol 41:S488–S492CrossRefGoogle Scholar
  10. Canakis AM, Cutz E, Mason D et al (2002) Pulmonary interstitial glycogenosis. a new variant of neonatal interstitial lung disease. Am J Respir Crit Care Med 165:1557–1565PubMedGoogle Scholar
  11. Capitanio MA, Kirkpatrick JA (1972) Lateral decubitus film: an aid in determining air-trapping in children. Radiology 103:460–462PubMedCrossRefGoogle Scholar
  12. Choi D, Lee KS, Suh GY et al (1999) Pulmonary tuberculosis presenting as acute respiratory failure: radiologic findings. J Comput Assist Tomogr 23:107–113PubMedCrossRefGoogle Scholar
  13. Choi SJ, Choi BK, Kim HJ et al (2002) Lateral decubitus HRCT: a simple technique to replace expiratory CT in children with air trapping. Pediatr Radiol 32:179–182PubMedCrossRefGoogle Scholar
  14. Chung T, Hoffer FA, Connor L et al (2000) The use of oral pentobarbital sodium (Nembutal) versus oral chloral hydrate in infants undergoing CT and MR imaging—a pilot study. Pediatr Radiol 30:332–335PubMedCrossRefGoogle Scholar
  15. Collins J, Stern EJ (1997) Ground-glass opacity at CT: the ABCs. AJR Am J Roentgenol 169:355–367PubMedCrossRefGoogle Scholar
  16. Copley SJ, Coren M, Nicholson AG et al (2000) Diagnostic accuracy of thin-section CT and chest radiography of pediatric interstitial lung disease. AJR Am J Roentgenol 174:549–554PubMedCrossRefGoogle Scholar
  17. Deterding RR, Pye C, Fan LL et al (2005) Persistent tachypnea of infancy is associated with neuroendocrine cell hyperplasia. Pediat Pulmonol 40:157–165CrossRefGoogle Scholar
  18. Dougeni E, Faulkner K, Panayiotakis G (2012) A review of patient dose and optimisation methods in adult and paediatric CT scanning. Eur J Radiol 81:665–683CrossRefGoogle Scholar
  19. Edey AJ, Devaraj AA, Barker RP et al (2011) Fibrotic idiopathic interstitial pneumonias: HRCT findings that predict mortality. Eur Radiol 21:1586–1593PubMedCrossRefGoogle Scholar
  20. Egelhoff JC, Ball WS, Koch BL et al (1997) Safety and efficacy of sedation in children using a structured sedation program. AJR Am J Roentgenol 168:1259–1262PubMedCrossRefGoogle Scholar
  21. Escuissato DL, Gasparetto EL, Marchiori E et al (2005) Pulmonary infections after bone marrow transplantation: high-resolution CT findings in 111 patients. AJR Am J Roentgenol 185:608–615PubMedCrossRefGoogle Scholar
  22. Ferretti GR, Lantejuol S, Brambilla E et al (1996) Pulmonary involvement in Niemann-Pick disease subtype B: CT findings. J Comput Assist Tomogr 20:990–992PubMedCrossRefGoogle Scholar
  23. Fink C, Schmaelh A, Bock M et al (2003) Pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation. Image findings with multiphasic pulmonary magnetic resonance angiography. Circulation 107:e129–e130PubMedCrossRefGoogle Scholar
  24. Fisher DM (1990) Sedation of pediatric patients: an anesthesiologist’s perspective. Radiology 175:613–615PubMedCrossRefGoogle Scholar
  25. Franquet T, Gimenez A, Brodes R et al (1998) The crazy paving pattern in exogenous lipoid pneumonia. CT-pathologic correlation. AJR Am J Roentgenol 170:315–317PubMedCrossRefGoogle Scholar
  26. Fricke BL, Donnelly LF, Frush DP et al (2003) In-plane bismuth breast shields for pediatric CT: effects on radiation dose and image quality using experimental and clinical data. AJR Am J Roentgenol 180:407–411PubMedCrossRefGoogle Scholar
  27. García-Peña P, Boixadera H, Barber I et al (2011) Thoracic findings of systemic diseases at high-resolution CT in children. Radiographics 31:465–482PubMedCrossRefGoogle Scholar
  28. Garcia-Peña P, Lucaya J (2004) HRCT in children: technique and indications. Eur Radiol 14:L13–L30PubMedCrossRefGoogle Scholar
  29. Giovagnorio F, Cavallo V (1995) HRCT evaluation of secondary lobules and acini of the lung. J Thorac Imaging 10:129–133PubMedCrossRefGoogle Scholar
  30. Geleijns J, Wang J, McCollough C (2010) The use of breast shielding for dose reduction in pediatric CT: arguments against the proposition. Pediatr Radiol 40:1744–1747PubMedCrossRefGoogle Scholar
  31. Gruden JF, Webb WR, Warnock M et al (1994) Centrilobular opacities in the lung on high-resolution CT: diagnostic considerations and pathologic correlation. AJR Am J Roentgenol 162:569–574PubMedCrossRefGoogle Scholar
  32. Hansell DM (2010) Thin-section CT of the lungs: the hinterland of normal. Radiology 256:695–711PubMedCrossRefGoogle Scholar
  33. Hansell DM, Bankier AA, MacMahon H et al (2008) Fleischner society: glossary of terms for thoracic imaging. Radiology 246:697–722PubMedCrossRefGoogle Scholar
  34. Hansell DM, Wells AU, Rubens MB et al (1994) Bronchiectasis: functional significance of areas of decreased attenuation at expiratory CT. Radiology 193:369–374PubMedCrossRefGoogle Scholar
  35. Hartman TE, Primack SL, Lee KS et al (1994) CT of bronchial and bronchiolar diseases. Radiographics 14:991–1003PubMedCrossRefGoogle Scholar
  36. Heng Vong C, Bajard A, Thiesse P et al (2012) Deep sedation in pediatric imaging: efficacy and safety of intravenous chlorpromazine. Pediatr Radiol 42:552–561PubMedCrossRefGoogle Scholar
  37. Henry TS, Lane MA, Weil GJ et al (2012) Chest CT features of North American paragonimiasis. AJR Am J Roentgenol 198:1076–1783PubMedCrossRefGoogle Scholar
  38. Hubbard AM, Markowitz RI, Kimmel B et al (1992) Sedation for pediatric patients undergoing CT and MRI. J Comput Assist Tomogr 16:3–6PubMedCrossRefGoogle Scholar
  39. Johkoh T, Müller NL, Ichikado K et al (1999a) Respiratory change in size of honeycombing: inspiratory and expiratory spiral volumetric CT analysis of 97 cases. J Comput Assist Tomogr 23:174–180PubMedCrossRefGoogle Scholar
  40. Johkoh T, Müller NL, Pickford HA et al (1999b) Lymphocytic interstitial pneumonia: thin-section CT findings in 22 patients. Radiology 212:567–572PubMedCrossRefGoogle Scholar
  41. Karian VE, Burrows PE, Zurakowski D et al (1999) Sedation for pediatric radiological procedures: analysis of potential causes of sedation failure and paradoxical reactions. Pediatr Radiol 29:869–873PubMedCrossRefGoogle Scholar
  42. Kim S, Frush DP, Yoshizumi TT (2010) Bismuth shielding in CT: support for use in children. Pediatr Radiol 40:1739–1743PubMedCrossRefGoogle Scholar
  43. Kim SJ, Lee KS, Ryu YH et al (2003) Reversed halo sign on high-resolution CT of cryptogenic organizing pneumonia: diagnostic implications. AJR Am J Roentgenol 180:1251–1254PubMedCrossRefGoogle Scholar
  44. Klusmann M, Owens C (2009) HRCT in paediatric diffuse interstitial lung disease—a review for 2009. Pediatr Radiol 39:S471–S481CrossRefGoogle Scholar
  45. Koyama M, Johkoh T, Honda O et al (2003) Chronic cystic lung disease: diagnostic accuracy of high-resolution CT in 92 patients. AJR Am J Roentgenol 180:827–835PubMedCrossRefGoogle Scholar
  46. Kroft L, Roelofs J, Geleijns J (2010) Scan time and patient dose for thoracic imaginmg in neonatesand small children using 320-detector row CT compared to helical 64-, 32-, and 16-detector row CT acquisitions. Pediatr Radiol 40:294–300PubMedCentralPubMedCrossRefGoogle Scholar
  47. Land CE, Tokunaga M, Tokuaka AS et al (1993) Early-onset breast cancer in A-bomb survivors. Lancet 342:237PubMedCrossRefGoogle Scholar
  48. Landry BA, Melhem RE (1989) Pulmonary nodules secondary to total parenteral alimentation. Pediatr Radiol 19:456–457PubMedCrossRefGoogle Scholar
  49. Lee KH, Kim WS, Cheon JE et al (2005) Squalene aspiration pneumonia in children: radiographic and CT findings as the first clue to diagnosis. Pediatr Radiol 35:619–623PubMedCrossRefGoogle Scholar
  50. Lee C (2007) The crazy-paving sign. Radiology 243:905–906PubMedCrossRefGoogle Scholar
  51. Lee EY (2013) Interstitial lung disease in infants: new classification system, imaging technique, clinical presentation and imaging findings. Pediatr Radiol 43:3–13PubMedCrossRefGoogle Scholar
  52. Levine D, Akikusa J, Manson D et al (2007) Chest CT findings in pediatric Wegener’s granulomatosis. Pediatr Radiol 37:57–62PubMedCrossRefGoogle Scholar
  53. Lucaya J, García-Peña P, Herrera L et al (1999) Expiratory chest CT in children. AJR Am J Roentgenol 174:235–241CrossRefGoogle Scholar
  54. Lucaya J, Piqueras J, García-Peña P et al (2000) Low-dose high-resolution CT in children and young adults: dose, cooperation, artifact incidence, and image quality. AJR Am J Roentgenol 175:985–992PubMedCrossRefGoogle Scholar
  55. Lynch DA, Hay T, Newel JD et al (1999) Pediatric diffuse lung disease. AJR Am J Roengenol 173:713–718CrossRefGoogle Scholar
  56. Macias CG, Chumpitazi CE (2011) Sedation and anesthesia for CT: emerging issues for providing high-quality care. Pediatr Radiol 41:S517–S522CrossRefGoogle Scholar
  57. Marchiori E, Zanetti G, Mereilles GS et al (2011) The reversed halo sign onhigh-resolution CT in infectious and noninfectious pulmonary diseases. AJR Am J Roentgenol 197:69–75CrossRefGoogle Scholar
  58. Mason KP, Prescilla R, Fontaine PJ et al (2011) Pediatric CT sedation: comparison of dexmedetomidine and pentobarbital. AJR Am J Roentgenol 196:194–198CrossRefGoogle Scholar
  59. Mayo JR, Webb WR, Gould R et al (1987) High-resolution CT of the lungs: an optimal approach. Radiology 163:507–510PubMedCrossRefGoogle Scholar
  60. Mayo JR, Jackson SA, Müller NL (1993) High-resolution CT of the chest: radiation dose. AJR Am J Roentgenol 160:479–481PubMedCrossRefGoogle Scholar
  61. McCollough CH, Chen GH, Kalender W et al (2012a) Achieving routine submillisievert CT scanning: report from the summit on management of radiation dose in CT. Radiology 264:567–580PubMedCentralPubMedCrossRefGoogle Scholar
  62. McCollough CH, Wang J, Gould RG et al (2012b) Point/counterpoint. the use of bismuth breast shields for CT should be discouraged. Med Phys 39:2321–2324PubMedCrossRefGoogle Scholar
  63. Moon WK, Kim Ws, Kim IO et al (1996) Diffuse pulmonary disease in children. High-resolution CT findings. AJR Am J Roentgenol 167:1405–1408PubMedCrossRefGoogle Scholar
  64. Murata K, Khan A, Rojas KA et al (1988) Optimization of computed tomography technique to demonstrate the fine structure of the lung. Invest Radiol 23:170–175PubMedCrossRefGoogle Scholar
  65. Murata K, Khan A, Herman PG (1989) Pulmonary parenchymal diseases: evaluation with high resolution CT. Radiology 170:629–635PubMedCrossRefGoogle Scholar
  66. Newman B, Kuhn JP, Kramer SS et al (2001) Congenital surfactant protein B deficiency. Emphasis on imaging. Pediatr Radiol 31:327–331PubMedCrossRefGoogle Scholar
  67. Nievelstein RA, van Dam IM, van der Molen AJ (2010) Multidetector CT in children: current concepts and dose reduction strategies. Pediatr Radiol 40:1324–1344PubMedCentralPubMedCrossRefGoogle Scholar
  68. Oh YW, Effmann EL, Redding GJ et al (1999) Follicular hyperplasia of bronchus-associated lymphoid tissue causing severe air-trapping. AJR Am J Roentgenol 172:745–747PubMedCrossRefGoogle Scholar
  69. Oppenheim C, Mamou-Mani T, Sayegh N et al (1994) Bronchopulmonary dysplasia: value of CT in identifying pulmonary sequelae. AJR Am J Roentgenol 163:169–172PubMedCrossRefGoogle Scholar
  70. Ouellette H (1999) The signet ring sign. Radiology 212:67–68PubMedCrossRefGoogle Scholar
  71. Pearce MS, Salotti JA, Little MP et al (2012) Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 380:499–505PubMedCentralPubMedCrossRefGoogle Scholar
  72. Pererira JK, Burrows PE, Rickards HM et al (1993) Comparison of sedation regimens for pediatric outpatient CT. Pediatr Radiol 23:341–344CrossRefGoogle Scholar
  73. Pinto PS (2004) The halo sign. Radiology 230:109–110PubMedCrossRefGoogle Scholar
  74. Popler J, Lesnick B, Dishop MK et al (2012) New coding in the international classification of diseases, ninth revision, for children’s interstitial lung disease. Chest 142:774–780PubMedCrossRefGoogle Scholar
  75. Rastogi R, Garg R, Thulkar S et al (2008) Unusual thoracic CT manifestations of osteosarcoma: review of 16 cases. Pediatr Radiol 38:551–558PubMedCrossRefGoogle Scholar
  76. Rimmer MJ, Dixon AK, Flower DR et al (1985) Bleomycin lung: computed tomographic observations. Br J Radiol 58:1041–1045PubMedCrossRefGoogle Scholar
  77. Roberton BJ, Hansell DM (2011) Organizing pneumonia: a kaleidoscope of concepts and morphologies. Eur Radiol 21:2244–2254PubMedCrossRefGoogle Scholar
  78. Rooks VJ, Chung T, Connor N et al (2003) Comparison of oral pentopharbital sodium (neumbutal) and oral chloral hydrate for sedation of infants during radiologic imaging. Preliminary results. AJR Am J Roentgenol 180:1125–1128PubMedCrossRefGoogle Scholar
  79. Rossi SE, Franquet T, Volpacchio M et al (2005) Tree- in bud pattern and thin section CT of the lungs: radiologic-pathologic overview. Radiographics 25:289–901CrossRefGoogle Scholar
  80. Rothemberg LN, Pentlow KS (1992) Radiation dose in CT. Radiographics 12:1225–1243CrossRefGoogle Scholar
  81. Sakai S, Shida Y, Takahashi N et al (2006) Pulmonary lesions associated with visceral larva migrans due to ascaris suum or toxocara canis: imaging of six cases. AJR Am J Roentgenol 186:1697–1702PubMedCrossRefGoogle Scholar
  82. Sanborn PA, Michna E, Zurazowski D et al (2005) Adverse cardiovascular and respiratory events during sedation of pediatric patients for imaging examinations. Radiology 237:288–294PubMedCrossRefGoogle Scholar
  83. Schultz R, Mattila J, Gappa M et al (2001) Development of progressive pulmonary interstitial and intra-alveolar cholesterol granulomas associated with therapy-resistent chronic systemic juvenile arthritis. Pediat Pulmonol 32:397–402CrossRefGoogle Scholar
  84. Seaman Dm, Meyer CA, Gilman MD et al (2011) Diffuse cystic lung disease at high-resolution CT. AJR Am J Roentgenol 196:1305–1311PubMedCrossRefGoogle Scholar
  85. Seely JM, Jones LT, Wallace C (1998) Systemic sclerosis: using high-resolution CT to detect lung disease in children. AJR Am J Roentgenol 170:691–697PubMedCrossRefGoogle Scholar
  86. Shankar VR (2008) Sedating children for radiological procedures: an intensivist’s perspective. Pediatr Radiol 38:S213–S217PubMedCrossRefGoogle Scholar
  87. Shepard JA (1995) The bronchi: an imaging perspective. J Thorac Imaging 10:236–254PubMedCrossRefGoogle Scholar
  88. Sigal-Cinqualbre AB, Hennequin R, Abada HT et al (2004) Low-kilovoltage multi-detector row chest CT in adults: feasibility and effect on image quality and iodine dose. Radiology 231:169–174PubMedCrossRefGoogle Scholar
  89. Silva CT, Amaral JG, Moineddin R et al (2010) CT characteristics of lung nodules present at diagnosis of extrapulmonary malignancy in children. AJR Am J Roentgenol 194:772–778PubMedCrossRefGoogle Scholar
  90. Sodickson A (2012) Strategies for reducing radiation exposure in multi-detector row CT. Radiol Clin North Am 50:1–14PubMedCrossRefGoogle Scholar
  91. Song I, Yi CA, Han J et al (2012) CT findings of late-onset noninfectious pulmonary complications in patients with pathologically proven graft-versus-host disease after allogeneic stem cell transplant. AJR Am J Roentgenol 199:581–587PubMedCrossRefGoogle Scholar
  92. Stern EJ, Müller NL, Swensen SJ et al (1995) CT mosaic pattern of lung attenuation: etiologies and terminology. J Thorac Imaging 10:294–297PubMedCrossRefGoogle Scholar
  93. Tomiyama N, Ikezoe J, Miyamoto M et al (1994) CT halo sign in metastasis of osteosarcoma. AJR Am J Roentgenol 162:468PubMedCrossRefGoogle Scholar
  94. Tyrrell VJ, Asher MI, Chan Y (1999) Subpleural lung cysts in down’s syndrome. Pediat Pulmonol 28:145–148CrossRefGoogle Scholar
  95. Vade A, Sukhani R, Dolenga M et al (1995) Chloral hydrate sedation of children undergoing CT and MR imaging: safety as judged by American academy of pediatrics guidelines. AJR Am J Roentgenol 165:905–909PubMedCrossRefGoogle Scholar
  96. Webb WR, Müller NL, Naidich DP (1996) High-resolution CT of the lung, 2nd edn. Lippincott-Raven Publishers, PhiladelphiaGoogle Scholar
  97. Weibel ER (1979) Looking into the lungs: what can it tell us? AJR Am J Roentgenol 133:1021–1031PubMedCrossRefGoogle Scholar
  98. Willemink MJ, Leiner T, de Jong PA et al (2013) Iterative reconstruction techniques for computed tomography part 2: initial results in dose reduction and image quality. Eur Radiol 16 Google Scholar

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© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Department of Pediatric Radiology and Institute of Diagnostic ImagingVall d’Hebrón HospitalsBarcelonaSpain
  2. 2.Department of Pediatric RadiologyVall d’Hebrón HospitalsBarcelonaSpain

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