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Childhood interstitial lung disease (chILD) encompasses a spectrum of diffuse childhood lung diseases presenting with at least 3 of 4 criteria: (1) respiratory symptoms, (2) hypoxemia, (3) respiratory signs, (4) diffuse abnormalities on chest radiographs or computed tomography (CT).
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Imaging in chILD primarily relies on CT with whole lung volumetric CT for the initial evaluation and with high-resolution CT for the follow-up evaluation.
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Imaging findings of chILD are typically nonspecific for a
Current Update on Interstitial Lung Disease of Infancy: New Classification System, Diagnostic Evaluation, Imaging Algorithms, Imaging Findings, and Prognosis
Section snippets
Key points
Clinical presentation
The most consistent clinical presentation in those affected by chILD is tachypnea, which occurs in 75% to 93% of cases.9, 10, 11, 12 Cough, failure to thrive, and/or crackles are also common clinical presentations.8, 10, 12 However, affected patients may present only with mild wheezing or have normal breath sounds. Profound respiratory failure may occur in the neonatal period, whereas a more insidious course can be seen in older children presenting with failure to thrive or intolerance to
Nonimaging Evaluation
Nonradiologic diagnostic testing in chILD includes echocardiography, pulmonary function tests (PFTs), genetic testing, bronchoscopy with bronchoalveolar lavage, and lung biopsy.
The utility of echocardiography is twofold. First, both congenital heart disease and pulmonary vascular disease can coexist with or mimic chILD.6 Second, in patients with isolated chILD, echocardiography can help in the evaluation of concurrent pulmonary hypertension, a finding that is associated with a worse prognosis.9
Spectrum of imaging findings
Communication of imaging findings in chILD should closely follow the standard lexicon as put forth by the Fleischner Society in their glossary of terms for thoracic imaging.30 Using this lexicon, the predominant findings in chILD consist of varying combinations of air-trapping, ground-glass opacities, consolidations, nodules, cysts, and linear/reticular opacities.2 As can be ascertained, these imaging findings are nonspecific and can be seen in a host of infectious, inflammatory, genetic,
Summary
Despite their rarity, childhood interstitial lung diseases are an important cause of morbidity and mortality in infants and young children. Many have nonspecific imaging findings, and, thus, a definitive diagnosis cannot be made on imaging alone. For the interpreting radiologist, obtaining appropriate and adequate imaging is paramount. Furthermore, familiarity with these diseases and their classification is important, as the treating physician may be unfamiliar, or at least not considering,
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Cited by (15)
Advances in Imaging of the ChILD – Childhood Interstitial Lung Disease
2022, Radiologic Clinics of North AmericaCitation Excerpt :Although it lacks specificity and sensitivity for the definitive diagnosis of chILD, chest radiography remains useful for initial screening and follow-up of previously characterized disease, as most infants and children with ILD often have abnormalities on chest radiographs (Fig. 1).1,5 However, these abnormalities are usually nonspecific and further characterization with CT is often necessary for complete assessment.3,5,6 CT, usually performed as high-resolution CT (HRCT) without intravenous contrast, has been the gold standard imaging modality for the evaluation of chILD due to its superior anatomic detail and use of multiplanar reformats and 3D reconstructions.4
Neuroendocrine cell hyperplasia of infancy: Feasibility of objective evaluation with quantitative CT
2022, Clinical ImagingCitation Excerpt :However, inspiratory and expiratory images are difficult to obtain in patients of this age. The normal attenuation of the lung parenchyma in young children is higher than in older children due to the small alveolar diameter and higher ratio of alveolar-septal tissue to intra-alveolar air.11,21 If the most frequent imaging findings in children with NEHI are ground glass opacities,6 one would expect the mean lung density to be higher compared to controls.
Normal age-related quantitative CT values in the pediatric lung: from the first breath to adulthood
2021, Clinical ImagingCitation Excerpt :Lung development is divided into four prenatal stages: embryonic (4–7 weeks), pseudo-glandular (5–17 weeks), canalicular (16–26 weeks), saccular (24 weeks-term), and a last post-natal stage, termed “alveolarization,” which occurs between term and around 21 years of age.2 The postnatal lung growth and parenchymal changes can be appreciated on computed tomography (CT), but can potentially be misinterpreted as pathologic findings.3 Quantitative CT is a relatively new technique that obtain objective information about the lung parenchyma based on tissue density.
Childhood Interstitial Lung Disease
2023, Pediatric, Allergy, Immunology, and PulmonologyInterstitial lung disease in autoinflammatory disease in childhood: A systematic review of the literature
2023, Pediatric PulmonologySurfactant Protein C Deficiency-associated Diffuse Lung Disease
2023, Applied Radiology