1
|
Casey A, Fiorino EK, Wambach J. Innovations in Childhood Interstitial and Diffuse Lung Disease. Clin Chest Med 2024; 45:695-715. [PMID: 39069332 PMCID: PMC11366208 DOI: 10.1016/j.ccm.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Children's interstitial and diffuse lung diseases (chILDs) are a heterogenous and diverse group of lung disorders presenting during childhood. Infants and children with chILD disorders present with respiratory signs and symptoms as well as diffuse lung imaging abnormalities. ChILD disorders are associated with significant health care resource utilization and high morbidity and mortality. The care of patients with chILD has been improved through multidisciplinary care, multicenter collaboration, and the establishment of patient research networks in the United Stated and abroad. This review details past and current innovations in the diagnosis and clinical care of children with chILD.
Collapse
Affiliation(s)
- Alicia Casey
- Department of Pediatrics, Division of Pulmonary Medicine, Harvard Medical School, Boston Children's Hospital, Boston, MA 02115, USA.
| | - Elizabeth K Fiorino
- Department of Science Education and Pediatrics, Donald and Barabara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Jennifer Wambach
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110, USA
| |
Collapse
|
2
|
Liszewski MC, Smalley R, Boulais J, Winant AJ, Vargas SO, Lee EY. Neonatal Chest Imaging: Congenital and Acquired Disorders. Semin Roentgenol 2024; 59:238-248. [PMID: 38997179 DOI: 10.1053/j.ro.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 02/23/2024] [Indexed: 07/14/2024]
Affiliation(s)
- Mark C Liszewski
- Department of Radiology, Columbia University Irving Medical Center, New York, NY.
| | - Robert Smalley
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Jaclyn Boulais
- Division of Neonatology, Department of Pediatrics, Tufts Medical Center, Tufts University School of Medicine, Boston, MA
| | - Abbey J Winant
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Sara O Vargas
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| |
Collapse
|
3
|
O'Callaghan B, Zablah JE, Weinman JP, Englund EK, Morgan GJ, Ivy DD, Frank BS, Mong DA, Malone LJ, Browne LP. Computed tomographic parenchymal lung findings in premature infants with pulmonary vein stenosis. Pediatr Radiol 2023; 53:1874-1884. [PMID: 37106091 DOI: 10.1007/s00247-023-05673-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Developmental pulmonary vein pulmonary vein stenosis in the setting of prematurity is a rare and poorly understood condition. Diagnosis can be challenging in the setting of chronic lung disease of prematurity. High-resolution non-contrast chest computed tomography (CT) is the conventional method of evaluating neonates for potential structural changes contributing to severe lung dysfunction and pulmonary hypertension but may miss pulmonary venous stenosis due to the absence of contrast and potential overlap in findings between developmental pulmonary vein pulmonary vein stenosis and lung disease of prematurity. OBJECTIVE To describe the parenchymal changes of pediatric patients with both prematurity and pulmonary vein stenosis, correlate them with venous disease and to describe the phenotypes associated with this disease. MATERIALS AND METHODS A 5-year retrospective review of chest CT angiography (CTA) imaging in patients with catheterization-confirmed pulmonary vein stenosis was performed to identify pediatric patients (< 18 years) who had a history of prematurity (< 35 weeks gestation). Demographic and clinical data associated with each patient were collected, and the patients' CTAs were re-reviewed to evaluate pulmonary veins and parenchyma. Patients with post-operative pulmonary vein stenosis and those with congenital heart disease were excluded. Data was analyzed and correlated for descriptive purposes. RESULTS A total of 17 patients met the inclusion criteria (12 female, 5 male). All had pulmonary hypertension. There was no correlation between mild, moderate, and severe grades of bronchopulmonary dysplasia and the degree of pulmonary vein stenosis. There was a median of 2 (range 1-4) diseased pulmonary veins per patient. In total, 41% of the diseased pulmonary veins were atretic. The right upper and left upper lobe pulmonary veins were the most frequently diseased (n = 13/17, 35%, n = 10/17, 27%, respectively). Focal ground glass opacification, interlobular septal thickening, and hilar soft tissue enlargement were always associated with the atresia of an ipsilateral vein. CONCLUSION Recognition of the focal parenchymal changes that imply pulmonary vein stenosis, rather than chronic lung disease of prematurity changes, may improve the detection of a potentially treatable source of pulmonary hypertension, particularly where nonangiographic studies result in a limited direct venous assessment.
Collapse
Affiliation(s)
| | - Jenny E Zablah
- The Heart Institute, Children's Hospital Colorado, Aurora, CO, USA
- University of Colorado Medical School, Anschutz Medical Campus, Aurora, CO, USA
| | - Jason P Weinman
- University of Colorado Medical School, Anschutz Medical Campus, Aurora, CO, USA
- Department of Pediatric Radiology, Children's Hospital Colorado, Aurora, CO, USA
| | - Erin K Englund
- University of Colorado Medical School, Anschutz Medical Campus, Aurora, CO, USA
- Department of Pediatric Radiology, Children's Hospital Colorado, Aurora, CO, USA
| | - Gareth J Morgan
- The Heart Institute, Children's Hospital Colorado, Aurora, CO, USA
- University of Colorado Medical School, Anschutz Medical Campus, Aurora, CO, USA
| | - D Dunbar Ivy
- The Heart Institute, Children's Hospital Colorado, Aurora, CO, USA
- University of Colorado Medical School, Anschutz Medical Campus, Aurora, CO, USA
| | - Benjamin S Frank
- The Heart Institute, Children's Hospital Colorado, Aurora, CO, USA
- University of Colorado Medical School, Anschutz Medical Campus, Aurora, CO, USA
| | - David Andrew Mong
- University of Colorado Medical School, Anschutz Medical Campus, Aurora, CO, USA
- Department of Pediatric Radiology, Children's Hospital Colorado, Aurora, CO, USA
| | - LaDonna J Malone
- University of Colorado Medical School, Anschutz Medical Campus, Aurora, CO, USA
- Department of Pediatric Radiology, Children's Hospital Colorado, Aurora, CO, USA
| | - Lorna P Browne
- University of Colorado Medical School, Anschutz Medical Campus, Aurora, CO, USA.
- Department of Pediatric Radiology, Children's Hospital Colorado, Aurora, CO, USA.
| |
Collapse
|
4
|
Gabitova NK, Cherezova IN, Arafat A, Sadykova D. Interstitial Lung Disease in Neonates: A Long Road Is Being Paved. CHILDREN (BASEL, SWITZERLAND) 2023; 10:916. [PMID: 37371148 DOI: 10.3390/children10060916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/16/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023]
Abstract
Background: Interstitial lung disease (ILD) is one of the most difficult conditions in pulmonology due to difficulties in diagnosing, classifying, and treating this condition. They require invasive approaches to diagnose (e.g., lung biopsy), non-applicable methods (e.g., lung function tests in newborns), or potentially non-accessible methods (e.g., genetic testing in not-well-equipped facilities, and several weeks are required for results to be announced). They represent a heterogeneous group of diseases in which the alveolar epithelium, parenchyma, and capillaries of the lungs are damaged, which leads to changes in the pulmonary interstitium, proliferation of connective tissue, and thickening of the alveolar-capillary membranes and alveolar septa. These changes are accompanied by impaired oxygen diffusion, progressive respiratory failure, and radiographic signs of bilateral dissemination. Although adult and child classifications for ILD have evolved over the years, classification for ILD in neonates remains a challenge. Case presentation: Here we discuss ILD in neonates briefly, and report two rare cases of ILD (a male white neonate, two-day-old with fibrosing alveolitis, and another male white neonate, one-day old with desquamative interstitial pneumonitis), with these diagnoses initially thought to be presented only in adulthood. Lung biopsy and histopathological findings of the two neonates have shown mononuclear cells in the alveolar spaces, and thickening of the alveolar walls confirmed the diagnosis of fibrosing alveolitis in one neonate, and desquamation of the large mononuclear cells in the intra-alveolar space in the other neonate, with the diagnosis of desquamative interstitial pneumonitis being confirmed. Interstitial lung disease lacks a consensus guideline on classification and diagnosis in neonates, rendering it one of the greatest challenges to pediatricians and neonatologists with remarkable morbidity and mortality rates. Conclusions: Fibrosing alveolitis and desquamative interstitial pneumonitis (DIP) are not adult-only conditions, although rare in neonates, histopathological examination and clinical practice can confirm the diagnosis. Based on our clinical practice, prenatal and maternal conditions may serve as potential risk factors for developing IDL in neonates, and further studies are needed to prove this hypothesis.
Collapse
Affiliation(s)
- N Kh Gabitova
- Department of Pediatrics, School of Medicine, Kazan State Medical University, 420012 Kazan, Russia
- Children's Republican Clinical Hospital, 420012 Kazan, Russia
| | - I N Cherezova
- Department of Pediatrics, School of Medicine, Kazan State Medical University, 420012 Kazan, Russia
- Children's Republican Clinical Hospital, 420012 Kazan, Russia
| | - Ahmed Arafat
- Department of Pediatrics, School of Medicine, Kazan State Medical University, 420012 Kazan, Russia
- Children's Republican Clinical Hospital, 420012 Kazan, Russia
- Department of Pediatrics, NICU Division, Ismailia Medical Complex, Egypt Healthcare Authority, Ismailia 41511, Egypt
| | - Dinara Sadykova
- Department of Pediatrics, School of Medicine, Kazan State Medical University, 420012 Kazan, Russia
- Children's Republican Clinical Hospital, 420012 Kazan, Russia
| |
Collapse
|
5
|
Miraftabi P, Kirjavainen T, Suominen JS, Lohi J, Martelius L. Children's interstitial lung disease: Multidetector computed tomography patterns and correlations between imaging and histopathology. Eur J Radiol 2023; 165:110886. [PMID: 37267893 DOI: 10.1016/j.ejrad.2023.110886] [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: 01/25/2023] [Revised: 05/08/2023] [Accepted: 05/19/2023] [Indexed: 06/04/2023]
Abstract
PURPOSE Childhood interstitial lung disease (chILD) is an umbrella concept covering a wide range of rare lung diseases, many of which are unique to childhood. The diagnosis is based on clinical presentation, multidetector computed tomography (MDCT), genetic testing, lung-function testing, and lung biopsy. Because knowledge of the usefulness of MDCT pattern recognition in ChILD is at present limited, we examined the occurrence of MDCT patterns in children with histologically confirmed interstitial lung disease. METHOD We searched the biopsy, MDCT, and clinical information database of a single national paediatric referral hospital for 2004-2020. Data were from affected children under age 18. MDCT images we reanalysed while blinded to the identity and referral information. RESULTS We included 90 patients, of whom 63 (70 %) were male. The median age at biopsy was 1.3 years (interquartile range 0.1-16.8). Biopsy findings fell into 26 histological classes covering all nine chILD classification categories. We recognized six distinct MDCT patterns: neuroendocrine cell hyperplasia of infancy (23), organizing pneumonia (5), non-specific interstitial pneumonia (4), bronchiolitis obliterans (3), pulmonary alveolar proteinosis (2), and bronchopulmonary dysplasia (n = 2). Of the total 90, in 51 (57 %) children, none of these six MDCT patterns appeared. Of those 39 children with a recognizable MDCT pattern, in 34 (87 %), that pattern predicted their final diagnosis. CONCLUSIONS Among cases of chILD, we identified a specific predefined MDCT pattern in only 43 %. However, when such a recognizable pattern occurred, it was predictive of the final chILD diagnosis.
Collapse
Affiliation(s)
- Päria Miraftabi
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Finland.
| | - Turkka Kirjavainen
- Department of Paediatrics, Children's Hospital, University of Helsinki and Helsinki University Hospital, Finland
| | - Janne S Suominen
- Department of Paediatric Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Jouko Lohi
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Finland
| | - Laura Martelius
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Finland
| |
Collapse
|
6
|
Nathan N, Griese M, Michel K, Carlens J, Gilbert C, Emiralioglu N, Torrent-Vernetta A, Marczak H, Willemse B, Delestrain C, Epaud R. Diagnostic workup of childhood interstitial lung disease. Eur Respir Rev 2023; 32:32/167/220188. [PMID: 36813289 PMCID: PMC9945877 DOI: 10.1183/16000617.0188-2022] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 12/18/2022] [Indexed: 02/24/2023] Open
Abstract
Childhood interstitial lung diseases (chILDs) are rare and heterogeneous diseases with significant morbidity and mortality. An accurate and quick aetiological diagnosis may contribute to better management and personalised treatment. On behalf of the European Respiratory Society Clinical Research Collaboration for chILD (ERS CRC chILD-EU), this review summarises the roles of the general paediatrician, paediatric pulmonologists and expert centres in the complex diagnostic workup. Each patient's aetiological chILD diagnosis must be reached without prolonged delays in a stepwise approach from medical history, signs, symptoms, clinical tests and imaging, to advanced genetic analysis and specialised procedures including bronchoalveolar lavage and biopsy, if necessary. Finally, as medical progress is fast, the need to revisit a diagnosis of "undefined chILD" is stressed.
Collapse
Affiliation(s)
- Nadia Nathan
- AP-HP, Sorbonne Université, Pediatric Pulmonology Department and Reference Center for Rare Lung Disease RespiRare, Armand Trousseau Hospital, Paris, France .,Sorbonne Université, Inserm UMR_S933 Laboratory of Childhood Genetic Diseases, Armand Trousseau Hospital, Paris, France
| | - Matthias Griese
- Department of Paediatric Pneumology, Dr von Hauner Children's Hospital, German Centre for Lung Research, University of Munich, Munich, Germany
| | - Katarzyna Michel
- Department of Paediatric Pneumology, Dr von Hauner Children's Hospital, German Centre for Lung Research, University of Munich, Munich, Germany
| | - Julia Carlens
- Clinic for Pediatric Pneumology, Hannover Medical School, Hannover, Germany
| | - Carlee Gilbert
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Alba Torrent-Vernetta
- Pediatric Allergy and Pulmonology Section, Department of Pediatrics, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Honorata Marczak
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Brigitte Willemse
- Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Céline Delestrain
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands,Centre Hospitalier Intercommunal de Créteil, Service de Pédiatrie Générale, Créteil, France,Centre des Maladies Respiratoires Rares (RESPIRARE®), CRCM, Créteil, France
| | - Ralph Epaud
- Centre Hospitalier Intercommunal de Créteil, Service de Pédiatrie Générale, Créteil, France,Centre des Maladies Respiratoires Rares (RESPIRARE®), CRCM, Créteil, France,University Paris Est Créteil, INSERM, IMRB, Créteil, France
| |
Collapse
|
7
|
Nguyen HN, Salman R, Vogel TP, Silva-Carmona M, DeGuzman M, Guillerman RP. Imaging findings of COPA Syndrome. Pediatr Radiol 2023; 53:844-853. [PMID: 36746811 DOI: 10.1007/s00247-023-05600-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/21/2022] [Accepted: 01/11/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Autosomal dominant mutations in the coatomer-associated protein alpha (COPA) gene cause an immune dysregulation disorder associated with pulmonary hemorrhage, lymphoid hyperplasia, arthritis, and glomerulonephritis. OBJECTIVE To describe the thoracic, musculoskeletal, and renal imaging findings of COPA syndrome with a focus on the evolution of the pulmonary findings. MATERIALS AND METHODS With approval of the Institutional Review Board, consensus retrospective review of findings on chest radiography and computed tomography (CT), musculoskeletal radiography and magnetic resonance imaging (MRI), and renal ultrasound (US) was performed for pediatric COPA syndrome patients. COPA syndrome patients < 18 years of age presenting between 1992 and 2019 were identified from an institutional rheumatology registry. RESULTS Twelve pediatric COPA syndrome patients (mean age of 6.5 years at first imaging exam; 6 females) were identified. Imaging exams available for review included 45 chest CT exams on 12 patients, 37 musculoskeletal exams on 4 patients, and 10 renal US exams on 5 patients. All 12 had abnormal chest CT exams, with findings including ground-glass opacities (12/12), cysts (8/12), septal thickening (9/12), nodules (8/12), fibrosis (7/12), crazy-paving (2/12), consolidation (1/12), hilar/mediastinal lymphadenopathy (11/12), and chest wall deformity (5/12). Nine had at least one follow-up chest CT, which showed improvement in nodules (7/9), ground-glass opacities (4/9), and lymphadenopathy (9/9), but worsening of septal thickening (3/9), cyst formation (3/9), and fibrosis (3/9). Four had musculoskeletal imaging revealing synovitis (2/4), bone erosions (1/4), tenosynovitis (1/4), enthesitis (1/4), and subcutaneous nodules (1/4). Five had at least one renal US, revealing renal size abnormalities (4/5) and cortical hyperechogenicity (3/5). CONCLUSION The most prevalent imaging finding of COPA syndrome is diffuse lung disease related to early childhood-onset recurrent pulmonary hemorrhage and lymphoid hyperplasia that may progress to pulmonary fibrosis. Other imaging findings manifesting later in childhood or adolescence relate to arthritis and glomerulonephritis.
Collapse
Affiliation(s)
- HaiThuy N Nguyen
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA
| | - Rida Salman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA.
| | - Tiphanie P Vogel
- Division of Rheumatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA
- Center for Human Immunobiology, Texas Children's Hospital, Houston, TX, 77030, USA
| | - Manuel Silva-Carmona
- Pulmonary Division, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Marietta DeGuzman
- Division of Rheumatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - R Paul Guillerman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA
| |
Collapse
|
8
|
Ionescu MD, Popescu NA, Stănescu D, Enculescu A, Bălgrădean M, Căpitănescu GM, Bumbăcea D. The Challenging Diagnosis of Interstitial Lung Disease in Children-One Case Report and Literature Review. J Clin Med 2022; 11:jcm11226736. [PMID: 36431212 PMCID: PMC9698870 DOI: 10.3390/jcm11226736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
Childhood interstitial lung disease (chILD) includes a heterogeneous spectrum of rare respiratory disorders in children associated with substantial morbi-mortality. Interstitial tissue, and other pulmonary structures, epithelium, blood vessels, or pleura are involved, resulting in a restrictive lung disfunction. Respiratory symptoms set in progressively and are often subtle, making thorough clinical history and physical examination fundamental. The etiology often is obscure. The clinical presentation mimics pneumonia or asthma, leading to a diagnostic delay. Challenging diagnosis may require genetic tests, bronchoalveolar lavage, or lung biopsy. Alongside general supportive therapeutic measures, anti-inflammatory, immunosuppressive or antifibrotic agents may be used, based on data derived from adult studies. However, if accurate diagnosis and treatment are delayed, irreversible chronic respiratory failure may ensue, impacting prognosis. The most frequent chILD is hypersensitivity pneumonitis (HP), although it is rare in children. HP is associated with exposure to an environmental antigen, resulting in inflammation of the airways. Detailed antigen exposure history and identification of the inciting trigger are the cornerstones of diagnostic. This article provides the current state of chILD, revealing specific features of HP, based on a clinical case report of a patient admitted in our clinic, requiring extensive investigations for diagnosis, with a favorable long-term outcome.
Collapse
Affiliation(s)
- Marcela Daniela Ionescu
- Department of Pediatrics, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- “Marie S. Curie” Emergency Children’s Clinical Hospital, 041451 Bucharest, Romania
| | | | - Diana Stănescu
- “Marie S. Curie” Emergency Children’s Clinical Hospital, 041451 Bucharest, Romania
| | - Augustina Enculescu
- “Marie S. Curie” Emergency Children’s Clinical Hospital, 041451 Bucharest, Romania
| | - Mihaela Bălgrădean
- Department of Pediatrics, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- “Marie S. Curie” Emergency Children’s Clinical Hospital, 041451 Bucharest, Romania
| | | | - Dragos Bumbăcea
- Department of Cardio-Thoracic Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Pneumology and Acute Respiratory Care, Elias Emergency University Hospital, 041451 Bucharest, Romania
| |
Collapse
|
9
|
Schapiro AH, Baker ML, Rattan MS, Crotty EJ. Childhood interstitial lung disease more prevalent in infancy: a practical review. Pediatr Radiol 2022; 52:2267-2277. [PMID: 35501606 DOI: 10.1007/s00247-022-05375-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/24/2022] [Accepted: 04/01/2022] [Indexed: 11/28/2022]
Abstract
Childhood interstitial lung disease (chILD) is a heterogeneous group of uncommon, mostly chronic pediatric pulmonary disorders characterized by impaired gas exchange and diffuse abnormalities on imaging. A subset of these diseases occurs more frequently in infants and young children than in older children and teenagers. Some of these disorders occur in certain clinical scenarios and/or have typical imaging features that can help the radiologist recognize when to suggest a possible diagnosis and potentially spare a child a lung biopsy. We review the clinical, histopathological and computed tomography features of chILD more prevalent in infancy, including diffuse developmental disorders, growth abnormalities, specific conditions of undefined etiology, and surfactant dysfunction mutations and related disorders, to familiarize the pediatric radiologist with this group of disorders.
Collapse
Affiliation(s)
- Andrew H Schapiro
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA. .,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Michael L Baker
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Mantosh S Rattan
- Department of Radiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Eric J Crotty
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
10
|
Willmering MM, Walkup LL, Niedbalski PJ, Wang H, Wang Z, Hysinger EB, Myers KC, Towe CT, Driehuys B, Cleveland ZI, Woods JC. Pediatric 129 Xe Gas-Transfer MRI-Feasibility and Applicability. J Magn Reson Imaging 2022; 56:1207-1219. [PMID: 35244302 PMCID: PMC9519191 DOI: 10.1002/jmri.28136] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND 129 Xe gas-transfer MRI provides regional measures of pulmonary gas exchange in adults and separates xenon in interstitial lung tissue/plasma (barrier) from xenon in red blood cells (RBCs). The technique has yet to be demonstrated in pediatric populations or conditions. PURPOSE/HYPOTHESIS To perform an exploratory analysis of 129 Xe gas-transfer MRI in children. STUDY TYPE Prospective. POPULATION Seventy-seven human volunteers (38 males, age = 17.7 ± 15.1 years, range 5-68 years, 16 healthy). Four pediatric disease cohorts. FIELD STRENGTH/SEQUENCE 3-T, three-dimensional-radial one-point Dixon Fast Field Echo (FFE) Ultrashort Echo Time (UTE). ASSESSMENT Breath hold compliance was assessed by quantitative signal-to-noise and dynamic metrics. Whole-lung means and standard deviations were extracted from gas-transfer maps. Gas-transfer metrics were investigated with respect to age and lung disease. Clinical pulmonary function tests were retrospectively acquired for reference lung disease severity. STATISTICAL TESTS Wilcoxon rank-sum tests to compare age and disease cohorts, Wilcoxon signed-rank tests to compare pre- and post-breath hold vitals, Pearson correlations between age and gas-transfer metrics, and limits of normal with a binomial exact test to compare fraction of subjects with abnormal gas-transfer. P ≤ 0.05 was considered significant. RESULTS Eighty percentage of pediatric subjects successfully completed 129 Xe gas-transfer MRI. Gas-transfer parameters differed between healthy children and adults, including ventilation (0.75 and 0.67) and RBC:barrier ratio (0.31 and 0.46) which also correlated with age (ρ = -0.76, 0.57, respectively). Bone marrow transplant subjects had impaired ventilation (90% of reference) and increased dissolved 129 Xe standard deviation (242%). Bronchopulmonary dysplasia subjects had decreased barrier-uptake (69%). Cystic fibrosis subjects had impaired ventilation (91%) and increased RBC-transfer (146%). Lastly, childhood interstitial lung disease subjects had increased ventilation heterogeneity (113%). Limits of normal provided detection of abnormalities in additional gas-transfer parameters. DATA CONCLUSION Pediatric 129 Xe gas-transfer MRI was adequately successful and gas-transfer metrics correlated with age. Exploratory analysis revealed abnormalities in a variety of pediatric obstructive and restrictive lung diseases. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 2.
Collapse
Affiliation(s)
- Matthew M. Willmering
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Laura L. Walkup
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, USA
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Peter J. Niedbalski
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Hui Wang
- MR Clinical Science, Philips, Cincinnati, Ohio, USA
- Department of Physics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Ziyi Wang
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Erik B. Hysinger
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Kasiani C. Myers
- Department of Pediatrics, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Christopher T. Towe
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Bastiaan Driehuys
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Zackary I. Cleveland
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, USA
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jason C. Woods
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Physics, University of Cincinnati, Cincinnati, Ohio, USA
| |
Collapse
|
11
|
Pediatric hypersensitivity pneumonitis: literature update and proposal of a diagnostic algorithm. Ital J Pediatr 2022; 48:51. [PMID: 35346317 PMCID: PMC8962565 DOI: 10.1186/s13052-022-01239-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/09/2022] [Indexed: 11/10/2022] Open
Abstract
Hypersensitivity pneumonitis (HP) is a rare disease in childhood with the prevalence of 4 cases per 1 million children and an incidence of 2 cases per year. The average age of diagnosis at pediatric age is approximately 10 years. The pathogenesis of HP is characterized by an immunological reaction caused by recurrent exposure to triggering environmental agents (mostly bird antigens in children). The clinical picture of HP is complex and variable in children, often presenting in subacute forms with cough and exertion dyspnea. A diagnosis of HP should be considered in patients with an identified exposure to a triggering antigen, respiratory symptoms, and radiologic signs of interstitial lung disease. Blood tests and pulmonary function tests (PFT) support the diagnosis. Bronchoscopy (with bronchoalveolar lavage and tissue biopsy) may be needed in unclear cases. Antigen provocation test is rarely required. Of note, the persistence of symptoms despite various treatment regimens may support HP diagnosis. The avoidance of single/multiple triggers is crucial for effective treatment. No evidence- based guidelines for treatment are available; in particular, the role of systemic glucocorticoids in children is unclear. With adequate antigen avoidance, the prognosis in children with HP is generally favorable.
Collapse
|
12
|
Xu X, Liu L, Xu X, Ma Q, Teng L, Zhou H, Yang L, Lu M. Etiologic Profile of Older Children With Diffuse Radiological Changes in Eastern China. Front Pediatr 2022; 10:823350. [PMID: 35586823 PMCID: PMC9108256 DOI: 10.3389/fped.2022.823350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 04/12/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To analyze the etiology of chest diffuse radiological changes (DRC) in children older than 2 years. METHODS A retrospective study was conducted on a primary cohort of children with DRC underwent high resolution computed tomography (HRCT). RESULTS DRC mainly included bronchial wall thickening, interlobular septal thickening, pleural thickening, ground glass opacity, mosaic perfusion, reticular & linear opacities, nodular opacity, and tree-in-bud. Of the identified 457 children with DRC, 83 of children older than 2 years with DRC were included in the present study. Ground glass opacity (53, 63.9%) and reticular & linear opacities (44, 53.0%) were frequently identified findings of HRCT, and no tree-in-bud pattern was observed. By contrast, among children with DRC by M. pneumoniae (n = 64), bronchial wall thickening (33, 51.6%), and mosaic perfusion (17, 26.6%) were common patterns of HRCT in addition to ground glass opacity (36, 56.3%). Most of etiologies were connective tissue disease (24, 28.9%), followed by diffuse alveolar hemorrhage syndrome (9, 10.8%), Langerhans cell histiocytosis (7, 8.4%), and recurrent aspiration (6, 7.2%). CONCLUSIONS This study adds further insights into the role of HRCT in diagnosing childhood interstitial lung diseases, indirectly reflecting disease compositions.
Collapse
Affiliation(s)
- Xuefeng Xu
- Department of Rheumatology Immunology and Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Lingke Liu
- Department of Rheumatology Immunology and Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xuchen Xu
- Department of Rheumatology Immunology and Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Qian Ma
- Department of Rheumatology Immunology and Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Liping Teng
- Department of Rheumatology Immunology and Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Haichun Zhou
- Department of Radiology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Li Yang
- Department of Radiology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Meiping Lu
- Department of Rheumatology Immunology and Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| |
Collapse
|
13
|
Surfactant protein disorders in childhood interstitial lung disease. Eur J Pediatr 2021; 180:2711-2721. [PMID: 33839914 DOI: 10.1007/s00431-021-04066-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/26/2021] [Accepted: 04/04/2021] [Indexed: 10/24/2022]
Abstract
Surfactant, which was first identified in the 1920s, is pivotal to lower the surface tension in alveoli of the lungs and helps to lower the work of breathing and prevents atelectasis. Surfactant proteins, such as surfactant protein B and surfactant protein C, contribute to function and stability of surfactant film. Additionally, adenosine triphosphate binding cassette 3 and thyroid transcription factor-1 are also integral for the normal structure and functioning of pulmonary surfactant. Through the study and improved understanding of surfactant over the decades, there is increasing interest into the study of childhood interstitial lung diseases (chILD) in the context of surfactant protein disorders. Surfactant protein deficiency syndrome (SPDS) is a group of rare diseases within the chILD group that is caused by genetic mutations of SFTPB, SFTPC, ABCA3 and TTF1 genes.Conclusion: This review article seeks to provide an overview of surfactant protein disorders in the context of chILD. What is Known: • Surfactant protein disorders are an extremely rare group of disorders caused by genetic mutations of SFTPB, SPTPC, ABCA3 and TTF1 genes. • Given its rarity, research is only beginning to unmask the pathophysiology, inheritance, spectrum of disease and its manifestations. What is New: • Diagnostic and treatment options continue to be explored and evolve in these conditions. • It is, therefore, imperative that we as paediatricians are abreast with current development in this field.
Collapse
|
14
|
Prognostic Significance of Computed Tomography Findings in Pulmonary Vein Stenosis. CHILDREN-BASEL 2021; 8:children8050402. [PMID: 34067561 PMCID: PMC8155841 DOI: 10.3390/children8050402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/10/2021] [Accepted: 05/14/2021] [Indexed: 11/17/2022]
Abstract
(1) Pulmonary vein stenosis (PVS) can be a severe, progressive disease with lung involvement. We aimed to characterize findings by computed tomography (CT) and identify factors associated with death; (2) Veins and lung segments were classified into five locations: right upper, middle, and lower; and left upper and lower. Severity of vein stenosis (0–4 = no disease–atresia) and lung segments (0–3 = unaffected–severe) were scored. A PVS severity score (sum of all veins + 2 if bilateral disease; maximum = 22) and a total lung severity score (sum of all lung segments; maximum = 15) were reported; (3) Of 43 CT examinations (median age 21 months), 63% had bilateral disease. There was 30% mortality by 4 years after CT. Individual-vein PVS severity was associated with its corresponding lung segment severity (p < 0.001). By univariate analysis, PVS severity score >11, lung cysts, and total lung severity score >6 had higher hazard of death; and perihilar induration had lower hazard of death; (4) Multiple CT-derived variables of PVS severity and lung disease have prognostic significance. PVS severity correlates with lung disease severity.
Collapse
|
15
|
Blickensdorf M, Timme S, Figge MT. Hybrid Agent-Based Modeling of Aspergillus fumigatus Infection to Quantitatively Investigate the Role of Pores of Kohn in Human Alveoli. Front Microbiol 2020; 11:1951. [PMID: 32903715 PMCID: PMC7438790 DOI: 10.3389/fmicb.2020.01951] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/24/2020] [Indexed: 12/31/2022] Open
Abstract
The healthy state of an organism is constantly threatened by external cues. Due to the daily inhalation of hundreds of particles and pathogens, the immune system needs to constantly accomplish the task of pathogen clearance in order to maintain this healthy state. However, infection dynamics are highly influenced by the peculiar anatomy of the human lung. Lung alveoli that are packed in alveolar sacs are interconnected by so called Pores of Kohn. Mainly due to the lack of in vivo methods, the role of Pores of Kohn in the mammalian lung is still under debate and partly contradicting hypotheses remain to be investigated. Although it was shown by electron microscopy that Pores of Kohn may serve as passageways for immune cells, their impact on the infection dynamics in the lung is still unknown under in vivo conditions. In the present study, we apply a hybrid agent-based infection model to quantitatively compare three different scenarios and discuss the importance of Pores of Kohn during infections of Aspergillus fumigatus. A. fumigatus is an airborne opportunistic fungus with rising incidences causing severe infections in immunocompromised patients that are associated with high mortality rates. Our hybrid agent-based model incorporates immune cell dynamics of alveolar macrophages – the resident phagocytes in the lung – as well as molecular dynamics of diffusing chemokines that attract alveolar macrophages to the site of infection. Consequently, this model allows a quantitative comparison of three different scenarios and to study the importance of Pores of Kohn. This enables us to demonstrate how passaging of alveolar macrophages and chemokine diffusion affect A. fumigatus infection dynamics. We show that Pores of Kohn alter important infection clearance mechanisms, such as the spatial distribution of macrophages and the effect of chemokine signaling. However, despite these differences, a lack of passageways for alveolar macrophages does impede infection clearance only to a minor extend. Furthermore, we quantify the importance of recruited macrophages in comparison to resident macrophages.
Collapse
Affiliation(s)
- Marco Blickensdorf
- Research Group Applied Systems Biology, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knöll Institute, Jena, Germany.,Faculty of Biological Sciences, Institute of Microbiology, Friedrich Schiller University Jena, Jena, Germany
| | - Sandra Timme
- Research Group Applied Systems Biology, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knöll Institute, Jena, Germany
| | - Marc Thilo Figge
- Research Group Applied Systems Biology, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knöll Institute, Jena, Germany.,Faculty of Biological Sciences, Institute of Microbiology, Friedrich Schiller University Jena, Jena, Germany
| |
Collapse
|
16
|
Vece TJ, Wambach JA, Hagood JS. Childhood rare lung disease in the 21st century: "-omics" technology advances accelerating discovery. Pediatr Pulmonol 2020; 55:1828-1837. [PMID: 32533908 PMCID: PMC8711209 DOI: 10.1002/ppul.24809] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/28/2020] [Indexed: 01/14/2023]
Abstract
Childhood rare lung diseases comprise a large number of heterogeneous respiratory disorders that are individually rare but are collectively associated with substantial morbidity, mortality, and healthcare resource utilization. Although the genetic mechanisms for several of these disorders have been elucidated, the pathogenesis mechanisms for others remain poorly understood and treatment options remain limited. Childhood rare lung diseases are enriched for genetic etiologies; identification of the disease mechanisms underlying these rare disorders can inform the biology of normal human lung development and has implications for the treatment of more common respiratory diseases in children and adults. Advances in "-omics" technology, such as genomic sequencing, clinical phenotyping, biomarker discovery, genome editing, in vitro and model organism disease modeling, single-cell analyses, cellular imaging, and high-throughput drug screening have enabled significant progress for diagnosis and treatment of rare childhood lung diseases. The most striking example of this progress has been realized for patients with cystic fibrosis for whom effective, personalized therapies based on CFTR genotype are now available. In this chapter, we focus on recent technology advances in childhood rare lung diseases, acknowledge persistent challenges, and identify promising new technologies that will impact not only biological discovery, but also improve diagnosis, therapies, and survival for children with these rare disorders.
Collapse
Affiliation(s)
- Timothy J. Vece
- Division of Pediatric Pulmonology, Program for Rare and Interstitial Lung Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jennifer A. Wambach
- Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - James S. Hagood
- Division of Pediatric Pulmonology, Program for Rare and Interstitial Lung Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
17
|
Nathan N, Berdah L, Delestrain C, Sileo C, Clement A. Interstitial lung diseases in children. Presse Med 2020; 49:103909. [PMID: 32563946 DOI: 10.1016/j.lpm.2019.06.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 06/11/2019] [Indexed: 01/16/2023] Open
Abstract
Interstitial lung disease (ILD) in children (chILD) is a heterogeneous group of rare respiratory disorders that are mostly chronic and associated with high morbidity and mortality. The pathogenesis of the various chILD is complex and the diseases share common features of inflammatory and fibrotic changes of the lung parenchyma that impair gas exchanges. The etiologies of chILD are numerous. In this review, we chose to classify them as ILD related to exposure/environment insults, ILD related to systemic and immunological diseases, ILD related to primary lung parenchyma dysfunctions and ILD specific to infancy. A growing part of the etiologic spectrum of chILD is being attributed to molecular defects. Currently, the main genetic mutations associated with chILD are identified in the surfactant genes SFTPA1, SFTPA2, SFTPB, SFTPC, ABCA3 and NKX2-1. Other genetic contributors include mutations in MARS, CSF2RA and CSF2RB in pulmonary alveolar proteinosis, and mutations in TMEM173 and COPA in specific auto-inflammatory forms of chILD. However, only few genotype-phenotype correlations could be identified so far. Herein, information is provided about the clinical presentation and the diagnosis approach of chILD. Despite improvements in patient management, the therapeutic strategies are still relying mostly on corticosteroids although specific therapies are emerging. Larger longitudinal cohorts of patients are being gathered through ongoing international collaborations to improve disease knowledge and targeted therapies. Thus, it is expected that children with ILD will be able to reach the adulthood transition in a better condition.
Collapse
Affiliation(s)
- Nadia Nathan
- Pediatric pulmonology department, Trousseau hospital, reference center for rare lung diseases RespiRare, Assistance publique-Hôpitaux de Paris (AP-HP), , 75012 Paris, France; Sorbonne université and Inserm UMRS933, 75012 Paris, France
| | - Laura Berdah
- Pediatric pulmonology department, Trousseau hospital, reference center for rare lung diseases RespiRare, Assistance publique-Hôpitaux de Paris (AP-HP), , 75012 Paris, France; Sorbonne université and Inserm UMRS933, 75012 Paris, France
| | - Céline Delestrain
- Pediatric pulmonology department, Trousseau hospital, reference center for rare lung diseases RespiRare, Assistance publique-Hôpitaux de Paris (AP-HP), , 75012 Paris, France
| | - Chiara Sileo
- Radiology department, AP-HP, Trousseau hospital, 75012 Paris, France
| | - Annick Clement
- Pediatric pulmonology department, Trousseau hospital, reference center for rare lung diseases RespiRare, Assistance publique-Hôpitaux de Paris (AP-HP), , 75012 Paris, France; Sorbonne université and Inserm UMRS933, 75012 Paris, France.
| |
Collapse
|
18
|
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.
Collapse
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.
| |
Collapse
|
19
|
Liang TIH, Lee EY. Interstitial Lung Diseases in Children, Adolescents, and Young Adults: Different from Infants and Older Adults. Radiol Clin North Am 2020; 58:487-502. [PMID: 32276699 DOI: 10.1016/j.rcl.2020.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Childhood interstitial lung disease (chILD) in children, teenagers, and young adults presents a challenge to the clinicians and radiologist, given its rarity, diverse imaging manifestations, and often nonspecific clinical examination findings. This article discusses the utility of available imaging techniques and associated characteristic imaging findings, and reviews the 2015 chILD classification scheme, with clinical examples highlighting the imaging features to help the radiologist aid in an efficient and accurate multidisciplinary diagnosis of chILD.
Collapse
Affiliation(s)
- Teresa I-Han Liang
- Department of Radiology, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
20
|
Urbankowska E, Urbankowski T, Drobczyński Ł, Griese M, Lange J, Brzewski M, Kulus M, Krenke K. Lung ultrasound-a new diagnostic modality in persistent tachypnea of infancy. Pediatr Pulmonol 2020; 55:1028-1036. [PMID: 31978279 DOI: 10.1002/ppul.24654] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 01/06/2020] [Indexed: 01/14/2023]
Abstract
Lung ultrasound (LUS) has been increasingly used in diagnosing and monitoring of various pulmonary diseases in children. The aim of the current study was to evaluate its usefulness in children with persistent tachypnea of infancy (PTI). This was a controlled, prospective, cross-sectional study that included children with PTI and healthy subjects. In patients with PTI, LUS was performed at baseline and then after 6 and 12 months of follow-up. Baseline results of LUS were compared to (a) baseline high-resolution computed tomography (HRCT) images, (b) LUS examinations in control group, and (c) follow-up LUS examinations. Twenty children with PTI were enrolled. B-lines were found in all children with PTI and in 11 (55%) control subjects (P < .001). The total number of B-lines, the maximal number of B lines in any intercostal space, the distance between B-lines, and pleural thickness were significantly increased in children with PTI compared to controls. An irregularity of the pleural line was found in all patients with PTI and in none of the healthy children. There were no significant changes in LUS findings in patients with PTI during the study period. The comparison of HRCT indices and LUS findings revealed significant correlations between the mean lung attenuation, skewness, kurtosis and fraction of interstitial pulmonary involvement, and the number of B-lines as well as the pleural line thickness. LUS seems to be a promising diagnostic tool in children with PTI. Its inclusion in the diagnostic work-up may enable to reduce the number of costly, hazardous, and ionizing radiation-based imaging procedures.
Collapse
Affiliation(s)
- Emilia Urbankowska
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Urbankowski
- Department of Internal Medicine, Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Łukasz Drobczyński
- Pediatric Radiology Department, Jan Polikarp Brudziński Pediatric Hospital, Warsaw, Poland
| | - Matthias Griese
- Department of Pediatric Pneumology, Dr. von Hauner Children's Hospital, Ludwig-Maximilians University, German Centre for Lung Research (DZL), Munich, Germany
| | - Joanna Lange
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Michał Brzewski
- Department of Pediatric Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Marek Kulus
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Krenke
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
21
|
Abstract
Interstitial (diffuse) lung diseases in infants and children comprise a rare heterogeneous group of parenchymal lung disorders, with clinical syndromes characterized by dyspnea, tachypnea, crackles, and hypoxemia. They arise from a wide spectrum of developmental, genetic, inflammatory, infectious, and reactive disorders. In the past, there has been a paucity of information and limited understanding regarding their pathogenesis, natural history, imaging findings, and histopathologic features, which often resulted in enormous diagnostic challenges and confusion. In recent years, there has been a substantial improvement in the understanding of interstitial lung disease in pediatric patients due to the development of a structured classification system based on the etiology of the lung disease, established pathologic criteria for consistent diagnosis, and the improvement of thoracoscopic techniques for lung biopsy. Imaging plays an important role in evaluating interstitial lung diseases in infants and children by confirming and characterizing the disorder, generating differential diagnoses, and providing localization for lung biopsy for pathological diagnosis. In this chapter, the authors present the epidemiology, challenges, and uncertainties of diagnosis and amplify a recently developed classification system for interstitial lung disease in infants and children with clinical, imaging, and pathological correlation.
Collapse
Affiliation(s)
- Robert H. Cleveland
- Department of Radiology, Harvard Medical School Boston Children’s Hospital, Boston, MA USA
| | - Edward Y. Lee
- Department of Radiology, Harvard Medical School Boston Children’s Hospital, Boston, MA USA
| |
Collapse
|
22
|
Phung B, Lam A. Pediatric Acute Respiratory Distress Syndrome and Hypersensitivity Pneumonitis Related to E-cigarette Vaping. J Pediatr Intensive Care 2019; 9:128-134. [PMID: 32351768 DOI: 10.1055/s-0039-3400961] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 10/29/2019] [Indexed: 01/06/2023] Open
Abstract
In recent years, electronic cigarettes (e-cigs) have been falsely advertised as safe alternatives to conventional smoking. We report a case involving a 16-year-old female who presented with fever, nonproductive cough, and shortness of breath after vaping e-cig/tetrahydrocannabinol dab pen. Her symptoms rapidly deteriorated and met diagnostic criteria for pediatric acute respiratory distress syndrome. Chest radiograph revealed extensive patchy airspace disease and computed tomography scan showed bilateral ground glass opacities. Bronchoalveolar lavage fluid revealed increased neutrophils, lymphocytosis, but absent eosinophilia. After the results of a comprehensive workup for infectious etiology returned negative, she was diagnosed with hypersensitivity pneumonitis and started on systemic corticosteroids.
Collapse
Affiliation(s)
- Binh Phung
- Department of Pediatrics, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, United States
| | - Anh Lam
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, United States
| |
Collapse
|
23
|
Childhood Interstitial (Diffuse) Lung Disease: Pattern Recognition Approach to Diagnosis in Infants. AJR Am J Roentgenol 2019; 212:958-967. [PMID: 30835521 DOI: 10.2214/ajr.18.20696] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE. The purpose of this article is to discuss imaging techniques and a pattern-based approach for diagnosing childhood interstitial (diffuse) lung diseases in infants. CONCLUSION. Childhood interstitial (diffuse) lung disease in infants consists of a heterogeneous group of disorders previously classified with clinical, radiologic, and pathologic features. By use of an imaging-guided algorithm, the assessment of lung volumes and the presence of ground-glass opacities or cysts can assist the radiologist in making an accurate and timely diagnosis.
Collapse
|
24
|
High-pitch CT, decreasing need for sedation and its potential side effects: some practical considerations and future directions. Pediatr Radiol 2019; 49:297-300. [PMID: 30535876 DOI: 10.1007/s00247-018-4314-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 11/26/2018] [Indexed: 12/21/2022]
|
25
|
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
| |
Collapse
|
26
|
Nathan N, Berdah L, Borensztajn K, Clement A. Chronic interstitial lung diseases in children: diagnosis approaches. Expert Rev Respir Med 2018; 12:1051-1060. [PMID: 30345849 DOI: 10.1080/17476348.2018.1538795] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Introduction: Children interstitial lung disease (chILD) is a heterogeneous group of rare respiratory disorders characterized by inflammatory and fibrotic changes of the lung parenchyma. They include ILD related to exposure/environment insults, ILD related to systemic diseases processes, ILD related to primary lung parenchyma dysfunctions and ILD specific to infancy. Areas covered: This review provides an update on chILD pathophysiology and diagnosis approaches in immunocompetent children. It includes current information on genetic causes. Expert commentary: ChILD covers a large spectrum of entities with heterogeneous disease expression. Various classifications have been reported, but none of them seems completely satisfactory. Recently, progress in molecular genetics has allowed identifying some genetic contributors, with, so far, a lack of correlations between gene disorders and disease expression. Despite improvements in patient management, chILD prognosis is still burdened by significant morbidity and mortality. Ongoing international collaborations will allow gathering larger longitudinal cohorts of patients to improve disease knowledge and personalized care. The overall goal is to help the children with ILD to reach the adulthood transition in a better condition, and to structure genetic counseling for their family.
Collapse
Affiliation(s)
- Nadia Nathan
- a Service de pneumologie pédiatrique, Centre national de référence des maladies respiratoires rares RespiRare , Hôpital Armand Trousseau, Assistance Publique Hôpitaux de Paris (AP-HP) , Paris , France.,b Sorbonne Université and Inserm UMRS933 , Paris , France
| | - Laura Berdah
- a Service de pneumologie pédiatrique, Centre national de référence des maladies respiratoires rares RespiRare , Hôpital Armand Trousseau, Assistance Publique Hôpitaux de Paris (AP-HP) , Paris , France
| | | | - Annick Clement
- a Service de pneumologie pédiatrique, Centre national de référence des maladies respiratoires rares RespiRare , Hôpital Armand Trousseau, Assistance Publique Hôpitaux de Paris (AP-HP) , Paris , France.,b Sorbonne Université and Inserm UMRS933 , Paris , France
| |
Collapse
|
27
|
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.
Collapse
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.
| |
Collapse
|
28
|
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.
Collapse
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
| |
Collapse
|
29
|
López-Andreu JA, Hidalgo-Santos AD, Fuentes-Castelló MA, Mancheño-Franch N, Cerón-Pérez JA, Esteban-Ricós MJ, Pedrola-Vidal L, Nogee LM. Delayed Presentation and Prolonged Survival of a Child with Surfactant Protein B Deficiency. J Pediatr 2017; 190:268-270.e1. [PMID: 28888561 DOI: 10.1016/j.jpeds.2017.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/26/2017] [Accepted: 07/06/2017] [Indexed: 11/29/2022]
Abstract
Surfactant protein B encoding gene mutations have been related to early onset fatal respiratory distress in full-term neonates. We report a school-aged male child homozygous for a surfactant protein B encoding gene missense mutation who presented after the neonatal period. His respiratory insufficiency responded to high dose intravenous methylprednisolone and hydroxychloroquine.
Collapse
Affiliation(s)
- Juan A López-Andreu
- Pediatric Respiratory and Allergy Section, University and Polytechnic Hospital La Fe, Valencia, Spain.
| | - Antonio D Hidalgo-Santos
- Pediatric Respiratory and Allergy Section, University and Polytechnic Hospital La Fe, Valencia, Spain
| | | | | | - Juan A Cerón-Pérez
- Department of Clinical Genetics, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Maria J Esteban-Ricós
- Section of Pediatric Radiology, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Laia Pedrola-Vidal
- Department of Clinical Genetics, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Lawrence M Nogee
- Eudowood Neonatal Pulmonary Division, Department of Pediatrics, Johns Hopkins University, Baltimore, MD
| |
Collapse
|
30
|
Jolles S, Sánchez-Ramón S, Quinti I, Soler-Palacín P, Agostini C, Florkin B, Couderc LJ, Brodszki N, Jones A, Longhurst H, Warnatz K, Haerynck F, Matucci A, de Vries E. Screening protocols to monitor respiratory status in primary immunodeficiency disease: findings from a European survey and subclinical infection working group. Clin Exp Immunol 2017; 190:226-234. [PMID: 28708268 PMCID: PMC5629444 DOI: 10.1111/cei.13012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2017] [Indexed: 02/01/2023] Open
Abstract
Many patients with primary immunodeficiency (PID) who have antibody deficiency develop progressive lung disease due to underlying subclinical infection and inflammation. To understand how these patients are monitored we conducted a retrospective survey based on patient records of 13 PID centres across Europe, regarding the care of 1061 adult and 178 paediatric patients with PID on immunoglobulin (Ig) G replacement. The most common diagnosis was common variable immunodeficiency in adults (75%) and hypogammaglobulinaemia in children (39%). The frequency of clinic visits varied both within and between centres: every 1-12 months for adult patients and every 3-6 months for paediatric patients. Patients diagnosed with lung diseases were more likely to receive pharmaceutical therapies and received a wider range of therapies than patients without lung disease. Variation existed between centres in the frequency with which some clinical and laboratory monitoring tests are performed, including exercise tests, laboratory testing for IgG subclass levels and specific antibodies, and lung function tests such as spirometry. Some tests were carried out more frequently in adults than in children, probably due to difficulties conducting these tests in younger children. The percentage of patients seen regularly by a chest physician, or who had microbiology tests performed following chest and sinus exacerbations, also varied widely between centres. Our survey revealed a great deal of variation across Europe in how frequently patients with PID visit the clinic and how frequently some monitoring tests are carried out. These results highlight the urgent need for consensus guidelines on how to monitor lung complications in PID patients.
Collapse
Affiliation(s)
- S Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - S Sánchez-Ramón
- Department of Immunology and IdISSC, Hospital Clínico San Carlos, Madrid, Spain
| | - I Quinti
- Department of Molecular Medicine, Sapienza University of Rome, Italy
| | - P Soler-Palacín
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Jeffrey Modell Diagnostic and Research Centre, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - C Agostini
- Department of Medicine (DIMED), Clinical Immunology Unit, University of Padua, Italy
| | - B Florkin
- University Department of Pediatrics, CHR Liege, Belgium
| | - L-J Couderc
- Respiratory Diseases Department, Hôpital FOCH, University Versailles-St Quentin, Suresnes, France
| | - N Brodszki
- The Children's Hospital, Skåne University Hospital, Lund, Sweden
| | - A Jones
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - H Longhurst
- Department of Immunology, Barts and The London National Health Service Trust, London, UK
| | - K Warnatz
- Center for Chronic Immunodeficiency, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - F Haerynck
- Center for Primary Immunodeficiency, Department of Paediatric Immunology and Pulmonology, Jeffrey Modell Diagnostic and Research Centre, Ghent University Hospital, Belgium
| | - A Matucci
- Department of Biomedicine, Immunoallergology Unit, AOU Craeggi, University of Florence, Italy
| | - E de Vries
- Jeroen Bosch Academy, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands.,Tranzo, Tilburg University, Tilburg, the Netherlands
| |
Collapse
|
31
|
Saddi V, Beggs S, Bennetts B, Harrison J, Hime N, Kapur N, Lipsett J, Nogee LM, Phu A, Suresh S, Schultz A, Selvadurai H, Sherrard S, Strachan R, Vyas J, Zurynski Y, Jaffé A. Childhood interstitial lung diseases in immunocompetent children in Australia and New Zealand: a decade's experience. Orphanet J Rare Dis 2017; 12:133. [PMID: 28743279 PMCID: PMC5526310 DOI: 10.1186/s13023-017-0637-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 04/19/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Childhood interstitial lung disease (chILD) represents a rare heterogeneous group of respiratory disorders. In the absence of randomized controlled clinical trials, global collaborations have utilized case series with an aim to standardising approaches to diagnosis and management. Australasian data are lacking. The aim of this study was to calculate prevalence and report the experience of chILD in Australasia over a decade. METHODS Paediatric pulmonologists in Australia and New Zealand involved in the care of patients aged 0-18 years with chILD completed a questionnaire on demographics, clinical features and outcomes, over a 10 year period. These data, together with data from the 2 reference genetics laboratories, were used to calculate prevalence. RESULTS One hundred fifteen cases were identified equating to a period prevalence (range) of 1.5 (0.8-2.1) cases/million for children aged 0-18years. Clinical data were provided on 106 patients: the <2 year group comprised 66 children, median age (range) 0.50 years (0.01-1.92); the ≥2 year group comprised 40 children, median age 8.2 years (2.0-18.0). Management approach was heterogeneous. Overall, 79% of patients had a good clinical outcome. Mortality rate was 7% in the study population. CONCLUSION chILD is rare in Australasia. This study demonstrates variation in the investigations and management of chILD cases across Australasia, however the general outcome is favorable. Further international collaboration will help finesse the understanding of these disorders.
Collapse
Affiliation(s)
- Vishal Saddi
- Department of Respiratory Medicine, Discipline of Paediatrics, Sydney Children’s Hospital, Randwick, Sydney, NSW 2031 Australia
| | - Sean Beggs
- Department of Paediatrics, Royal Hobart Hospital, Hobart, TAS 7000 Australia
| | - Bruce Bennetts
- Department of Molecular Genetics, The Children’s Hospital at Westmead, Sydney, NSW 2145 Australia
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Joanne Harrison
- Department of Respiratory Medicine, The Children’s Hospital, Melbourne, VIC 3052 Australia
| | - Neil Hime
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia
- Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney, NSW 2145 Australia
| | - Nitin Kapur
- Department of Respiratory Medicine, Lady Cilento Children’s Hospital, Brisbane, QLD 4101 Australia
| | - Jill Lipsett
- Anatomical Pathology, S.A. Pathology, Women’s and Children’s Hospital, Adelaide, South Australia 5154 Australia
| | - Lawrence M. Nogee
- Eudowood Neonatal Pulmonary Division, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287 USA
| | - Amy Phu
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia
- Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney, NSW 2145 Australia
| | - Sadasivam Suresh
- Department of Respiratory Medicine, Lady Cilento Children’s Hospital, Brisbane, QLD 4101 Australia
| | - André Schultz
- Department of Respiratory Medicine, Princess Margaret Hospital for Children, Perth, WA 6008 Australia
| | - Hiran Selvadurai
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia
- Department of Respiratory Medicine, The Children’s Hospital at Westmead, Sydney, NSW 2145 Australia
| | - Stephanie Sherrard
- Department of Respiratory Medicine, Princess Margaret Hospital for Children, Perth, WA 6008 Australia
| | - Roxanne Strachan
- Department of Respiratory Medicine, Discipline of Paediatrics, Sydney Children’s Hospital, Randwick, Sydney, NSW 2031 Australia
| | - Julian Vyas
- Department of Respiratory Paediatrics, Starship Children’s Hospital, Auckland, 1023 New Zealand
| | - Yvonne Zurynski
- Australian Paediatric Surveillance Unit, Kids Research Institute, Sydney, NSW 2145 Australia
| | - Adam Jaffé
- School of Women’s and Children’s Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2031 Australia
| |
Collapse
|
32
|
Burrage LC, Guillerman RP, Das S, Singh S, Schady DA, Morris SA, Walkiewicz M, Schecter MG, Heinle JS, Lotze TE, Lalani SR, Mallory GB. Lung Transplantation for FLNA-Associated Progressive Lung Disease. J Pediatr 2017; 186:118-123.e6. [PMID: 28457522 PMCID: PMC5534178 DOI: 10.1016/j.jpeds.2017.03.045] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 01/10/2017] [Accepted: 03/17/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe a series of patients with pathogenic variants in FLNA and progressive lung disease necessitating lung transplantation. STUDY DESIGN We conducted a retrospective chart review of 6 female infants with heterozygous presumed loss-of-function pathogenic variants in FLNA whose initial presentation was early and progressive respiratory failure. RESULTS Each patient received lung transplantation at an average age of 11 months (range, 5-15 months). All patients had pulmonary arterial hypertension and chronic respiratory failure requiring tracheostomy and escalating levels of ventilator support before transplantation. All 6 patients survived initial lung transplantation; however, 1 patient died after a subsequent heart-lung transplant. The remaining 5 patients are living unrestricted lives on chronic immunosuppression at most recent follow-up (range, 19 months to 11.3 years post-transplantation). However, in all patients, severe ascending aortic dilation has been observed with aortic regurgitation. CONCLUSIONS Respiratory failure secondary to progressive obstructive lung disease during infancy may be the presenting phenotype of FLNA-associated periventricular nodular heterotopia. We describe a cohort of patients with progressive respiratory failure related to a pathogenic variant in FLNA and present lung transplantation as a viable therapeutic option for this group of patients.
Collapse
Affiliation(s)
- Lindsay C. Burrage
- Department of Molecular and Human Genetics, Baylor College of Medicine,Texas Children’s Hospital
| | | | - Shailendra Das
- Section of Pediatric Pulmonology, Department of Pediatrics, Baylor College of Medicine
| | - Shipra Singh
- Division of Pulmonology, Department of Pediatrics, State University of New York - Buffalo
| | | | - Shaine A. Morris
- Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine
| | | | - Marc G. Schecter
- Division of Pulmonary Medicine, Department of Pediatrics, University of Cincinnati School of Medicine
| | - Jeffrey S. Heinle
- Division of Congenital Heart Surgery, Department of Surgery, Baylor College of Medicine
| | - Timothy E. Lotze
- Section of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine
| | - Seema R. Lalani
- Department of Molecular and Human Genetics, Baylor College of Medicine,Texas Children’s Hospital
| | - George B. Mallory
- Section of Pediatric Pulmonology, Department of Pediatrics, Baylor College of Medicine
| |
Collapse
|
33
|
Liszewski MC, Stanescu AL, Phillips GS, Lee EY. Respiratory Distress in Neonates. Radiol Clin North Am 2017; 55:629-644. [DOI: 10.1016/j.rcl.2017.02.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
34
|
Abstract
Defective regulation of type I interferon response is associated with severe inflammatory phenotypes and autoimmunity. Type I interferonopathies are a clinically heterogenic group of Mendelian diseases with a constitutive activation of this pathway that might present as atypical, severe, early onset rheumatic diseases. Skin vasculopathy with chilblains and livedo reticularis, interstitial lung disease, and panniculitis are common. Recent studies have implicated abnormal responses to nucleic acid stimuli or defective regulation of downstream effector molecules in disease pathogenesis. As observed for IL1-β and autoinflammatory diseases, knowledge of the defects responsible for type I interferonopathies will likely promote the development of targeted therapy.
Collapse
|
35
|
Volpi S, Picco P, Caorsi R, Candotti F, Gattorno M. Type I interferonopathies in pediatric rheumatology. Pediatr Rheumatol Online J 2016; 14:35. [PMID: 27260006 PMCID: PMC4893274 DOI: 10.1186/s12969-016-0094-4] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 05/11/2016] [Indexed: 12/13/2022] Open
Abstract
Defective regulation of type I interferon response is associated with severe inflammatory phenotypes and autoimmunity. Type I interferonopathies are a clinically heterogenic group of Mendelian diseases with a constitutive activation of this pathway that might present as atypical, severe, early onset rheumatic diseases. Skin vasculopathy with chilblains and livedo reticularis, interstitial lung disease, and panniculitis are common. Recent studies have implicated abnormal responses to nucleic acid stimuli or defective regulation of downstream effector molecules in disease pathogenesis. As observed for IL1-β and autoinflammatory diseases, knowledge of the defects responsible for type I interferonopathies will likely promote the development of targeted therapy.
Collapse
Affiliation(s)
- Stefano Volpi
- U.O. Pediatria 2, Istituto Giannina Gaslini, Genoa, Italy
| | - Paolo Picco
- U.O. Pediatria 2, Istituto Giannina Gaslini, Genoa, Italy
| | - Roberta Caorsi
- U.O. Pediatria 2, Istituto Giannina Gaslini, Genoa, Italy
| | - Fabio Candotti
- Division of Immunology and Allergy, University Hospital of Lausanne, Lausanne, Switzerland
| | - Marco Gattorno
- U.O. Pediatria 2, Istituto Giannina Gaslini, Genoa, Italy.
| |
Collapse
|
36
|
Spagnolo P, Bush A. Interstitial Lung Disease in Children Younger Than 2 Years. Pediatrics 2016; 137:peds.2015-2725. [PMID: 27245831 DOI: 10.1542/peds.2015-2725] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2015] [Indexed: 11/24/2022] Open
Abstract
Childhood interstitial lung disease (chILD) represents a highly heterogeneous group of rare disorders associated with substantial morbidity and mortality. Although our understanding of chILD remains limited, important advances have recently been made, the most important being probably the appreciation that disorders that present in early life are distinct from those occurring in older children and adults, albeit with some overlap. chILD manifests with diffuse pulmonary infiltrates and nonspecific respiratory signs and symptoms, making exclusion of common conditions presenting in a similar fashion an essential preliminary step. Subsequently, a systematic approach to diagnosis includes a careful history and physical examination, computed tomography of the chest, and some or all of bronchoscopy with bronchoalveolar lavage, genetic testing, and if diagnostic uncertainty persists, lung biopsy. This review focuses on chILD presenting in infants younger than 2 years of age and discusses recent advances in the classification, diagnostic approach, and management of chILD in this age range. We describe novel genetic entities, along with initiatives that aim at collecting clinical data and biologic samples from carefully characterized patients in a prospective and standardized fashion. Early referral to expert centers and timely diagnosis may have important implications for patient management and prognosis, but effective therapies are often lacking. Following massive efforts, international collaborations among the key stakeholders are finally starting to be in place. These have allowed the setting up and conducting of the first randomized controlled trial of therapeutic interventions in patients with chILD.
Collapse
Affiliation(s)
- Paolo Spagnolo
- Medical University Clinic, Canton Hospital Baselland, and University of Basel, Liestal, Switzerland;
| | - Andrew Bush
- Royal Brompton Hospital and Harefield NHS Foundation Trust, London, United Kingdom; and National Heart and Lung Institute, Imperial College, London, United Kingdom
| |
Collapse
|
37
|
Vece TJ, Young LR. Update on Diffuse Lung Disease in Children. Chest 2016; 149:836-45. [PMID: 26502226 DOI: 10.1378/chest.15-1986] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 09/22/2015] [Accepted: 10/04/2015] [Indexed: 12/31/2022] Open
Abstract
Diffuse lung diseases in children, also called children's interstitial lung disease, are a diverse group of rare disorders that cause disturbances of gas exchange in the lungs. Although individually rare, there are many different forms of diffuse lung disease in children, and collectively these disorders are associated with significant morbidity and mortality, as well as health-care resource utilization. Over the past several years, there have been many significant advances in the field, including genetic discoveries and the development of clinical practice guidelines. This review summarizes recent advances in the understanding, diagnosis, and treatment of diffuse lung diseases in children.
Collapse
Affiliation(s)
- Timothy J Vece
- Section of Pulmonology, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
| | - Lisa R Young
- Pulmonary Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN; Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
38
|
Multimodality thoracic imaging of juvenile systemic sclerosis: emphasis on clinical correlation and high-resolution CT of pulmonary fibrosis. AJR Am J Roentgenol 2015; 204:408-22. [PMID: 25615765 DOI: 10.2214/ajr.14.12461] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE. Juvenile systemic sclerosis is a rare multisystem autoimmune disorder characterized by vasculopathy and multiorgan fibrosis. Cardiopulmonary complications are the leading cause of morbidity and mortality. Although pulmonary fibrosis is the complication that is most common and well described, cardiovascular and esophageal involvement may also be observed. In this article, common thoracic findings in juvenile systemic sclerosis will be discussed. We will focus on chest CT, including CT findings of pulmonary fibrosis and associated grading methods, as well as cardiac MRI and esophageal imaging. CONCLUSION. Radiologists play a pivotal role in the initial diagnosis and follow-up evaluation of pediatric patients with systemic sclerosis. Treatment decisions and prognostic assessment are directly related to imaging findings along with clinical evaluation.
Collapse
|
39
|
Gomes VCC, Silva MCC, Maia Filho JH, Daltro P, Ramos SG, Brody AS, Marchiori E. Diagnostic criteria and follow-up in neuroendocrine cell hyperplasia of infancy: a case series. J Bras Pneumol 2014; 39:569-78. [PMID: 24310630 PMCID: PMC4075883 DOI: 10.1590/s1806-37132013000500007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 09/06/2013] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Neuroendocrine cell hyperplasia of infancy (NEHI) is a form of childhood interstitial lung disease characterized by tachypnea, retractions, crackles, and hypoxia. The aim of this study was to report and discuss the clinical, imaging, and histopathological findings in a series of NEHI cases at a tertiary pediatric hospital, with an emphasis on diagnostic criteria and clinical outcomes. METHODS Between 2003 and 2011, 12 full-term infants were diagnosed with NEHI, based on clinical and tomographic findings. Those infants were followed for 1-91 months. Four infants were biopsied, and the histopathological specimens were stained with bombesin antibody. RESULTS In this case series, symptoms appeared at birth in 6 infants and by 3 months of age in the remaining 6. In all of the cases, NEHI was associated with acute respiratory infection. The most common initial chest HRCT findings were ground-glass opacities that were in the middle lobe/lingula in 12 patients and in other medullary areas in 10. Air trapping was the second most common finding, being observed in 7 patients. Follow-up HRCT scans (performed in 10 patients) revealed normal results in 1 patient and improvement in 9. The biopsy findings were nonspecific, and the staining was positive for bombesin in all samples. Confirmation of NEHI was primarily based on clinical and tomographic findings. Symptoms improved during the follow-up period (mean, 41 months). A clinical cure was achieved in 4 patients. CONCLUSIONS In this sample of patients, the diagnosis of NEHI was made on the basis of the clinical and tomographic findings, independent of the lung biopsy results. Most of the patients showed clinical improvement and persistent tomographic changes during the follow-up period, regardless of the initial severity of the disease or type of treatment.
Collapse
|
40
|
Newman B, Caplan J. Cystic lung lesions in newborns and young children: differential considerations and imaging. Semin Ultrasound CT MR 2014; 35:571-87. [PMID: 25454053 DOI: 10.1053/j.sult.2014.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Numerous diverse entities produce cystic lung changes in neonates and young children. This review provides an evidence-based, age-appropriate, differential diagnostic framework to use when confronted with pulmonary cystic changes. The categories of diseases that have been discussed include congenital cystic bronchopulmonary malformations, neoplastic conditions, infections, collagen or soft tissue abnormalities, and mimics of cystic lung disease. An understanding of the pathophysiology, imaging appearance, and demographics of these entities is essential in guiding optimal care. Important educational points include differentiating bronchopulmonary malformations from neoplasms and the management and surveillance of lung cysts in young children.
Collapse
Affiliation(s)
- Beverley Newman
- Department of Radiology, Stanford University School of Medicine, Lucile Packard Children׳s Hospital, Stanford, CA.
| | - Jordan Caplan
- Shady Grove Radiology/Shady Grove Adventist Hospital, Rockville, MD
| |
Collapse
|
41
|
Bressieux-Degueldre S, Rotman S, Hafen G, Aubert JD, Rochat I. Idiopathic desquamative interstitial pneumonia in a child: a case report. BMC Res Notes 2014; 7:383. [PMID: 24954625 PMCID: PMC4078007 DOI: 10.1186/1756-0500-7-383] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 06/12/2014] [Indexed: 12/01/2022] Open
Abstract
Background Desquamative interstitial pneumonia is a rare form of interstitial lung disease in children. Respiratory symptoms appear progressively, are often subtle, and diagnosis is often delayed by a mean of 6 months after onset. High resolution chest computed tomography is the most sensitive imaging technique for demonstrating and identifying interstitial pneumonia. The typical histologic pattern of desquamative interstitial pneumonia, with prominent clustered alveolar macrophages, diffuse reactive alveolar epithelial hyperplasia and globular proteinaceous material, is diagnostic. Desquamative interstitial pneumonia in children can be idiopathic, though it is mostly related to an inborn error of surfactant metabolism. Case presentation We present the complex clinical course and pathologic findings of a 30-months-old Mauritian and Senegalese girl with idiopathic desquamative interstitial pneumonia and multiple extrapulmonary manifestations. To our knowledge, this is the first case report of desquamative interstitial pneumonia to occur as part of a syndrome with multiple organ involvement. Conclusion We believe that desquamative interstitial pneumonia is not always associated with mutations of the surfactant proteins, and can still be idiopathic, especially when occurring as part of a syndrome with multiple organ involvement, as described in other interstitial lung diseases.
Collapse
Affiliation(s)
- Sabrina Bressieux-Degueldre
- Pediatric Pulmonology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | | | | | | | | |
Collapse
|
42
|
Poralla C, Specht S, Born M, Müller A, Bartmann P, Müller A. Treatment of congenital generalized lymphangiectasia with propranolol in a preterm infant. Pediatrics 2014; 133:e439-42. [PMID: 24446440 DOI: 10.1542/peds.2012-2087] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Generalized lymphangiectasia is a rare congenital disorder characterized by dilated lymphatic vessels with a fatal prognosis, especially in cases with thoracic involvement. We describe the use of propranolol in the therapy of generalized lymphangiectasia in a preterm infant with hydrops fetalis. Propranolol was well tolerated and effective within the first months. It remains to be shown whether propranolol is a treatment option for infants with generalized lymphangiectasia.
Collapse
|
43
|
Diffuse Lung Disease. PEDIATRIC CHEST IMAGING 2014. [PMCID: PMC7120093 DOI: 10.1007/174_2014_1021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Diffuse lung disease (DLD) comprises a diverse group of disorders characterized by widespread pulmonary parenchymal pathology and impaired gas exchange. While many of these disorders are categorized under the rubric of interstitial lung disease (ILD), some of these disorders involve the airspaces or peripheral airways in addition to, or rather than, the interstitium. Some of these disorders are present primarily in infancy or early childhood, while others that are prevalent in adulthood rarely occur in childhood. This chapter will review the classification of pediatric DLD and the characteristic imaging findings of specific disorders to facilitate accurate diagnosis and guide appropriate treatment of children with these disorders.
Collapse
|
44
|
Abstract
Children's interstitial lung disease (ILD) includes a wide range of rare respiratory disorders associated with high morbidity and mortality. Genetic factors, systemic disease processes, nonspecific inflammatory or fibrotic patterns of repair seen in a number of clinical settings are involved in the ILD pathogenesis. Specific disorders more prevalent in young children include diffuse developmental disorders, alveolar growth abnormalities, genetic surfactant disorders, pulmonary interstitial glycogenosis and neuroendocrine cell hyperplasia of infancy. It may be difficult to recognize these entities and this can lead to delayed treatment. The diagnostic approach is based on a combination of history/physical examinations, imaging studies, pulmonary function testing, genetic testing, bronchoalveolar lavage (BAL) and in most cases an open lung biopsy. Although some disease types overlap with those seen in adults, in this review emphasis is placed on entities unique to the pediatric population focusing on clinical characteristics, histologic definitions, radiologic-pathologic correlation and therapeutic strategies.
Collapse
|
45
|
Soares JJ, Deutsch GH, Moore PE, Fazili MF, Austin ED, Brown RF, Sokolow AG, Hilmes MA, Young LR. Childhood interstitial lung diseases: an 18-year retrospective analysis. Pediatrics 2013; 132:684-91. [PMID: 24081995 PMCID: PMC3784299 DOI: 10.1542/peds.2013-1780] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Childhood interstitial lung diseases (ILD) occur in a variety of clinical contexts. Advances in the understanding of disease pathogenesis and use of standardized terminology have facilitated increased case ascertainment. However, as all studies have been performed at specialized referral centers, the applicability of these findings to general pulmonary practice has been uncertain. The objective of this study was to determine the historical occurrence of childhood ILD to provide information reflecting general pediatric pulmonary practice patterns. METHODS Childhood ILD cases seen at Vanderbilt Children's Hospital from 1994 to 2011 were retrospectively reviewed and classified according to the current pediatric diffuse lung disease histopathologic classification system. RESULTS A total of 93 cases were identified, of which 91.4% were classifiable. A total of 68.8% (64/93) of subjects underwent lung biopsy in their evaluations. The largest classification categories were disorders related to systemic disease processes (24.7%), disorders of the immunocompromised host (24.7%), and disorders more prevalent in infancy (22.6%). Eight cases of neuroendocrine cell hyperplasia of infancy (NEHI) were identified, including 5 that were previously unrecognized before this review. CONCLUSIONS Our findings demonstrate the general scope of childhood ILD and that these cases present within a variety of pediatric subspecialties. Retrospective review was valuable in recognizing more recently described forms of childhood ILD. As a significant portion of cases were classifiable based on clinical, genetic, and/or radiographic criteria, we urge greater consideration to noninvasive diagnostic approaches and suggest modification to the current childhood ILD classification scheme to accommodate the increasing number of cases diagnosed without lung biopsy.
Collapse
Affiliation(s)
- Jennifer J. Soares
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics
| | - Gail H. Deutsch
- Department of Pathology, Seattle Children’s Hospital, Seattle, Washington
| | - Paul E. Moore
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics
| | - Mohammad F. Fazili
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics
| | - Eric D. Austin
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics
| | - Rebekah F. Brown
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics
| | - Andrew G. Sokolow
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics
| | | | - Lisa R. Young
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics,,Allergy, Pulmonary and Critical Care, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; and
| |
Collapse
|
46
|
Abstract
PURPOSE OF REVIEW Advances in genetics and clinical diagnostics, along with recently described clinical entities and refined classification schemes, have improved our understanding of diffuse and interstitial lung diseases in children. This review presents recent updates in these disorders in the context of systemic inflammatory conditions. RECENT FINDINGS Classification of childhood diffuse lung disease (DLD) using adult paradigms is not useful. Distinct clinical-pathologic entities exist in children. Infants are more likely to present with genetic and developmental disorders, and older children with inflammatory and immune-mediated conditions. A combination of clinical evaluation, high-resolution computed tomography scanning, pulmonary function testing and serology, with bronchoscopy and surgical lung biopsy in selected cases, is most useful in the evaluation of DLD in the context of rheumatologic conditions. Common causes of DLD, such as infection, especially in the setting of immunodeficiency, must be ruled out. Optimal therapy for specific disorders will require careful analysis of data from national registries. Emerging use of biomarkers and high-throughput molecular analysis will yield novel insight into these disorders. SUMMARY In the setting of known or suspected rheumatologic disorders, diagnosis and management of DLD are challenging, and require close collaboration among rheumatologists, pulmonologists, and other specialists.
Collapse
|
47
|
Lee EY. Interstitial lung disease in infants: new classification system, imaging technique, clinical presentation and imaging findings. Pediatr Radiol 2013; 43:3-13; quiz p.128-9. [PMID: 23229343 DOI: 10.1007/s00247-012-2524-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 08/09/2012] [Accepted: 08/11/2012] [Indexed: 12/13/2022]
Abstract
Interstitial lung disease (ILD) is defined as a rare, heterogeneous group of parenchymal lung conditions that develop primarily because of underlying developmental or genetic disorders. Affected infants typically present with clinical syndromes characterized by dyspnea, tachypnea, crackles and hypoxemia. Until recently, the understanding of ILD in infants has been limited largely owing to a lack of evidence-based information of underlying pathogenesis, natural history, imaging findings and histopathological features. However, ILD in infants is now better understood and managed because of (1) advances in imaging methods that result in rapid and accurate detection, (2) improved thoracoscopic techniques for lung biopsy, (3) a consensus regarding the pathological criteria for these particular lung conditions and (4) a new classification system based on the underlying etiology of ILD. This article reviews the new classification system, imaging technique, clinical presentation and imaging findings of ILD in infants. Specialized knowledge of this new classification system in conjunction with recognition of characteristic imaging findings of ILD in infants has great potential for early and accurate diagnosis, which in turn can lead to optimal patient management.
Collapse
Affiliation(s)
- Edward Y Lee
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA.
| |
Collapse
|
48
|
Shue EH, Soares B, Courtier J, Hogue J, Shimotake T, MacKenzie TC. Type IV intestinal atresia, congenital bilateral perisylvian syndrome, and chronic pulmonary hypertension secondary to multiple vascular disruption syndrome in a monochorionic twin. J Pediatr Surg 2012; 47:1938-42. [PMID: 23084212 DOI: 10.1016/j.jpedsurg.2012.08.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Revised: 08/16/2012] [Accepted: 08/17/2012] [Indexed: 10/27/2022]
Abstract
We describe a rare case of multiple intestinal atresias, congenital bilateral perisylvian polymicrogyria, and chronic pulmonary hypertension in a surviving monochorionic twin with co-twin demise. This constellation of congenital anomalies represents a multiple vascular disruption syndrome due to intrauterine vascular compromise in the setting of possible twin-to-twin transfusion syndrome.
Collapse
Affiliation(s)
- Eveline H Shue
- Department of Surgery, University of California, San Francisco, CA 94143-0570, USA
| | | | | | | | | | | |
Collapse
|
49
|
Abstract
Diffuse lung disease [DLD] in children comprises a group of heterogeneous, rare disorders. Despite the rarity of these diseases there has been a considerable increase in our knowledge of DLD in children including their diagnosis and management. Diagnosis of these diseases requires a detailed history and physical examination, diagnostic imaging, pulmonary function testing, selected and directed laboratory testing, bronchoalveolar lavage and in most cases an open lung biopsy. Once a diagnosis is made, treatment is centred on supportive care including nutritional and supplemental oxygen therapy when needed. Medications including corticosteroids and other immunomodulatory medications are often used. Lung transplantation has been used for final treatment in some cases of DLD. Formation of research collaborations will continue to further our understanding of these diseases.
Collapse
Affiliation(s)
- Timothy J Vece
- Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas 77030, USA.
| | | |
Collapse
|
50
|
Lee EY, Cleveland RH, Langston C. Interstitial Lung Disease in Infants and Children: New Classification System with Emphasis on Clinical, Imaging, and Pathological Correlation. IMAGING IN PEDIATRIC PULMONOLOGY 2011. [PMCID: PMC7120961 DOI: 10.1007/978-1-4419-5872-3_8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
Interstitial lung diseases in infants and children comprise a rare heterogeneous group of parenchymal lung disorders, with clinical syndromes characterized by dyspnea, tachypnea, crackles, and hypoxemia. They arise from a wide spectrum of developmental, genetic, inflammatory, infectious, and reactive disorders. In the past, there has been a paucity of information and limited understanding regarding their pathogenesis, natural history, imaging findings, and histopathologic features, which often resulted in enormous diagnostic challenges and confusion. In recent years, there has been a substantial improvement in the understanding of interstitial lung disease in the pediatric patient, due to the development of a structured classification system based on etiology of the lung disease, established pathologic criteria for consistent diagnosis, and improvement of thoracoscopic techniques for lung biopsy. Imaging plays an important role in evaluating interstitial lung diseases in infants and children by confirming and characterizing the disorder, generating differential diagnoses, and providing localization for lung biopsy for pathological diagnosis. In this chapter, the authors present epidemiology, challenges and uncertainties of diagnosis, and amplify a recently developed classification system for interstitial lung disease in infants and children with clinical, imaging, and pathological correlation.
Collapse
|