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Parapneumonic Effusion and Empyema

KEY FACTS Terminology Pleural effusions classified as transudative or exudative Parapneumonic effusions are exudative secondary to adjacent lung infection & ↑ capillary permeability Imaging Upright chest radiograph Flattened & elevated hemidiaphragm, lateral shift of diaphragm apex, gastric bubble > 1.5 cm from diaphragm secondary to subpulmonic fluid Blunted posterior costophrenic angle (∼ 50 mL) Blunted lateral costophrenic angle (∼ 200 mL) Hemidiaphragm inversion (> 2,000 mL)…

Round Pneumonia

KEY FACTS Terminology Bacterial lung infection with very round, well-defined appearance on chest radiography; simulates mass lesion Majority seen in patients < 8 years of age Imaging Well-circumscribed round opacity ± air bronchograms Most common posteriorly in lower lobe superior segments No mass effect on or invasion of adjacent tissues No mediastinal or vascular distortion No splaying or erosion of ribs Margins of round lung “mass”…

Viral Chest Infection

KEY FACTS Terminology Viral infection may involve airways &/or lung parenchyma Bronchiolitis: Acute inflammation & necrosis of epithelial cells lining small airways with ↑ mucus production Classically < 2 years of age Other terms: Viral pneumonia, lower respiratory tract infection, peribronchial pneumonia Imaging Primary goal of chest radiography: Differentiate viral airway infection from bacterial pneumonia 92% negative predictive value for bacterial pneumonia Best imaging clues for…

Bronchopulmonary Dysplasia

KEY FACTS Terminology Current definition of bronchopulmonary dysplasia (BPD) Chronic lung disease of premature infants born at < 32-week gestation O₂ dependency for at least 28 days Failure of O₂ challenge at 36-week postmenstrual age Chest radiograph abnormalities no longer required Old BPD Larger, later preterm infants with prolonged mechanical ventilation & O₂ therapy New BPD More diffuse but overall milder disease of earlier, smaller preterm…

Surfactant Deficiency Disease

KEY FACTS Terminology Surfactant deficiency disease (SDD) favored term a.k.a. respiratory distress syndrome & hyaline membrane disease (archaic) Common lung disease occurring in premature infants due to lack of surfactant Microatelectasis & abnormal pulmonary compliance are hallmarks of disease Imaging Premature infants < 32-week gestation at risk Initial findings are low lung volumes & diffuse granular opacities Signs of tension (lung collapse, mediastinal shift) less likely…

Congenital Diaphragmatic Hernia

KEY FACTS Terminology Herniation of abdominal contents into chest via congenital defect in diaphragm, most commonly posterior (Bochdalek) Side of congenital diaphragmatic hernia (CDH): Left 85%, right 13%, bilateral 2% Imaging Best clue: Bubbly, round, or tubular, relatively uniform air-filled lucencies in hemithorax displacing mediastinum Intrathoracic herniated contents may include stomach, small & large bowel, liver, gallbladder, spleen Results in paucity of bowel gas in abdomen…

Esophageal Atresia and Tracheoesophageal Fistula

KEY FACTS Terminology Atresia: Congenital occlusion of lumen Fistula: Anomalous connection between 2 lumens Imaging 5 major anatomic variations of esophageal atresia-tracheoesophageal fistula (EA-TEF) Fistula level variable depending on type of EA-TEF Most commonly above/near carina Atretic segments variable in length Gap often long in EA without TEF Radiographs Air-distended upper esophageal pouch Enteric tube tip near thoracic inlet in pouch EA with TEF: Gas in…