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Age: 1

Sex: Male

Indication: Fever

Save ("V")

Case #13


Findings

  • Mild hyperinflation with diffuse peribronchial thickening


Diagnosis

  • Viral bronchiolitis

Sample Report

Mild hyperinflation with diffuse peribronchial thickening consistent with viral bronchiolitis. No focal airspace disease.

Normal size and configuration of the cardiothymic silhouette.


Discussion

  • Viral bronchiolitis is an incredibly common finding on pediatric chest radiographs, especially in the winter months
  • The hallmark of viral bronchiolitis in young children (< 2) is hyperinflation. Bronchial inflammation results in lower airways obstruction and air trapping which is further compounded by the fact that when respiratory rate increases, time allowed for expiration decreases. Multifocal, shifting atelectasis can also occur as a result of airway obstruction
  • Hyperinflation is a less predictable finding in older children (> 2) because their airways are larger in caliber and the degree of inflammation with viral infections is often not enough to result in significant airway narrowing
  • Peribronchial thickening or central haziness is also a common finding, though the crowding of hilar structures in underinflated lungs is a mimic to which many radiologists fall victim
  • As a general rule, there is hyperinflation if the lungs are expanded below the 6th anterior or 9th posterior rib on the frontal view. There should be flattening of the hemidiaphragms on both views
  • Older children (> 2-3) are sometimes overzealous when asked to take in a deep breath, so hyperinflation can be a manifestation of effort rather than pathology in these patients (hyperinflation in children < 2 should be considered pathologic)



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