الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Thoracic non-traumatic non-cardiac pediatric emergencies are the most common emergencies in children and they may be very dramatic, especially in cases of acute respiratory failure. Radiology is essential in making a rapid diagnosis in daily clinical practice in order to plan treatment and avoid the severe complications of the disease.
Evaluating patients who present to the Emergency Department (ED) with thoracic symptoms is a challenge for clinicians. Excluding the traumatic and vascular causes, many other potential causes can lead to these conditions, such as infectious diseases, pneumothorax or neoplasms.
Although clinical history, physical examination and the presence of risk factors are important in establishing the etiology of the symptoms, these methods need to be integrated with laboratory and radiologic testing to make a correct and prompt diagnosis.
A correct interpretation of the radiological findings is of great importance in diagnosing and monitoring the illness and in avoiding serious complications. In the emergency setting the first-line imaging method used is chest x-ray (CXR), which is capable of assessing the localization and presence of any pleural and pulmonary parenchymal alterations as well as evaluation of mediastinal structures. However, the main limitation of CXR is its low sensitivity. Thoracic ultrasound (US) is also used in emergencies, given its easy availability and execution at the patient’s bedside, it can detect pleural effusion and peripheral lung abnormalities.
Cross-sectional techniques such as multi-detector computed tomography (MDCT) and magnetic resonance imaging (MRI) are mainly used to study pulmonary, mediastinal masses and congenital abnormalities of the great vessels and the lungs.
The aim of this study was to review the role of MDCT in non-traumatic non-cardiac pediatric thoracic emergencies. It was conducted on thirty patients of the pediatric age group with clinical presentation suggestive of non-traumatic non-cardiac thoracic emergency presented to the radiology department for further CT assessment.
High-resolution computed tomography with reconstruction algorithm including 3D (three dimensional), MIP, Min IP (Minimal Intensity Projection), and VR (Volume Rendering) techniques were used. Non-ionic low osmolar intravenous contrast agent was used (if needed) in a dose of 1-5 – 2 ml/kg after reviewing renal function tests and excluding any history of previous allergic reaction.
The present study showed that the most common abnormality seen in chest X-rays was lung opacity seen in fifteen patients, prominent hilar shadows was seen in seven patients and cystic lesion was seen in three patients, while pleural effusion was seen in three patients, mediastinal shift was seen in two patients and mediastinal widening seen in one patient.
Regarding the findings on MDCT in the current study; ground glass opacity was the most common finding seen in twenty patients, other finding as consolidation, interlobular septal thickening, reticular opacity, cavitary lesion, mediastinal mass and bronchiectasis were also reported.
Studies by Mindy X, Wang et al and C. de Lange (4, 53) agreed with the results in the current study, where they stated that the most common finding in patients with infection or emergencies were; early segmental and lobar opacities of the lungs, consolidations and ground glass opacities that can include most of the lungs. Pneumonic complications as para pneumonic effusion, cavitary lung lesions and pneumatocele formations.
Final diagnosis in the current study was based on clinical, laboratory and radiological data. Eleven patients were diagnosed with atypical viral pneumonia, nine patients were diagnosed with lobar pneumonia, five patients were diagnosed with bronchopneumonia, three patients were diagnosed as infected CPAM, one patient diagnosed as infected lung sequestration and one patient was diagnosed as mediastinal lymphoma.
MDCT was helpful in diagnosis cases of early atypical viral pneumonia where the x-ray imaging data were inconclusive, in clarifying the nature of the cystic lesions seen in x ray images with diagnosis of CPAM and rolling out complications. MDCT with contrast enhancement gave us detailed information about lung sequestration with its aberrant formation of segmental lung tissue. particularly helpful in detecting anomalous arterial vessels and anomalous veins. Also, MDCT helped in differentiating the mediastinal masses seen on x ray images and in diagnosis of mediastinal lymphoma.
Although Arthur R. et al (19) reported that chest radiography is the first line and most performed imaging examination in pediatric patients with probable thoracic disorders, owing to its low cost, portability and low radiation burden, yet the multi-detector computed tomography (MDCT) is considered the most valuable diagnostic tool available to accurately evaluate the central airway, cardiovascular, mediastinal abnormalities and the lung parenchyma. This is due to its superior anatomic resolution and the high contrast between lung pathology and the adjacent air-filled lung parenchyma, a difference that can be further augmented with the use of intravenous contrast.
Compared with chest radiography, CT provides a superior characterization of abnormalities and aids in preprocedural evaluation by affording superior relational anatomy.
The increase in the use of computed tomography (CT) has been driven by its ready availability at all hours and its ability to detect subtle diseases missed by radiography.
Imaging in non-cardiovascular and non-traumatic thoracic emergencies is essential to recognize potentially life-threatening causes such as airway obstruction that have to be promptly recognized to allow a correct and timely therapeutic decision. This matched with results in the present study.