Current Management of Complicated Pneumonia in Children

1. Current Management of Complicated Pneumonia in Children Sherman Alter, M.D. Elizabeth H. Ey, M.D. Mark Warren, D.O. Jeffrey Pence, M.D.

2. Updates on: Infectious Disease Diagnostic Imaging Interventional Radiology Surgical Options

3. Diagnostic Imaging of Complicated Pneumonia in Children Elizabeth H. Ey, M.D. Medical Imaging Dayton Children’s Medical Center

4. Chest Imaging Options Chest radiography Fluoroscopy Ultrasound Computerized Tomography Magnetic Resonance Imaging Radionuclide lung scan

5. Chest Imaging Options Chest radiography Portable or in department Vertical or horizontal beam Low radiation dose No sedation No preparation Inexpensive

6. Chest Imaging Options Fluoroscopy Dynamic observation Trachea Diaphragm Catheter, wire, tube placement

7. Chest Imaging Options Ultrasound Department or bedside Most useful for evaluation of pleural fluid Simple versus complex fluid Consolidated lung Assess blood flow No radiation No sedation

8. Chest Imaging Options Computerized Tomography (CT) High resolution, soft tissue contrast Multiplanar and 3D reconstructions IV contrast usually needed Sedation may be needed NPO guidelines May need pre authorization Radiation dose

9. Chest Imaging Options Magnetic Resonance Imaging Soft tissue contrast Spine, spinal cord, masses, malformations Cardiovascular imaging Often requires sedation Sometimes requires contrast No ionizing radiation May need pre authorization

10. Chest Imaging Options Radionuclide chest imaging Perfusion imaging Quantify blood flow to each lung Demonstrate areas of diminished perfusion Ventilation imaging Aerosol No portable studies

11. Pneumonia Lung infection - inhaled, hematogenous Alveolus fills with fluid and inflammatory cells Bacterial pneumonia typically unilateral Segmental Lobar

12. Pneumonia

13. One Day Later

14. Parapneumonic effusion Abnormal accumulation of fluid in pleural space secondary to adjacent pulmonary infection

15. Parapneumonic effusion Simple, transudative effusion Fibrinopurulent exudate (empyema)

16. Simple effusionAP Supine Right Decubitus

17. When not to perform decubitus

18. Simple or Transudative effusion Ultrasound

19. Simple effusion after drain

20. Fibrinopurulent effusion Empyema

21. UltrasoundFibrinopurulent effusion

22. CT Chest with Contrast

23. Complicated Pneumonia Cavitating or necrotizing pneumonia Pneumatocele Lung abscess Bronchopleural fistula

24. CavitatingPneumonia Severe inflammation in lung parenchyma Thrombotic occlusion of alveolar capillaries Ischemia with eventual necrosis and cavitation

25. Complicated Pneumonia

26. CT Chest with Contrast

27. May 5 June 17

28. Complicated pneumoniaUnderlying Lesion Congenital malformation CCAM Sequestration Bronchial obstruction Congenital Acquired (foreign body) Tumor

29. Chest Dec 12

30. Chest Dec 23

31. Chest US

32. Chest CT

33. Chest Dec 25

34. Chest Feb 11

35. Chest March 3

36. Chest Post Op

37. Chest 12-23

38. Right Decubitus

39. CT Chest +C

40. Chest CT +C

43. Interventional Radiology Mark Warren, D.O.

44. Questions?