Excerpts from RSNA Case-based Review of Thoracic Radiology (An Interactive Session)- Part 1

Webinar :Case-based Review of Thoracic Radiology (An Interactive Session) 

This was part of RSNA 2017 virtual meeting. I am writing down the salient points from this excellent lecture:

Paediatric chest:

• Congenital immunodeficiency syndromes:

  • Chronic Granulomatous Disease:

    • Inability to kill catalase positive organisms like staphylococcus and aspergillus.
    • Early manifestations: Miliary nodules, abscess, pneumonia, empyema.
    • Late manifestations: bronchiectasis and pulmonary fibrosis.

  • Leukocyte adhesion deficiency type I.

    • Presents in infants as bacterial infection.
    • Affects mucosa and skin.
    • No pus formation.

  • G6PD deficiency

    • May present with infections similar that of CGD.
    • Haemolytic anaemia on consumption of fava beans or medications.

  • Myeloperoxidase deficiency

    • Typically occurs in patients with diabetes.
    • Most common infection is Candida.

• Cardiac tumours.

  • Rhabdomyoma:

    • Paediatric chest x-ray showing cardiomegaly.
    • The most common primary cardiac tumour in children.
    • It is associated with the ventricular myocardium and appears homogeneously hyperintense on T2-weighted images.
    • 50 to 70% are associated with tuberous sclerosis.
    • Spontaneous regression is common.
    • Tuberous sclerosis can have pulmonary manifestations in the form of
      • LAM (lymphangioleiomyomatosis): Uniform sized cysts.
      • Multifocal micronodular pneumocyte hyperplasia (MMPH):  multiple well-defined nodules. Image on AJNR : MMPH. Article : MMPH

Case courtesy of Dr Effendi Mansoor, <a href=”https://radiopaedia.org/”>Radiopaedia.org</a>. From the case <a href=”https://radiopaedia.org/cases/17302″>rID: 17302</a>

• • Fibroma:

    • 2^nd MC
    • Free wall of ventricle
    • Associated with Gorlin Syndrome.

  • Myxoma:

    • 3^rd MC
    • Pedunculated. Interatrial septum.
    • Asso with Carney complex: Hyperpigmentation and endocrine overactivity

  • Teratoma:

    • Within pericardium
    • Pericardial effusion.
    • Heterogenous with fat/calcification.

• Sickle Cell disease:

  • Dactylitis.

    • 6m-3y
    • Soft tissue swelling.
    • Periosteal reaction.
    • Cortical disruption.
    • Spontaneous improvement.

  • Chest syndorme.

    • New opacity.
    • Increased pulmonary vasculature.
    • Cardiomegaly.

• Langerhans Cell Histiocytosis:

  • Early: Nodules with small cysts. Spontaenous pneumothorax.
  • Advanced: Large cysts with pulmonary fibrosis.
  • Can involve bones as well.

• Wegner’s granulomatosis:

  • Trachea: Subglottic stenosis. Image from RSNA article: Wegners uncommon and common manifestations.
  • Pulmonary nodules with cavitation.
  • Glomerulonerphritis.

Part 2 here: