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Kaur H, Bhat V, Mukund B, Mahajan G. Masqueraders of pneumonia in children: A case series. Lung India 2024; 41:67-70. [PMID: 38160462 PMCID: PMC10883445 DOI: 10.4103/lungindia.lungindia_231_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/28/2023] [Indexed: 01/03/2024] Open
Abstract
Pneumonia remains the top most killer of under-five Indian children. Pneumonia in children is usually caused by viral or bacterial infections. However, there are some unusual causes of pneumonia that merit consideration when pneumonia is recurrent or persistent.
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Affiliation(s)
- Hardeep Kaur
- Department of Paediatrics, INHS Asvini, Near RC Church, Colaba, Mumbai, Maharashtra, India
| | - Vivek Bhat
- Department of Paediatrics, INHS Asvini, Near RC Church, Colaba, Mumbai, Maharashtra, India
| | - Bal Mukund
- Department of Paediatrics, INHS Asvini, Near RC Church, Colaba, Mumbai, Maharashtra, India
| | - Gaurav Mahajan
- Department of Medicine, Command Hospital (Northern Command), Udhampur, Jammu and Kashmir, India
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2
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Qing Q, Zha P, Dai LY, Wang Y. Effect of different ventilation methods combined with pulmonary surfactant on neonatal acute respiratory distress syndrome. World J Clin Cases 2023; 11:5878-5886. [PMID: 37727476 PMCID: PMC10506026 DOI: 10.12998/wjcc.v11.i25.5878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/07/2023] [Accepted: 08/11/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Acute respiratory distress syndrome precipitates is widespread pulmonary injury in impacted individuals, the neonatal respiratory distress syndrome (NRDS), primarily observed in preterm infants, represents a prevalent critical condition in neonatal clinical settings. AIM To investigate the clinical efficacy of various ventilation strategies combined with pulmonary surfactant (PS) therapy in the treatment of NRDS. METHODS A total of 20 neonates diagnosed with respiratory distress syndrome, admitted between May 2021 and June 2022, were randomly assigned to either a research group or a control group. Neonates in the research group received treatment involving high-frequency oscillatory ventilation (HFOV) in conjunction with PS. In contrast, neonates in the control group were administered either controlled mechanical ventilation or synchronous intermittent mandatory ventilation, combined with PS. Arterial blood samples from the neonates in both groups were collected before treatment, as well as 6 h, 12 h, 24 h, and 48 h post-treatment. These samples underwent blood gas analysis, with measurements taken for pH value, partial pressures of oxygen (O2) and carbon dioxide. Concurrently, data was collected on the duration of ventilator use, length of hospitalization time, O2 treatment time, treatment outcomes, and complications of the ventilator. RESULTS From 6-48 h post-treatment, both groups demonstrated significant improvements in arterial blood pH and oxygen partial pressure, along with a significant decrease in carbon dioxide partial pressure compared to pre-treatment values (P < 0.05). Although these changes progressed over time, there were no significant differences between the two groups (P > 0.05). However, the research group had significantly lower X-ray scores, shorter hospitalization time, and less time on O2 therapy compared to the control group (P < 0.05). Mortality rates were similar between the two groups (P > 0.05), but the research group had a significantly lower incidence of complications (P < 0.05). CONCLUSION The integration of HFOV combine with PS has proven to effectively expedite the treatment duration, decrease the occurrence of complications, and secure the therapeutic efficacy in managing NRDS.
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Affiliation(s)
- Qing Qing
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei 230001, Anhui Province, China
| | - Ping Zha
- Department of Neonatology, Anhui Provincial Children's Hospital, Hefei 230001, Anhui Province, China
| | - Li-Ying Dai
- Department of Neonatology, Anhui Provincial Children's Hospital, Hefei 230001, Anhui Province, China
| | - Yang Wang
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei 230001, Anhui Province, China
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3
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Nayir Buyuksahin H, Kiper N. Childhood Interstitial Lung Disease. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2023; 36:5-15. [PMID: 36695653 DOI: 10.1089/ped.2022.0013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Childhood interstitial lung disease (chILD) is a heterogeneous group of diseases with various clinical and imaging findings. The incidence and prevalence have increased in recent years, probably due to better comprehension of these rare diseases and increased awareness among physicians. chILDs present with nonspecific pulmonary symptoms, such as tachypnea, hypoxemia, cough, rales, and failure to thrive. Unnecessary invasive procedures can be avoided if specific mutations are detected through genetic examinations or if typical imaging patterns are recognized on computed tomography. Disease knowledge and targeted therapies are improving through international collaboration. Pulmonary involvement in systemic diseases is not uncommon. Pulmonary involvement may be the first finding in connective tissue diseases. This review aims to present a systematic patient-targeted approach to the diagnosis of chILD.
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Affiliation(s)
- Halime Nayir Buyuksahin
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
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4
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Nayir Buyuksahin H, Basaran O, Balık Z, Bilginer Y, Ozen S, Dogru D. Interstitial lung disease in autoinflammatory disease in childhood: A systematic review of the literature. Pediatr Pulmonol 2023; 58:367-373. [PMID: 36314652 DOI: 10.1002/ppul.26220] [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: 07/06/2022] [Revised: 10/07/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND/OBJECTIVES The lung is one of the target organs in the systemic involvement of autoinflammatory disease (AID), and interstitial lung disease (ILD) is the primary phenotype of lung involvement in AID. In this review, we aimed to conduct a systematic review of the available literature to highlight ILD in AID. METHODS We conducted a systematic literature search in PubMed/MEDLINE and Scopus from the inception of the databases to January 2022. References were first screened by title and then by abstract by two authors. Eighteen original papers were selected for full-text review. RESULTS During the literature search, we identified 18 relevant articles describing 52 cases of AID and ILD. Of those, 44 patients had stimulator of interferon genes-associated vasculopathy with onset in infancy (SAVI), six had coatomer protein complex (COPA) syndrome, one had haploinsufficiency of A20, and one had mevalonate kinase deficiency. Pulmonary fibrosis, cyst formation, and ground glass areas were the most common findings in chest tomography of patients with COPA syndrome and SAVI. Janus kinase inhibitors were used to treat most of the patients with SAVI, which stabilized ILD. CONCLUSIONS ILD should be considered carefully in children with AID, especially those with interferonopathy.
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Affiliation(s)
- Halime Nayir Buyuksahin
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ozge Basaran
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, and Hacettepe University Vasculitis Research Center, Ankara, Turkey
| | - Zeynep Balık
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, and Hacettepe University Vasculitis Research Center, Ankara, Turkey
| | - Yelda Bilginer
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, and Hacettepe University Vasculitis Research Center, Ankara, Turkey
| | - Seza Ozen
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, and Hacettepe University Vasculitis Research Center, Ankara, Turkey
| | - Deniz Dogru
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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5
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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.
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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
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6
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Incidence and Prevalence of Children's Diffuse Lung Disease in Spain. Arch Bronconeumol 2022; 58:22-29. [DOI: 10.1016/j.arbres.2021.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/15/2021] [Accepted: 06/02/2021] [Indexed: 02/03/2023]
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7
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Zheng YR, Lei YQ, Liu JF, Wu HL, Xu N, Huang ST, Cao H, Chen Q. Effect of High-Frequency Oscillatory Ventilation Combined With Pulmonary Surfactant in the Treatment of Acute Respiratory Distress Syndrome After Cardiac Surgery: A Prospective Randomised Controlled Trial. Front Cardiovasc Med 2021; 8:675213. [PMID: 34368243 PMCID: PMC8339213 DOI: 10.3389/fcvm.2021.675213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background: This study aimed to evaluate the effects of pulmonary surfactant (PS) combined with high-frequency oscillatory ventilation (HFOV) or conventional mechanical ventilation (CMV) in infants with acute respiratory distress syndrome (ARDS) after congenital cardiac surgery. Methods: A total of 61 infants with ARDS were eligible and were randomised to the CMV + PS group (n = 30) or the HFOV + PS group (n = 31) between January 2020 and December 2020. The primary outcomes were the changes in arterial blood gas parameters. The duration of mechanical ventilation, length of hospitalisation and the incidence of complications were considered secondary outcomes. Results: A total of 61 infants completed the study. In the HFOV + PS group, the blood gas analysis results were significantly improved (P < 0.05), while the duration of mechanical ventilation and length of hospitalisation were shorter than the CMV + PS group (P < 0.05). However, the incidence of complications was not different between the two groups (P > 0.05). Conclusions: Compared with the CMV + PS group, the HFOV + PS group showed significantly improved ABG variables and had a shortened length of hospitalisation and mechanical ventilation in infants with ARDS after cardiac surgery. Clinical Trial Registration: Chinese Clinical Trial Registry; Number: ChiCTR2000039457.
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Affiliation(s)
- Yi-Rong Zheng
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Yu-Qing Lei
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Jian-Feng Liu
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Hong-Lin Wu
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Ning Xu
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Shu-Ting Huang
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China.,Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
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8
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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.
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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
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9
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Challands J, Brooks K. Paediatric respiratory distress. BJA Educ 2019; 19:350-356. [DOI: 10.1016/j.bjae.2019.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2019] [Indexed: 10/25/2022] Open
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10
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Sun J, Zhang Q, Hu D, Shen Y, Yang H, Chen C, Zhou Z, Peng Y. Feasibility study of using one-tenth mSv radiation dose in young children chest CT with 80 kVp and model-based iterative reconstruction. Sci Rep 2019; 9:12481. [PMID: 31462667 PMCID: PMC6713735 DOI: 10.1038/s41598-019-48946-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 08/16/2019] [Indexed: 01/24/2023] Open
Abstract
CT has become a routine imaging modality based on its excellent ability of displaying lung structures and diseases. But, how to reduce radiation dose of routine CT examination is a concern for radiologists. Our study aimed to evaluate the feasibility of using 80kVp and a model-based iterative reconstruction (MBIR) algorithm to achieve one-tenth mSv dose chest CT in infants and young children. Thirty-two cases (study group, average age 1.71 ± 1.01 years) underwent non-contrast chest CT examination at low dose with 80 kV, 4mAs and was reconstructed with MBIR (LD-MBIR) and the standard adaptive statistical iterative reconstruction (ASIR) algorithm (LD-ASIR); another group (control group) of 32 children underwent routine-dose chest CT with 100 kV and was reconstructed with ASIR only (RD-ASIR). The subjective and objective image quality of the three groups were measured and statistically compared. The radiation dose for the low dose scan was 0.09 ± 0.02 mSv, 6% of the routine dose. All LD-MBIR images were diagnostically acceptable. Compared with the RD-ASIR images, the LD-MBIR images were similar in noise in the left ventricle, muscles, lung field, on-par in displaying large airways, lung lucency and mediastinum, but were inferior in displaying lung marking, small airways and mediastinum. Thus, MBIR images with low dose in pediatric chest CT can be used in the diagnosis for lung field and air way disorders in infants and young children.
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Affiliation(s)
- Jihang Sun
- Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56, Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Qifeng Zhang
- Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56, Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Di Hu
- Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56, Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Yun Shen
- Department of Radiology, Tokyo Women's Medical University &Medical Center East, Tokyo, 116-8567, Japan
| | - Haiming Yang
- Respiratory Department, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56, Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Chenghao Chen
- Department of Thoracic surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56, Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Zuofu Zhou
- Department of radiology, Fujian Provincial Maternity and Children's Hospital, affiliated hospital of Fujian Medical University, No.18 Daoshan Road, Gulou District, Fujian, 350000, China
| | - Yun Peng
- Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56, Nanlishi Road, Xicheng District, Beijing, 100045, China.
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11
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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.
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12
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Pastroma A, Papaioannou G, Raissaki M, Alexopoulou E. The Common Among the Rare: A Pictorial Essay of the Most Common Diffuse Lung Diseases in Children. Can Assoc Radiol J 2018; 69:468-478. [PMID: 30390964 DOI: 10.1016/j.carj.2018.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 07/17/2018] [Accepted: 07/24/2018] [Indexed: 12/29/2022] Open
Affiliation(s)
- Angeliki Pastroma
- 2nd Department of Radiology, General University Hospital ATTIKON Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | | | - Maria Raissaki
- Department of Radiology, Faculty of Medicine, University Hospital of Heraklion, University of Crete, Crete, Greece
| | - Efthymia Alexopoulou
- 2nd Department of Radiology, General University Hospital ATTIKON Medical School, National and Kapodistrian University of Athens, Athens, Greece
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13
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Mastej EJ, DeBoer EM, Humphries SM, Cook MC, Hunter KS, Liptzin DR, Weinman JP, Deterding RR. Lung and airway shape in neuroendocrine cell hyperplasia of infancy. Pediatr Radiol 2018; 48:1745-1754. [PMID: 29955904 DOI: 10.1007/s00247-018-4189-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/14/2018] [Accepted: 06/14/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Neuroendocrine cell hyperplasia of infancy (NEHI) is a rare lung disease associated with significant air trapping. Although chest CT is crucial in establishing a diagnosis, CT and biopsy findings do not reveal airway abnormalities to explain the air trapping. OBJECTIVE We compared lung and airway morphology obtained from chest CT scans in children with NEHI and control children. In the children with NEHI, we explored relationships between lung and airway shape and lung function. MATERIALS AND METHODS We performed a retrospective review of children with NEHI who underwent clinical chest CT. We identified control children of similar size and age. We created lung masks and airway skeletons using semi-automated software and compared them using statistical shape modeling methods. Then we calculated a logistic regression model using lung and airway shape to differentiate NEHI from controls, and we compared shape model parameters to lung function measurements. RESULTS Airway and lung shapes were statistically different between children with NEHI and controls. We noted a broad lung apex in the children with NEHI and a significantly increased apical anterior-posterior lung diameter. A logistic regression model including lung shape was 90% accurate in differentiating children with NEHI from controls. Correlation coefficients were significant between lung function values and lung and airway shape. CONCLUSION Lung and airway shapes were different between children with NEHI and control children in this cohort. Children with NEHI had an increased anteroposterior diameter of their lungs that might be useful in the diagnostic criteria.
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Affiliation(s)
- Emily J Mastej
- Department of Pediatrics and Breathing Institute, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, 13123 E. 16th Ave. B-395, Aurora, CO, 80045, USA
| | - Emily M DeBoer
- Department of Pediatrics and Breathing Institute, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, 13123 E. 16th Ave. B-395, Aurora, CO, 80045, USA.
| | | | - Marlijne C Cook
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kendall S Hunter
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Deborah R Liptzin
- Department of Pediatrics and Breathing Institute, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, 13123 E. 16th Ave. B-395, Aurora, CO, 80045, USA
| | - Jason P Weinman
- Department of Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Robin R Deterding
- Department of Pediatrics and Breathing Institute, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, 13123 E. 16th Ave. B-395, Aurora, CO, 80045, USA
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14
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Abstract
We describe two cases of neonatal onset interstitial lung disease eventually diagnosed as mucopolysaccharidosis type I (MPS I). In both cases, evaluation led to lung biopsy, pathology review, and identification of glycogen deposition. Pulmonary interstitial glycogenosis (PIG) was considered as a clinical diagnosis in case one; however, further review of electron microscopy (EM) was more consistent with MPS I rather than PIG. Both cases were confirmed to have MPS I by enzyme and molecular analysis. Neonatal interstitial lung disease is an atypical presentation for MPS I which is likely under-recognized. Diagnosis through clinical guidelines and a multidisciplinary approach had a major impact on patient management. The diagnosis of MPS I prompted timely initiation of enzyme replacement therapy (ERT) and the patients ultimately underwent hematopoietic stem cell transplantation (HSCT) to improve symptomatic outcomes. In addition to treatment, immediate precautionary recommendations were made to avoid potentially catastrophic outcomes associated with cervical instability. These cases add to the clinical spectrum of MPS I in the newborn period. They further illustrate the difficulties in early recognition of the disease, and importance of a definitive diagnosis of MPS I in infants with interstitial lung disease.
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15
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Nattes E, Lejeune S, Carsin A, Borie R, Gibertini I, Balinotti J, Nathan N, Marchand-Adam S, Thumerelle C, Fauroux B, Bosdure E, Houdouin V, Delestrain C, Louha M, Couderc R, De Becdelievre A, Fanen P, Funalot B, Crestani B, Deschildre A, Dubus JC, Epaud R. Heterogeneity of lung disease associated with NK2 homeobox 1 mutations. Respir Med 2017; 129:16-23. [DOI: 10.1016/j.rmed.2017.05.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 04/13/2017] [Accepted: 05/25/2017] [Indexed: 12/18/2022]
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16
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Bromley S, Vizcaya D. Pulmonary hypertension in childhood interstitial lung disease: A systematic review of the literature. Pediatr Pulmonol 2017; 52:689-698. [PMID: 27774750 DOI: 10.1002/ppul.23632] [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: 06/30/2016] [Revised: 09/30/2016] [Accepted: 10/05/2016] [Indexed: 12/16/2022]
Abstract
Childhood interstitial lung disease (chILD) comprises a wide heterogeneous group of rare parenchymal lung disorders associated with substantial morbidity and mortality. Pulmonary hypertension is a common comorbidity in adults with interstitial lung disease (ILD) and associated with poor survival. We aimed to systematically review the literature regarding the occurrence of pulmonary hypertension (PH) in chILD, its effect on prognosis and healthcare use, and its treatment in clinical practice. Searches of PubMed and EMBASE databases (up to February 2016), and American Thoracic Society conference abstracts (2009-2015) were conducted using relevant keywords. References from selected articles and review papers were scanned to identify further relevant articles. A total of 20 articles were included; estimates of PH in chILD ranged from 1% to 64% with estimates among specific chILD entities ranging from 0% to 43%. Comparisons between studies were limited by differences in the study populations, including the size, age range, and heterogeneous composition of the ILD case series in terms of the nature and severity of the clinical entities, and also the methods used to diagnose PH. Three studies found that among patients with chILD, those with PH had a significantly higher risk (up to sevenfold) of death compared with those without PH. Information on the treatment of pulmonary hypertension in chILD or the effect of PH on healthcare use was not available. Data on the use and effectiveness of treatments for pulmonary hypertension in chILD are required to address this area of unmet need. Pediatr Pulmonol. 2017;52:689-698. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Susan Bromley
- EpiMed Communications Ltd, 121 South Avenue, Abingdon, Oxford, OX14 1QS, United Kingdom.,London School of Hygiene and Tropical Medicine, London, United Kingdom
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17
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[Clinical effects of different ways of mechanical ventilation combined with pulmonary surfactant in treatment of acute lung injury/acute respiratory distress syndrome in neonates: a comparative analysis]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2016. [PMID: 27817767 PMCID: PMC7389847 DOI: 10.7499/j.issn.1008-8830.2016.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To compare the therapeutic effects of high-frequency oscillatory ventilation+pulmonary surfactant (HFOV+PS), conventional mechanical ventilation+pulmonary surfactant (CMV+PS), and conventional mechanical ventilation (CMV) alone for acute lung injury/acute respiratory distress syndrome (ALI/ARDS) in neonates. METHODS A total of 136 neonates with ALI/ARDS were enrolled, among whom 73 had ALI and 63 had ARDS. They were divided into HFOV+PS group (n=45), CMV+PS group (n=53), and CMV group (n=38). The neonates in the first two groups were given PS at a dose of 70-100 mg/kg. The partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), PaO2/fraction of inspired oxygen (FiO2), oxygenation index (OI), and respiratory index (RI) were measured at 0, 12, 24, 48, and 72 hours of mechanical ventilation. RESULTS At 12, 24, and 48 hours of mechanical ventilation, the HFOV+PS group had higher PaO2 and lower PaCO2 than the CMV+PS and CMV groups (P<0.05). At 12, 24, 48, and 72 hours of mechanical ventilation, the HFOV+PS group had higher PaO2/FiO2 and lower OI and RI than the CMV+PS and CMV groups (P<0.05). The HFOV+PS group had shorter durations of mechanical ventilation and oxygen use than the CMV+PS and CMV groups (P<0.05). There were no significant differences in the incidence rates of air leakage and intracranial hemorrhage and cure rate between the three groups. CONCLUSIONS In neonates with ALI/ARDS, HFOV combined with PS can improve pulmonary function more effectively and shorten the durations of mechanical ventilation and oxygen use compared with CMV+PS and CMV alone. It does not increase the incidence of complications.
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Thacker PG, Vargas SO, Fishman MP, Casey AM, Lee EY. Current Update on Interstitial Lung Disease of Infancy. Radiol Clin North Am 2016; 54:1065-1076. [DOI: 10.1016/j.rcl.2016.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Drummond D, Thumerelle C, Reix P, Fayon M, Epaud R, Clement A, Mahloul M, Habouria D, Delacourt C, Hadchouel A. Effectiveness of palivizumab in children with childhood interstitial lung disease: The French experience. Pediatr Pulmonol 2016; 51:688-95. [PMID: 26636747 DOI: 10.1002/ppul.23354] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/03/2015] [Accepted: 11/21/2015] [Indexed: 11/06/2022]
Abstract
INTRODUCTION There is a lack of evidence concerning the effectiveness of immunoprophylaxis with palivizumab in children with childhood interstitial lung disease (chILD). In this retrospective study, we evaluated the effectiveness of palivizumab for decreasing the rate of RSV-related hospitalizations in children under the age of 24 months with chILD treated with corticosteroids. METHODS A retrospective national study was conducted in France. Patients born between 2007 and 2013, diagnosed with chILD and on corticosteroid treatment were identified through the French online database for pediatric interstitial lung disease (Respirare(®) ). Data were collected for the etiology and severity of chILD, risk factors and preventive measures for bronchiolitis, palivizumab immunoprophylaxis, and hospitalizations for bronchiolitis and RSV-bronchiolitis. RESULTS We included and evaluated 24 children during their first two RSV seasons, corresponding to 36 patient-seasons. The observed rate of RSV-related hospitalization (305/1000 patient-seasons), and the median length of stay (7 days), were higher than those for the general population. RSV-related hospitalization rates did not differ significantly between children with and without palivizumab prophylaxis (5/16 vs. 4/18, respectively, P = 0.70). CONCLUSION Children with chILD on corticosteroid treatment are at high risk of hospitalization for RSV-bronchiolitis, which tends to be more severe in these children than in the general population. The effectiveness of palivizumab prophylaxis in this population remains to be demonstrated. Pediatr Pulmonol. 2016;51:688-695. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- David Drummond
- Service de Pneumologie et d'Allergologie Pédiatriques, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, 75015, Paris, France.,Université Paris-Descartes, Paris, France
| | - Caroline Thumerelle
- Unité de pneumologie pédiatrique, hôpital Jeanne-de-Flandre, CHRU de Lille, Lille, France
| | - Philippe Reix
- Centre de Référence de la Mucoviscidose, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France
| | - Michael Fayon
- Université de Bordeaux, Centre de Recherche Cardio-thoracique de Bordeaux, Bordeaux, France.,CHU de Bordeaux, Hôpital Pellegrin-Enfants, Pneumologie Pédiatrique, Centre d'Investigation Clinique (CIC 1401), Bordeaux, France
| | - Ralph Epaud
- Centre Intercommunal de Créteil, Service de Pédiatrie, Créteil, France.,Inserm, U955, Equipe 5, Créteil, France.,Université Paris-Est, Faculté de Médecine, Créteil, France
| | - Annick Clement
- PediatricPulmonary Department AP-HP Hôpital Trousseau Paris, France Université Pierre et Marie Curie-Paris, Paris, France
| | - Malika Mahloul
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France.,AP-HP, Hôpital Armand Trousseau, Centre de Référence des Maladies Respiratoires Rares, Paris, France
| | - Delphine Habouria
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France.,AP-HP, Hôpital Armand Trousseau, Centre de Référence des Maladies Respiratoires Rares, Paris, France
| | - Christophe Delacourt
- Service de Pneumologie et d'Allergologie Pédiatriques, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, 75015, Paris, France.,Université Paris-Descartes, Paris, France.,INSERM U-955, équipe 4, Créteil, France
| | - Alice Hadchouel
- Service de Pneumologie et d'Allergologie Pédiatriques, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, 75015, Paris, France.,Université Paris-Descartes, Paris, France.,INSERM U-955, équipe 4, Créteil, France
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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.
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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
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21
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Montella S, Vece TJ, Langston C, Carrera P, Nogee LM, Hamvas A, Manna A, Cervasio M, Cervasio M, Santamaria F. A disorder of surfactant metabolism without identified genetic mutations. Ital J Pediatr 2015; 41:93. [PMID: 26606984 PMCID: PMC4658764 DOI: 10.1186/s13052-015-0198-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 11/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surfactant metabolism disorders may result in diffuse lung disease in children. CASE PRESENTATION We report a 3-years-old boy with dry cough, progressive hypoxemia, dyspnea and bilateral ground glass opacities at chest high-resolution computed tomography (HRCT) who had no variants in genes encoding surfactant proteins or transcription factors. Lung histology strongly suggested an abnormality of surfactant protein. A 7-month course of pulse intravenous high-dose methylprednisolone plus oral hydroxychloroquine and azithromycin led to gradual weaning from oxygen and oral steroids, and to improvement of cough and dyspnea. Over the follow-up period, hydroxychloroquine and azithromycin were not withdrawn as cough and dyspnea re-appeared at each attempt and disappeared at re-start. At 6 years of age chest HRCT still appeared unchanged, but clinical symptoms or signs were absent. CONCLUSIONS In children suspected of inborn errors of pulmonary surfactant metabolism who do not have a recognized genetic mutation, lung biopsy with consistent histology may help physicians to address the definitive diagnosis.
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Affiliation(s)
- Silvia Montella
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini, 5 - 80131, Naples, Italy.
| | - Timothy J Vece
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
| | - Claire Langston
- Department of Pathology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
| | - Paola Carrera
- Division of Genetics and Cell Biology, IRCCS Ospedale San Raffaele, Milano, Italy.
| | - Lawrence M Nogee
- Department of Pediatrics, Division of Neonatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Aaron Hamvas
- Edward Mallinckrodt Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine, St. Louis, MO, USA. .,Department of Pediatrics, Division of Neonatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Angelo Manna
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini, 5 - 80131, Naples, Italy.
| | | | - Mara Cervasio
- Department of Advanced Biomedical Sciences, Anatomo-Pathology Unit, Federico II University, Naples, Italy.
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini, 5 - 80131, Naples, Italy.
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O'Reilly R, Kilner D, Ashworth M, Aurora P. Diffuse lung disease in infants less than 1 year of age: Histopathological diagnoses and clinical outcome. Pediatr Pulmonol 2015; 50:1000-8. [PMID: 25603783 DOI: 10.1002/ppul.23124] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 08/18/2014] [Accepted: 09/28/2014] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Interstitial lung disease (ILD) in infants is rare. Clinical and radiological features are often non-specific, and overlap with growth disorders and infection. In infants with severe respiratory compromise, lung biopsy is often necessary to guide acute management, but the risk and diagnostic yield of this procedure is incompletely understood. AIMS To retrospectively review infants undergoing open lung biopsy for suspected ILD at a large referral center; to determine morbidity and mortality related to the procedure; and to describe subsequent diagnosis and outcome. METHODS Lung biopsies performed in infants (aged <1 year) between January 1, 2005 and March 31, 2012 were identified and clinical data were collected. Biopsies were reclassified using the ChILD classification for diffuse lung disorders in infants. RESULTS Twenty-seven infants were identified, with the number of biopsies performed increasing each year over the study period. There was no mortality and negligible morbidity associated with biopsy. Diagnoses seen were similar to those reported by the ChILD network. Histopathological diagnosis was not compatible with life in the absence of lung transplant in 6/27 (22%) of infants. Of the 14 children longitudinally followed up (median 0.5 (0.4 - 5.81) years), only four continued to require supplemental oxygen. CONCLUSION Lung biopsy in infants with suspected ILD is safe, and histopathological diagnosis frequently assists treatment decisions, particularly with regard to withdrawal of care.
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Affiliation(s)
- Ruth O'Reilly
- Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital for Children, London, UK
| | - David Kilner
- Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital for Children, London, UK
| | - Michael Ashworth
- Department of Pathology, Great Ormond Street Hospital for Children, London, UK
| | - Paul Aurora
- Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital for Children, London, UK.,Portex Respiratory Unit, UCL Institute of Child Health, London, UK
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Mulugeta S, Nureki SI, Beers MF. Lost after translation: insights from pulmonary surfactant for understanding the role of alveolar epithelial dysfunction and cellular quality control in fibrotic lung disease. Am J Physiol Lung Cell Mol Physiol 2015; 309:L507-25. [PMID: 26186947 PMCID: PMC4572416 DOI: 10.1152/ajplung.00139.2015] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 07/10/2015] [Indexed: 01/08/2023] Open
Abstract
Dating back nearly 35 years ago to the Witschi hypothesis, epithelial cell dysfunction and abnormal wound healing have reemerged as central concepts in the pathophysiology of idiopathic pulmonary fibrosis (IPF) in adults and in interstitial lung disease in children. Alveolar type 2 (AT2) cells represent a metabolically active compartment in the distal air spaces responsible for pulmonary surfactant biosynthesis and function as a progenitor population required for maintenance of alveolar integrity. Rare mutations in surfactant system components have provided new clues to understanding broader questions regarding the role of AT2 cell dysfunction in the pathophysiology of fibrotic lung diseases. Drawing on data generated from a variety of model systems expressing disease-related surfactant component mutations [surfactant proteins A and C (SP-A and SP-C); the lipid transporter ABCA3], this review will examine the concept of epithelial dysfunction in fibrotic lung disease, provide an update on AT2 cell and surfactant biology, summarize cellular responses to mutant surfactant components [including endoplasmic reticulum (ER) stress, mitochondrial dysfunction, and intrinsic apoptosis], and examine quality control pathways (unfolded protein response, the ubiquitin-proteasome system, macroautophagy) that can be utilized to restore AT2 homeostasis. This integrated response and its derangement will be placed in the context of cell stress and quality control signatures found in patients with familial or sporadic IPF as well as non-surfactant-related AT2 cell dysfunction syndromes associated with a fibrotic lung phenotype. Finally, the need for targeted therapeutic strategies for pulmonary fibrosis that address epithelial ER stress, its downstream signaling, and cell quality control are discussed.
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Affiliation(s)
- Surafel Mulugeta
- Pulmonary, Allergy, and Critical Care Division; Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; and
| | - Shin-Ichi Nureki
- Department of Respiratory Medicine and Infectious Diseases, Oita University, Yufu, Oita, Japan
| | - Michael F Beers
- Pulmonary, Allergy, and Critical Care Division; Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; and
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Lee J, Sanchez TR, Zhang Y, Jhawar S. The role of high-resolution chest CT in the diagnosis of neuroendocrine cell hyperplasia of infancy - A rare form of pediatric interstitial lung disease. Respir Med Case Rep 2015; 16:101-3. [PMID: 26744669 PMCID: PMC4681975 DOI: 10.1016/j.rmcr.2015.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 08/30/2015] [Accepted: 09/01/2015] [Indexed: 12/27/2022] Open
Abstract
Interstitial lung disease (ILD) is rare in infancy or early childhood. Differentiating between the different types of ILD is important for reasons of treatment, monitoring of clinical course and prognosis. We present a case of a 5-month old female with tachypnea and hypoxemia. The clinical suspicion of neuroendocrine cell hyperplasia of infancy (NEHI) was confirmed by high-resolution chest CT and subsequent lung biopsy. We conclude that high-resolution chest CT has characteristics findings that can be used as a non-invasive test to support the clinical diagnosis of neuroendocrine cell hyperplasia of infancy.
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Affiliation(s)
- Julia Lee
- Department of Pediatrics, University of California, Davis, Sacramento, CA, USA
| | - Thomas Ray Sanchez
- Department of Radiology, From the Division of Pediatric Radiology, University of California, Davis Medical Center Children's Hospital, 4860 Y St., Suite 3100 ACC, Sacramento, CA, 95817, USA
- Corresponding author.
| | - Yanhong Zhang
- Department of Pathology and Laboratory Medicine, University of California, Davis Medical Center, Sacramento, CA, USA
| | - Sanjay Jhawar
- Department of Pediatric Pulmonology, University of California, Davis Medical Center and Children's Hospital, Sacramento, CA, USA
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25
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Pulmonary interstitial glycogenosis within a discrete pulmonary lesion mimicking congenital pulmonary airway malformation. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Pramanik AK, Rangaswamy N, Gates T. Neonatal respiratory distress: a practical approach to its diagnosis and management. Pediatr Clin North Am 2015; 62:453-69. [PMID: 25836708 DOI: 10.1016/j.pcl.2014.11.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Respiratory disorders are the most frequent cause of admission to the special care nursery both in term and preterm infants. Pediatricians and primary care providers may encounter newborn infants with respiratory distress in their office, emergency room, delivery room, or during physical assessment in the newborn nursery. The authors have proposed a practical approach to diagnose and manage such infants with suggestions for consulting a neonatologist at a regional center. Their objective is that practicing pediatricians should be able to assess and stabilize such infants, and transfer to or consult a neonatologist, cardiologist, or pulmonologist after reading this article.
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Affiliation(s)
| | | | - Thomas Gates
- LSU Health, 1501 Kings Highway, Shreveport, LA 71130, USA
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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.
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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.
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Affiliation(s)
- Sabrina Bressieux-Degueldre
- Pediatric Pulmonology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland.
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Hamvas A, Deterding R, Balch WE, Schwartz DA, Albertine KH, Whitsett JA, Cardoso WV, Kotton DN, Kourembanas S, Hagood JS. Diffuse lung disease in children: summary of a scientific conference. Pediatr Pulmonol 2014; 49:400-9. [PMID: 23798474 PMCID: PMC4145861 DOI: 10.1002/ppul.22805] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 02/24/2013] [Indexed: 12/14/2022]
Abstract
A multi-disciplinary scientific conference focused on diffuse and interstitial lung diseases in children was held in La Jolla, CA in June 2012. The conference brought together clinicians (including Pediatric and Adult Pulmonologists, Neonatologists, Pathologists, and Radiologists), clinical researchers, basic scientists, government agency representatives, patient advocates, as well as children affected by diffuse lung disease (DLD) and their families, to review recent scientific developments and emerging concepts in the pathophysiology of childhood DLD. Invited speakers discussed translational approaches, including genetics and proteomics, epigenetics and epigenomics, models of DLD, including animal models and induced pluripotent stem cells, and regenerative medicine approaches. The presentations of the invited speakers are summarized here.
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Affiliation(s)
- Aaron Hamvas
- Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri
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30
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Hime NJ, Fitzgerald D, Robinson P, Selvadurai H, Van Asperen P, Jaffé A, Zurynski Y. Childhood interstitial lung disease due to surfactant protein C deficiency: frequent use and costs of hospital services for a single case in Australia. Orphanet J Rare Dis 2014; 9:36. [PMID: 24642012 PMCID: PMC3994663 DOI: 10.1186/1750-1172-9-36] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 03/13/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Rare chronic diseases of childhood are often complex and associated with multiple health issues. Such conditions present significant demands on health services, but the degree of these demands is seldom reported. This study details the utilisation of hospital services and associated costs in a single case of surfactant protein C deficiency, an example of childhood interstitial lung disease. METHODS Hospital records and case notes for a single patient were reviewed. Costs associated with inpatient services were extracted from a paediatric hospital database. Actual costs were compared to cost estimates based on both disease/procedure-related cost averages for inpatient hospital episodes and a recently implemented Australian hospital funding algorithm (activity-based funding). RESULTS To age 8 years and 10 months the child was a hospital inpatient for 443 days over 32 admissions. A total of 298 days were spent in paediatric intensive care. Investigations included 58 chest x-rays, 9 bronchoscopies, 10 lung function tests and 11 sleep studies. Comprehensive disease management failed to prevent respiratory decline and a lung transplant was required. Costs of inpatient care at three tertiary hospitals totalled $966,531 (Australian dollars). Disease- and procedure-related cost averages underestimated costs of paediatric inpatient services for this patient by 68%. An activity-based funding algorithm that is currently being adopted in Australia estimated the cost of hospital health service provision with more accuracy. CONCLUSIONS Health service usage and inpatient costs for this case of rare chronic childhood respiratory disease were substantial. This case study demonstrates that disease- and procedure-related cost averages are insufficient to estimate costs associated with rare chronic diseases that require complex management. This indicates that the health service use for similar episodes of hospital care is greater for children with rare diseases than other children. The impacts of rare chronic childhood diseases should be considered when planning resources for paediatric health services.
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Affiliation(s)
- Neil J Hime
- Australian Paediatric Surveillance Unit, Kids Research Institute, Westmead, NSW 2145, Australia
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney Sydney, Australia
| | - Dominic Fitzgerald
- 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, Westmead, NSW 2145, Australia
| | - Paul Robinson
- 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, Westmead, NSW 2145, 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, Westmead, NSW 2145, Australia
| | - Peter Van Asperen
- 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, Westmead, NSW 2145, Australia
| | - Adam Jaffé
- Department of Respiratory Medicine, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
- Discipline of Paediatrics, School of Women’s and Children’s Health, UNSW Medicine, The University of New South Wales, Sydney, Australia
| | - Yvonne Zurynski
- Australian Paediatric Surveillance Unit, Kids Research Institute, Westmead, NSW 2145, Australia
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney Sydney, Australia
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Deterding RR, White CW. Humidifier and environmental "chILD" risks. Am J Respir Crit Care Med 2014; 189:10-2. [PMID: 24381989 DOI: 10.1164/rccm.201311-2050ed] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Robin R Deterding
- 1 Breathing Institute Children's Hospital Colorado Aurora, Colorado and
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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.
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Gower WA, Nogee LM. Candidate gene analysis of the surfactant protein D gene in pediatric diffuse lung disease. J Pediatr 2013; 163:1778-80. [PMID: 23932215 PMCID: PMC3846094 DOI: 10.1016/j.jpeds.2013.06.063] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 05/29/2013] [Accepted: 06/25/2013] [Indexed: 01/02/2023]
Abstract
Mutations in surfactant-associated genes cause childhood diffuse lung disease. Mice lacking surfactant protein D develop lung disease with age. However, we identified no novel surfactant protein D gene (SFTPD) coding or splice region variants in 73 unrelated children with diffuse lung disease from a cohort enriched for genetic surfactant dysfunction.
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Affiliation(s)
- W. Adam Gower
- Section of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics and Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC USA 27157
| | - Lawrence M. Nogee
- Eudowood Neonatal Pulmonary Division, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD USA 21287
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Popler J, Wagner BD, Tarro HL, Accurso FJ, Deterding RR. Bronchoalveolar lavage fluid cytokine profiles in neuroendocrine cell hyperplasia of infancy and follicular bronchiolitis. Orphanet J Rare Dis 2013; 8:175. [PMID: 24216293 PMCID: PMC3892041 DOI: 10.1186/1750-1172-8-175] [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: 01/24/2013] [Accepted: 10/05/2013] [Indexed: 12/22/2022] Open
Abstract
Background Neuroendocrine Cell Hyperplasia of Infancy (NEHI) and Follicular Bronchiolitis (FB) are rare pediatric diffuse lung diseases with poorly understood pathogenesis and similar clinical presentations. We sought to determine if cellular and cytokine profiles in bronchoalveolar lavage fluid (BALF) from subjects with NEHI and FB would differ from pediatric disease controls. Methods BALF was obtained from forty-one subjects classified into four disease groups: NEHI, Cystic Fibrosis (CF), other airway disease controls (DC), and FB during clinically indicated procedures. BALF cellular profiles and ten cytokines were measured and values compared across groups using descriptive and nonparametric statistics. Results Significant BALF cellular and cytokine differences were seen across all groups. NEHI subjects exhibited the lowest total absolute white blood cell (WBC) levels with a higher percentage of BALF alveolar macrophages compared to controls. NEHI also had lower levels of IL-1β, MIP-1β and IL-8 and FB had higher levels of IL-1ra, G-CSF and VEGF compared to all groups. IL-6 was elevated in CF and FB. Conclusions BALF cytokine and cellular profiles differed between NEHI, FB, CF and DC subjects. This pilot data suggests different and distinguishing inflammatory responses in the airway, with the least inflammatory being NEHI. These data could have diagnostic implications.
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Affiliation(s)
- Jonathan Popler
- Georgia Pediatric Pulmonology Associates, P,C,, 1100 Lake Hearn Drive, Suite 450, Atlanta, GA 30342, USA.
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35
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Rice A, Tran-Dang MA, Bush A, Nicholson AG. Diffuse lung disease in infancy and childhood: expanding the chILD classification. Histopathology 2013; 63:743-55. [PMID: 24117670 DOI: 10.1111/his.12185] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 05/02/2013] [Indexed: 01/03/2023]
Abstract
AIMS Diffuse parenchymal lung diseases (DPLD) in children comprise a wide spectrum of rare disorders. In 2007 the Children's Interstitial Lung Disease (chILD) Research Cooperative proposed a classification system for DPLD in children <2 years of age. The aims of our study were to determine the utility and reproducibility of this system in children <2 years of age, and test its extension to 18 years of age. METHODS AND RESULTS Of 211 cases, 93 were <2 years of age at presentation and 58% were included in the chILD classification. In 118 cases aged between 2 and 18 years there was a wider distribution of disorders, overlapping with those seen in adults, necessitating expansion of the chILD classification types to encompass all reviewed cases, in particular patients with 'adult' diffuse lung diseases. Many cases showed mixed histological patterns, overlap often being between groups of disorders more prevalent in infancy. Concordance between reporting pathologists was 90%. CONCLUSIONS The chILD scheme allows classification of conditions more common in children <2 years of age. It can be applied to children of any age, although additional entities need to be included. We propose a more histologically based system for use when assessing biopsies in this context.
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Affiliation(s)
- Alexandra Rice
- Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College, London, UK
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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.
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Affiliation(s)
- Edward Y Lee
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA.
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Popler J, Lesnick B, Dishop MK, Deterding RR. New coding in the International Classification of Diseases, Ninth Revision, for children's interstitial lung disease. Chest 2013; 142:774-780. [PMID: 22948581 DOI: 10.1378/chest.12-0492] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The term "children's interstitial lung disease" (chILD) refers to a heterogeneous group of rare and diffuse lung diseases associated with significant morbidity and mortality. These disorders include neuroendocrine cell hyperplasia of infancy, pulmonary interstitial glycogenosis, surfactant dysfunction mutations, and alveolar capillary dysplasia with misalignment of pulmonary veins. Diagnosis can be challenging, which may lead to a delay in recognition and treatment of these disorders. Recently, International Classifications of Diseases, Ninth Revision codes have been added for several of the chILD disorders. The purpose of this article is to give an overview of the chILD disorders and appropriate diagnostic coding.
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Affiliation(s)
| | - Burton Lesnick
- Department of Pathology, University of Colorado Denver School of Medicine, Children's Hospital Colorado Denver, Aurora, CO
| | - Megan K Dishop
- Department of Pathology, University of Colorado Denver School of Medicine, Children's Hospital Colorado Denver, Aurora, CO
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38
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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.
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Affiliation(s)
- Timothy J Vece
- Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas 77030, USA.
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40
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Current world literature. Curr Opin Pediatr 2011; 23:356-63. [PMID: 21566469 DOI: 10.1097/mop.0b013e3283481706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Deterding RR. Expanding Our Understanding of Children's Interstitial Lung Disease. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2010; 23:3-4. [PMID: 22332027 DOI: 10.1089/ped.2010.2302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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43
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Vece TJ, Fan LL. Interstitial Lung Disease in Children Older Than 2 Years. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2010; 23:33-41. [PMID: 22332030 DOI: 10.1089/ped.2010.0008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 03/20/2010] [Indexed: 11/12/2022]
Abstract
The spectrum of childhood interstitial lung diseases (chILD) encompasses a group of heterogeneous, rare disorders in children characterized by diffuse pulmonary infiltrates and disordered gas exchange. Whereas the disorders that present in early life are unique to children, those that present in older children are also seen in adults. This review will concentrate on chILD presenting in children older than 2 years of age with a focus on the idiopathic interstitial pneumonias, connective tissue diseases, alveolar hemorrhage, and hypersensitivity pneumonitis. A systematic approach to diagnosis that includes a careful history and physical, computed tomography of the chest, bronchoalveolar lavage, and lung biopsy can be very helpful in establishing the correct diagnosis. Treatment approaches are described, including general supportive measures, indications for a trial of systemic corticosteroids, or other immunomodulating therapies, and when lung transplantation reserved for those with end-stage lung disease should be considered.
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Affiliation(s)
- Timothy J Vece
- Department of Pediatrics, Texas Children's Hospital , and Baylor College of Medicine, Houston, Texas
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44
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Guillerman RP. Imaging of Childhood Interstitial Lung Disease. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2010; 23:43-68. [PMID: 22332031 DOI: 10.1089/ped.2010.0010] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2010] [Accepted: 03/22/2010] [Indexed: 01/15/2023]
Abstract
The aphorism that children are not little adults certainly applies for the imaging of interstitial lung disease. Acquiring motion-free images of fine pulmonary structures at desired lung volumes is much more difficult in children than in adults. Several forms of interstitial lung disease are unique to children, and some forms of interstitial lung disease encountered in adults rarely, if ever, occur in children. Meticulous attention to imaging technique and specialized knowledge are required to properly perform and interpret chest imaging studies obtained for the evaluation of childhood interstitial lung disease (chILD). This review will address technique recommendations for imaging chILD, the salient imaging findings in various forms of chILD, and the efficacy of imaging in the diagnosis and management of chILD.
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Affiliation(s)
- R Paul Guillerman
- Department of Radiology, Baylor College of Medicine, Singleton Department of Diagnostic Imaging, Texas Children's Hospital , Houston, Texas
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