The age of our patients varies between 2 days and 17 years.
Many pathologies were diagnosed on imaging investigations .They were distributed in the table 1.
Chest pathologies
|
Number of cases
|
pulmonary infection
|
33
|
pulmonary hydatic cyst
|
2
|
airway obstruction
|
2
|
aortic arch abnormality
|
3
|
Diaphragmatic disease
|
3
|
lobar emphysema
|
1
|
pneumomediastinum
|
1
|
dyskinesie ciliaire
|
1
|
caustic esophagus perforation
|
1
|
pulmonary sequestrations
|
1
|
congenital cystic adenomatoid malformation
|
2
|
lymphoma
|
2
|
cystic fibrosis
|
1
|
Langerhans’ cell histiocytosis
|
2
|
Thoracic imaginge tools are based on chest radiograph ,
Thoracic ultrasonography,
chest CT and MRI.
The chest radiograph remains the primary imaging tool.It should be realised in supine position,
arm raised with compression by straps and sandbag up to two yearsBetween 2 and 6 years old,
standing with anteroposterior incidence is required.Then postero-anterior incidence is recommanded.chest ultrasound is a useful imaging alternative to CXR for the diagnosis of other pediatric pulmonary diseases(1).
in the infant population,
it is realised through the acoustic windows created by the thymus,
the heart or the liverOn the other hand in the larger child,
it is realised through suprasternal,
supraclavicular,
para-sternal,
sub-xyphoid and even inter-costal spaces(2).
Ultrasound is useful for the examination of the pleura,
the pulmonary parenchyma,
of the diaphragm and the mediastinum ,to differentiate an adenopathy from the normal thymus.Chest CT is a radiating examination that must be justified and done under restraint with Optimization of the dose (80 and 120 kV)(3).Different thoracic pathologies have been diagnosed: malformative,
infectious,
tumoral .
Pulmonary infection
The roles of imaging in the management of pneumonia are the evaluation for possible pneumonia,
the determination of a specific etiologic agent,
the exclusion of other pathology and the evaluation of its complications(4)Figure1,2 .
The radiological control of a pneumopathy is recommended in France after a delay of 3 weeks to 1 month.
Pulmonary hydatic cyst
Pulmonary hydatid disease is more frequent than hepatic hydatid disease in children,
typically older than 9 years(5).Figure 3
Tuberculosis
Primary TB is most commonly seen in children Lymphadenopathy in the hilus or mediastinum is observed in 90–95% of pediatric cases(6) Generally,
Tuberculosis can cause pulmonary condensation of the upper lobes.
Figure 4
Vascular Anomalies of Aorta,
Pulmonary and Systemic vessels.
Definitive aortic arch is formed from the fourth arch,
while the pulmonary artery is formed from the anterior bud of the sixth arch.
Parts of the third arch and anterior segments of the branchial arches contribute to formation of left common,
external and internal carotid arteries(7) figure 5.
The various anomalies in aortic arch can be explained by the pattern of breaks at different levels in the Edwards’ double aortic arch model.
Abnormal persistence or regression of various segments leads to several types of malformations Figure 5,6 .
Evaluation of aortic coarctation is also a routine application of CT angiography.figure 7.
Diaphragmatic disease
Left postero-lateral hernia of Bochdalek is the most common disease (75%) Figure 8.
Ciliary dyskinesia (Kartegaener’s syndrome) and cystic fibrosis
Thoracic manifestations include bronchiectasis,
airspace disease,
adenopathy,
pneumothorax and pneumomediastinum.
Radiography is used to assess acute signs or symptoms.
CT is a better modality for assessing disease progression or when radiography is inconclusive Figure 9.
Pulmonary sequestrations
A PS is defined as a segment of lung parenchyma that receives its blood supply from the systemic circulation and that does not communicate with the tracheobronchial tree(4).Figure 10.
Classically,
two forms of PS have been described: extralobar (ELPS) and intralobar (ILPS).
extralobar (ELPS)
|
intralobar (ILPS)
|
own pleural layers
|
Commun pleural layers
|
25%
|
75%
|
venous drainage is to the systemic circulation
|
drain by way of the pulmonary venous system to the left atrium.
|
in the costophrenic sulcus on the left side
|
in the posterobasal portion of the lower lobes.
|
Congenital cystic adenomatoid malformation
CCAMs are an abnormal bronchoalveolar development early in fetal life.
Typically,
they are unilobar.figure11
There are 3types:
Type I: contain one or more cysts measuring over 2 cm in diameter,
surrounded by multiple smaller cysts.
Type II: contain cysts measuring up to 2 cm in diameter.
Type III: usually contain cysts less than 0.5 cm in diameter.
Lymphoma
Lymphomas are the third most common group of cancers in children and adolescents.
Non-Hodgkin’s lymphoma represents approximately 60%.
The anterior mediastinum is a common site for neoplasms,
particularly lymphoma,figure 12.
Sonographically,
lymphoma may appear as discrete masses,
nodal enlargement or with diffuse thymic infiltration.
Langerhans’ cell histiocytosis
LCH affecting the ribs,
clavicles,
and scapula has a variable appearance ranging from poorly defined lytic lesions to sharply marginated,
sclerotic lesions.
Additionally,
an adjacent soft tissue mass,
adenopathy,
pulmonary cysts may be present figure 13.