Aspiration pneumonia in children: an iconographic essay

In most cases of aspiration pneumonia in children, the disease is specific to this age group. Clinical and radiological correlation is essential for the diagnosis. The present pictorial essay is aimed at showing typical images of the most common etiologies.

Keywords:
Pneumonia; Aspiration; Childhood

Authorship

Gabriel Antonio de Oliveira

MD, Radiologist at Hospital Infantil Nossa Senhora da Glória, Vitória, ES, Brazil.Hospital Infantil Nossa Senhora da GlóriaBrazilVitória, ES, BrazilMD, Radiologist at Hospital Infantil Nossa Senhora da Glória, Vitória, ES, Brazil.

Laís Bastos Pessanha

MDs, Residents of Radiology at Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil.Universidade Federal do Espírito SantoBrazilVitória, ES, BrazilMDs, Residents of Radiology at Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil.

Luiz Felipe Alves Guerra

Diego Lima Nava Martins

Ronaldo Garcia Rondina

Jamine Ronacher Passos Silva

MD, Resident of Neurology at Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil.Universidade Federal do Espírito SantoBrazilVitória, ES, BrazilMD, Resident of Neurology at Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil.

Mailing Address: Dra. Laís Bastos Pessanha. Departamento de Clínica Médica/ CCS/UFES. Avenida Marechal Campos, 1468, Nazareth. Vitória, ES, Brazil, 29043-900. E-mail: laispessanha@hotmail.com.

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (9)

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Figure 1
A neonate with encephalopathy caused by perinatal anoxia, presenting with respiratory symptoms. A: Anteroposterior chest radiography showing opacity in the upper third of the right lung, limited by the horizontal scissure, characterizing involvement of the right upper lobe. B: Deglutition study demonstrating the contrast agent transit into the nasopharynx (arrows), characterizing lack of motor coordination.

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Figure 2
A three-month-old male child with neurological sequelae of congenital toxoplasmosis. Inadvertent contrast aspiration into the bronchial three during EGDS, resulting from non-coordinated deglutition. Chest radiography demonstrating paracardiac opacities corresponding to aspiration bronchopneumonia.

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Figure 3
A previously healthy 18-month-old, afebrile male child, presented vomiting during recovering from anesthesia for palpebral injury suture, progressing to respiratory failure requiring ventilatory assistance. Anteroposterior view of the chest demonstrating opacities in the right upper lobe and in the upper segment of the left lower lobe, which represent usual sites in cases of aspiration occurring with the child in dorsal decubitus.

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Figure 4
A seven-month-old male child with repetition pneumonia. Anteroposterior view of the chest with esophageal contrast-enhancement. Opacity is observed in the right upper lobe, compatible with pneumonia. Concentric narrowing of the lumen of the proximal esophageal third, with upstream dilatation. Such findings are strongly suggestive of extrinsic compression by double aortic arch. After surgical correction, the respiratory symptoms and the esophageal compression disappeared.

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Figure 5
A six-year-old boy with repetition pneumonia. A: Chest radiography, anteroposterior view showing subtle diffuse opacities in both lungs, confluent in the middle lobe. The caudal sift of the horizontal scissure (arrows) characterizes the presence of atelectatic component. B: Esophagography demonstrating H-type fistula to the trachea (arrow). C: High resolution computed tomography, axial section at the level of the fistula characterized by the dark dot (arrow) between the esophagus (with air) and the trachea. Centrilobular opacities, some of them branching, demonstrating involvement of small airways.

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Figure 6
A twenty-month-old female child presenting with fever and cough. A: Anteroposterior chest radiography revealing the presence of bilateral, diffuse, ill defined, coalescent opacities in the middle lobe, conditioning the partial fading of the cardiac silhouette. B: Computed tomography, axial section identifying bilateral, predominantly central consolidations with air bronchograms. C: EGDS demonstrating reflux. As no clinical and radiological improvement was observed after antibiotic therapy, lung biopsy was indicated and showed foreign body granulomas and vegetal fibers presumably coming from gastroesophageal reflux. After appropriate treatment, clinical and radiological healing was observed.

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Figure 7
A neonate with Down syndrome and respiratory symptoms. A: Anteroposterior chest radiography showing left lung with decreased volume and transparency. Fading of the left cardiac silhouette indicates upper lobe atelectasis. B: EGDS. Small bowel transit shows partial obstruction at the level of the second duodenal portion, with appearance suggestive of duodenal diaphragm (windsock sign). C: Secondary gastroesophageal reflux.

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Figure 8
Anteroposterior view of chest in a three-year-old boy undergoing treatment for constipation with mineral oil e diagnosis of bronchopneumonia refractory to antibiotics. Coalescent opacities in both lungs, with "butterfly wing" distribution. In the clinical context, such a finding allows for the diagnosis of lipoid pneumonia, with no need for biopsy.

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Figure 9
A six-year-old male child said to be asthmatic, presented with dyspnea and sudden chest pain. A: Anteroposterior view showing left hemithorax with decreased volume and transparency, right lung herniation and mediastinal displacement to the left, characterizing left lung atelectasis. B: EGDS demonstrating reflux. After four-day anti-reflux treatment, the symptoms disappeared and chest radiography was normal. C: Normal anteroposterior chest radiography after treatment for gastroesophageal reflux disease.

Figure 1 A neonate with encephalopathy caused by perinatal anoxia, presenting with respiratory symptoms. A: Anteroposterior chest radiography showing opacity in the upper third of the right lung, limited by the horizontal scissure, characterizing involvement of the right upper lobe. B: Deglutition study demonstrating the contrast agent transit into the nasopharynx (arrows), characterizing lack of motor coordination.

Figure 2 A three-month-old male child with neurological sequelae of congenital toxoplasmosis. Inadvertent contrast aspiration into the bronchial three during EGDS, resulting from non-coordinated deglutition. Chest radiography demonstrating paracardiac opacities corresponding to aspiration bronchopneumonia.

Figure 3 A previously healthy 18-month-old, afebrile male child, presented vomiting during recovering from anesthesia for palpebral injury suture, progressing to respiratory failure requiring ventilatory assistance. Anteroposterior view of the chest demonstrating opacities in the right upper lobe and in the upper segment of the left lower lobe, which represent usual sites in cases of aspiration occurring with the child in dorsal decubitus.

Figure 4 A seven-month-old male child with repetition pneumonia. Anteroposterior view of the chest with esophageal contrast-enhancement. Opacity is observed in the right upper lobe, compatible with pneumonia. Concentric narrowing of the lumen of the proximal esophageal third, with upstream dilatation. Such findings are strongly suggestive of extrinsic compression by double aortic arch. After surgical correction, the respiratory symptoms and the esophageal compression disappeared.

Figure 5 A six-year-old boy with repetition pneumonia. A: Chest radiography, anteroposterior view showing subtle diffuse opacities in both lungs, confluent in the middle lobe. The caudal sift of the horizontal scissure (arrows) characterizes the presence of atelectatic component. B: Esophagography demonstrating H-type fistula to the trachea (arrow). C: High resolution computed tomography, axial section at the level of the fistula characterized by the dark dot (arrow) between the esophagus (with air) and the trachea. Centrilobular opacities, some of them branching, demonstrating involvement of small airways.

Figure 6 A twenty-month-old female child presenting with fever and cough. A: Anteroposterior chest radiography revealing the presence of bilateral, diffuse, ill defined, coalescent opacities in the middle lobe, conditioning the partial fading of the cardiac silhouette. B: Computed tomography, axial section identifying bilateral, predominantly central consolidations with air bronchograms. C: EGDS demonstrating reflux. As no clinical and radiological improvement was observed after antibiotic therapy, lung biopsy was indicated and showed foreign body granulomas and vegetal fibers presumably coming from gastroesophageal reflux. After appropriate treatment, clinical and radiological healing was observed.

Figure 7 A neonate with Down syndrome and respiratory symptoms. A: Anteroposterior chest radiography showing left lung with decreased volume and transparency. Fading of the left cardiac silhouette indicates upper lobe atelectasis. B: EGDS. Small bowel transit shows partial obstruction at the level of the second duodenal portion, with appearance suggestive of duodenal diaphragm (windsock sign). C: Secondary gastroesophageal reflux.

Figure 8 Anteroposterior view of chest in a three-year-old boy undergoing treatment for constipation with mineral oil e diagnosis of bronchopneumonia refractory to antibiotics. Coalescent opacities in both lungs, with "butterfly wing" distribution. In the clinical context, such a finding allows for the diagnosis of lipoid pneumonia, with no need for biopsy.

Figure 9 A six-year-old male child said to be asthmatic, presented with dyspnea and sudden chest pain. A: Anteroposterior view showing left hemithorax with decreased volume and transparency, right lung herniation and mediastinal displacement to the left, characterizing left lung atelectasis. B: EGDS demonstrating reflux. After four-day anti-reflux treatment, the symptoms disappeared and chest radiography was normal. C: Normal anteroposterior chest radiography after treatment for gastroesophageal reflux disease.

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