Pediatric Pathology

hyaline membrane disease or immature lung disease

Leading cause of infant morality especially premature infants (approximately 90% of all cases)

1st 72 hours after birth is the most critical

Causative agent: • lacks surfactant (a chemical detergent/lubricant) needed to keep the lungs from total collapse (atelectasis) during expiration

clinical signs 
distressed breathing -
acid base blood imbalance (acidosis)  nasotracheal tube and umbilical catheter are used to monitor the progression of the disease-

AP chest( most important view) demonstrates-
-ground glass
air-bronchogram sign

treatment requires vigorous respiratory support with follow-up chest films to “chart” the disease

also know as crib death
• unknown cause, although occurs more frequently in winter months and underweight
babies (more males and non-Caucasian)

• occurs generally between 3 weeks and 4 months of age

• no specific radiographic signs on post mortem films

hereditary disease characterized by excessive viscous mucus serections 

cause – defective gene middle chromosome 7

most common genetic disorder among Caucasian children with up to a 90% mortality rate due to respiratory involvement

generalized irregular thickening of lung markings coupled with lung hyperinflation similar to adult severe chronic lung disease

inflammatory condition characterized by laryngitis with laryngeal spasm that can cause upper airway obstruction 

infant will have a bark-like cough

causative agent: virus

AP and lateral soft tissue neck (key films)

Narrowing (hourglass shape) of subglottic portion of trachea

If chest ordered, must include entire upper airway (include bottom of earlobe and down)

acute inflammation of the bowel mucosa with formation of pseudomembraneous plaques covering areas of bowel ulceration

abdominal disorder of premature infants that can be fatal( can occur to other patient populations)

clinical signs -
bloody diarrhea
abdominal distention
metabolic acidosis (blood)

radiographic signs 
AP abdomen demonstrates: 

gaseous small bowel distention – 1st sign pneumatosis coli – air in the wall of small bowel

Left lateral decub demonstrates: 
Location of gas pattern

Necrotizing enterocolitis (NEC)
treatments-

telescoping or invagination of part of the large bowel into a distal portion

95% of cases are children – 87% before age 2, 70% between ages 4 and 11 months  possible complication – bowel becomes gangrenous,
life threatening

severe, intermittent abdominal pain 

vomiting of stomach contents, later mixed with bile
bnormal currant jelly-like stools

sausage-like palpable mass in abdomen

barium enema demonstrates:
• major filling defect with ileum telescopes into the ileum – coiled spring sign

Intussusception treament

known as congenital aganglionic megacolon •familial congenital defect more common in Caucasian males

lacks ganglion cells in the rectosigmoid area causing difficulty in stool evacuation (large amount of feces retained in the colon)

sings
gaseous distention of the large bowel, constipation with repeated bowel obstructions

radiographic signs:

barium enema without usual prep demonstrates:
grossly dilated sigmoid colon containing feces with a narrowed segment below the dilatation

treament

surgical resection or temporary colostomy