Acute Chest Diseases: Infection and Trauma

  • José Fonseca Santos
Part of the Medical Radiology book series (MEDRAD)


Acute chest diseases include clinical situations with infectious and traumatic etiology. Pulmonary infection is the most common indication for performing chest radiography. Radiological imaging often confirms the diagnosis and allows the evaluation of the location and extent of infection. Chest radiography is the primary imaging procedure and the starting point for the evaluation of all children with acute chest disease. Accurate interpretation of pediatric chest films also requires a basic understanding of the physiologic and anatomic differences among adults, neonates, and infants and their most important differences will be referred. Characterization of pulmonary infiltrates is important, because patterns of abnormality suggest specific organisms and aetiologies. Although providing evidence suggestive of the causative agent, the chest radiograph cannot confirm viral infection, confirm or exclude bacterial etiology. In fact, in infancy, pneumonia usually produces a combination of alterations of the airspace and interstitium. However, some aspects may be useful in distinguishing between viral and bacterial pneumonia. Close attention to CT technique is crucial for imaging evaluation of pneumonia in pediatric patients, namely those with persistent symptoms and/or progressive symptoms despite medical or surgical therapy, or in immunocompromised patients. CT with low radiation dose technique should be carefully performed in these cases. CT examination with IV contrast is very useful for the evaluation of complications of chest infection. Thoracic trauma in children is rare, only 4–6 % of children are hospitalized following severe trauma. Only a small number of children with trauma have thoracic injury (14 %), but the injuries tend to be of serious nature. About 25–50 % of thoracic trauma cases occur in combination with other trauma locations. Pulmonary contusion and lacerations, tracheobronchial injuries, pneumothorax, and esophageal rupture are referred as the main consequences of trauma. The decision for the appropriate use of imaging techniques must consider the specific case under review. Chest radiography should be the initial screening method. The decision to use CT is determined by the nature of the trauma, the clinical circumstances, and the prediction of future revaluation, always taking into account the radiation dose applied to the child.


Respiratory Syncytial Virus Pleural Fluid Bacterial Pneumonia High Resolution Compute Tomography Thoracic Trauma 
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. Bransom RT, Griscom NT, Cleveland RH (2005) Interpretation of chest radiographs in Children with cough and fever. Radiology 236:22–29CrossRefGoogle Scholar
  2. Carty H (2000) Imaging infection. In: Fonseca-Santos J, Aragão-Machado M, Santos C (eds) Pediatric radiology—The State of the Art in 2000—ESPR—Syllabus—Bracco—Education in Diagnostic Imaging—ed. Springer pp 3–5Google Scholar
  3. Chaumoitre K, Merrot T, Petit P, Panuel M (2008) Particularités des traumatismes thoraciques et abdominaux chez l’enfant. J Radiol 89:1871–1888PubMedCrossRefGoogle Scholar
  4. Daltro P, Santos EN, Gasparetto MEUC et al (2011) Pulmorary infections. Pediatr Radiol 41:S69–S82. doi: 10.1007/s00247-011-2012-8 PubMedCrossRefGoogle Scholar
  5. Donnelly LF, Klosterman LA (1997a) CT appearance of parapneumonic effusions in children: findings are not specific for empyema. AJR Am J Roentgenol 169:179–182PubMedCrossRefGoogle Scholar
  6. Donnelly LF, Klosterman LA (1997b) Pneumonia in children: decreased parenchymal contrast enhancement- CT sign of intense illness and impeding cavity necrosis. Radiology 205:817–820PubMedCrossRefGoogle Scholar
  7. Donnelly LF, Klosterman LA (1997c) Subpleural sparing: a CT finding of lung contusion in children. Radiology 204:385–387PubMedCrossRefGoogle Scholar
  8. Donnelly LF, Klosterman LA (1998a) Cavity necrosis complicating pneumonia in children: sequential findings on chest radiography. AJR Am J Roentgenol 171:253–256PubMedCrossRefGoogle Scholar
  9. Donnelly LF, Klosterman LA (1998b) The yield of CT of children who have complicated pneumonia and non-contributory chest radiograph. AJR Am J Roentgenol 170:1627–1631PubMedCrossRefGoogle Scholar
  10. Donnelly LF (2002) CT of acute pulmonary infection/trauma. In: Lucaya J, Strife J (eds) Pediatric chest imaging, 1st edn. Springer-Verlag, Berlin, pp 113–127Google Scholar
  11. Donnely LF (2008) CT of acute pulmonary disease: infection, infarction, and trauma. In: Lucaya J, Strife J (eds) Pediatric chest imaging, 2nd edn. Springer-Verlag, Berlin, pp 147–164CrossRefGoogle Scholar
  12. Duncan AW (2002) Emergency chest radiology in children. In: Carty H (ed) Emergency pediatric radiology, 2nd edn. Springer-Verlag, Berlin, pp 33–116CrossRefGoogle Scholar
  13. Durant C, Piolat C, Nugues F, Bessaguet S, Alvarez C, Baudin P (2005) Imagerie thoracique en urgence chez l’enfant. J Radiol 86:198–206CrossRefGoogle Scholar
  14. Enriquez G, Aso C, Serres X (2008) Chest US. In: Lucaya J, Strife J (eds) Pediatric chest imaging, 2nd edn. Springer-Verlag, Berlin, pp 1–35CrossRefGoogle Scholar
  15. Garcia-Peña P, Lucaya J (2004) HRCT in children: tecnique and indications. Eur Radiol 14:L13–L30PubMedCrossRefGoogle Scholar
  16. Eslamy HK, Beverley Newman MD (2011) Pneumonia in normal and immunocompromised Children: an overview and update. MD Radiol Clin N Am 49:895–920. doi: 10.1016/j.rcl.2011.06.007 Google Scholar
  17. Hedlund GL, Griscom NT, Cleveland RH et al (1997) Respiratory system. In: Kirks DR (ed) Practical pediatric imaging, vol 3., LittleBrown and Company, Boston, pp 619–821Google Scholar
  18. Lucaya J, Gartner S, Garcia-Peña P et al (1998) Spectrum of manifestations of Swyer-James.McLeod syndrome. J Comp Assist Tomogr 22:592–597CrossRefGoogle Scholar
  19. Lucaya J, Garcia-Peña P, Herrera L et al (1999) Expiratory chest CT in children. AJR Am J Roengenol 174:235–241CrossRefGoogle Scholar
  20. Lucaya J, Ducou le Point H (2008) High-resolution CT of the lung in children. In: Lucaya J, Strife J (eds) Pediatric chest imaging, 2nd edn. Springer-Verlag, Berlin, pp 77–121CrossRefGoogle Scholar
  21. Ho M-L, Gutierrez FR (2009) Chest radiography in thoracic polytrauma. AJR 192:599–612PubMedCrossRefGoogle Scholar
  22. Markel TA, Kumar R, Koontz NA (2009) The utility of computed tomography as a screening tool for the evaluation of pediatric blunt chest trauma. doi: 10.1097/TA.0b013e318184ba9a
  23. Moore MA, Wallace EC, Westra J (2011) Chest trauma in children: current imaging guidelines and techniques Radiol Clin N Am 49:949–968. doi: 10.1016/j.rcl.2011.06.002
  24. Peltola V, Ruuskanen O, Svedström E (2008) Magnetic resonance imaging of lung infections in children. Pediatr Radiol 38(11):1225–1231PubMedCrossRefGoogle Scholar
  25. Sivit CJ, Taylor GA, Eichelberg MR (1989) Chest injury in children with abdominal trauma: evaluation with CT. Radiology 171:815–818PubMedCrossRefGoogle Scholar
  26. Wesenberg RL, Figarola MS, Estrada B (2006) Child with cough and fever. In: Hilton S, Edwards D (eds) Practical pediatric radiology, 3rd edn. Saunders-Elsevier, USA, pp 311–349Google Scholar
  27. Westra SJ, Wallace EC (2005) Imaging evaluation of pediatric chest trauma. Radiolo Clin N Am 43:267–281CrossRefGoogle Scholar
  28. Wylie J, Morrison GC, Nalk K et al (2009) Lung contusion in children—early computed tomography versus radiography. Ped Crit Care Med 10(6):643–646Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Hospital de Santa MariaLisbonPortugal

Personalised recommendations