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Chest Imaging - Asthma, Pediatric

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RADIOLOGY from Pediatric Team

by Hank Baskin, MD

frontal-17yo-attack — (Left) Frontal radiograph in a 17-year-old during an asthma attack shows hyperexpanded lungs, resulting in a narrow cardiac silhouette ﬅ & flattening of the diaphragm . Subsegmental opacity in the left lower lobe st was favored to represent atelectasis. (Right) Lateral image in the same patient reveals prominence of the retrosternal clear space & diaphragmatic flattening caused by air trapping. Imaging is often near-normal in asthma patients & is best used to identify complications or alternative diagnoses.

frontal-6yo-mycoplasma — (Left) Frontal radiograph in a 6-year-old with an asthma exacerbation caused by Mycoplasma pneumoniae shows peribronchial airway thickening st & scattered subsegmental opacities in the perihilar & lower lungs ﬅ. Infection from M. pneumoniae is a common cause of asthma exacerbation. (Right) Frontal radiograph in a child with shortness of breath shows a dense, triangular-shaped opacity from left lower lobe collapse. Lobar collapse & atelectasis are common findings in patients with asthma exacerbation.

frontal-17yo-severe-plus-rhinovirus — (Left) Frontal radiograph in a 17-year-old with a severe asthma attack precipitated by rhinovirus infection shows extensive subcutaneous emphysema st, pneumomediastinum ﬅ, right pneumothorax, & right lower lobe collapse. (Right) Axial CECT in the same patient shows extraventilatory gas in the soft tissues st & mediastinum ﬅ as well as a small left pneumothorax & right lower lobe collapse. Barotrauma is a common complication in asthma patients.

young-child-wheezing — Left) Frontal chest radiograph from a young child with wheezing (who was later diagnosed with asthma) shows peribronchial airway thickening ﬅ & multifocal atelectasis st bilaterally. (Right) Frontal radiograph from a child with chronic asthma complicated by plastic bronchitis (which is the development of luminal casts, in this case due to inflammation) that caused bronchial occlusion & near total right lung collapse shows widespread opacity ﬅ & shift of the mediastinum to the right st.

14yo-severe — (Left) Frontal chest radiograph in a 14-year-old with a severe asthma exacerbation shows subcutaneous emphysema in the neck st & streaky lucencies in the mediastinum ﬅ from pneumomediastinum. (Right) Axial sinus CT in a 14-year-old with asthma & allergic rhinitis reveals extensive sinonasal polyposis. The united airway disease hypothesis underscores how sinonasal disease & airway hyperreactivity seen in asthma are manifestations of the same inflammatory process.

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