Pediatric radiology cases Medical Presentation

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CASE PRESENTATION Children hospital NOV. 2011 Ali Hassan Elmokadem. ASS. Lecturer OF RADIO-DIAGNOSIS Mansoura university
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Full term female baby. Fifth day of life. Presented by respiratory distress soon after delivery she was admitted in private nursery where she was on CPAP. It was referred as a case of right sided pleural effusion as reported on CT outside our hospital and admitted for chest tube insertion. Clinical Presentation
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Respiratory distress grade III. Diminished air entry on the right side. Signs of septic shock. On examination
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Before the chest tube insertion X-ray chest was done and revealed: Investigation
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Follow up X-ray after 1 day Follow up X-ray after chest tube insertion
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Differential Diagnosis Differential Diagnosis
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Congenital cystic adenomatoid malformation (CCAM) type 1 The most commonly diagnosed lung malformation in prenatal patients . Congenital Pulmonary Airway Malformation (CPAM) Diagnosis
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Congenital cystic adenomatoid malformation (CCAM) Defined as: an abnormal branching of the immature bronchioles, with a lack of normal alveolar development. Because CCAM usually communicates with the normal tracheo-bronchial tree, the malformation may consist of both cystic and solid areas.
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Types
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Clinical Presntation
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Other associated anomalies
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Imaging Findings Variable depending on size and Type. Prenatal ultrasound: echogenic lung mass that may demonstrate mass effect or compression of adjacent lung. No evidence of systemic arterial supply. Polyhydramnios may be seen.
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Imaging Findings Variable depending on size and Type. CXR: solid to multicystic mass with variable amounts of air and fluid. May demonstrate mass effect or contralateral shifting of the mediastinum depending on size.
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Imaging Findings Variable depending on size and Type. CT: Cystic to solid mass depending on size and type. No evidence of arterial supply. Possible mass effect or mediastinal shift depending on size
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Imaging Findings Variable depending on size and Type. MRI: Usually performed prenatally. T1WI: Isointense Iesion usually confined to one lobe. T2WI: Hyperintense mass. May be seen with fetal hydrops
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Differential Diagnosis Sequestration: Typically do not contain air during the neonatal period. Systemic arterial supply to mass demonstrated. Congenital diaphragmatic hernia (CDH): Appearance does not change in position with CCAM over serial films, can with CDH. Lack of bowel gas in abdomen. Congenital lobar emphysema: Hyperlucency and hyperexpansion of affected lobe. No multicystic appearance.
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Differential Diagnosis Differential Diagnosis
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Take Home Messages
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