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Ramphul M, Gallagher K, Warrier K, Jagani S, Bhatt JM. Why is a paediatric respiratory specialist integral to the paediatric rheumatology clinic? Breathe (Sheff) 2020; 16:200212. [PMID: 33447294 PMCID: PMC7792836 DOI: 10.1183/20734735.0212-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/01/2020] [Indexed: 12/20/2022] Open
Abstract
Systemic connective tissue diseases (CTDs) are characterised by the presence of autoantibodies and multiorgan involvement. Although CTDs are rare in children, they are associated with pulmonary complications, which have a high morbidity and mortality rate. The exact pathophysiology remains unclear. The pleuropulmonary complications in CTD are diverse in their manifestations and are often complex to diagnose and manage. The most common CTDs are discussed. These include juvenile systemic lupus erythematosus, juvenile dermatomyositis, juvenile systemic sclerosis, Sjögren's syndrome and mixed connective tissue disease. We describe the clinical features of the pleuropulmonary complications, focusing on their screening, diagnosis and monitoring. Treatment strategies are also discussed, highlighting the factors and interventions that influence the outcome of lung disease in CTD and pulmonary complications of treatment. Early detection and prompt treatment in a multidisciplinary team setting, including respiratory and rheumatology paediatricians and radiologists, is paramount in achieving the best possible outcomes for these patients.
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Affiliation(s)
- Manisha Ramphul
- Dept of Paediatric Respiratory Medicine, Nottingham Children's Hospital, Nottingham University Hospitals, Nottingham, UK
| | - Kathy Gallagher
- Dept of Paediatric Respiratory Medicine, Nottingham Children's Hospital, Nottingham University Hospitals, Nottingham, UK
| | - Kishore Warrier
- Dept of Paediatric Respiratory Medicine, Nottingham Children's Hospital, Nottingham University Hospitals, Nottingham, UK
| | - Sumit Jagani
- Dept of Radiology, Nottingham University Hospitals, Nottingham, UK
| | - Jayesh Mahendra Bhatt
- Dept of Paediatric Respiratory Medicine, Nottingham Children's Hospital, Nottingham University Hospitals, Nottingham, UK
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2
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Verma N, Altmayer S, Hochhegger B, Barros MC, Rajderkar D, Mohammed TL. ChILD: A Pictorial Review of Pulmonary Imaging Findings in Childhood Interstitial Lung Diseases. Curr Probl Diagn Radiol 2020; 50:95-103. [PMID: 32317133 DOI: 10.1067/j.cpradiol.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 03/18/2020] [Indexed: 11/22/2022]
Abstract
Childhood interstitial lung disease (chILD) is a group of lung disorders characterized by lung remodeling leading to abnormal gas exchange. ChILD is classified differently from adult interstitial lung disease and encompasses 2 broad categories: "disorders more prevalent in infancy" (<2 years) and "disorders not specific to infancy" (>2 years). High-resolution computed tomography can play an important role in the evaluation of chILD by narrowing the differential diagnosis and preventing unnecessary invasive procedures if typical imaging patterns are recognized. Thus, the pediatric radiologist should consider chILD in children with respiratory distress and identify the imaging patterns to suggest the diagnosis.
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Affiliation(s)
- Nupur Verma
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL
| | - Stephan Altmayer
- Department of Radiology, Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Bruno Hochhegger
- Department of Radiology, Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Dhanashree Rajderkar
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL
| | - Tan-Lucien Mohammed
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL.
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3
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Bajaj S, Muranjan M, Karande S, Prabhat D. Rare disease heralded by pulmonary manifestations: Avoiding pitfalls of an "asthma" label. J Postgrad Med 2019; 63:122-127. [PMID: 28272068 PMCID: PMC5414422 DOI: 10.4103/0022-3859.201416] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pulmonary manifestations are seldom recognized as symptoms of storage disorders. The report describes the diagnostic journey in a 30-month-old male infant, born of a third-degree consanguineous marriage referred to our institute as severe persistent asthma. History revealed that the child had progressively worsening breathlessness and persistent dry cough not associated with fever but accompanied by weight loss. On physical examination, there was growth failure, respiratory distress, clubbing, hepatosplenomegaly, and occasional rhonchi. Blood gas revealed hypoxemia which improved with oxygen administration. Plain X-rays and high-resolution computed tomography of the chest showed perihilar alveolar infiltrates and patchy consolidation. The clinicoradiological features did not support a diagnosis of asthma but favored interstitial lung disease (ILD). Bronchoalveolar lavage was performed as a first-tier investigation. It showed periodic acid-Schiff-negative foamy macrophages. The clues of consanguinity, visceromegaly, ILD, and foamy macrophages in the bronchoalveolar fluid prompted consideration of lysosomal storage disorders as the likely etiology. Gaucher disease and Niemann-Pick disease A/B were ruled out by enzyme estimation. Niemann-Pick disease type C was suspected and confirmed by detecting a homozygous mutation in the NPC2 gene. This case serves to caution physicians against labeling breathlessness in every toddler as asthma. It emphasizes the importance of searching for tell-tale signs such as clubbing and extrapulmonary clues which point to a systemic disease such as lysosomal storage disorders as a primary etiology of chronic respiratory symptoms.
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Affiliation(s)
- S Bajaj
- Department of Pediatrics, Genetic Clinic, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - M Muranjan
- Department of Pediatrics, Genetic Clinic, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - S Karande
- Department of Pediatrics, Genetic Clinic, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - D Prabhat
- Department of Pathology, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Pryhuber GS. Renewed Promise of Nonionizing Radiation Imaging for Chronic Lung Disease in Preterm Infants. Am J Respir Crit Care Med 2018; 198:1248-1249. [PMID: 29944841 DOI: 10.1164/rccm.201805-0963ed] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Gloria S Pryhuber
- 1 Department of Pediatrics and.,2 Department of Environmental Medicine University of Rochester Medical Center Rochester, New York
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Pastroma A, Papaioannou G, Raissaki M, Alexopoulou E. The Common Among the Rare: A Pictorial Essay of the Most Common Diffuse Lung Diseases in Children. Can Assoc Radiol J 2018; 69:468-478. [PMID: 30390964 DOI: 10.1016/j.carj.2018.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 07/17/2018] [Accepted: 07/24/2018] [Indexed: 12/29/2022] Open
Affiliation(s)
- Angeliki Pastroma
- 2nd Department of Radiology, General University Hospital ATTIKON Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | | | - Maria Raissaki
- Department of Radiology, Faculty of Medicine, University Hospital of Heraklion, University of Crete, Crete, Greece
| | - Efthymia Alexopoulou
- 2nd Department of Radiology, General University Hospital ATTIKON Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Demirel N, Ochoa R, Dishop MK, Holm T, Gershan W, Brottman G. Respiratory distress in a 2-month-old infant: Is the primary cause cardiac, pulmonary or both? Respir Med Case Rep 2018; 25:61-65. [PMID: 30003023 PMCID: PMC6039757 DOI: 10.1016/j.rmcr.2018.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/18/2018] [Accepted: 06/18/2018] [Indexed: 12/17/2022] Open
Abstract
A 2-month-old female with worsening cough, respiratory distress and an abnormal chest X-ray was referred to our institution for further evaluation of suspected scimitar syndrome. She was found to have normal pulmonary venous drainage with a large patent ductus arteriosus and severe pulmonary arterial hypertension. Chest CT was suggestive of interstitial lung disease. Wedge lung biopsy revealed alveolar simplification and patchy pulmonary interstitial glycogenosis. A definitive diagnosis of Filamin A deficiency was made with genetic studies. The patient is currently showing clinical improvement on systemic glucocorticoid therapy.
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Affiliation(s)
- Nadir Demirel
- Division of Pediatric Pulmonology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Roberto Ochoa
- Department of Medicine, Universidad de Ciencias Médicas, San José, Costa Rica
| | - Megan K Dishop
- Pathology and Laboratory Medicine, Phoenix Children's, Phoenix, AZ, USA
| | - Tara Holm
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - William Gershan
- Division of Pediatric Pulmonology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Gail Brottman
- Division of Pediatric Pulmonology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
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Toma P, Secinaro A, Sacco O, Curione D, Cutrera R, Ullmann N, Granata C. CT features of diffuse lung disease in infancy. Radiol Med 2018; 123:577-585. [PMID: 29569218 DOI: 10.1007/s11547-018-0878-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 03/14/2018] [Indexed: 12/01/2022]
Abstract
Diffuse lung disease in infancy includes a wide range of very rare and peculiar pulmonary conditions usually not seen in older children, in whom diffuse lung disease has much greater overlap with adult disorders. The acronym chILD (childhood Interstitial Lung Disease) commonly defines these disorders, although air spaces, airways, alveolar epithelium, vasculature, pleura, and pleural spaces can also be involved, besides the pulmonary interstitium. chILD can be caused by diffuse developmental disorders, alveolar growth abnormalities, surfactant dysfunction disorders, and other specific conditions of poorly understood etiology. Chest CT imaging studies play a pivotal role in the evaluation of chILD. In some conditions CT findings can be specific, and thus make it possible avoiding further testing. In other disorders, findings are nonspecific, although they may suggest a diagnostic pattern and guide further testing. Nevertheless, chILD disorders often remain unrecognized on imaging studies, as they are very rare. The aim of this article is to review the CT patterns of lung involvement in a series of infants with chILD.
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Affiliation(s)
- Paolo Toma
- Department of Imaging, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Aurelio Secinaro
- Department of Imaging, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Oliviero Sacco
- Pulmonary and Allergy Disease Unit and Cystic Fibrosis Center, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Davide Curione
- Department of Imaging, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Renato Cutrera
- Paediatric Pulmonology and Sleep and Long Term Ventilation Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Nicola Ullmann
- Paediatric Pulmonology and Sleep and Long Term Ventilation Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Claudio Granata
- Department of Pediatric Radiology, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
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Semple TR, Ashworth MT, Owens CM. Interstitial Lung Disease in Children Made Easier…Well, Almost. Radiographics 2018; 37:1679-1703. [PMID: 29019755 DOI: 10.1148/rg.2017170006] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Interstitial lung disease (ILD) in pediatric patients is different from that in adults, with a vast array of pathologic conditions unique to childhood, varied modes of presentation, and a different range of radiologic appearances. Although rare, childhood ILD (chILD) is associated with significant morbidity and mortality, most notably in conditions of disordered surfactant function, with respiratory failure in 100% of neonates with surfactant protein B dysfunction and 100% mortality without lung transplantation. The authors present a summary of lung development and anatomy, followed by an organized approach, using the structure and nomenclature of the 2013 update to the chILD Research Network classification system, to aid radiologic diagnosis of chILD. Index radiologic cases with contemporaneous histopathologic findings illustrate a summary of recent imaging studies covering the full spectrum of chILD. chILD is best grouped by age at presentation from infancy (diffuse developmental disorders, lung growth abnormalities, specific conditions of unknown origin, surfactant dysfunction mutations) to later childhood (disorders of the normal host, disorders related to systemic disease processes, disorders related to immunocompromise). Appreciation of the temporal division of chILD into infant and later childhood onset, along with a sound understanding of pulmonary organogenesis and surfactant homeostasis, will aid in providing useful insight into this important group of pediatric conditions. Application of secondary lobular anatomy to interpretation of thin-section computed tomographic images is pivotal to understanding patterns of ILD and will aid in selecting and narrowing a differential diagnosis. ©RSNA, 2017.
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Affiliation(s)
- Thomas R Semple
- From the Department of Imaging, Royal Brompton Hospital, Sydney Street, London, England SW3 6NP (T.R.S.); and Departments of Imaging (T.R.S., C.M.O.) and Histopathology (M.T.A.), Great Ormond Street Hospital, London, England
| | - Michael T Ashworth
- From the Department of Imaging, Royal Brompton Hospital, Sydney Street, London, England SW3 6NP (T.R.S.); and Departments of Imaging (T.R.S., C.M.O.) and Histopathology (M.T.A.), Great Ormond Street Hospital, London, England
| | - Catherine M Owens
- From the Department of Imaging, Royal Brompton Hospital, Sydney Street, London, England SW3 6NP (T.R.S.); and Departments of Imaging (T.R.S., C.M.O.) and Histopathology (M.T.A.), Great Ormond Street Hospital, London, England
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Abstract
PURPOSE OF REVIEW The present review intends to provide an overview of the diversity and complexity of pulmonary manifestations of rheumatologic diseases and gaps in knowledge to effectively manage them. RECENT FINDINGS Diffuse lung disease in children with rheumatologic diseases represents a heterogeneous group of autoimmune disorders. Despite their significant morbidity and mortality, we have limited understanding about their pathogenesis. Here, we provide an overview of the pathophysiology and current management approach of these disorders, highlighting tools which assist with diagnosis, risk stratification and therapy. In this context, we address the need to develop a standardized approach to diagnose at-risk patients with rheumatologic disease and to predict their progression and the need to develop robust studies which evaluate the factors and interventions that influence pulmonary disease outcome. SUMMARY Diffuse lung disease in children with rheumatologic diseases represents a heterogeneous group of severe autoimmune disorders. By adopting a collaborative research approach among multicenters to help diagnose, risk stratify, and understand disease progression, effective management decisions can be optimized to improve clinical outcome.
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