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Pneumonia in children including SARS Winnie Chu The Chinese University of Hong Kong Department of Diagnostic Radiology and Organ Imaging Prince of Wales Hospital
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Role of imaging of pulmonary infection in children
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Role of imaging in pneumonia Confirmation/ exclusion Underlying cause when failure to resolve or recur Acute complications Chronic sequelae Characterization and prediction of infectious agent
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Follow up CXR Not a routine Post-obstructive pneumonia secondary to CA is not a concern reserved for: persistent symptoms recurrent symptoms immunodeficiency
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Persistent/ recurrent pneumonia Developmental lung masses sequestration bronchogenic cyst cystic adenomatoid malformation reflux, aspiration, systemic disorders
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Acute complications Parapneumonic effusion cavitary necrosis empyema lung abscess pneumothorax purulent pericarditis
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Guiding management Placement of chest tubes loculated collection
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Chronic sequelae Parenchymal scarring bronchial wall thickening bronchiectasis bronchiolitis obliterans Swyer-James syndrome
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Typical pneumonia
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SARS Severe Acute Respiratory Syndrome
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Risk in children household contact healthcare setting contact
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Presenting symptoms of SARS children 0 20 40 60 80 100 120 fever cough myalgia chills/ rigor runny nose dyspnoea sorethroat headache dizziness malaise febrile convulsion Percentage
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Zonal distribution of air-space opacification Upper zone Middle zone Lower zone Upper & lower
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Distribution of air-space opacification on CXR focal multi-focal bilateral
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Radiological change Worst CXR appearance
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Radiological changes Complete resolution of CXR
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Role of HRCT in SARS Aid diagnosis in children with strong clinical suspicion of SARS but non- contributory CXR Assessment of treatment response in prolonged course of the disease
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i.Ribavirin i.v. ii.Hydrocortisone i.v./ prednisolone p.o. iii.Cefotaxime i.v. iv.Clarithromycin p.o. Suspected paediatric SARS Mild symptoms Moderately severe symptoms + High swinging fever i.Cefotaxime i.v. ii.Clarithromycin i.v. iii.Ribavarin i.v. No improvement Persistent fever, Clinical deterioration + Prednisolone p.o. + Pulse Methylprednisolone i.v. No improvement + Pulse Methylprednisolone i.v.
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Outcome Discharge: 16 Observation: 1 Mortality : 0
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Conclusion Young children develop a milder form of the disease with a less aggressive clinical course and milder radiological changes
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Conclusion Teenagers may simulate adult pattern, presenting with a more severe clinical disease and bizzare radiological finding
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THANK YOU
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